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_partd_model_flag	pbp_a_pdss_model_flag	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						06/07/2021	2022.01	06/07/2021 03:35:07 PM Eastern Daylight Time					06/07/2021 03:39:28 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	2022	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						05/25/2021	2022.01	05/25/2021 12:27:27 PM Eastern Daylight Time					06/01/2021 12:22:18 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	2022	National		1					2						www.hopbenefits.com/medicareRx	www.hopbenefits.com/medicareRx										(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						05/25/2021	2022.01	05/25/2021 12:28:07 PM Eastern Daylight Time					06/01/2021 12:22:18 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	2022	National		1					2						www.hopbenefits.com/medicareRx	www.hopbenefits.com/medicareRx										(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	1	1						06/01/2021	2022.01	06/01/2021 12:53:57 PM Mountain Daylight Time					06/02/2021 09:33:12 AM Mountain Daylight Time	MODOT/MSHP MEDICAL AND LIFE INSURANCE PLAN	MISSOURI DEPARTMENT OF TRANSPORTATION	https://www.modot.org/medicare	Missouri Department of Transportatio/ Highway Patr (Employer PDP)	13	30					E4744	801	0	2022	National		1					2						https://mp.medimpact.com/pharmacyportal/public/Login.jsp	https://www.modot.org/medicare										(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	4	1						07/21/2021	2022.01	07/21/2021 05:00:51 PM Eastern Daylight Time					07/22/2021 09:18:45 AM Eastern 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	2022	CL, CU, FU, GE, GR, LA, LO, LU, ME, MO, OT, WO		2	12383	2			2						mmp.buckeyehealthplan.com/findadoctor	mmp.buckeyehealthplan.com/formulary	mmp.buckeyehealthplan.com/findadoctor	(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	007	0	1	01	01	H0028_007_0	7	1	2	1	1		0	08/02/2021	2022.01	08/02/2021 12:14:02 PM Eastern Daylight Time	08/03/2021 05:43:31 PM Eastern Daylight Time	07/30/2021 09:50:44 AM Eastern Daylight Time			08/04/2021 02:05:43 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H0028-007 (HMO D-SNP)	01	01		1			H0028	007	0	2022	Omaha		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	013	0	1	01	01	H0028_013_0	6	1			1		1	08/01/2021	2022.01	08/01/2021 01:25:44 PM Eastern Daylight Time	08/03/2021 05:40:35 PM Eastern Daylight Time	07/30/2021 09:51:00 AM Eastern Daylight Time			08/04/2021 01:40:20 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-013 (HMO)	01	01		1			H0028	013	0	2022	Wichita area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	6	1			1		1	08/01/2021	2022.01	08/01/2021 01:27:10 PM Eastern Daylight Time	08/03/2021 05:36:26 PM Eastern Daylight Time	07/30/2021 09:51:16 AM Eastern Daylight Time			08/04/2021 01:40:20 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-014 (HMO)	01	01		1			H0028	014	0	2022	St. Louis Metro area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	7	1	2	1	1		0	08/02/2021	2022.01	08/02/2021 12:43:51 PM Eastern Daylight Time	08/03/2021 05:32:28 PM Eastern Daylight Time	07/30/2021 09:51:32 AM Eastern Daylight Time			08/04/2021 01:40:20 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H0028-015 (HMO D-SNP)	01	01		1			H0028	015	0	2022	Select Counties in Missouri		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		1	07/19/2021	2022.01	07/19/2021 12:26:07 PM Eastern Daylight Time	08/03/2021 05:38:31 PM Eastern Daylight Time	07/30/2021 09:51:48 AM Eastern Daylight Time			08/04/2021 01:40:20 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-016 (HMO)	01	01		1			H0028	016	0	2022	Springfield/Joplin		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		1	07/09/2021	2022.01	07/09/2021 03:17:20 PM Eastern Daylight Time	08/03/2021 05:37:30 PM Eastern Daylight Time	07/30/2021 09:52:04 AM Eastern Daylight Time			08/04/2021 01:40:20 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-017 (HMO)	01	01		1			H0028	017	0	2022	Kansas City		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	6	1			1		0	07/21/2021	2022.01	07/21/2021 04:40:43 PM Eastern Daylight Time	08/03/2021 06:30:31 PM Eastern Daylight Time	07/30/2021 09:52:22 AM Eastern Daylight Time			08/04/2021 01:40:20 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Value Plus H0028-018 (HMO)	01	01		1			H0028	018	0	2022	Select Counties in Kansas		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		1	08/02/2021	2022.01	08/02/2021 11:18:26 AM Eastern Daylight Time	08/03/2021 06:57:06 PM Eastern Daylight Time	07/30/2021 09:52:38 AM Eastern Daylight Time			08/04/2021 12:06:39 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-019 (HMO)	01	01		1			H0028	019	0	2022	Albuquerque Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	021	0	1	01	01	H0028_021_0	4	1			1		1	07/31/2021	2022.01	07/31/2021 02:03:13 PM Eastern Daylight Time	08/03/2021 06:57:47 PM Eastern Daylight Time	07/30/2021 09:52:54 AM Eastern Daylight Time			08/04/2021 12:06:39 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-021 (HMO)	01	01		1			H0028	021	0	2022	Pima and Pinal Counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		1	07/09/2021	2022.01	07/09/2021 09:37:11 AM Eastern Daylight Time	08/03/2021 06:58:25 PM Eastern Daylight Time	07/30/2021 09:53:10 AM Eastern Daylight Time			08/04/2021 12:06:39 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-023 (HMO)	01	01		1			H0028	023	0	2022	Yavapai, La Paz, Mohave, and Maricopa Counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		1	08/02/2021	2022.01	08/02/2021 11:23:20 AM Eastern Daylight Time	08/03/2021 06:59:07 PM Eastern Daylight Time	07/30/2021 09:53:26 AM Eastern Daylight Time			08/04/2021 12:06:39 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-024 (HMO)	01	01		1			H0028	024	0	2022	La Paz and Mohave counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		1	08/02/2021	2022.01	08/02/2021 11:26:13 AM Eastern Daylight Time	08/03/2021 07:08:33 PM Eastern Daylight Time	07/30/2021 09:53:42 AM Eastern Daylight Time			08/04/2021 12:06:39 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-025 (HMO)	01	01		1			H0028	025	1	2022	Colorado	Denver Metro Area	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		1	08/02/2021	2022.01	08/02/2021 11:27:39 AM Eastern Daylight Time	08/03/2021 07:09:22 PM Eastern Daylight Time	07/30/2021 09:53:56 AM Eastern Daylight Time			08/04/2021 12:06:39 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-025 (HMO)	01	01		1			H0028	025	2	2022	Colorado	North and South Colorado Area	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		1	07/31/2021	2022.01	07/31/2021 02:17:50 PM Eastern Daylight Time	08/03/2021 06:59:50 PM Eastern Daylight Time	07/30/2021 09:54:12 AM Eastern Daylight Time			08/04/2021 01:27:12 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-027 (HMO)	01	01		1			H0028	027	0	2022	Maricopa County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	028	0	1	01	01	H0028_028_0	5	1			1		1	07/31/2021	2022.01	07/31/2021 02:04:21 PM Eastern Daylight Time	08/03/2021 07:01:23 PM Eastern Daylight Time	07/30/2021 09:54:26 AM Eastern Daylight Time			08/04/2021 12:06:39 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-028 (HMO)	01	01		1			H0028	028	0	2022	Maricopa and Yavapai Counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	08/04/2021	2022.01	08/04/2021 02:15:26 PM Eastern Daylight Time	08/03/2021 05:56:48 PM Eastern Daylight Time	07/30/2021 09:54:42 AM Eastern Daylight Time			08/04/2021 02:25:13 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-029 (HMO)	01	01		1			H0028	029	0	2022	Corpus Christi Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		1	08/01/2021	2022.01	08/01/2021 07:39:05 AM Eastern Daylight Time	08/03/2021 05:57:05 PM Eastern Daylight Time	07/30/2021 09:54:58 AM Eastern Daylight Time			08/04/2021 02:25:13 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-030 (HMO)	01	01		1			H0028	030	0	2022	San Antonio Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	1		0	07/28/2021	2022.01	07/28/2021 12:10:33 PM Eastern Daylight Time	08/03/2021 05:57:27 PM Eastern Daylight Time	07/30/2021 09:55:14 AM Eastern Daylight Time			08/04/2021 01:53:42 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H0028-031 (HMO D-SNP)	01	01		1			H0028	031	0	2022	Select Counties in Texas		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	1		0	08/01/2021	2022.01	08/01/2021 07:59:40 AM Eastern Daylight Time	08/03/2021 06:00:23 PM Eastern Daylight Time	07/30/2021 09:55:30 AM Eastern Daylight Time			08/04/2021 01:53:42 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H0028-032 (HMO D-SNP)	01	01		1			H0028	032	0	2022	Select Counties in Texas		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	6	1	2	1	1		0	08/01/2021	2022.01	08/01/2021 08:02:00 AM Eastern Daylight Time	08/03/2021 06:00:40 PM Eastern Daylight Time	07/30/2021 09:55:46 AM Eastern Daylight Time			08/04/2021 01:53:42 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H0028-033 (HMO D-SNP)	01	01		1			H0028	033	0	2022	Fort Bend, Harris and Montgomery counties		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1	2	1	1		0	07/08/2021	2022.01	07/08/2021 05:11:55 PM Eastern Daylight Time	08/03/2021 06:00:57 PM Eastern Daylight Time	07/30/2021 09:56:02 AM Eastern Daylight Time			08/04/2021 01:53:42 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H0028-034 (HMO D-SNP)	01	01		1			H0028	034	0	2022	El Paso County		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	08/01/2021	2022.01	08/01/2021 07:40:39 AM Eastern Daylight Time	08/03/2021 05:57:43 PM Eastern Daylight Time	07/30/2021 09:56:18 AM Eastern Daylight Time			08/04/2021 02:25:13 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-035 (HMO)	01	01		1			H0028	035	0	2022	El Paso County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1	2	1	1		0	07/08/2021	2022.01	07/08/2021 05:22:02 PM Eastern Daylight Time	08/03/2021 05:58:01 PM Eastern Daylight Time	07/30/2021 09:56:34 AM Eastern Daylight Time			08/04/2021 02:25:13 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H0028-036 (HMO D-SNP)	01	01		1			H0028	036	0	2022	Corpus Christi/San Antonio area		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	08/01/2021	2022.01	08/01/2021 07:41:41 AM Eastern Daylight Time	08/03/2021 05:58:18 PM Eastern Daylight Time	07/30/2021 09:56:50 AM Eastern Daylight Time			08/04/2021 02:25:13 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-037 (HMO)	01	01		1			H0028	037	0	2022	Bastrop, Hays, Travis and Williamson counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	1		1	08/01/2021	2022.01	08/01/2021 07:42:32 AM Eastern Daylight Time	08/03/2021 05:58:37 PM Eastern Daylight Time	07/30/2021 09:57:08 AM Eastern Daylight Time			08/04/2021 02:25:13 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus - Diabetes and Heart (HMO C-SNP)	01	01		1			H0028	039	0	2022	Corpus Christi Metro Area		2		2			1	4			00000000000000000010		https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		1	08/01/2021	2022.01	08/01/2021 07:43:24 AM Eastern Daylight Time	08/03/2021 05:58:54 PM Eastern Daylight Time	07/30/2021 09:57:24 AM Eastern Daylight Time			08/04/2021 02:25:13 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-041 (HMO)	01	01		1			H0028	041	0	2022	Select Counties in Texas		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	08/01/2021	2022.01	08/01/2021 07:44:20 AM Eastern Daylight Time	08/03/2021 05:59:11 PM Eastern Daylight Time	07/30/2021 09:57:40 AM Eastern Daylight Time			08/04/2021 02:25:13 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-042 (HMO)	01	01		1			H0028	042	0	2022	Houston Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		1	08/01/2021	2022.01	08/01/2021 08:04:22 AM Eastern Daylight Time	08/03/2021 05:59:28 PM Eastern Daylight Time	07/30/2021 09:57:56 AM Eastern Daylight Time			08/04/2021 01:53:42 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-043 (HMO)	01	01		1			H0028	043	1	2022	Dallas area	Dallas area	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		1	08/01/2021	2022.01	08/01/2021 08:07:59 AM Eastern Daylight Time	08/03/2021 05:59:46 PM Eastern Daylight Time	07/30/2021 09:58:10 AM Eastern Daylight Time			08/04/2021 01:53:42 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-043 (HMO)	01	01		1			H0028	043	2	2022	Dallas area	Dallas area	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	044	0	1	01	01	H0028_044_0	5	1	2	1	1		0	08/01/2021	2022.01	08/01/2021 01:33:38 PM Eastern Daylight Time	08/03/2021 06:01:15 PM Eastern Daylight Time	07/30/2021 09:58:26 AM Eastern Daylight Time			08/04/2021 02:25:13 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H0028-044 (HMO D-SNP)	01	01		1			H0028	044	0	2022	Bastrop, Hays, Travis and Williamson counties		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	045	0	1	01	01	H0028_045_0	4	1	2	1	1		0	07/08/2021	2022.01	07/08/2021 05:29:15 PM Eastern Daylight Time	08/03/2021 06:01:32 PM Eastern Daylight Time	07/30/2021 09:58:42 AM Eastern Daylight Time			08/04/2021 02:25:13 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H0028-045 (HMO D-SNP)	01	01		1			H0028	045	0	2022	Cameron, Hidalgo and Willacy counties		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	046	0	1	01	01	H0028_046_0	4	1			1		1	08/01/2021	2022.01	08/01/2021 07:50:37 AM Eastern Daylight Time	08/03/2021 06:01:50 PM Eastern Daylight Time	07/30/2021 09:58:58 AM Eastern Daylight Time			08/04/2021 02:34:31 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-046 (HMO)	01	01		1			H0028	046	0	2022	Cameron, Hidalgo and Willacy counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	047	0	1	01	01	H0028_047_0	4	1			1		1	07/09/2021	2022.01	07/09/2021 10:17:09 AM Eastern Daylight Time	08/03/2021 07:11:35 PM Eastern Daylight Time	07/30/2021 09:59:14 AM Eastern Daylight Time			08/04/2021 01:27:12 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-047 (HMO)	01	01		1			H0028	047	0	2022	Colorado		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	048	1	1	01	01	H0028_048_1	4	1			1		1	08/04/2021	2022.01	08/04/2021 11:48:21 AM Eastern Daylight Time	08/03/2021 07:41:32 PM Eastern Daylight Time	07/30/2021 09:59:30 AM Eastern Daylight Time			08/04/2021 02:33:03 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-048 (HMO)	01	01		1			H0028	048	1	2022	Honolulu, Kauai and Maui counties	Honolulu County	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	048	2	1	01	01	H0028_048_2	5	1			1		1	08/04/2021	2022.01	08/04/2021 11:49:33 AM Eastern Daylight Time	08/03/2021 07:52:06 PM Eastern Daylight Time	07/30/2021 09:59:46 AM Eastern Daylight Time			08/04/2021 02:33:03 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-048 (HMO)	01	01		1			H0028	048	2	2022	Honolulu, Kauai and Maui counties	Kauai and Maui counties	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	049	0	1	01	01	H0028_049_0	5	1			2		1	08/02/2021	2022.01	08/02/2021 12:29:32 PM Eastern Daylight Time	08/03/2021 06:12:26 PM Eastern Daylight Time	07/30/2021 10:00:02 AM Eastern Daylight Time			08/04/2021 02:38:36 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-049 (HMO)	01	01		1			H0028	049	0	2022	Kansas City		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	050	0	1	01	01	H0028_050_0	5	1		1	2		1	08/01/2021	2022.01	08/01/2021 03:27:49 PM Eastern Daylight Time	08/03/2021 06:15:13 PM Eastern Daylight Time	07/30/2021 10:00:18 AM Eastern Daylight Time			08/04/2021 02:38:36 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus - Diabetes and Heart (HMO C-SNP)	01	01		1			H0028	050	0	2022	Select Counties in Kansas and Missouri		2		2			1	4			00000000000000000010		https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	051	0	1	01	01	H0028_051_0	5	1		1	2		1	08/01/2021	2022.01	08/01/2021 12:40:30 PM Eastern Daylight Time	08/03/2021 06:14:16 PM Eastern Daylight Time	07/30/2021 10:00:34 AM Eastern Daylight Time			08/04/2021 02:38:36 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus - Diabetes and Heart (HMO C-SNP)	01	01		1			H0028	051	0	2022	Select Counties in Missouri		2		2			1	4			00000000000000000010		https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	052	0	1	01	01	H0028_052_0	4	1			1		1	08/02/2021	2022.01	08/02/2021 11:09:00 AM Eastern Daylight Time	08/03/2021 07:19:30 PM Eastern Daylight Time	07/30/2021 10:00:50 AM Eastern Daylight Time			08/04/2021 12:06:39 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-052 (HMO)	01	01		1			H0028	052	0	2022	Maricopa		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	053	1	1	01	01	H0028_053_1	6	1			1		1	08/01/2021	2022.01	08/01/2021 12:36:14 PM Eastern Daylight Time	08/03/2021 06:17:32 PM Eastern Daylight Time	07/30/2021 10:01:06 AM Eastern Daylight Time			08/04/2021 02:05:43 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-053 (HMO)	01	01		1			H0028	053	1	2022	Iowa, Nebraska, South Dakota	Des Moines	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	053	2	1	01	01	H0028_053_2	6	1			1		1	08/01/2021	2022.01	08/01/2021 01:11:05 PM Eastern Daylight Time	08/03/2021 06:20:24 PM Eastern Daylight Time	07/30/2021 10:01:24 AM Eastern Daylight Time			08/04/2021 02:05:43 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-053 (HMO)	01	01		1			H0028	053	2	2022	Iowa, Nebraska, South Dakota	Cedar Rapids	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	053	3	1	01	01	H0028_053_3	6	1			1		1	08/01/2021	2022.01	08/01/2021 01:12:18 PM Eastern Daylight Time	08/03/2021 06:18:27 PM Eastern Daylight Time	07/30/2021 10:01:38 AM Eastern Daylight Time			08/04/2021 02:05:43 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-053 (HMO)	01	01		1			H0028	053	3	2022	Iowa, Nebraska, South Dakota	Omaha	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	053	4	1	01	01	H0028_053_4	8	1			1		1	08/03/2021	2022.01	08/03/2021 05:04:33 PM Eastern Daylight Time	08/03/2021 06:19:27 PM Eastern Daylight Time	07/30/2021 10:01:56 AM Eastern Daylight Time			08/04/2021 02:05:43 PM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0028-053 (HMO)	01	01		1			H0028	053	4	2022	Iowa, Nebraska, South Dakota	South Dakota	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1						05/21/2021	2022.01	05/21/2021 12:21:09 PM Eastern Daylight Time					06/04/2021 08:33:40 AM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H0028	801	0	2022	Select Counties in Multi States		1	41835	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242		(866)396-8810		(866)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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H0028	802	0	1	01	01	H0028_802_0	1	1				0	0	05/24/2021	2022.01	05/24/2021 02:30:02 PM Eastern Daylight Time					06/04/2021 08:33:40 AM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H0028	802	0	2022	Select Counties in Multi States		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H0028	804	0	1	01	01	H0028_804_0	1	1						05/27/2021	2022.01	05/27/2021 02:19:54 PM Eastern Daylight Time					06/04/2021 08:33:40 AM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H0028	804	0	2022	Select Counties in Multi States		1	18691	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242		(866)396-8810		(866)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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					2				
H0028	805	0	1	01	01	H0028_805_0	1	1				0	0	05/27/2021	2022.01	05/27/2021 02:25:44 PM Eastern Daylight Time					06/04/2021 08:33:40 AM Eastern Daylight Time	CHA HMO, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H0028	805	0	2022	Select Counties in Multi States		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					2				
H0029	801	0	1	01	01	H0029_801_0	2	1						05/03/2021	2022.01	05/03/2021 01:09:54 PM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	COORDINATED CARE OF WASHINGTON, INC.	Allwell	allwell.coordinatedcarehealth.com	Allwell Group (HMO)	01	01		1			H0029	801	0	2022	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		(844)942-0039		(844)942-0039		(855)848-6940		(855)848-6940		(844)942-0039		(844)942-0039		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H0029	802	0	1	01	01	H0029_802_0	2	1				0	0	05/03/2021	2022.01	05/03/2021 01:07:04 PM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	COORDINATED CARE OF WASHINGTON, INC.	Allwell	allwell.coordinatedcarehealth.com	Allwell Group (HMO)	01	01		1			H0029	802	0	2022	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		(844)942-0039		(844)942-0039										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H0029	803	0	1	01	01	H0029_803_0	2	1						05/03/2021	2022.01	05/03/2021 01:07:49 PM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	COORDINATED CARE OF WASHINGTON, INC.	Allwell	allwell.coordinatedcarehealth.com	Allwell Group (HMO)	01	01		1			H0029	803	0	2022	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		(844)942-0039		(844)942-0039		(855)848-6940		(855)848-6940		(844)942-0039		(844)942-0039		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H0034	001	0	1	01	01	H0034_001_0	6	1	2	1			0	08/04/2021	2022.01	08/04/2021 04:59:03 PM Eastern Daylight Time	08/04/2021 04:54:43 PM Eastern Daylight Time	08/05/2021 02:15:54 PM Eastern Daylight Time			08/05/2021 02:24:28 PM Eastern Daylight Time	HAMASPIK, INC.	Hamaspik, Inc.	www.hamaspik.com	Hamaspik Medicare Select (HMO D-SNP)	01	01		1			H0034	001	0	2022	New York City metro, Hudson Valley, Albany metro		2		2			1	3		2		1	www.hamaspik.com	www.hamaspik.com	www.hamaspik.com	(888)426-2774		(845)388-1122		(888)426-2774		(845)388-1122		(888)426-2774		(845)388-1122		(888)426-2774		(845)388-1122		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					1					1	2			
H0034	002	0	1	01	01	H0034_002_0	6	1	2	1			0	08/04/2021	2022.01	08/04/2021 05:01:32 PM Eastern Daylight Time	08/04/2021 04:54:50 PM Eastern Daylight Time	08/05/2021 02:15:57 PM Eastern Daylight Time			08/05/2021 02:26:19 PM Eastern Daylight Time	HAMASPIK, INC.	Hamaspik, Inc.	www.hamaspik.com	Hamaspik Medicare Choice (HMO D-SNP)	01	01		1			H0034	002	0	2022	NYC Metro area and Hudson Valley Counties		2		2			1	3		2		1	www.hamaspik.com	www.hamaspik.com	www.hamaspik.com	(888)426-2774		(845)388-1122		(888)426-2774		(845)388-1122		(888)426-2774		(845)388-1122		(888)426-2774		(845)388-1122		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					1					1	2			
H0062	002	0	1	01	01	H0062_002_0	4	1					0	07/31/2021	2022.01	07/31/2021 10:27:44 AM Pacific Daylight Time	08/03/2021 10:01:03 PM Eastern Daylight Time	07/29/2021 11:49:25 PM Eastern Daylight Time			08/04/2021 10:52:49 PM Eastern Daylight Time	SUPERIOR HEALTHPLAN COMMUNITY SOLUTIONS, INC.	Wellcare by Allwell	www.wellcare.com/allwellTX	Wellcare No Premium Medicare (HMO)	01	01		1			H0062	002	0	2022	Select counties in TX		2	5610	2			2						www.wellcare.com/allwellTX	www.wellcare.com/allwellTX	www.wellcare.com/allwellTX	(844)796-6811		(844)796-6811		(866)277-6583		(866)277-6583		(844)796-6811		(844)796-6811		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0062	003	0	1	01	01	H0062_003_0	4	1					0	07/31/2021	2022.01	07/31/2021 10:29:27 AM Pacific Daylight Time	08/03/2021 10:01:52 PM Eastern Daylight Time	07/29/2021 11:50:14 PM Eastern Daylight Time			08/04/2021 10:52:49 PM Eastern Daylight Time	SUPERIOR HEALTHPLAN COMMUNITY SOLUTIONS, INC.	Wellcare by Allwell	www.wellcare.com/allwellTX	Wellcare No Premium Medicare (HMO)	01	01		1			H0062	003	0	2022	Select counties in TX		2	6165	2			2						www.wellcare.com/allwellTX	www.wellcare.com/allwellTX	www.wellcare.com/allwellTX	(844)796-6811		(844)796-6811		(866)277-6583		(866)277-6583		(844)796-6811		(844)796-6811		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0062	801	0	1	01	01	H0062_801_0	2	1						06/02/2021	2022.01	06/02/2021 08:09:21 AM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	SUPERIOR HEALTHPLAN COMMUNITY SOLUTIONS, INC.	Wellcare by Allwell	allwell.superiorhealthplan.com	Allwell Group (HMO)	01	01		1			H0062	801	0	2022	Texas		1	100	2			2						allwell.superiorhealthplan.com/findadoctor	allwell.superiorhealthplan.com/formulary	allwell.superiorhealthplan.com/findadoctor	(844)796-6811		(844)796-6811		(844)942-0039		(844)942-0039		(844)796-6811		(844)796-6811		(844)942-0039		(844)942-0039		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H0062	802	0	1	01	01	H0062_802_0	2	1				0	0	05/03/2021	2022.01	05/03/2021 01:10:29 PM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	SUPERIOR HEALTHPLAN COMMUNITY SOLUTIONS, INC.	Wellcare by Allwell	allwell.superiorhealthplan.com	Allwell Group (HMO)	01	01		1			H0062	802	0	2022	Texas		1	100	2			2						allwell.superiorhealthplan.com/findadoctor	allwell.superiorhealthplan.com/formulary	allwell.superiorhealthplan.com/findadoctor	(844)796-6811		(844)796-6811		(844)942-0039		(844)942-0039										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H0062	803	0	1	01	01	H0062_803_0	2	1						05/03/2021	2022.01	05/03/2021 01:10:40 PM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	SUPERIOR HEALTHPLAN COMMUNITY SOLUTIONS, INC.	Wellcare by Allwell	allwell.superiorhealthplan.com	Allwell Group (HMO)	01	01		1			H0062	803	0	2022	Texas		1	100	2			2						allwell.superiorhealthplan.com/findadoctor	allwell.superiorhealthplan.com/formulary	allwell.superiorhealthplan.com/findadoctor	(844)796-6811		(844)796-6811		(844)942-0039		(844)942-0039		(844)796-6811		(844)796-6811		(844)942-0039		(844)942-0039		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H0074	001	0	1	04	01	H0074_001_0	5	1					0	08/01/2021	2022.01	08/01/2021 03:41:33 PM Eastern Daylight Time	08/03/2021 10:02:21 PM Eastern Daylight Time	07/29/2021 11:51:05 PM Eastern Daylight Time			08/04/2021 08:53:46 PM Eastern Daylight Time	WELLCARE OF MISSISSIPPI, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium Open (PPO)	01	04		1			H0074	001	0	2022	Select counties in MS		2	5468	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0074	002	0	1	04	01	H0074_002_0	5	1					0	08/01/2021	2022.01	08/01/2021 03:39:43 PM Eastern Daylight Time	08/03/2021 10:02:56 PM Eastern Daylight Time	07/29/2021 11:51:53 PM Eastern Daylight Time			08/04/2021 08:53:46 PM Eastern Daylight Time	WELLCARE OF MISSISSIPPI, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Premium Hybrid Open (PPO)	01	04		1			H0074	002	0	2022	Select counties in MS		2	0	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0074	003	0	1	04	01	H0074_003_0	5	1					0	06/02/2021	2022.01	06/02/2021 11:32:22 AM Eastern Daylight Time	08/03/2021 10:03:28 PM Eastern Daylight Time	07/29/2021 11:52:41 PM Eastern Daylight Time			08/04/2021 08:53:46 PM Eastern Daylight Time	WELLCARE OF MISSISSIPPI, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Community Assist (PPO)	01	04		1			H0074	003	0	2022	Select counties in MS		2	0	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0088	002	0	1	04	01	H0088_002_0	6	1					0	08/03/2021	2022.01	08/03/2021 11:02:43 AM Eastern Daylight Time	08/04/2021 07:56:17 AM Eastern Daylight Time	07/29/2021 11:53:31 PM Eastern Daylight Time			08/04/2021 11:02:27 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Giveback Open (PPO)	01	04		1			H0088	002	0	2022	Select counties in NY		2	15423	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0088	003	0	1	04	01	H0088_003_0	6	1					0	08/03/2021	2022.01	08/03/2021 11:04:36 AM Eastern Daylight Time	08/04/2021 08:24:04 AM Eastern Daylight Time	07/29/2021 11:54:20 PM Eastern Daylight Time			08/04/2021 11:02:27 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium Open (PPO)	01	04		1			H0088	003	0	2022	Select counties in NY		2	2379	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0104	012	0	1	04	01	H0104_012_0	5	1					1	08/04/2021	2022.01	08/04/2021 08:38:47 AM Central Daylight Time	08/04/2021 03:17:08 PM Central Daylight Time	08/04/2021 03:28:04 PM Central Daylight Time			08/05/2021 11:38:46 AM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Blue Cross and Blue Shield of Alabama	www.bcbsalmedicare.com	Blue Advantage Complete (PPO)	01	04		1			H0104	012	0	2022	State of Alabama		2	713898	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	5	1					1	08/04/2021	2022.01	08/04/2021 08:38:56 AM Central Daylight Time	08/04/2021 03:18:28 PM Central Daylight Time	08/04/2021 03:29:22 PM Central Daylight Time			08/05/2021 11:38:46 AM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Blue Cross and Blue Shield of Alabama	www.bcbsalmedicare.com	Blue Advantage Complete (PPO)	01	04		1			H0104	014	0	2022	Birmingham/Mobile		2	479304	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	7	1					1	08/04/2021	2022.01	08/04/2021 08:34:31 AM Central Daylight Time	08/04/2021 03:19:44 PM Central Daylight Time	08/04/2021 03:30:26 PM Central Daylight Time			08/05/2021 10:51:13 AM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Blue Cross and Blue Shield of Alabama	www.bcbsalmedicare.com	Blue Advantage Premier (PPO)	01	04		1			H0104	015	0	2022	State of Alabama		2	61788	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	1	1				0	0	05/03/2021	2022.01	05/03/2021 03:18:46 PM Central Daylight Time					06/05/2021 12:34:16 PM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Blue Cross and Blue Shield of Alabama	www.bcbsalmedicare.com	Blue Advantage Employer Group Plan 801 (PPO)	01	04		1			H0104	801	0	2022	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	(855)314-4990		(855)314-4990		(855)314-4990		(855)314-4990										(711)-		(711)-		(711)-		(711)-										1	2		2		1									
H0104	802	0	1	04	01	H0104_802_0	1	1						05/17/2021	2022.01	05/17/2021 12:37:50 PM Central Daylight Time					06/07/2021 10:55:14 AM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Blue Cross and Blue Shield of Alabama	www.bcbsalmedicare.com	Blue Advantage Employer Group Plan 802 (PPO)	01	04		1			H0104	802	0	2022	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	(855)314-4990		(855)314-4990		(855)314-4990		(855)314-4990		(855)314-4990		(855)314-4990		(855)314-4990		(855)314-4990		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H0104	804	0	1	04	01	H0104_804_0	1	1						05/03/2021	2022.01	05/03/2021 03:20:08 PM Central Daylight Time					06/05/2021 12:34:16 PM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Blue Cross and Blue Shield of Alabama	www.bcbsalmedicare.com	Blue Advantage Employer Group Plan 804 (PPO)	01	04		1			H0104	804	0	2022	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	1	1						05/03/2021	2022.01	05/03/2021 03:21:34 PM Central Daylight Time					06/05/2021 12:34:16 PM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Blue Cross and Blue Shield of Alabama	www.bcbsalmedicare.com	Blue Advantage Employer Group Plan 805 (PPO)	01	04		1			H0104	805	0	2022	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	1	1						05/03/2021	2022.01	05/03/2021 03:28:22 PM Central Daylight Time					06/05/2021 12:34:16 PM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Blue Cross and Blue Shield of Alabama	www.bcbsalmedicare.com	Blue Advantage Employer Group Plan 806 (PPO)	01	04		1			H0104	806	0	2022	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	(855)453-5185		(855)453-5185		(855)453-5185		(855)453-5185		(855)453-5185		(855)453-5185		(855)453-5185		(855)453-5185		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H0104	807	0	1	04	01	H0104_807_0	1	1						05/17/2021	2022.01	05/17/2021 12:38:54 PM Central Daylight Time					06/07/2021 10:55:14 AM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Blue Cross and Blue Shield of Alabama	www.bcbsalmedicare.com	Blue Advantage Employer Group Plan 807 (PPO)	01	04		1			H0104	807	0	2022	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	808	0	1	04	01	H0104_808_0	1	1						05/03/2021	2022.01	05/03/2021 03:29:08 PM Central Daylight Time					06/05/2021 12:34:16 PM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Blue Cross and Blue Shield of Alabama	www.bcbsalmedicare.com	Blue Advantage Employer Group Plan 808 (PPO)	01	04		1			H0104	808	0	2022	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	809	0	1	04	01	H0104_809_0	1	1						05/03/2021	2022.01	05/03/2021 03:29:38 PM Central Daylight Time					06/05/2021 12:34:16 PM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Blue Cross and Blue Shield of Alabama	www.bcbsalmedicare.com	Blue Advantage Employer Group Plan 809 (PPO)	01	04		1			H0104	809	0	2022	State of Alabma		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									
H0105	001	0	1	20	08	H0105_001_0	1	1						06/02/2021	2022.01	06/02/2021 12:48:10 PM Eastern Daylight Time		06/02/2021 11:50:25 AM Eastern Daylight Time			06/02/2021 12:59:29 PM 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	2022	Rural South Carolina		2		2			2						http://www.theoakspace.com	www.groveparkpharmacy.com	http://www.theoakspace.com									(866)884-9856		(803)268-5300		(855)268-5300		(803)268-5300										(866)884-9856		(803)268-5306		(855)268-5300		(803)535-1561																
H0105	002	0	1	20	08	H0105_002_0	1	1						06/02/2021	2022.01	06/02/2021 12:48:41 PM Eastern Daylight Time		06/02/2021 11:52:25 AM Eastern Daylight Time			06/02/2021 12:59:29 PM 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	2022	Rural South Carolina		2		2			2						http://www.theoakspace.com	www.groveparkpharmacy.com	http://www.theoakspace.com									(866)884-9856		(803)268-5300		(855)268-5300		(803)268-5300										(866)884-9856		(803)268-5306		(855)268-5300		(803)535-1561																
H0107	003	0	1	04	01	H0107_003_0	4	1					0	07/15/2021	2022.01	07/15/2021 09:39:23 AM Mountain Daylight Time	08/03/2021 09:28:18 AM Mountain Daylight Time	08/04/2021 03:57:16 PM Mountain Daylight Time			08/05/2021 04:15:40 PM 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	2022	Montana		2	95449	2			2						www.getbluemt.com/pharmacies	www.getbluemt.com/mapd/druglist	www.getbluemt.com/providers	(877)774-8592		(877)774-8592		(877)774-8592		(877)774-8592		(877)774-8592		(877)774-8592		(877)774-8592		(877)774-8592		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0107	004	0	1	04	01	H0107_004_0	6	1					0	06/03/2021	2022.01	06/03/2021 10:58:53 AM Mountain Daylight Time	08/03/2021 09:28:46 AM Mountain Daylight Time	08/04/2021 03:57:34 PM Mountain Daylight Time			08/05/2021 04:53:55 PM 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	2022	Montana		2	19346	2			2						www.getbluemt.com/mapd/pharmacies	www.getbluemt.com/mapd/druglist	www.getbluemt.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			
H0107	005	0	1	04	01	H0107_005_0	3	1					0	06/03/2021	2022.01	06/03/2021 10:59:26 AM Mountain Daylight Time	08/03/2021 05:40:48 PM Mountain Daylight Time	08/04/2021 03:57:54 PM Mountain Daylight Time			08/05/2021 04:53:55 PM Mountain Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of Montana	www.getbluemt.com/mapd	Blue Cross Medicare Advantage PPO (PPO)	01	04		1			H0107	005	0	2022	Montana Counties		2	53530	2			2						www.getbluemt.com/pharmacies	www.getbluemt.com/mapd/druglist	www.getbluemt.com/mapd/providers	(877)774-8592		(877)774-8592		(877)774-8592		(877)774-8592		(877)774-8592		(877)774-8592		(877)774-8592		(877)774-8592		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0107	006	0	1	04	01	H0107_006_0	2	1					0	06/03/2021	2022.01	06/03/2021 11:00:16 AM Mountain Daylight Time	06/05/2021 03:11:36 PM Mountain Daylight Time	06/05/2021 03:17:59 PM Mountain Daylight Time			06/05/2021 03:44:56 PM Mountain Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of Montana	www.getbluemt.com/mapd	Blue Cross Medicare Advantage Flex (PPO)	01	04		1			H0107	006	0	2022	Montana Counties		2	311	2			2						www.getbluemt.com/pharmacies	www.getbluemt.com/mapd/druglist	www.getbluemt.com/mapd/providers	(877)774-8592		(877)774-8592		(877)774-8592		(877)774-8592		(877)774-8592		(877)774-8592		(877)774-8592		(877)774-8592		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0107	801	0	1	04	01	H0107_801_0	2	1						05/26/2021	2022.01	05/26/2021 10:46:22 AM Central Daylight Time					06/03/2021 06:13:22 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of Montana	www.getbluemt.com/mapd	Blue Cross Group Medicare Advantage Plan (PPO)	01	04		1			H0107	801	0	2022	Montana		1	22559	2			2						www.getbluemt.com/pharmacies	www.getbluemt.com/mapd/druglist	www.getbluemt.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)-		2					2						2			
H0107	802	0	1	04	01	H0107_802_0	2	1						05/26/2021	2022.01	05/26/2021 06:32:53 AM Central Daylight Time					06/03/2021 06:13:22 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of Montana	www.getbluemt.com/mapd	Blue Cross Group Medicare Advantage Plan (PPO)	01	04		1			H0107	802	0	2022	Montana		1	44900	2			2						www.getbluemt.com/pharmacies	www.getbluemt.com/mapd/druglist	www.getbluemt.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)-		2					2						2			
H0107	803	0	1	04	01	H0107_803_0	2	1				0	0	04/23/2021	2022.01	04/23/2021 02:43:25 PM Central Daylight Time					06/03/2021 06:13:22 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of Montana	www.getbluemt.com/mapd	Blue Cross Group Medicare Advantage Plan (PPO)	01	04		1			H0107	803	0	2022	State of Montana		1	1	2			2						www.getbluemt.com/pharmacies	www.getbluemt.com/mapd/druglist	www.getbluemt.com/mapd/providers	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129										(711)-		(711)-		(711)-		(711)-										2					2						2			
H0107	804	0	1	04	01	H0107_804_0	2	1				0	0	05/26/2021	2022.01	05/26/2021 06:33:19 AM Central Daylight Time					06/03/2021 06:13:22 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of Montana	www.getbluemt.com/mapd	Blue Cross Group Medicare Advantage Plan (PPO)	01	04		1			H0107	804	0	2022	State of Montana		1	1	2			2						www.getbluemt.com/pharmacies	www.getbluemt.com/mapd/druglist	www.getbluemt.com/providers	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129										(711)-		(711)-		(711)-		(711)-										2					2						2			
H0107	805	0	1	04	01	H0107_805_0	2	1						05/26/2021	2022.01	05/26/2021 06:34:33 AM Central Daylight Time					06/03/2021 06:13:22 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of Montana	www.getbluemt.com/mapd	Blue Cross Group Medicare Advantage Plan (PPO)	01	04		1			H0107	805	0	2022	Montana		1	1	2			2						www.getbluemt.com/pharmacies	www.getbluemt.com/mapd/druglist	www.getbluemt.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)-		2					2						2			
H0107	806	0	1	04	01	H0107_806_0	2	1						05/26/2021	2022.01	05/26/2021 06:35:25 AM Central Daylight Time					06/03/2021 06:13:22 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of Montana	www.getbluemt.com/mapd	Blue Cross Group Medicare Advantage Plan (PPO)	01	04		1			H0107	806	0	2022	Montana		1	1	2			2						www.getbluemt.com/pharmacies	www.getbluemt.com/mapd/druglist	www.getbluemt.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)-		2					2						2			
H0107	807	0	1	04	01	H0107_807_0	2	1						05/26/2021	2022.01	05/26/2021 06:35:47 AM Central Daylight Time					06/03/2021 06:13:22 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of Montana	www.getbluemt.com/mapd	Blue Cross Group Medicare Advantage Plan (PPO)	01	04		1			H0107	807	0	2022	Montana		1	1	2			2						www.getbluemt.com/pharmacies	www.getbluemt.com/mapd/druglist	www.getbluemt.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)-		2					2						2			
H0111	001	0	1	04	01	H0111_001_0	4	1					0	08/04/2021	2022.01	08/04/2021 11:21:01 AM Eastern Daylight Time	08/03/2021 10:04:32 PM Eastern Daylight Time	07/29/2021 11:55:09 PM Eastern Daylight Time			08/04/2021 09:57:30 PM Eastern Daylight Time	WELLCARE OF GEORGIA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium Open (PPO)	01	04		1			H0111	001	0	2022	Select counties in GA		2	82124	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0111	002	0	1	04	01	H0111_002_0	4	1					0	08/02/2021	2022.01	08/02/2021 03:43:01 PM Eastern Daylight Time	08/03/2021 10:05:04 PM Eastern Daylight Time	07/29/2021 11:55:58 PM Eastern Daylight Time			08/04/2021 09:57:30 PM Eastern Daylight Time	WELLCARE OF GEORGIA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Low Premium Open (PPO)	01	04		1			H0111	002	0	2022	Select counties in GA		2	6188	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0111	003	0	1	04	01	H0111_003_0	4	1					0	08/02/2021	2022.01	08/02/2021 03:45:48 PM Eastern Daylight Time	08/03/2021 10:05:36 PM Eastern Daylight Time	07/29/2021 11:56:51 PM Eastern Daylight Time			08/04/2021 09:57:30 PM Eastern Daylight Time	WELLCARE OF GEORGIA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Premium Enhanced Open (PPO)	01	04		1			H0111	003	0	2022	Select counties in GA		2	6988	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0111	004	0	1	04	01	H0111_004_0	4	1	2	1			0	07/18/2021	2022.01	07/18/2021 06:21:13 PM Eastern Daylight Time	08/03/2021 10:06:06 PM Eastern Daylight Time	07/29/2021 11:57:42 PM Eastern Daylight Time			08/04/2021 09:57:30 PM Eastern Daylight Time	WELLCARE OF GEORGIA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Access Open (PPO D-SNP)	01	04		1			H0111	004	0	2022	Select counties in GA		2	50755	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0111	005	0	1	04	01	H0111_005_0	5	1					0	08/02/2021	2022.01	08/02/2021 03:55:21 PM Eastern Daylight Time	08/03/2021 10:06:39 PM Eastern Daylight Time	07/29/2021 11:58:32 PM Eastern Daylight Time			08/04/2021 09:57:30 PM Eastern Daylight Time	WELLCARE OF GEORGIA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Endurance Open (PPO)	01	04		1			H0111	005	0	2022	Select counties in GA		2	31406	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0112	001	0	1	20	08	H0112_001_0	1	1						06/02/2021	2022.01	06/02/2021 10:29:40 AM Eastern Daylight Time		06/02/2021 10:14:16 AM Eastern Daylight Time			06/02/2021 10:31:06 AM Eastern Daylight Time	MORSE LIFE HOME CARE, INC.	Palm Beach PACE	www.MorseLife.org	Palm Beach PACE (PACE)	08	20		1			H0112	001	0	2022	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	1	1						06/02/2021	2022.01	06/02/2021 10:29:56 AM Eastern Daylight Time		06/02/2021 10:14:36 AM Eastern Daylight Time			06/02/2021 10:31:06 AM Eastern Daylight Time	MORSE LIFE HOME CARE, INC.	Palm Beach PACE	www.MorseLife.org	Palm Beach PACE (PACE)	08	20		1			H0112	002	0	2022	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	5	1						07/29/2021	2022.01	07/29/2021 11:57:31 AM Eastern Daylight Time					07/29/2021 12:02:28 PM Eastern Daylight Time	COMMONWEALTH CARE ALLIANCE, INC.	Commonwealth Care Alliance, Inc.	www.commonwealthcarealliance.org/become-a-member	Commonwealth Care Alliance (Medicare-Medicaid Plan)	05	48		1			H0137	001	0	2022	BERK BAR BRI ESS FRA HMD HMP MID NOR PLY SUF WOR		2	350241	2			2						http://www.commonwealthcarealliance.org/members/pharmacy-program	www.commonwealthcarealliance.org/members/one-care/2021-one-care-formulary/	provider-directory.commonwealthcarealliance.org/	(866)610-2273		(866)610-2273		(866)275-1222		(866)275-1222		(866)610-2273		(866)610-2273		(866)275-1222		(866)275-1222		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H0148	001	0	1	48	05	H0148_001_0	1	1						05/27/2021	2022.01	05/27/2021 04:22:34 PM Pacific Daylight Time					06/03/2021 09:48:36 AM Pacific Daylight Time	BLUE SHIELD OF CALIFORNIA PROMISE HEALTH PLAN	Blue Shield of California Promise Health Plan	blueshieldca.com/promise/calmediconnect	Blue Shield Promise Cal MediConnect Plan (Medicare-Medicaid Plan)	05	48		1			H0148	001	0	2022	San Diego County		2		2			2						blueshieldca.com/promise/cmcpharmacy	blueshieldca.com/promise/cmcpharmacy	blueshieldca.com/promise/CMCfind-a-doctor	(855)905-3825		(855)905-3825		(844)515-9072		(844)515-9072		(855)905-3825		(855)905-3825		(844)515-9072		(844)515-9072		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H0148	002	0	1	48	05	H0148_002_0	1	1						05/27/2021	2022.01	05/27/2021 04:23:08 PM Pacific Daylight Time					06/03/2021 09:48:36 AM Pacific Daylight Time	BLUE SHIELD OF CALIFORNIA PROMISE HEALTH PLAN	Blue Shield of California Promise Health Plan	blueshieldca.com/promise/calmediconnect	Blue Shield Promise Cal MediConnect Plan (Medicare-Medicaid Plan)	05	48		1			H0148	002	0	2022	Los Angeles County		2		2			2						blueshieldca.com/promise/cmcpharmacy	blueshieldca.com/promise/cmcpharmacy	blueshieldca.com/promise/CMCfind-a-doctor	(855)905-3825		(855)905-3825		(844)515-9072		(844)515-9072		(855)905-3825		(855)905-3825		(844)515-9072		(844)515-9072		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H0154	008	0	1	01	01	H0154_008_0	5	1				0	0	07/02/2021	2022.01	07/02/2021 01:44:50 PM Central Daylight Time	06/06/2021 01:49:36 PM Central Daylight Time				07/07/2021 04:54:59 PM Central Daylight Time	VIVA HEALTH, INC.	VIVA Medicare	www.vivahealth.com/Medicare	VIVA Medicare Select (HMO)	01	01		1			H0154	008	0	2022	North, 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.vivahealth.com/medicare/MemberResources/#ProviderNetwork	(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	6	1					0	08/03/2021	2022.01	08/03/2021 01:08:40 PM Central Daylight Time	08/04/2021 12:18:52 PM Central Daylight Time	07/29/2021 05:21:14 PM Central Daylight Time			08/05/2021 05:45:36 AM Central Daylight Time	VIVA HEALTH, INC.	VIVA Medicare	www.vivahealth.com/Medicare	VIVA Medicare Premier (HMO)	01	01		1			H0154	011	0	2022	Northwest, Central and South Alabama		2		2			2						www.vivahealth.com/Medicare/MemberResources/#PharmacyDirectories	www.vivahealth.com/Medicare/MemberResources/#Formularies	www.vivahealth.com/Medicare/MemberResources/#ProviderNetwork	(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	6	1	2	1			0	08/03/2021	2022.01	08/03/2021 01:11:02 PM Central Daylight Time	08/04/2021 12:20:42 PM Central Daylight Time	07/29/2021 05:19:52 PM Central Daylight Time			08/05/2021 05:45:36 AM Central Daylight Time	VIVA HEALTH, INC.	VIVA Medicare	www.vivahealth.com/Medicare	VIVA Medicare Extra Value (HMO D-SNP)	01	01		1			H0154	012	0	2022	Northwest, Central, and South Alabama		2		2			1	3		2		2	www.vivahealth.com/Medicare/MemberResources/#PharmacyDirectories	www.vivahealth.com/Medicare/MemberResources/#Formularies	www.vivahealth.com/Medicare/MemberResources/#ProviderNetwork	(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	6	1					0	08/03/2021	2022.01	08/03/2021 01:13:08 PM Central Daylight Time	08/04/2021 12:21:48 PM Central Daylight Time	07/29/2021 05:22:44 PM Central Daylight Time			08/05/2021 05:45:36 AM Central Daylight Time	VIVA HEALTH, INC.	VIVA Medicare	www.vivahealth.com/Medicare	VIVA Medicare Me (HMO)	01	01		1			H0154	014	0	2022	Central and Southeast Alabama		2		2			2						www.vivahealth.com/Medicare/MemberResources/#PharmacyDirectories	www.vivahealth.com/Medicare/MemberResources/#Formularies	www.vivahealth.com/Medicare/MemberResources/#ProviderNetwork	(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	6	1					0	08/03/2021	2022.01	08/03/2021 01:15:09 PM Central Daylight Time	08/04/2021 12:24:12 PM Central Daylight Time	07/29/2021 05:23:56 PM Central Daylight Time			08/05/2021 05:45:36 AM Central Daylight Time	VIVA HEALTH, INC.	VIVA Medicare	www.vivahealth.com/Medicare	VIVA Medicare Plus (HMO)	01	01		1			H0154	015	1	2022	Northwest, Central, and South Alabama	Northwest, Central and South Alabama	2		2			2						www.vivahealth.com/Medicare/MemberResources/#PharmacyDirectories	www.vivahealth.com/Medicare/MemberResources/#Formularies	www.vivahealth.com/Medicare/MemberResources/#ProviderNetwork	(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	6	1					0	08/03/2021	2022.01	08/03/2021 01:17:24 PM Central Daylight Time	08/04/2021 12:26:30 PM Central Daylight Time	07/29/2021 05:25:08 PM Central Daylight Time			08/05/2021 05:45:36 AM Central Daylight Time	VIVA HEALTH, INC.	VIVA Medicare	www.vivahealth.com/Medicare	VIVA Medicare Plus (HMO)	01	01		1			H0154	015	2	2022	Northwest, Central, and South Alabama	Ft Payne/Troy/Tuskegee/Jasper/Russellville Areas	2		2			2						www.vivahealth.com/Medicare/MemberResources/#PharmacyDirectories	www.vivahealth.com/Medicare/MemberResources/#Formularies	www.vivahealth.com/Medicare/MemberResources/#ProviderNetwork	(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	6	1					0	08/03/2021	2022.01	08/03/2021 01:19:24 PM Central Daylight Time	08/04/2021 12:29:44 PM Central Daylight Time	07/29/2021 05:26:34 PM Central Daylight Time			08/05/2021 05:45:36 AM Central Daylight Time	VIVA HEALTH, INC.	VIVA Medicare	www.vivahealth.com/Medicare	VIVA Medicare Prime (HMO)	01	01		1			H0154	016	0	2022	Northwest, Central and South Alabama		2		2			2						www.vivahealth.com/Medicare/MemberResources/#PharmacyDirectories	www.vivahealth.com/Medicare/MemberResources/#Formularies	www.vivahealth.com/Medicare/MemberResources/#ProviderNetwork	(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	017	0	1	01	01	H0154_017_0	6	1					0	08/03/2021	2022.01	08/03/2021 01:24:00 PM Central Daylight Time	08/04/2021 12:31:34 PM Central Daylight Time	07/29/2021 05:27:40 PM Central Daylight Time			08/05/2021 05:45:36 AM Central Daylight Time	VIVA HEALTH, INC.	VIVA Medicare	www.vivahealth.com/Medicare	VIVA Medicare Classic (HMO)	01	01		1			H0154	017	0	2022	Limestone, Madison, Marshall and Morgan Counties		2		2			2						www.vivahealth.com/Medicare/MemberResources/#PharmacyDirectories	www.vivahealth.com/Medicare/MemberResources/#Formularies	www.vivahealth.com/Medicare/MemberResources/#ProviderNetwork	(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	018	0	1	01	01	H0154_018_0	6	1					0	08/03/2021	2022.01	08/03/2021 01:26:21 PM Central Daylight Time	08/04/2021 12:35:20 PM Central Daylight Time	07/29/2021 05:29:36 PM Central Daylight Time			08/05/2021 05:45:36 AM Central Daylight Time	VIVA HEALTH, INC.	VIVA Medicare	www.vivahealth.com/Medicare	VIVA Medicare Preferred (HMO)	01	01		1			H0154	018	0	2022	Limestone, Madison, Marshall and Morgan Counties		2		2			2						www.vivahealth.com/Medicare/#PharmacyDirectories	www.vivahealth.com/Medicare/#Formularies	www.vivahealth.com/Medicare/MemberResources/#ProviderNetwork	(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	019	0	1	01	01	H0154_019_0	6	1	2	1			0	08/03/2021	2022.01	08/03/2021 01:28:27 PM Central Daylight Time	08/04/2021 12:38:02 PM Central Daylight Time	07/29/2021 05:30:32 PM Central Daylight Time			08/05/2021 05:45:36 AM Central Daylight Time	VIVA HEALTH, INC.	VIVA Medicare	www.vivahealth.com/Medicare	VIVA Medicare Extra Care (HMO D-SNP)	01	01		1			H0154	019	0	2022	Limestone, Madison, Marshall and Morgan Counties		2		2			1	3		2		2	www.vivahealth.com/Medicare/MemberResources/#PharmacyDirectories	www.vivahealth.com/Medicare/MemberResources/#Formularies	www.vivahealth.com/Medicare/MemberResources/#ProviderNetwork	(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	020	0	1	01	01	H0154_020_0	6	1					0	08/03/2021	2022.01	08/03/2021 01:01:30 PM Central Daylight Time	08/04/2021 12:40:20 PM Central Daylight Time	07/29/2021 05:31:52 PM Central Daylight Time			08/05/2021 05:45:36 AM Central Daylight Time	VIVA HEALTH, INC.	VIVA Medicare	www.vivahealth.com/Medicare	VIVA Medicare Infirmary Health Advantage (HMO)	01	01		1			H0154	020	0	2022	Counties: Mobile and Baldwin		2		2			2						www.vivahealth.com/Medicare/MemberResources/#PharmacyDirectories	www.vivahealth.com/Medicare/MemberResources/#Formularies	www.vivahealth.com/Medicare/MemberResources/#ProviderNetwork	(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	5	1						06/03/2021	2022.01	06/03/2021 06:44:01 PM Central Daylight Time					06/06/2021 08:26:04 PM Central Daylight Time	VIVA HEALTH, INC.	VIVA Medicare	www.vivahealth.com/Medicare	VIVA Medicare Group Plan with Rx (CY) (HMO)	01	01		1			H0154	801	0	2022	State of Alabama		1	450	2			2						www.vivahealth.com/Medicare/MemberResources/#PharmacyDirectories	www.vivahealth.com/Medicare/MemberResources/#Formularies	www.vivahealth.com/Medicare/MemberResources/#ProviderNetwork	(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;3-4;5;6;7c;7i;8a;8b1;8b2;9a1;9a2;9b;10a;11a;11b;12;15;	2		1					1				
H0154	802	0	1	01	01	H0154_802_0	5	1				0	0	06/02/2021	2022.01	06/02/2021 03:00:33 PM Central Daylight Time					06/06/2021 08:26:04 PM Central Daylight Time	VIVA HEALTH, INC.	VIVA Medicare	www.vivahealth.com/Medicare	VIVA Medicare Group Plan (no Rx CY) (HMO)	01	01		1			H0154	802	0	2022	State of Alabama		1	70	2			2						http://www.vivamedicaremember.com/Download.aspx?ID=992&Type=doc	http://www.vivamedicaremember.com/Download.aspx?ID=1326&Type=doc	www.vivahealth.com/Medicare/MemberResources/#ProviderNetwork	(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;3-4;5;6;7c;7i;8a;8b1;8b2;9a1;9a2;9b;10a;11a;11b;12;15;	2		1					1				
H0154	803	0	1	01	01	H0154_803_0	5	1						06/02/2021	2022.01	06/02/2021 04:40:01 PM Central Daylight Time					06/06/2021 08:26:04 PM Central Daylight Time	VIVA HEALTH, INC.	VIVA Medicare	www.vivahealth.com/Medicare	VIVA Medicare Plus Group Plan with Rx (not CY) (HMO)	01	01		1			H0154	803	0	2022	State of Alabama		1	250	2			2						www.vivahealth.com/Medicare/MemberResources/#PharmacyDirectories	www.vivahealth.com/Medicare/MemberResources/#Formularies	www.vivahealth.com/Medicare/MemberResources/#ProviderNetwork	(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;3-4;5;7c;7i;8a;8b1;8b2;9a1;9a2;9b;10a;11a;11b;12;15;	2		1					1				
H0169	001	0	1	01	01	H0169_001_0	4	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 02:42:19 PM Central Daylight Time	08/03/2021 08:46:32 PM Central Daylight Time	07/29/2021 06:38:33 PM Central Daylight Time			08/05/2021 09:27:57 AM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDWEST, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO D-SNP)	01	01		1			H0169	001	0	2022	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	4	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 10:39:28 AM Central Daylight Time	08/03/2021 12:16:57 PM Central Daylight Time	07/29/2021 06:38:47 PM Central Daylight Time			08/05/2021 12:04:43 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDWEST, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO D-SNP)	01	01		1			H0169	002	0	2022	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	4	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 02:43:30 PM Central Daylight Time	08/03/2021 12:17:29 PM Central Daylight Time	07/29/2021 06:39:02 PM Central Daylight Time			08/05/2021 09:27:57 AM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDWEST, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Plan 1 (HMO D-SNP)	01	01		1			H0169	003	0	2022	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			
H0169	004	0	1	02	01	H0169_004_0	4	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 10:41:18 AM Central Daylight Time	08/03/2021 12:18:01 PM Central Daylight Time	07/29/2021 06:39:18 PM Central Daylight Time			08/05/2021 12:04:43 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDWEST, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete LP1 (HMO-POS D-SNP)	01	02		1			H0169	004	0	2022	Select Counties in Kansas		2		2			1	3		2		2	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			
H0174	002	0	1	01	01	H0174_002_0	4	1					0	07/31/2021	2022.01	07/31/2021 10:31:14 AM Pacific Daylight Time	08/03/2021 10:07:31 PM Eastern Daylight Time	07/29/2021 11:59:23 PM Eastern Daylight Time			08/04/2021 10:52:49 PM Eastern Daylight Time	WELLCARE OF TEXAS, INC.	Wellcare	www.wellcare.com/medicare	Wellcare TexanPlus No Premium (HMO)	01	01		1			H0174	002	0	2022	Select counties in TX		2	11507	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0174	004	0	1	01	01	H0174_004_0	4	1	2	1			0	06/03/2021	2022.01	06/03/2021 05:41:12 PM Pacific Daylight Time	08/03/2021 10:08:00 PM Eastern Daylight Time	07/30/2021 12:00:14 AM Eastern Daylight Time			08/04/2021 10:52:49 PM Eastern Daylight Time	WELLCARE OF TEXAS, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Access (HMO D-SNP)	01	01		1			H0174	004	0	2022	Select counties in TX		2	114609	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0174	006	0	1	01	01	H0174_006_0	4	1	2	1			0	06/03/2021	2022.01	06/03/2021 05:44:18 PM Pacific Daylight Time	08/03/2021 10:08:28 PM Eastern Daylight Time	07/30/2021 12:01:03 AM Eastern Daylight Time			08/04/2021 10:52:49 PM Eastern Daylight Time	WELLCARE OF TEXAS, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Liberty (HMO D-SNP)	01	01		1			H0174	006	0	2022	Select counties in TX		2	61658	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0174	008	0	1	01	01	H0174_008_0	4	1		1			1	07/31/2021	2022.01	07/31/2021 10:32:53 AM Pacific Daylight Time	08/03/2021 10:08:54 PM Eastern Daylight Time	07/30/2021 12:01:54 AM Eastern Daylight Time			08/04/2021 10:52:49 PM Eastern Daylight Time	WELLCARE OF TEXAS, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Specialty No Premium (HMO C-SNP)	01	01		1			H0174	008	0	2022	Select counties in TX		2	1426	2			1	4			00000000000000000010		www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0174	009	0	1	01	01	H0174_009_0	4	1					0	06/04/2021	2022.01	06/04/2021 01:23:16 PM Eastern Daylight Time	08/03/2021 10:09:23 PM Eastern Daylight Time	07/30/2021 12:02:48 AM Eastern Daylight Time			08/04/2021 10:52:49 PM Eastern Daylight Time	WELLCARE OF TEXAS, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Assist (HMO)	01	01		1			H0174	009	0	2022	Select counties in TX		2	37582	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0174	010	0	1	01	01	H0174_010_0	4	1					0	07/31/2021	2022.01	07/31/2021 10:34:28 AM Pacific Daylight Time	08/03/2021 10:09:54 PM Eastern Daylight Time	07/30/2021 12:03:38 AM Eastern Daylight Time			08/04/2021 10:52:49 PM Eastern Daylight Time	WELLCARE OF TEXAS, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO)	01	01		1			H0174	010	0	2022	Select counties in TX		2	69377	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0174	011	1	1	01	01	H0174_011_1	4	1					0	07/31/2021	2022.01	07/31/2021 10:35:59 AM Pacific Daylight Time	08/03/2021 10:10:22 PM Eastern Daylight Time	07/30/2021 12:04:30 AM Eastern Daylight Time			08/04/2021 10:52:49 PM Eastern Daylight Time	WELLCARE OF TEXAS, INC.	Wellcare	www.wellcare.com/medicare	Wellcare TexanPlus No Premium (HMO)	01	01		1			H0174	011	1	2022	Select counties in TX	San Antonio	2	6445	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0174	011	2	1	01	01	H0174_011_2	4	1					0	07/31/2021	2022.01	07/31/2021 10:37:19 AM Pacific Daylight Time	08/03/2021 10:10:49 PM Eastern Daylight Time	07/30/2021 12:05:13 AM Eastern Daylight Time			08/04/2021 10:52:49 PM Eastern Daylight Time	WELLCARE OF TEXAS, INC.	Wellcare	www.wellcare.com/medicare	Wellcare TexanPlus No Premium (HMO)	01	01		1			H0174	011	2	2022	Select counties in TX	El Paso	2	2698	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0174	011	3	1	01	01	H0174_011_3	4	1					0	07/31/2021	2022.01	07/31/2021 10:38:41 AM Pacific Daylight Time	08/03/2021 10:11:17 PM Eastern Daylight Time	07/30/2021 12:05:57 AM Eastern Daylight Time			08/04/2021 10:52:49 PM Eastern Daylight Time	WELLCARE OF TEXAS, INC.	Wellcare	www.wellcare.com/medicare	Wellcare TexanPlus No Premium (HMO)	01	01		1			H0174	011	3	2022	Select counties in TX	Houston/Beaumont	2	1309	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0174	011	4	1	01	01	H0174_011_4	4	1					0	07/31/2021	2022.01	07/31/2021 10:40:01 AM Pacific Daylight Time	08/03/2021 10:11:44 PM Eastern Daylight Time	07/30/2021 12:06:43 AM Eastern Daylight Time			08/04/2021 10:52:49 PM Eastern Daylight Time	WELLCARE OF TEXAS, INC.	Wellcare	www.wellcare.com/medicare	Wellcare TexanPlus No Premium (HMO)	01	01		1			H0174	011	4	2022	Select counties in TX	Dallas Fort Worth	2	763	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0174	012	1	1	02	01	H0174_012_1	4	1					0	07/31/2021	2022.01	07/31/2021 10:41:24 AM Pacific Daylight Time	08/03/2021 10:12:13 PM Eastern Daylight Time	07/30/2021 12:07:33 AM Eastern Daylight Time			08/04/2021 10:52:49 PM Eastern Daylight Time	WELLCARE OF TEXAS, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO-POS)	01	02		1			H0174	012	1	2022	Select counties in TX	Austin	2	5490	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0174	012	2	1	02	01	H0174_012_2	4	1					0	07/31/2021	2022.01	07/31/2021 10:42:46 AM Pacific Daylight Time	08/03/2021 10:12:41 PM Eastern Daylight Time	07/30/2021 12:08:18 AM Eastern Daylight Time			08/04/2021 10:52:49 PM Eastern Daylight Time	WELLCARE OF TEXAS, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO-POS)	01	02		1			H0174	012	2	2022	Select counties in TX	Dallas Fort Worth	2	50587	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0174	012	3	1	02	01	H0174_012_3	4	1					0	07/31/2021	2022.01	07/31/2021 10:44:11 AM Pacific Daylight Time	08/03/2021 10:13:09 PM Eastern Daylight Time	07/30/2021 12:09:03 AM Eastern Daylight Time			08/04/2021 10:52:49 PM Eastern Daylight Time	WELLCARE OF TEXAS, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO-POS)	01	02		1			H0174	012	3	2022	Select counties in TX	Houston/Beaumont	2	61899	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0174	012	4	1	02	01	H0174_012_4	4	1					0	07/31/2021	2022.01	07/31/2021 10:45:40 AM Pacific Daylight Time	08/03/2021 10:13:37 PM Eastern Daylight Time	07/30/2021 12:09:48 AM Eastern Daylight Time			08/04/2021 10:52:49 PM Eastern Daylight Time	WELLCARE OF TEXAS, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO-POS)	01	02		1			H0174	012	4	2022	Select counties in TX	San Antonio	2	25455	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0174	012	5	1	02	01	H0174_012_5	4	1					0	08/02/2021	2022.01	08/02/2021 01:06:05 PM Pacific Daylight Time	08/03/2021 10:14:08 PM Eastern Daylight Time	07/30/2021 12:10:33 AM Eastern Daylight Time			08/04/2021 10:52:49 PM Eastern Daylight Time	WELLCARE OF TEXAS, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO-POS)	01	02		1			H0174	012	5	2022	Select counties in TX	El Paso	2	10502	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0174	013	1	1	01	01	H0174_013_1	4	1					0	08/02/2021	2022.01	08/02/2021 01:07:44 PM Pacific Daylight Time	08/03/2021 10:14:38 PM Eastern Daylight Time	07/30/2021 12:11:25 AM Eastern Daylight Time			08/04/2021 10:52:49 PM Eastern Daylight Time	WELLCARE OF TEXAS, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Giveback (HMO)	01	01		1			H0174	013	1	2022	Select counties in TX	Austin	2	9456	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0174	013	2	1	01	01	H0174_013_2	4	1					0	08/02/2021	2022.01	08/02/2021 01:09:21 PM Pacific Daylight Time	08/03/2021 10:15:11 PM Eastern Daylight Time	07/30/2021 12:12:10 AM Eastern Daylight Time			08/04/2021 10:52:49 PM Eastern Daylight Time	WELLCARE OF TEXAS, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Giveback (HMO)	01	01		1			H0174	013	2	2022	Select counties in TX	Dallas Fort Worth	2	69939	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0174	013	3	1	01	01	H0174_013_3	4	1					0	08/02/2021	2022.01	08/02/2021 01:11:04 PM Pacific Daylight Time	08/03/2021 10:15:45 PM Eastern Daylight Time	07/30/2021 12:12:55 AM Eastern Daylight Time			08/04/2021 10:52:49 PM Eastern Daylight Time	WELLCARE OF TEXAS, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Giveback (HMO)	01	01		1			H0174	013	3	2022	Select counties in TX	Houston/Beaumont	2	123976	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0174	013	4	1	01	01	H0174_013_4	4	1					0	08/02/2021	2022.01	08/02/2021 01:12:47 PM Pacific Daylight Time	08/03/2021 10:16:18 PM Eastern Daylight Time	07/30/2021 12:13:40 AM Eastern Daylight Time			08/04/2021 10:52:49 PM Eastern Daylight Time	WELLCARE OF TEXAS, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Giveback (HMO)	01	01		1			H0174	013	4	2022	Select counties in TX	San Antonio	2	33640	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0174	013	5	1	01	01	H0174_013_5	4	1					0	08/02/2021	2022.01	08/02/2021 01:14:33 PM Pacific Daylight Time	08/04/2021 05:52:21 PM Eastern Daylight Time	07/30/2021 12:14:24 AM Eastern Daylight Time			08/04/2021 10:52:49 PM Eastern Daylight Time	WELLCARE OF TEXAS, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Giveback (HMO)	01	01		1			H0174	013	5	2022	Select counties in TX	El Paso	2	22563	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0174	014	0	1	01	01	H0174_014_0	4	1					0	07/31/2021	2022.01	07/31/2021 10:48:31 AM Pacific Daylight Time	08/04/2021 08:15:56 AM Eastern Daylight Time	07/30/2021 12:15:16 AM Eastern Daylight Time			08/04/2021 10:52:49 PM Eastern Daylight Time	WELLCARE OF TEXAS, INC.	Wellcare	www.wellcare.com/medicare	Wellcare TexanPlus No Premium (HMO)	01	01		1			H0174	014	0	2022	Select counties in TX		2	22243	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0192	001	0	1	48	05	H0192_001_0	5	1						07/21/2021	2022.01	07/21/2021 02:47:35 PM Central Daylight Time					07/21/2021 03:25:38 PM 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	2022	Wayne and Macomb Counties		2		2			2						www.amerihealthcaritasvipcareplus.com	www.amerihealthcaritasvipcareplus.com	www.amerihealthcaritasvipcareplus.com	(888)667-0318		(888)667-0318		(888)667-0318		(888)667-0318		(888)667-0318		(888)667-0318		(888)667-0318		(888)667-0318		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H0216	001	0	1	20	08	H0216_001_0	1	1						06/04/2021	2022.01	06/04/2021 04:51:33 PM Central Daylight Time		06/01/2021 10:30:10 AM Central Daylight Time			06/04/2021 04:53:55 PM Central Daylight Time	PACE IOWA	Immanuel Pathways Iowa	Immanuel.com	PACE Iowa (PACE)	08	20		1			H0216	001	0	2022	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						06/04/2021	2022.01	06/04/2021 04:52:03 PM Central Daylight Time		06/01/2021 10:30:10 AM Central Daylight Time			06/04/2021 04:53:55 PM Central Daylight Time	PACE IOWA	Immanuel Pathways Iowa	Immanuel.com	PACE Iowa (PACE)	08	20		1			H0216	002	0	2022	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																
H0235	001	0	1	20	08	H0235_001_0	4	1						07/28/2021	2022.01	07/28/2021 12:24:58 PM Eastern Daylight Time		07/28/2021 12:15:15 PM Eastern Daylight Time			07/28/2021 12:26:56 PM Eastern Daylight Time	PACE OF NORTHEAST INDIANA, LLC	PACE of Northeast Indiana, LLC	www.agingihs.org	PACE of NE IN - Dual Eligible (PACE)	08	20		1			H0235	001	0	2022	Allen		2		2			2						https://agingihs.org	https://agingihs.org/												(260)745-1200				(260)745-1200												(260)745-1200				(260)745-1200																
H0235	002	0	1	20	08	H0235_002_0	3	1						07/28/2021	2022.01	07/28/2021 12:25:17 PM Eastern Daylight Time		07/28/2021 12:15:27 PM Eastern Daylight Time			07/28/2021 12:26:56 PM Eastern Daylight Time	PACE OF NORTHEAST INDIANA, LLC	PACE of Northeast Indiana, LLC	www.agingihs.org	PACE of NE IN - Medicare Only (PACE)	08	20		1			H0235	002	0	2022	Allen		2		2			2						https://agingihs.org	https://agingihs.org/												(260)745-1200				(260)745-1200												(260)745-1200				(260)745-1200																
H0247	001	0	1	20	08	H0247_001_0	1	1						06/02/2021	2022.01	06/02/2021 02:28:07 PM Pacific Daylight Time		06/02/2021 01:16:37 PM Pacific Daylight Time			06/02/2021 02:52:50 PM Pacific Daylight Time	ALLCARE PACE, LLC	AllCare PACE, LLC	www.allcarehealth.com	AllCare PACE - Dual Eligible (PACE)	08	20		1			H0247	001	0	2022	Josephine and Jackson counties		2		2			2						www.allcarehealth.com	www.allcarehealth.com	www.allcarehealth.com									(844)950-7223		(541)474-8000		(844)950-7223		(541)474-8000												(711)-				(711)-																
H0247	002	0	1	20	08	H0247_002_0	1	1						06/02/2021	2022.01	06/02/2021 02:28:35 PM Pacific Daylight Time		06/02/2021 01:16:38 PM Pacific Daylight Time			06/02/2021 02:52:50 PM Pacific Daylight Time	ALLCARE PACE, LLC	AllCare PACE, LLC	www.allcarehealth.com	AllCare PACE - Medicare Only (PACE)	08	20		1			H0247	002	0	2022	Josephine and Jackson counties		2		2			2						www.allcarehealth.com	www.allcarehealth.com	www.allcarehealth.com									(844)950-7223		(541)474-8000		(844)950-7223		(541)474-8000												(711)-				(711)-																
H0251	002	0	1	01	01	H0251_002_0	5	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 11:08:06 AM Central Daylight Time	08/03/2021 12:27:35 PM Central Daylight Time	07/29/2021 06:39:34 PM Central Daylight Time			08/04/2021 01:23:58 PM Central Daylight Time	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO D-SNP)	01	01		1			H0251	002	0	2022	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	1		0	08/04/2021	2022.01	08/04/2021 11:06:39 AM Central Daylight Time	08/03/2021 12:28:09 PM Central Daylight Time	07/29/2021 06:39:49 PM Central Daylight Time			08/04/2021 01:23:58 PM Central Daylight Time	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete ONE (HMO D-SNP)	01	01		1			H0251	004	0	2022	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	1		0	08/04/2021	2022.01	08/04/2021 11:04:59 AM Central Daylight Time	08/03/2021 12:28:43 PM Central Daylight Time	07/29/2021 06:40:05 PM Central Daylight Time			08/04/2021 01:23:58 PM Central Daylight Time	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete ONE Plus (HMO D-SNP)	01	01		1			H0251	005	0	2022	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	5	1					0	08/01/2021	2022.01	08/01/2021 03:37:02 PM Eastern Daylight Time	08/03/2021 10:19:33 PM Eastern Daylight Time	07/30/2021 12:16:06 AM Eastern Daylight Time			08/04/2021 08:53:46 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Wellcare	www.wellcare.com/medicare	Wellcare No Premium Open (PPO)	01	04		1			H0270	001	0	2022	Select counties in AR		2	6416	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0270	002	0	1	04	01	H0270_002_0	5	1	2	1			0	08/03/2021	2022.01	08/03/2021 10:39:29 AM Eastern Daylight Time	08/03/2021 10:20:04 PM Eastern Daylight Time	07/30/2021 08:49:54 AM Eastern Daylight Time			08/04/2021 08:53:46 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Wellcare	www.wellcare.com/medicare	Wellcare Dual Access Open (PPO D-SNP)	01	04		1			H0270	002	0	2022	Select counties in AR		2	2661	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0271	002	0	1	04	01	H0271_002_0	4	1			2		0	08/04/2021	2022.01	08/04/2021 10:15:34 AM Central Daylight Time	08/03/2021 12:03:40 PM Central Daylight Time	07/29/2021 06:40:22 PM Central Daylight Time			08/04/2021 08:54:38 PM Central Daylight Time	UnitedHealthcare Insurance Company of America	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Assure (PPO)	01	04		1			H0271	002	0	2022	Select counties in Idaho		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			
H0271	004	0	1	04	01	H0271_004_0	4	1			2		0	08/04/2021	2022.01	08/04/2021 11:40:55 AM Central Daylight Time	08/03/2021 12:04:10 PM Central Daylight Time	07/29/2021 06:40:37 PM Central Daylight Time			08/04/2021 03:58:20 PM Central Daylight Time	UnitedHealthcare Insurance Company of America	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Assure (PPO)	01	04		1			H0271	004	0	2022	Select Counties in Illinois		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			
H0271	005	0	1	04	01	H0271_005_0	4	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 09:16:57 AM Central Daylight Time	08/03/2021 12:04:41 PM Central Daylight Time	07/29/2021 06:40:53 PM Central Daylight Time			08/05/2021 12:32:20 PM Central Daylight Time	UnitedHealthcare Insurance Company of America	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Dual Complete (PPO D-SNP)	01	04		1			H0271	005	0	2022	Select Counties in Indiana		2		2			1	3		1		1	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			
H0271	006	0	1	04	01	H0271_006_0	4	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 01:16:09 PM Central Daylight Time	08/03/2021 12:05:10 PM Central Daylight Time	07/29/2021 06:41:08 PM Central Daylight Time			08/05/2021 02:26:05 PM Central Daylight Time	UnitedHealthcare Insurance Company of America	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Dual Complete (PPO D-SNP)	01	04		1			H0271	006	0	2022	Select Counties in Maine		2		2			1	3		1		1	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			
H0271	007	0	1	04	01	H0271_007_0	3	1			2		0	08/04/2021	2022.01	08/04/2021 01:21:10 PM Central Daylight Time	08/03/2021 12:05:40 PM Central Daylight Time	07/29/2021 06:41:23 PM Central Daylight Time			08/05/2021 02:26:05 PM Central Daylight Time	UnitedHealthcare Insurance Company of America	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Assure (PPO)	01	04		1			H0271	007	0	2022	Counties in New Hampshire		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			
H0271	008	0	1	04	01	H0271_008_0	3	1			2		0	08/04/2021	2022.01	08/04/2021 09:04:50 AM Central Daylight Time	08/03/2021 12:06:10 PM Central Daylight Time	07/29/2021 06:41:39 PM Central Daylight Time			08/04/2021 06:48:07 PM Central Daylight Time	UnitedHealthcare Insurance Company of America	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Assure (PPO)	01	04		1			H0271	008	0	2022	Graham, Santa Cruz, and Yavapai counties		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			
H0271	010	0	1	04	01	H0271_010_0	3	1			2		0	08/04/2021	2022.01	08/04/2021 09:05:54 AM Central Daylight Time	08/03/2021 12:06:40 PM Central Daylight Time	07/29/2021 06:41:54 PM Central Daylight Time			08/04/2021 06:48:07 PM Central Daylight Time	UnitedHealthcare Insurance Company of America	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Assure (PPO)	01	04		1			H0271	010	0	2022	Select Counties in New Mexico		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			
H0271	011	0	1	04	01	H0271_011_0	3	1			2		0	08/04/2021	2022.01	08/04/2021 08:13:46 AM Central Daylight Time	08/03/2021 12:07:10 PM Central Daylight Time	07/29/2021 06:42:10 PM Central Daylight Time			08/04/2021 02:50:35 PM Central Daylight Time	UnitedHealthcare Insurance Company of America	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Assure (PPO)	01	04		1			H0271	011	0	2022	Dona Ana, Grant, Hidalgo, Luna, Sierra counties		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			
H0271	012	0	1	04	01	H0271_012_0	3	1			2		0	08/05/2021	2022.01	08/05/2021 10:54:47 AM Central Daylight Time	08/03/2021 12:07:39 PM Central Daylight Time	07/29/2021 06:42:24 PM Central Daylight Time			08/05/2021 02:26:05 PM Central Daylight Time	UnitedHealthcare Insurance Company of America	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Assure (PPO)	01	04		1			H0271	012	0	2022	Select counties in Vermont		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			
H0271	013	0	1	04	01	H0271_013_0	5	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 08:29:47 AM Central Daylight Time	08/03/2021 12:08:08 PM Central Daylight Time	07/29/2021 06:42:40 PM Central Daylight Time			08/04/2021 03:58:47 PM Central Daylight Time	UnitedHealthcare Insurance Company of America	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Dual Complete (PPO D-SNP)	01	04		1			H0271	013	0	2022	Select Counties in West Virginia		2		2			1	3		1		1	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			
H0271	014	0	1	04	01	H0271_014_0	4	1	2	1	1		0	08/05/2021	2022.01	08/05/2021 10:56:13 AM Central Daylight Time	08/03/2021 12:08:38 PM Central Daylight Time	07/29/2021 06:42:56 PM Central Daylight Time			08/05/2021 02:26:05 PM Central Daylight Time	UnitedHealthcare Insurance Company of America	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Dual Complete (PPO D-SNP)	01	04		1			H0271	014	0	2022	State of Connecticut		2		2			1	3		1		1	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			
H0271	016	0	1	04	01	H0271_016_0	5	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 08:31:32 AM Central Daylight Time	08/03/2021 07:29:42 PM Central Daylight Time	07/29/2021 06:43:12 PM Central Daylight Time			08/04/2021 03:58:47 PM Central Daylight Time	UnitedHealthcare Insurance Company of America	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Dual Complete (PPO D-SNP)	01	04		1			H0271	016	0	2022	Select counties in South Carolina		2		2			1	3		1		1	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			
H0271	017	0	1	04	01	H0271_017_0	3	1			2		0	08/04/2021	2022.01	08/04/2021 02:47:09 PM Central Daylight Time	08/03/2021 12:09:39 PM Central Daylight Time	07/29/2021 06:43:27 PM Central Daylight Time			08/05/2021 09:27:57 AM Central Daylight Time	UnitedHealthcare Insurance Company of America	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Assure (PPO)	01	04		1			H0271	017	0	2022	Select Counties in North Dakota		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			
H0271	018	0	1	04	01	H0271_018_0	3	1			2		0	08/04/2021	2022.01	08/04/2021 02:46:00 PM Central Daylight Time	08/03/2021 12:10:10 PM Central Daylight Time	07/29/2021 06:43:41 PM Central Daylight Time			08/05/2021 09:27:57 AM Central Daylight Time	UnitedHealthcare Insurance Company of America	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Assure (PPO)	01	04		1			H0271	018	0	2022	Select Counties in South Dakota		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			
H0271	019	0	1	04	01	H0271_019_0	3	1			2		0	08/04/2021	2022.01	08/04/2021 10:43:14 AM Central Daylight Time	08/03/2021 12:10:41 PM Central Daylight Time	07/29/2021 06:43:56 PM Central Daylight Time			08/05/2021 12:04:43 PM Central Daylight Time	UnitedHealthcare Insurance Company of America	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Assure (PPO)	01	04		1			H0271	019	0	2022	Select Counties in Illinois		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			
H0271	020	0	1	04	01	H0271_020_0	4	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 01:23:12 PM Central Daylight Time	08/03/2021 12:11:12 PM Central Daylight Time	07/29/2021 06:44:11 PM Central Daylight Time			08/05/2021 02:26:05 PM Central Daylight Time	UnitedHealthcare Insurance Company of America	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Dual Complete (PPO D-SNP)	01	04		1			H0271	020	0	2022	Select counties in North Maine		2		2			1	3		1		1	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			
H0271	022	0	1	04	01	H0271_022_0	3	1			2		0	08/04/2021	2022.01	08/04/2021 10:18:13 AM Central Daylight Time	08/03/2021 12:11:43 PM Central Daylight Time	07/29/2021 06:44:27 PM Central Daylight Time			08/04/2021 08:54:38 PM Central Daylight Time	UnitedHealthcare Insurance Company of America	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Assure (PPO)	01	04		1			H0271	022	0	2022	Select counties in Oregon		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			
H0271	023	0	1	04	01	H0271_023_0	4	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 11:03:22 AM Central Daylight Time	08/03/2021 12:12:15 PM Central Daylight Time	07/29/2021 06:44:42 PM Central Daylight Time			08/04/2021 01:23:58 PM Central Daylight Time	UnitedHealthcare Insurance Company of America	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Dual Complete Choice (PPO D-SNP)	01	04		1			H0271	023	0	2022	State of Arkansas		2		2			1	3		1		1	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			
H0271	024	0	1	04	01	H0271_024_0	4	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 11:01:34 AM Central Daylight Time	08/03/2021 12:12:47 PM Central Daylight Time	07/29/2021 06:45:02 PM Central Daylight Time			08/04/2021 01:23:58 PM Central Daylight Time	UnitedHealthcare Insurance Company of America	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Dual Complete Choice Select (PPO D-SNP)	01	04		1			H0271	024	0	2022	State of Arkansas		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			
H0271	025	0	1	04	01	H0271_025_0	3	1		1	2		0	08/04/2021	2022.01	08/04/2021 09:06:55 AM Central Daylight Time	08/03/2021 12:13:17 PM Central Daylight Time	07/29/2021 06:45:17 PM Central Daylight Time			08/04/2021 06:48:07 PM Central Daylight Time	UnitedHealthcare Insurance Company of America	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Chronic Complete Assure (PPO C-SNP)	01	04		1			H0271	025	0	2022	Graham, Santa Cruz, and Yavapai counties		2		2			1	4			00000000000000000010		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	026	0	1	04	01	H0271_026_0	3	1		1	2		0	08/04/2021	2022.01	08/04/2021 10:44:31 AM Central Daylight Time	08/03/2021 12:13:47 PM Central Daylight Time	07/29/2021 06:45:32 PM Central Daylight Time			08/05/2021 12:04:43 PM Central Daylight Time	UnitedHealthcare Insurance Company of America	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Chronic Complete Assure (PPO C-SNP)	01	04		1			H0271	026	0	2022	Select Counties in Illinois		2		2			1	4			00000000000000000010		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	027	0	1	04	01	H0271_027_0	3	1		1	2		0	08/04/2021	2022.01	08/04/2021 09:26:34 AM Central Daylight Time	08/03/2021 12:14:18 PM Central Daylight Time	07/29/2021 06:45:48 PM Central Daylight Time			08/04/2021 03:58:20 PM Central Daylight Time	UnitedHealthcare Insurance Company of America	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Chronic Complete Assure (PPO C-SNP)	01	04		1			H0271	027	0	2022	Select Counties in Illinois		2		2			1	4			00000000000000000010		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	028	0	1	04	01	H0271_028_0	4	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 09:28:01 AM Central Daylight Time	08/03/2021 12:14:49 PM Central Daylight Time	07/29/2021 06:46:13 PM Central Daylight Time			08/04/2021 03:58:20 PM Central Daylight Time	UnitedHealthcare Insurance Company of America	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Choice (PPO D-SNP)	01	04		1			H0271	028	0	2022	Select Counties in Michigan		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			
H0271	029	0	1	04	01	H0271_029_0	4	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 10:45:47 AM Central Daylight Time	08/03/2021 12:15:20 PM Central Daylight Time	07/29/2021 06:46:28 PM Central Daylight Time			08/05/2021 12:04:43 PM Central Daylight Time	UnitedHealthcare Insurance Company of America	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Choice (PPO D-SNP)	01	04		1			H0271	029	0	2022	Select Counties in Missouri		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			
H0271	030	0	1	04	01	H0271_030_0	4	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 09:25:19 AM Central Daylight Time	08/03/2021 12:15:51 PM Central Daylight Time	07/29/2021 06:46:44 PM Central Daylight Time			08/04/2021 06:48:07 PM Central Daylight Time	UnitedHealthcare Insurance Company of America	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Dual Complete Choice (PPO D-SNP)	01	04		1			H0271	030	0	2022	Select Counties in Montana		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	033	0	1	04	01	H0271_033_0	3	1		1	2		0	08/04/2021	2022.01	08/04/2021 09:26:28 AM Central Daylight Time	08/03/2021 12:16:21 PM Central Daylight Time	07/29/2021 06:47:00 PM Central Daylight Time			08/04/2021 06:48:07 PM Central Daylight Time	UnitedHealthcare Insurance Company of America	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Chronic Complete Assure (PPO C-SNP)	01	04		1			H0271	033	0	2022	Select Counties in New Mexico		2		2			1	4			00000000000000000010		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	034	0	1	04	01	H0271_034_0	3	1		1	2		0	08/04/2021	2022.01	08/04/2021 08:23:34 AM Central Daylight Time	08/03/2021 12:16:52 PM Central Daylight Time	07/29/2021 06:47:15 PM Central Daylight Time			08/04/2021 02:50:35 PM Central Daylight Time	UnitedHealthcare Insurance Company of America	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Chronic Complete Assure (PPO C-SNP)	01	04		1			H0271	034	0	2022	Dona Ana, Grant, Hidalgo, Luna, Sierra counties		2		2			1	4			00000000000000000010		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	035	0	1	04	01	H0271_035_0	3	1		1	2		0	08/04/2021	2022.01	08/04/2021 09:27:44 AM Central Daylight Time	08/03/2021 12:17:23 PM Central Daylight Time	07/29/2021 06:47:30 PM Central Daylight Time			08/04/2021 06:48:07 PM Central Daylight Time	UnitedHealthcare Insurance Company of America	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Chronic Complete Assure (PPO C-SNP)	01	04		1			H0271	035	0	2022	Select Counties in New Mexico		2		2			1	4			00000000000000000010		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	036	0	1	04	01	H0271_036_0	3	1		1	2		0	08/04/2021	2022.01	08/04/2021 10:22:47 AM Central Daylight Time	08/03/2021 12:17:53 PM Central Daylight Time	07/29/2021 06:47:45 PM Central Daylight Time			08/04/2021 08:54:38 PM Central Daylight Time	UnitedHealthcare Insurance Company of America	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Chronic Complete Assure (PPO C-SNP)	01	04		1			H0271	036	0	2022	Select Counties in Oregon		2		2			1	4			00000000000000000010		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	037	0	1	04	01	H0271_037_0	4	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 02:44:53 PM Central Daylight Time	08/03/2021 12:18:23 PM Central Daylight Time	07/29/2021 06:48:00 PM Central Daylight Time			08/05/2021 09:27:57 AM Central Daylight Time	UnitedHealthcare Insurance Company of America	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Dual Complete Choice (PPO D-SNP)	01	04		1			H0271	037	0	2022	Select Counties in South Dakota		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	038	0	1	04	01	H0271_038_0	4	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 10:24:44 AM Central Daylight Time	08/03/2021 12:18:52 PM Central Daylight Time	07/29/2021 06:48:16 PM Central Daylight Time			08/04/2021 08:54:38 PM Central Daylight Time	UnitedHealthcare Insurance Company of America	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Dual Complete Choice (PPO D-SNP)	01	04		1			H0271	038	0	2022	Select Counties in Utah		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	039	0	1	04	01	H0271_039_0	4	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 10:27:07 AM Central Daylight Time	08/03/2021 12:19:21 PM Central Daylight Time	07/29/2021 06:48:32 PM Central Daylight Time			08/04/2021 08:54:38 PM Central Daylight Time	UnitedHealthcare Insurance Company of America	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Dual Complete Select (PPO D-SNP)	01	04		1			H0271	039	0	2022	Select Counties in Utah		2		2			1	3		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			
H0271	042	0	1	04	01	H0271_042_0	5	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 09:29:12 AM Central Daylight Time	08/03/2021 12:19:50 PM Central Daylight Time	07/29/2021 06:48:47 PM Central Daylight Time			08/04/2021 08:15:21 PM Central Daylight Time	UnitedHealthcare Insurance Company of America	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Dual Complete Choice (PPO D-SNP)	01	04		1			H0271	042	0	2022	Select Counties in Wyoming		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			
H0292	001	0	1	01	01	H0292_001_0	7	1			1		1	08/02/2021	2022.01	08/02/2021 03:03:42 PM Eastern Daylight Time	08/03/2021 06:05:16 PM Eastern Daylight Time	07/30/2021 10:02:14 AM Eastern Daylight Time			08/04/2021 01:32:44 PM Eastern Daylight Time	HUMANA HEALTH PLAN OF OHIO, INC.	Humana	www.humana.com/medicare	Humana Community (HMO)	01	01		1			H0292	001	0	2022	Select counties in Northern Kentucky		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		1	07/15/2021	2022.01	07/15/2021 04:16:09 PM Eastern Daylight Time	08/03/2021 06:11:58 PM Eastern Daylight Time	07/30/2021 10:02:30 AM Eastern Daylight Time			08/04/2021 01:32:44 PM 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	2022	Select counties in Northern Kentucky		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1	08/04/2021	2022.01	08/04/2021 09:30:30 AM Central Daylight Time	08/03/2021 01:34:42 PM Central Daylight Time	07/29/2021 06:49:03 PM Central Daylight Time			08/04/2021 04:06:49 PM Central Daylight Time	CARE IMPROVEMENT PLUS WISCONSIN INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Assist (PPO C-SNP)	01	04		1			H0294	002	0	2022	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					1	08/04/2021	2022.01	08/04/2021 09:32:57 AM Central Daylight Time	08/03/2021 01:35:15 PM Central Daylight Time	07/29/2021 06:49:18 PM Central Daylight Time			08/04/2021 04:06:49 PM Central Daylight Time	CARE IMPROVEMENT PLUS WISCONSIN INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Open Plan 1 (PPO)	01	04		1			H0294	004	0	2022	Select counties in Wisconsin		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	3	1		1			1	08/04/2021	2022.01	08/04/2021 09:34:50 AM Central Daylight Time	08/03/2021 01:35:47 PM Central Daylight Time	07/29/2021 06:49:33 PM Central Daylight Time			08/04/2021 04:06:49 PM Central Daylight Time	CARE IMPROVEMENT PLUS WISCONSIN INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Assist (PPO C-SNP)	01	04		1			H0294	010	0	2022	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	3	1					1	08/04/2021	2022.01	08/04/2021 09:38:20 AM Central Daylight Time	08/03/2021 01:36:20 PM Central Daylight Time	07/29/2021 06:49:47 PM Central Daylight Time			08/04/2021 04:06:49 PM Central Daylight Time	CARE IMPROVEMENT PLUS WISCONSIN INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Open (PPO)	01	04		1			H0294	011	0	2022	Select counties in Wisconsin		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	3	1					1	08/04/2021	2022.01	08/04/2021 09:40:36 AM Central Daylight Time	08/03/2021 01:36:53 PM Central Daylight Time	07/29/2021 06:50:03 PM Central Daylight Time			08/04/2021 04:06:49 PM Central Daylight Time	CARE IMPROVEMENT PLUS WISCONSIN INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Open Premier (PPO)	01	04		1			H0294	012	0	2022	Select counties in Wisconsin		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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				0	0	07/14/2021	2022.01	07/14/2021 05:36:23 PM Central Daylight Time	06/03/2021 03:00:53 PM Central Daylight Time				07/15/2021 11:56:15 AM Central Daylight Time	CARE IMPROVEMENT PLUS WISCONSIN INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot Plan 1 (PPO)	01	04		1			H0294	014	0	2022	Select Wisconsin Counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)204-1002		(800)204-1002		(800)555-5757		(800)555-5757										(711)-		(711)-		(711)-		(711)-										2					2						2			
H0294	015	0	1	04	01	H0294_015_0	3	1					1	08/04/2021	2022.01	08/04/2021 09:43:35 AM Central Daylight Time	08/03/2021 01:37:24 PM Central Daylight Time	07/29/2021 06:50:18 PM Central Daylight Time			08/04/2021 04:06:49 PM Central Daylight Time	CARE IMPROVEMENT PLUS WISCONSIN INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Walgreens (PPO)	01	04		1			H0294	015	0	2022	Select counties in Eastern Wisconsin		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	016	0	1	04	01	H0294_016_0	4	1					1	08/04/2021	2022.01	08/04/2021 09:47:50 AM Central Daylight Time	08/03/2021 01:37:55 PM Central Daylight Time	07/29/2021 06:50:34 PM Central Daylight Time			08/04/2021 04:06:49 PM Central Daylight Time	CARE IMPROVEMENT PLUS WISCONSIN INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Open Plan 2 (PPO)	01	04		1			H0294	016	0	2022	Select Counties in South-Central Wisconsin		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	017	0	1	04	01	H0294_017_0	4	1					1	08/04/2021	2022.01	08/04/2021 09:49:24 AM Central Daylight Time	08/03/2021 01:38:25 PM Central Daylight Time	07/29/2021 06:50:49 PM Central Daylight Time			08/04/2021 04:06:49 PM Central Daylight Time	CARE IMPROVEMENT PLUS WISCONSIN INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Open Plan 1 (PPO)	01	04		1			H0294	017	0	2022	Detroit metro		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	018	0	1	04	01	H0294_018_0	4	1					1	08/04/2021	2022.01	08/04/2021 09:50:55 AM Central Daylight Time	08/03/2021 01:38:57 PM Central Daylight Time	07/29/2021 06:51:05 PM Central Daylight Time			08/04/2021 04:06:49 PM Central Daylight Time	CARE IMPROVEMENT PLUS WISCONSIN INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Open Plan 2 (PPO)	01	04		1			H0294	018	0	2022	Select Counties in Michigan		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	019	0	1	04	01	H0294_019_0	3	1					1	08/04/2021	2022.01	08/04/2021 09:52:22 AM Central Daylight Time	08/03/2021 01:39:27 PM Central Daylight Time	07/29/2021 06:51:20 PM Central Daylight Time			08/04/2021 04:06:49 PM Central Daylight Time	CARE IMPROVEMENT PLUS WISCONSIN INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Open Plan 1 (PPO)	01	04		1			H0294	019	0	2022	Select counties in Western Michigan		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	020	0	1	04	01	H0294_020_0	4	1					1	08/04/2021	2022.01	08/04/2021 09:53:58 AM Central Daylight Time	08/03/2021 01:39:59 PM Central Daylight Time	07/29/2021 06:51:34 PM Central Daylight Time			08/04/2021 04:06:49 PM Central Daylight Time	CARE IMPROVEMENT PLUS WISCONSIN INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Open Plan 2 (PPO)	01	04		1			H0294	020	0	2022	Select counties in Western Michigan		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	021	0	1	04	01	H0294_021_0	3	1					1	08/04/2021	2022.01	08/04/2021 09:55:35 AM Central Daylight Time	08/03/2021 01:40:29 PM Central Daylight Time	07/29/2021 06:51:50 PM Central Daylight Time			08/04/2021 04:06:49 PM Central Daylight Time	CARE IMPROVEMENT PLUS WISCONSIN INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Open (PPO)	01	04		1			H0294	021	0	2022	Select counties in the Upper Peninsula Michigan		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	022	0	1	04	01	H0294_022_0	2	1				0	0	07/14/2021	2022.01	07/14/2021 02:00:49 PM Central Daylight Time	06/03/2021 03:10:49 PM Central Daylight Time				07/15/2021 11:56:15 AM Central Daylight Time	CARE IMPROVEMENT PLUS WISCONSIN INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (PPO)	01	04		1			H0294	022	0	2022	Select Counties in Michigan		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)204-1002		(800)204-1002		(800)555-5757		(800)555-5757										(711)-		(711)-		(711)-		(711)-										2					2						2			
H0294	023	0	1	04	01	H0294_023_0	3	1					1	08/04/2021	2022.01	08/04/2021 02:48:44 PM Central Daylight Time	08/03/2021 01:41:00 PM Central Daylight Time	07/29/2021 06:52:05 PM Central Daylight Time			08/05/2021 09:27:57 AM Central Daylight Time	CARE IMPROVEMENT PLUS WISCONSIN INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H0294	023	0	2022	Select Counties in Western Wisconsin		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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			
H0302	001	0	1	01	01	H0302_001_0	9	1					0	07/26/2021	2022.01	07/26/2021 12:48:03 PM US Mountain Standard Time	08/04/2021 09:29:49 AM US Mountain Standard Time	08/03/2021 03:30:38 PM US Mountain Standard Time			08/04/2021 05:55:53 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	2022	Maricopa and Pinal Counties		2		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	9	1					0	06/25/2021	2022.01	06/25/2021 03:44:18 PM US Mountain Standard Time	08/04/2021 09:48:25 AM US Mountain Standard Time	08/03/2021 03:30:57 PM US Mountain Standard Time			08/04/2021 05:55:53 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	2022	Maricopa and Pinal Counties		2		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	9	1					0	06/25/2021	2022.01	06/25/2021 03:45:37 PM US Mountain Standard Time	08/04/2021 11:55:05 AM US Mountain Standard Time	08/03/2021 03:31:16 PM US Mountain Standard Time			08/04/2021 05:55:53 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	2022	Pima County		2		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	9	1					0	06/25/2021	2022.01	06/25/2021 03:47:12 PM US Mountain Standard Time	08/04/2021 11:57:35 AM US Mountain Standard Time	08/03/2021 03:31:33 PM US Mountain Standard Time			08/04/2021 05:55:53 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	2022	Santa Cruz County		2		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				0	0	06/02/2021	2022.01	06/02/2021 03:00:44 PM US Mountain Standard Time					06/06/2021 01:39:34 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	2022	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)-										2					2					2	2			
H0321	002	0	1	01	01	H0321_002_0	4	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 09:32:34 AM Central Daylight Time	08/03/2021 12:42:50 PM Central Daylight Time	07/29/2021 06:52:21 PM Central Daylight Time			08/04/2021 06:48:07 PM Central Daylight Time	ARIZONA PHYSICIANS IPA, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete LP (HMO D-SNP)	01	01		1			H0321	002	0	2022	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	4	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 09:31:00 AM Central Daylight Time	08/03/2021 12:43:26 PM Central Daylight Time	07/29/2021 06:52:36 PM Central Daylight Time			08/04/2021 06:48:07 PM Central Daylight Time	ARIZONA PHYSICIANS IPA, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete ONE (HMO D-SNP)	01	01		1			H0321	004	0	2022	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	5	1				0	0	07/18/2021	2022.01	07/18/2021 03:51:53 PM Central Daylight Time	08/05/2021 02:30:57 PM Mountain Daylight Time				08/05/2021 03:22:07 PM Mountain Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Silver (HMO)	01	01		1			H0332	001	0	2022	BO,FB,FV,HR, and MQ counties		2	19973	2			2						www.kelseycareadvantage.com	www.kelseycareadvantage.com	www.Kelseycareadvantage.com	(866)535-8343		(713)442-2273		(800)663-7146		(713)442-5646										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H0332	002	0	1	01	01	H0332_002_0	6	1					1	08/03/2021	2022.01	08/03/2021 03:06:02 PM Mountain Daylight Time	08/05/2021 02:30:58 PM Mountain Daylight Time	08/05/2021 02:30:58 PM Mountain Daylight Time			08/05/2021 03:22:07 PM Mountain Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Gold (HMO)	01	01		1			H0332	002	0	2022	BO,FB,FV,HR, and MQ counties		2	314475	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0332	003	0	1	02	01	H0332_003_0	5	1				0	0	07/18/2021	2022.01	07/18/2021 04:26:23 PM Central Daylight Time	08/05/2021 02:30:58 PM Mountain Daylight Time				08/05/2021 03:22:07 PM Mountain Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Silver Freedom (HMO-POS)	01	02		1			H0332	003	0	2022	BO,FB,FV,HR, and MQ counties		2	10499	2			2						www.kelseycareadvantage.com	www.kelseycareadvantage.com	www.Kelseycareadvantage.com	(866)535-8343		(713)442-2273		(800)663-7146		(713)442-5646										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H0332	004	0	1	02	01	H0332_004_0	6	1					1	08/03/2021	2022.01	08/03/2021 03:05:01 PM Mountain Daylight Time	08/05/2021 02:30:58 PM Mountain Daylight Time	08/05/2021 02:30:58 PM Mountain Daylight Time			08/05/2021 03:22:07 PM Mountain Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Gold Freedom (HMO-POS)	01	02		1			H0332	004	0	2022	BO,FB,FV,HR, and MQ counties		2	44586	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0332	007	0	1	02	01	H0332_007_0	5	1				0	0	07/18/2021	2022.01	07/18/2021 04:45:06 PM Central Daylight Time	08/05/2021 02:30:58 PM Mountain Daylight Time				08/05/2021 03:22:07 PM Mountain Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Silver Community (HMO-POS)	01	02		1			H0332	007	0	2022	AU,CH,GM,LB,SJ,WA,WL, and WH counties		2	192	2			2						www.kelseycareadvantage.com	www.kelseycareadvantage.com	www.Kelseycareadvantage.com	(866)535-8343		(713)442-2273		(800)663-7146		(713)442-5646										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H0332	008	0	1	02	01	H0332_008_0	6	1					1	08/03/2021	2022.01	08/03/2021 03:03:50 PM Mountain Daylight Time	08/05/2021 02:30:58 PM Mountain Daylight Time	08/05/2021 02:30:58 PM Mountain Daylight Time			08/05/2021 03:22:07 PM Mountain Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Gold Community (HMO-POS)	01	02		1			H0332	008	0	2022	AU,CH,GM,LB,SJ,WA,WL, and WH counties		2	2911	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0332	009	0	1	01	01	H0332_009_0	6	1					1	08/03/2021	2022.01	08/03/2021 03:00:38 PM Mountain Daylight Time	08/05/2021 02:30:58 PM Mountain Daylight Time	08/05/2021 02:30:58 PM Mountain Daylight Time			08/05/2021 03:22:07 PM Mountain Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Platinum (HMO)	01	01		1			H0332	009	0	2022	BO,FB,FV,HR, and MQ counties		2	25172	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0332	801	0	1	01	01	H0332_801_0	3	1				0	0	06/04/2021	2022.01	06/04/2021 11:57:23 AM Central Daylight Time					06/06/2021 09:07:38 AM Central Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Essential Retiree (HMO)	01	01		1			H0332	801	0	2022	Texas		1	0	2			2						www.kelseycareadvantage.com	www.kelseycareadvantage.com	www.Kelseycareadvantage.com	(866)534-0554		(713)442-2273		(800)663-7146		(713)442-5646										(711)-		(711)-		(711)-		(711)-										1	2		2		1					1				
H0332	803	0	1	01	01	H0332_803_0	3	1						06/04/2021	2022.01	06/04/2021 11:57:44 AM Central Daylight Time					06/06/2021 09:07:38 AM Central Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Rx Retiree (HMO)	01	01		1			H0332	803	0	2022	Texas		1	0	2			2						www.kelseycareadvantage.com	www.kelseycareadvantage.com	www.Kelseycareadvantage.com	(866)534-0554		(713)442-2273		(800)663-7146		(713)442-5646		(866)534-0554		(713)442-2273		(866)534-0554		(713)442-5646		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1				
H0332	804	0	1	01	01	H0332_804_0	3	1				0	0	06/04/2021	2022.01	06/04/2021 11:57:53 AM Central Daylight Time					06/06/2021 09:07:38 AM Central Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Essential+Choice Retiree (HMO)	01	01		1			H0332	804	0	2022	Texas		1	0	2			2						www.kelseycareadvantage.com	www.kelseycareadvantage.com	www.Kelseycareadvantage.com	(866)534-0554		(713)442-2273		(800)663-7146		(713)442-5646										(711)-		(711)-		(711)-		(711)-										1	2		2		1					1				
H0332	805	0	1	01	01	H0332_805_0	3	1						06/04/2021	2022.01	06/04/2021 11:58:01 AM Central Daylight Time					06/06/2021 09:07:38 AM Central Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Rx+Choice Retiree (HMO)	01	01		1			H0332	805	0	2022	Texas		1	0	2			2						www.kelseycareadvantage.com	www.kelseycareadvantage.com	www.Kelseycareadvantage.com	(866)534-0554		(713)442-2273		(800)663-7146		(713)442-5646		(866)534-0554		(713)442-2273		(866)534-0554		(713)442-5646		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1				
H0332	806	0	1	01	01	H0332_806_0	3	1				0	0	06/04/2021	2022.01	06/04/2021 11:58:11 AM Central Daylight Time					06/06/2021 09:07:38 AM Central Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Essential Retiree (HMO)	01	01		1			H0332	806	0	2022	Texas		1	0	2			2						www.kelseycareadvantage.com	www.kelseycareadvantage.com	www.Kelseycareadvantage.com	(877)853-9075		(713)442-2377		(877)853-9075		(713)442-5646										(711)-		(711)-		(711)-		(711)-										1	2		2		1					1				
H0332	807	0	1	01	01	H0332_807_0	3	1						06/04/2021	2022.01	06/04/2021 11:58:32 AM Central Daylight Time					06/06/2021 09:07:38 AM Central Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Rx Retiree (HMO)	01	01		1			H0332	807	0	2022	Texas		1	0	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1				
H0332	808	0	1	01	01	H0332_808_0	3	1				0	0	06/04/2021	2022.01	06/04/2021 11:58:40 AM Central Daylight Time					06/06/2021 09:07:38 AM Central Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Essential+Choice Retiree (HMO)	01	01		1			H0332	808	0	2022	Texas		1	6171	2			2						www.kelseycareadvantage.com	www.kelseycareadvantage.com	www.Kelseycareadvantage.com	(866)534-0556		(713)442-7555		(877)853-9075		(713)442-7555										(711)-		(711)-		(711)-		(711)-										1	2		2		1					1				
H0332	809	0	1	01	01	H0332_809_0	3	1						06/04/2021	2022.01	06/04/2021 11:58:47 AM Central Daylight Time					06/06/2021 09:07:38 AM Central Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Rx+Choice Retiree (HMO)	01	01		1			H0332	809	0	2022	Texas		1	0	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1				
H0332	810	0	1	01	01	H0332_810_0	3	1						06/04/2021	2022.01	06/04/2021 11:58:58 AM Central Daylight Time					06/06/2021 09:07:38 AM Central Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Rx Retiree (HMO)	01	01		1			H0332	810	0	2022	Texas		1	1640	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1				
H0332	811	0	1	01	01	H0332_811_0	3	1						06/04/2021	2022.01	06/04/2021 11:59:04 AM Central Daylight Time					06/06/2021 09:07:38 AM Central Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Rx Retiree (HMO)	01	01		1			H0332	811	0	2022	Texas		1	68233	2			2						www.kelseycareadvantage.com	www.kelseycareadvantage.com	www.Kelseycareadvantage.com	(866)535-8405		(713)442-2273		(866)535-8405		(713)442-5646		(866)535-8405		(713)442-2273		(866)535-8405		(713)442-5646		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1				
H0332	812	0	1	01	01	H0332_812_0	3	1						06/04/2021	2022.01	06/04/2021 11:59:10 AM Central Daylight Time					06/06/2021 09:07:38 AM Central Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Rx Retiree (HMO)	01	01		1			H0332	812	0	2022	Texas		1	0	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1				
H0332	813	0	1	01	01	H0332_813_0	3	1						06/04/2021	2022.01	06/04/2021 11:59:17 AM Central Daylight Time					06/06/2021 09:07:38 AM Central Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage RX Retiree (HMO)	01	01		1			H0332	813	0	2022	Texas		1	0	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1				
H0332	814	0	1	01	01	H0332_814_0	3	1				0	0	06/04/2021	2022.01	06/04/2021 11:59:22 AM Central Daylight Time					06/06/2021 09:07:38 AM Central Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Essential Retiree (HMO)	01	01		1			H0332	814	0	2022	Texas		1	0	2			2						www.kelseycareadvantage.com	www.kelseycareadvantage.com	www.Kelseycareadvantage.com	(866)534-0554		(713)442-2273		(866)534-0554		(713)442-5646										(711)-		(711)-		(711)-		(711)-										1	2		2		1					1				
H0336	001	0	1	48	05	H0336_001_0	3	1						07/28/2021	2022.01	07/28/2021 04:17:53 PM Eastern Daylight Time					07/28/2021 09:01:18 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana	www.humana.com/medicare/medicaid-dual/illinois/	Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)	05	48		1			H0336	001	0	2022	Illinois		2	156317	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)-																
H0342	001	0	1	04	01	H0342_001_0	7	1					0	09/27/2021	2022.01	09/27/2021 04:31:44 PM Eastern Daylight Time	08/03/2021 10:48:08 AM Eastern Daylight Time	08/02/2021 01:31:20 PM Eastern Daylight Time			09/27/2021 04:43:15 PM Eastern Daylight Time	CAREPARTNERS OF CONNECTICUT, INC.	CarePartners of Connecticut	www.carepartnersct.com	CarePartners Access (PPO)	01	04		1			H0342	001	0	2022	Most of Connecticut		2		2			2						www.carepartnersct.com/search-doctors	www.carepartnersct.com/drug-search	www.carepartnersct.com/search-doctors	(888)341-1507		(888)341-1507		(844)402-6874		(844)402-6874		(888)341-1507		(888)341-1507		(844)402-6874		(844)402-6874		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0351	038	0	1	01	01	H0351_038_0	7	1		1			1	08/03/2021	2022.01	08/03/2021 01:52:55 PM Central Daylight Time	08/03/2021 10:20:38 PM Eastern Daylight Time	07/30/2021 08:50:48 AM Eastern Daylight Time			08/04/2021 10:40:50 PM Eastern Daylight Time	HEALTH NET OF ARIZONA, INC.	Wellcare by Allwell	www.wellcare.com/allwellAZ	Wellcare Specialty No Premium (HMO C-SNP)	01	01		1			H0351	038	0	2022	Select counties in AZ		2	14165	2			1	4			00000000000000000100		www.wellcare.com/allwellAZ	www.wellcare.com/allwellAZ	www.wellcare.com/allwellAZ	(800)977-7522		(800)977-7522		(866)277-6583		(866)277-6583		(800)977-7522		(800)977-7522		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0351	052	0	1	01	01	H0351_052_0	5	1					0	08/03/2021	2022.01	08/03/2021 01:55:08 PM Central Daylight Time	08/03/2021 10:21:06 PM Eastern Daylight Time	07/30/2021 08:51:38 AM Eastern Daylight Time			08/04/2021 10:40:50 PM Eastern Daylight Time	HEALTH NET OF ARIZONA, INC.	Wellcare by Allwell	www.wellcare.com/allwellAZ	Wellcare No Premium (HMO)	01	01		1			H0351	052	0	2022	Select counties in AZ		2	131837	2			2						www.wellcare.com/allwellAZ	www.wellcare.com/allwellAZ	www.wellcare.com/allwellAZ	(800)977-7522		(800)977-7522		(866)277-6583		(866)277-6583		(800)977-7522		(800)977-7522		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0351	053	0	1	01	01	H0351_053_0	4	1					0	08/03/2021	2022.01	08/03/2021 01:56:37 PM Central Daylight Time	08/03/2021 10:21:36 PM Eastern Daylight Time	07/30/2021 08:52:28 AM Eastern Daylight Time			08/04/2021 10:40:50 PM Eastern Daylight Time	HEALTH NET OF ARIZONA, INC.	Wellcare by Allwell	www.wellcare.com/allwellAZ	Wellcare No Premium (HMO)	01	01		1			H0351	053	0	2022	Select counties in AZ		2	49327	2			2						www.wellcare.com/allwellAZ	www.wellcare.com/allwellAZ	www.wellcare.com/allwellAZ	(800)977-7522		(800)977-7522		(866)277-6583		(866)277-6583		(800)977-7522		(800)977-7522		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0351	054	0	1	01	01	H0351_054_0	4	1					0	08/03/2021	2022.01	08/03/2021 01:58:18 PM Central Daylight Time	08/03/2021 10:22:06 PM Eastern Daylight Time	07/30/2021 08:53:18 AM Eastern Daylight Time			08/04/2021 10:40:50 PM Eastern Daylight Time	HEALTH NET OF ARIZONA, INC.	Wellcare by Allwell	www.wellcare.com/allwellAZ	Wellcare Giveback (HMO)	01	01		1			H0351	054	0	2022	Select counties in AZ		2	17993	2			2						www.wellcare.com/allwellAZ	www.wellcare.com/allwellAZ	www.wellcare.com/allwellAZ	(800)977-7522		(800)977-7522		(866)277-6583		(866)277-6583		(800)977-7522		(800)977-7522		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0351	055	0	1	01	01	H0351_055_0	4	1					0	05/30/2021	2022.01	05/30/2021 11:07:08 AM Eastern Daylight Time	08/03/2021 10:22:36 PM Eastern Daylight Time	07/30/2021 08:54:06 AM Eastern Daylight Time			08/04/2021 10:40:50 PM Eastern Daylight Time	HEALTH NET OF ARIZONA, INC.	Wellcare by Allwell	www.wellcare.com/allwellAZ	Wellcare Assist (HMO)	01	01		1			H0351	055	0	2022	Select counties in Arizona		2	29058	2			2						www.wellcare.com/allwellAZ	www.wellcare.com/allwellAZ	www.wellcare.com/allwellAZ	(800)977-7522		(800)977-7522		(866)277-6583		(866)277-6583		(800)977-7522		(800)977-7522		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0351	056	0	1	01	01	H0351_056_0	4	1					0	08/03/2021	2022.01	08/03/2021 02:00:04 PM Central Daylight Time	08/03/2021 10:23:06 PM Eastern Daylight Time	07/30/2021 08:54:56 AM Eastern Daylight Time			08/04/2021 10:40:50 PM Eastern Daylight Time	HEALTH NET OF ARIZONA, INC.	Wellcare by Allwell	www.wellcare.com/allwellAZ	Wellcare Giveback (HMO)	01	01		1			H0351	056	0	2022	Select counties in AZ		2	85919	2			2						www.wellcare.com/allwellAZ	www.wellcare.com/allwellAZ	www.wellcare.com/allwellAZ	(800)977-7522		(800)977-7522		(866)277-6583		(866)277-6583		(800)977-7522		(800)977-7522		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0351	057	0	1	01	01	H0351_057_0	4	1		1			1	08/03/2021	2022.01	08/03/2021 02:03:53 PM Central Daylight Time	08/03/2021 10:23:36 PM Eastern Daylight Time	07/30/2021 08:55:50 AM Eastern Daylight Time			08/04/2021 10:40:50 PM Eastern Daylight Time	HEALTH NET OF ARIZONA, INC.	Wellcare by Allwell	www.wellcare.com/allwellAZ	Wellcare Specialty No Premium (HMO C-SNP)	01	01		1			H0351	057	0	2022	Select counties in AZ		2	9653	2			1	4			00000000000000000100		www.wellcare.com/allwellAZ	www.wellcare.com/allwellAZ	www.wellcare.com/allwellAZ	(800)977-7522		(800)977-7522		(866)277-6583		(866)277-6583		(800)977-7522		(800)977-7522		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0351	801	0	1	01	01	H0351_801_0	2	1						05/03/2021	2022.01	05/03/2021 01:28:02 PM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	HEALTH NET OF ARIZONA, INC.	Wellcare by Allwell	allwell.azcompletehealth.com	Allwell CoCare (HMO)	01	01		1			H0351	801	0	2022	All AZ Counties		1	100	2			2						allwell.azcompletehealth.com/findadoctor	allwell.azcompletehealth.com/formulary	allwell.azcompletehealth.com/findadoctor	(800)977-7522		(800)977-7522		(844)942-0039		(844)942-0039		(800)977-7522		(800)977-7522		(844)942-0039		(844)942-0039		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H0351	803	0	1	01	01	H0351_803_0	2	1				0	0	05/03/2021	2022.01	05/03/2021 01:28:13 PM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	HEALTH NET OF ARIZONA, INC.	Wellcare by Allwell	allwell.azcompletehealth.com	Allwell CoCare (HMO)	01	01		1			H0351	803	0	2022	All AZ Counties		1	100	2			2						allwell.azcompletehealth.com/findadoctor	allwell.azcompletehealth.com/formulary	allwell.azcompletehealth.com/findadoctor	(800)977-7522		(800)977-7522		(844)942-0039		(844)942-0039										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H0351	804	0	1	01	01	H0351_804_0	2	1						05/03/2021	2022.01	05/03/2021 01:28:26 PM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	HEALTH NET OF ARIZONA, INC.	Wellcare by Allwell	allwell.azcompletehealth.com	Allwell CoCare (HMO)	01	01		1			H0351	804	0	2022	All AZ Counties		1	100	2			2						allwell.azcompletehealth.com/findadoctor	allwell.azcompletehealth.com/formulary	allwell.azcompletehealth.com/findadoctor	(800)977-7522		(800)977-7522		(844)942-0039		(844)942-0039		(800)977-7522		(800)977-7522		(844)942-0039		(844)942-0039		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H0354	001	0	1	01	01	H0354_001_0	5	1					1	08/03/2021	2022.01	08/03/2021 11:02:17 AM Central Daylight Time	08/02/2021 09:00:24 PM Central Daylight Time	07/30/2021 11:19:13 AM Central Daylight Time			08/04/2021 09:32:40 AM Central Daylight Time	CIGNA HEALTHCARE OF ARIZONA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H0354	001	0	2022	Maricopa and Pinal Counties		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.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	5	1					1	08/03/2021	2022.01	08/03/2021 11:02:30 AM Central Daylight Time	08/02/2021 09:01:16 PM Central Daylight Time	07/30/2021 11:19:36 AM Central Daylight Time			08/04/2021 09:32:40 AM Central Daylight Time	CIGNA HEALTHCARE OF ARIZONA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H0354	024	0	2022	Pima County		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.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	027	0	1	01	01	H0354_027_0	5	1		1			0	08/03/2021	2022.01	08/03/2021 11:02:43 AM Central Daylight Time	08/02/2021 09:02:27 PM Central Daylight Time	07/30/2021 11:20:00 AM Central Daylight Time			08/04/2021 09:32:40 AM Central Daylight Time	CIGNA HEALTHCARE OF ARIZONA, INC.	Cigna	www.cignamedicare.com	Cigna Achieve Medicare (HMO C-SNP)	01	01		1			H0354	027	0	2022	Maricopa and Pinal Counties		2		2			1	4			00000010000000000000		www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.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	5	1					1	08/03/2021	2022.01	08/03/2021 11:03:05 AM Central Daylight Time	08/02/2021 09:03:35 PM Central Daylight Time	07/30/2021 11:20:24 AM Central Daylight Time			08/04/2021 09:32:40 AM Central Daylight Time	CIGNA HEALTHCARE OF ARIZONA, INC.	Cigna	www.cignamedicare.com	Cigna Alliance Medicare (HMO)	01	01		1			H0354	028	0	2022	Maricopa and Pinal Counties		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.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	3	1						05/10/2021	2022.01	05/10/2021 12:39:15 PM Central Daylight Time					06/02/2021 07:34:10 PM Central Daylight Time	CIGNA HEALTHCARE OF ARIZONA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H0354	804	0	2022	Statewide AZ		1	5952	2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.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;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H0354	805	0	1	01	01	H0354_805_0	3	1						05/10/2021	2022.01	05/10/2021 10:13:10 AM Central Daylight Time					06/02/2021 07:34:10 PM Central Daylight Time	CIGNA HEALTHCARE OF ARIZONA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare FY (HMO)	01	01		1			H0354	805	0	2022	Statewide AZ		1	924	2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.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;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H0363	001	0	1	01	01	H0363_001_0	7	1		1			0	08/05/2021	2022.01	08/05/2021 06:10:17 PM Eastern Daylight Time	08/02/2021 04:03:29 PM Eastern Daylight Time	08/02/2021 12:50:47 PM Eastern Daylight Time			08/05/2021 06:15:19 PM Eastern Daylight Time	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Longevity Health Plan	www.longevityhealthplan.com	Longevity Health Plan (HMO I-SNP)	01	01		1			H0363	001	0	2022	CO service areas		2		2			1	1	1				www.longevityhealthplan.com	www.longevityhealthplan.com	www.longevityhealthplan.com	(888)313-3609		(888)313-3609		(888)313-3609		(888)313-3609		(888)313-3609		(888)313-3609		(888)313-3609		(888)313-3609		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0390	001	0	1	20	08	H0390_001_0	1	1						06/02/2021	2022.01	06/02/2021 01:08:49 PM Eastern Daylight Time		06/02/2021 01:19:48 PM Eastern Daylight Time			06/02/2021 01:22:45 PM 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	2022	PACE of Southwest Michigan - Dual		2		2			2						www.paceswmi.org	www.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						06/02/2021	2022.01	06/02/2021 01:09:21 PM Eastern Daylight Time		06/02/2021 01:19:48 PM Eastern Daylight Time			06/02/2021 01:22:45 PM 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	2022	PACE of Southwest Michigan - Medicare Only		2		2			2						www.paceswmi.org	www.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	10	1					1	08/05/2021	2022.01	08/05/2021 04:54:34 PM Central Daylight Time	08/05/2021 02:45:20 PM Central Daylight Time	07/29/2021 06:07:28 PM Central Daylight Time			08/05/2021 06:53:47 PM Central Daylight Time	UCARE HEALTH, INC.	UCare	https://home.ucare.org	Care Core: M Health Fairview & North Memorial (HMO-POS)	01	02		1			H0422	001	0	2022	Twin Cities Metropolitan Area: 7 Counties		2		2			2						https://home.ucare.org	https://home.ucare.org/en-us/search-network/formulary	https://search.ucare.org	(888)618-2595		(612)676-6520		(877)671-1064		(612)676-6645		(888)618-2595		(612)676-6520		(877)671-1064		(612)676-6645		(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	003	0	1	02	01	H0422_003_0	10	1					1	07/21/2021	2022.01	07/21/2021 01:43:40 PM Central Daylight Time	08/05/2021 02:58:16 PM Central Daylight Time	07/29/2021 06:12:05 PM Central Daylight Time			08/05/2021 06:53:47 PM Central Daylight Time	UCARE HEALTH, INC.	UCare	home.ucare.org	Care Wise: M Health Fairview & North Memorial (HMO-POS)	01	02		1			H0422	003	0	2022	Twin Cities Metropolitan Area 7 Counties		2		2			2						home.ucare.org	home.ucare.org/en-us/search-network/formulary	search.ucare.org	(888)618-2595		(612)676-6520		(877)671-1064		(612)676-6645		(888)618-2595		(612)676-6520		(877)671-1064		(612)676-6645		(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	12	1	2	1	1		0	08/06/2021	2022.01	08/06/2021 11:16:51 AM Eastern Daylight Time	08/12/2021 10:44:50 AM Eastern Daylight Time	08/05/2021 10:27:04 AM Eastern Daylight Time			08/12/2021 10:48:55 AM Eastern Daylight Time	METROPLUS HEALTH PLAN, INC.	MetroPlus Health Plan	www.metroplusmedicare.org	MetroPlus Advantage Plan (HMO D-SNP)	01	01		1			H0423	001	0	2022	NYC - All five boroughs		2	90884	2			1	3		2		2	www.caremark.com	www.metroplus.org/member-services/formularies	www.metroplusmedicare.org	(866)986-0356		(866)986-0356		(866)986-0356		(866)986-0356		(866)693-4615		(866)693-4615		(866)693-4615		(866)693-4615		(711)-		(711)-		(711)-		(711)-		(800)881-2812		(800)881-2812		(800)881-2812		(800)881-2812		2					2					2	2			
H0423	004	0	1	01	01	H0423_004_0	7	1			2		0	07/09/2021	2022.01	07/09/2021 03:04:37 PM Eastern Daylight Time	08/05/2021 10:27:02 AM Eastern Daylight Time	08/05/2021 10:27:01 AM Eastern Daylight Time			08/05/2021 10:38:00 AM Eastern Daylight Time	METROPLUS HEALTH PLAN, INC.	MetroPlus Health Plan	www.metroplusmedicare.org	MetroPlus Platinum Plan (HMO)	01	01		1			H0423	004	0	2022	NYC - All five boroughs		2	4440	2			2						www.caremark.com	www.metroplus.org/member-services/formularies	www.metroplusmedicare.org	(866)986-0356		(866)986-0356		(866)986-0356		(866)986-0356		(866)693-4615		(866)693-4615		(866)693-4615		(866)693-4615		(711)-		(711)-		(711)-		(711)-		(800)881-2812		(800)881-2812		(800)881-2812		(800)881-2812		2					2					2	2			
H0423	007	0	1	01	01	H0423_007_0	7	1	2	1	2		0	07/09/2021	2022.01	07/09/2021 03:05:05 PM Eastern Daylight Time	08/05/2021 10:26:59 AM Eastern Daylight Time	08/05/2021 10:26:36 AM Eastern Daylight Time			08/05/2021 10:38:00 AM Eastern Daylight Time	METROPLUS HEALTH PLAN, INC.	MetroPlus Health Plan	www.metroplusmedicare.org	MetroPlus UltraCare (HMO D-SNP)	01	01		1			H0423	007	0	2022	NYC - All five boroughs		2	3512	2			1	3		1		1	www.caremark.com	www.metroplus.org/member-services/formularies	www.metroplusmedicare.org	(866)986-0356		(866)986-0356		(866)986-0356		(866)986-0356		(866)693-4615		(866)693-4615		(866)693-4615		(866)693-4615		(711)-		(711)-		(711)-		(711)-		(800)881-2812		(800)881-2812		(800)881-2812		(800)881-2812		2					2					2	2			
H0432	003	0	1	01	01	H0432_003_0	5	1			1		1	08/04/2021	2022.01	08/04/2021 10:59:14 AM Central Daylight Time	08/03/2021 01:16:14 PM Central Daylight Time	07/29/2021 06:52:51 PM Central Daylight Time			08/04/2021 01:23:58 PM Central Daylight Time	UNITEDHEALTHCARE OF ALABAMA, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO)	01	01		1			H0432	003	0	2022	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	5	1			1		1	08/04/2021	2022.01	08/04/2021 10:53:31 AM Central Daylight Time	08/03/2021 01:16:43 PM Central Daylight Time	07/29/2021 06:53:07 PM Central Daylight Time			08/04/2021 01:23:58 PM Central Daylight Time	UNITEDHEALTHCARE OF ALABAMA, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO)	01	01		1			H0432	004	0	2022	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	009	0	1	01	01	H0432_009_0	4	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 10:51:52 AM Central Daylight Time	08/03/2021 01:17:13 PM Central Daylight Time	07/29/2021 06:53:22 PM Central Daylight Time			08/04/2021 01:23:58 PM Central Daylight Time	UNITEDHEALTHCARE OF ALABAMA, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Dual Complete Plan 1 (HMO D-SNP)	01	01		1			H0432	009	0	2022	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		(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			
H0432	010	0	1	01	01	H0432_010_0	5	1			1		1	08/04/2021	2022.01	08/04/2021 10:49:25 AM Central Daylight Time	08/03/2021 01:17:44 PM Central Daylight Time	07/29/2021 06:53:38 PM Central Daylight Time			08/04/2021 01:23:58 PM Central Daylight Time	UNITEDHEALTHCARE OF ALABAMA, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Walgreens (HMO)	01	01		1			H0432	010	0	2022	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			
H0432	012	0	1	01	01	H0432_012_0	5	1			1	0	0	08/12/2021	2022.01	08/12/2021 09:02:13 AM Central Daylight Time	06/03/2021 03:09:20 PM Central Daylight Time				08/12/2021 09:23:25 AM Central Daylight Time	UNITEDHEALTHCARE OF ALABAMA, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (HMO)	01	01		1			H0432	012	0	2022	Entire state of 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										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H0432	013	0	1	01	01	H0432_013_0	4	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 10:45:45 AM Central Daylight Time	08/03/2021 01:19:36 PM Central Daylight Time	07/29/2021 06:53:53 PM Central Daylight Time			08/04/2021 01:23:58 PM Central Daylight Time	UNITEDHEALTHCARE OF ALABAMA, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Dual Complete Select (HMO D-SNP)	01	01		1			H0432	013	0	2022	Select Counties in AL		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			
H0439	002	0	1	01	01	H0439_002_0	5	1	2	1			0	07/08/2021	2022.01	07/08/2021 03:22:48 PM Central Daylight Time	08/04/2021 10:32:21 AM Central Daylight Time	07/30/2021 11:20:48 AM Central Daylight Time			08/04/2021 01:21:09 PM Central Daylight Time	CIGNA HEALTHCARE OF GEORGIA, INC.	Cigna	www.cignamedicare.com	Cigna TotalCare (HMO D-SNP)	01	01		1			H0439	002	0	2022	Georgia		2		2			1	3		2		2	www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101		(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0439	003	1	1	01	01	H0439_003_1	6	1					0	08/09/2021	2022.01	08/09/2021 08:03:00 AM Central Daylight Time	08/04/2021 10:36:10 AM Central Daylight Time	07/30/2021 11:21:12 AM Central Daylight Time			08/09/2021 11:33:33 AM Central Daylight Time	CIGNA HEALTHCARE OF GEORGIA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred GA Medicare (HMO)	01	01		1			H0439	003	1	2022	Georgia	Georgia Metro/Athens	2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101		(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0439	003	2	1	01	01	H0439_003_2	5	1					0	08/02/2021	2022.01	08/02/2021 06:31:57 PM Central Daylight Time	08/04/2021 10:39:02 AM Central Daylight Time	07/30/2021 11:21:37 AM Central Daylight Time			08/04/2021 01:21:09 PM Central Daylight Time	CIGNA HEALTHCARE OF GEORGIA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred GA Medicare (HMO)	01	01		1			H0439	003	2	2022	Georgia	Georgia Gainesville/Rome	2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101		(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0439	006	0	1	01	01	H0439_006_0	5	1					0	08/02/2021	2022.01	08/02/2021 06:32:30 PM Central Daylight Time	08/04/2021 10:40:10 AM Central Daylight Time	07/30/2021 11:22:00 AM Central Daylight Time			08/04/2021 01:21:09 PM Central Daylight Time	CIGNA HEALTHCARE OF GEORGIA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Plus Medicare (HMO)	01	01		1			H0439	006	0	2022	Georgia		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101		(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0439	007	0	1	01	01	H0439_007_0	5	1					0	08/02/2021	2022.01	08/02/2021 06:33:12 PM Central Daylight Time	08/04/2021 10:41:57 AM Central Daylight Time	07/30/2021 11:22:24 AM Central Daylight Time			08/04/2021 01:21:09 PM Central Daylight Time	CIGNA HEALTHCARE OF GEORGIA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H0439	007	0	2022	Georgia		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101		(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0439	008	0	1	01	01	H0439_008_0	5	1					0	08/02/2021	2022.01	08/02/2021 06:34:07 PM Central Daylight Time	08/04/2021 10:43:52 AM Central Daylight Time	07/30/2021 11:22:47 AM Central Daylight Time			08/04/2021 01:21:09 PM Central Daylight Time	CIGNA HEALTHCARE OF GEORGIA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H0439	008	0	2022	Georgia		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101		(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0439	009	0	1	01	01	H0439_009_0	5	1					0	08/02/2021	2022.01	08/02/2021 06:35:02 PM Central Daylight Time	08/04/2021 10:45:49 AM Central Daylight Time	07/30/2021 11:23:11 AM Central Daylight Time			08/04/2021 01:21:09 PM Central Daylight Time	CIGNA HEALTHCARE OF GEORGIA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H0439	009	0	2022	Georgia		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101		(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0439	010	0	1	01	01	H0439_010_0	5	1					0	08/02/2021	2022.01	08/02/2021 06:35:49 PM Central Daylight Time	08/04/2021 10:47:14 AM Central Daylight Time	07/30/2021 11:23:34 AM Central Daylight Time			08/04/2021 01:21:09 PM Central Daylight Time	CIGNA HEALTHCARE OF GEORGIA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H0439	010	0	2022	Georgia		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101		(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0439	011	0	1	01	01	H0439_011_0	5	1					0	08/02/2021	2022.01	08/02/2021 06:36:25 PM Central Daylight Time	08/04/2021 10:48:39 AM Central Daylight Time	07/30/2021 11:23:58 AM Central Daylight Time			08/04/2021 01:21:09 PM Central Daylight Time	CIGNA HEALTHCARE OF GEORGIA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H0439	011	0	2022	Georgia		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101		(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0439	012	0	1	01	01	H0439_012_0	5	1	2	1			0	07/09/2021	2022.01	07/09/2021 12:18:15 PM Central Daylight Time	08/04/2021 10:56:32 AM Central Daylight Time	07/30/2021 11:24:21 AM Central Daylight Time			08/04/2021 01:21:09 PM Central Daylight Time	CIGNA HEALTHCARE OF GEORGIA, INC.	Cigna	www.cignamedicare.com	Cigna TotalCare Plus (HMO D-SNP)	01	01		1			H0439	012	0	2022	Georgia		2		2			1	3		1		2	www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101		(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0439	801	0	1	01	01	H0439_801_0	3	1						05/10/2021	2022.01	05/10/2021 10:18:34 AM Central Daylight Time					06/02/2021 01:59:33 PM Central Daylight Time	CIGNA HEALTHCARE OF GEORGIA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H0439	801	0	2022	Statewide GA		1	2242	2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(866)625-2494		(866)625-2494		(888)281-7867		(888)281-7867		(866)625-2494		(866)625-2494		(888)281-7867		(888)281-7867		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H0473	001	0	1	04	01	H0473_001_0	4	1			2		1	08/01/2021	2022.01	08/01/2021 07:55:34 AM Eastern Daylight Time	08/03/2021 06:00:05 PM Eastern Daylight Time	07/30/2021 10:02:48 AM Eastern Daylight Time			08/04/2021 02:34:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF KENTUCKY	Humana	www.humana.com/medicare	HumanaChoice H0473-001 (PPO)	01	04		1			H0473	001	0	2022	Select Counties in Texas		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0473	003	0	1	04	01	H0473_003_0	4	1			2		1	08/01/2021	2022.01	08/01/2021 02:26:26 PM Eastern Daylight Time	08/03/2021 06:02:06 PM Eastern Daylight Time	07/30/2021 10:03:04 AM Eastern Daylight Time			08/04/2021 02:00:17 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF KENTUCKY	Humana	www.humana.com/medicare	HumanaChoice H0473-003 (PPO)	01	04		1			H0473	003	0	2022	Hays, Travis and Williamson counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0473	004	0	1	04	01	H0473_004_0	4	1			2		0	08/01/2021	2022.01	08/01/2021 08:25:11 AM Eastern Daylight Time	08/03/2021 06:02:44 PM Eastern Daylight Time	07/30/2021 10:03:20 AM Eastern Daylight Time			08/04/2021 02:00:17 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF KENTUCKY	Humana	www.humana.com/medicare	HumanaChoice H0473-004 (PPO)	01	04		1			H0473	004	0	2022	Select Counties in Texas		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0473	005	0	1	04	01	H0473_005_0	4	1			2		0	08/01/2021	2022.01	08/01/2021 08:27:46 AM Eastern Daylight Time	08/03/2021 06:03:03 PM Eastern Daylight Time	07/30/2021 10:03:34 AM Eastern Daylight Time			08/04/2021 02:00:17 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF KENTUCKY	Humana	www.humana.com/medicare	HumanaChoice H0473-005 (PPO)	01	04		1			H0473	005	0	2022	Select Counties in Texas		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0473	006	0	1	04	01	H0473_006_0	3	1	2	1	2		0	08/01/2021	2022.01	08/01/2021 01:36:00 PM Eastern Daylight Time	08/03/2021 06:02:24 PM Eastern Daylight Time	07/30/2021 10:03:50 AM Eastern Daylight Time			08/04/2021 02:00:17 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF KENTUCKY	Humana	www.humana.com/medicare	HumanaChoice SNP-DE H0473-006 (PPO D-SNP)	01	04		1			H0473	006	0	2022	Select Counties in Texas		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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						06/02/2021	2022.01	06/02/2021 01:08:58 PM Eastern Daylight Time		05/27/2021 05:15:09 PM Eastern Daylight Time			06/02/2021 01:28:48 PM Eastern Daylight Time	SERENITY CARE, INC.	Serenity Care PACE	http://www.serenitypace.org	Serenity PACE Dual (PACE)	08	20		1			H0477	001	0	2022	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						06/02/2021	2022.01	06/02/2021 01:09:28 PM Eastern Daylight Time		05/27/2021 05:16:07 PM Eastern Daylight Time			06/02/2021 01:28:48 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	2022	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	3	1						07/08/2021	2022.01	07/08/2021 12:11:43 PM Eastern Daylight Time					07/08/2021 01:10:21 PM Eastern Daylight Time	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Meridian	https://corp.mhplan.com/	MeridianComplete (Medicare-Medicaid Plan)	05	48		1			H0480	001	0	2022	Select counties in Michigan		2	80000	2			2						https://corp.mhplan.com/	https://corp.mhplan.com/	https://corp.mhplan.com/	(855)323-4578		(855)323-4578		(844)917-0175		(844)917-0175		(855)323-4578		(855)323-4578		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H0482	001	0	1	01	01	H0482_001_0	6	1					0	08/02/2021	2022.01	08/02/2021 04:13:47 PM Central Daylight Time	08/03/2021 09:24:07 PM Central Daylight Time	07/30/2021 07:56:40 AM Central Daylight Time			08/04/2021 10:17:29 PM Central Daylight Time	CENTENE VENTURE COMPANY MICHIGAN	Ascension Complete	ascensioncomplete.com	Ascension Complete Michigan Reward (HMO)	01	01		1			H0482	001	0	2022	Genesee, Iosco, Kalamazoo, and Saginaw Counties		2	672	2			2						ascensioncomplete.com/findadoctor	ascensioncomplete.com/formulary	ascensioncomplete.com/findadoctor	(833)431-1356		(833)431-1356		(844)578-1928		(844)578-1928		(833)431-1356		(833)431-1356		(844)578-1928		(844)578-1928		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0482	002	0	1	01	01	H0482_002_0	4	1					0	08/02/2021	2022.01	08/02/2021 04:02:43 PM Central Daylight Time	08/03/2021 09:24:35 PM Central Daylight Time	07/30/2021 07:57:28 AM Central Daylight Time			08/04/2021 10:17:29 PM Central Daylight Time	CENTENE VENTURE COMPANY MICHIGAN	Ascension Complete	ascensioncomplete.com	Ascension Complete Michigan Secure (HMO)	01	01		1			H0482	002	0	2022	Genesee, Iosco, Kalamazoo, and Saginaw Counties		2	7598	2			2						ascensioncomplete.com/findadoctor	ascensioncomplete.com/formulary	ascensioncomplete.com/findadoctor	(833)431-1356		(833)431-1356		(844)578-1928		(844)578-1928		(833)431-1356		(833)431-1356		(844)578-1928		(844)578-1928		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0482	003	0	1	01	01	H0482_003_0	4	1					0	08/02/2021	2022.01	08/02/2021 04:03:12 PM Central Daylight Time	08/03/2021 09:25:07 PM Central Daylight Time	07/30/2021 07:58:20 AM Central Daylight Time			08/04/2021 10:17:29 PM Central Daylight Time	CENTENE VENTURE COMPANY MICHIGAN	Ascension Complete	ascensioncomplete.com	Ascension Complete Michigan Reward (HMO)	01	01		1			H0482	003	0	2022	Detroit Area		2	1296	2			2						ascensioncomplete.com/findadoctor	ascensioncomplete.com/formulary	ascensioncomplete.com/findadoctor	(833)431-1356		(833)431-1356		(844)578-1928		(844)578-1928		(833)431-1356		(833)431-1356		(844)578-1928		(844)578-1928		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0482	004	0	1	01	01	H0482_004_0	4	1					0	08/02/2021	2022.01	08/02/2021 04:03:36 PM Central Daylight Time	08/03/2021 09:25:37 PM Central Daylight Time	07/30/2021 07:59:09 AM Central Daylight Time			08/04/2021 10:17:29 PM Central Daylight Time	CENTENE VENTURE COMPANY MICHIGAN	Ascension Complete	ascensioncomplete.com	Ascension Complete Michigan Secure (HMO)	01	01		1			H0482	004	0	2022	Detroit Area		2	11587	2			2						ascensioncomplete.com/findadoctor	ascensioncomplete.com/formulary	ascensioncomplete.com/findadoctor	(833)431-1356		(833)431-1356		(844)578-1928		(844)578-1928		(833)431-1356		(833)431-1356		(844)578-1928		(844)578-1928		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0482	005	0	1	01	01	H0482_005_0	4	1	2	1			0	08/02/2021	2022.01	08/02/2021 02:29:46 PM Central Daylight Time	08/03/2021 09:26:07 PM Central Daylight Time	07/30/2021 08:00:01 AM Central Daylight Time			08/04/2021 10:17:29 PM Central Daylight Time	CENTENE VENTURE COMPANY MICHIGAN	Ascension Complete	ascensioncomplete.com	Ascension Complete Michigan DSNP (HMO D-SNP)	01	01		1			H0482	005	0	2022	Genesee, Iosco,Kalamazoo, Saginaw		2	3161	2			1	3		1		1	ascensioncomplete.com/findadoctor	ascensioncomplete.com/formulary	ascensioncomplete.com/findadoctor	(833)431-1356		(833)431-1356		(844)578-1928		(844)578-1928		(833)431-1356		(833)431-1356		(844)578-1928		(844)578-1928		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0482	801	0	1	01	01	H0482_801_0	2	1						05/03/2021	2022.01	05/03/2021 01:28:38 PM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	CENTENE VENTURE COMPANY MICHIGAN	Ascension Complete	ascensioncomplete.com	Ascension Complete Group Medicare Advantage (HMO)	01	01		1			H0482	801	0	2022	Genesee, Iosco, Kalamazoo, Saginaw Counties		1	100	2			2						https://www.ascensioncomplete.com/drug-pharmacy/coverage-determinations-redeterminations.html	https://www.ascensioncomplete.com/drug-pharmacy/formulary.html	ascensioncomplete.com/mi-findadoctor	(855)848-6940		(855)848-6940		(844)942-0039		(844)942-0039		(855)848-6940		(855)848-6940		(844)942-0039		(844)942-0039		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H0482	802	0	1	01	01	H0482_802_0	2	1				0	0	05/03/2021	2022.01	05/03/2021 01:28:51 PM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	CENTENE VENTURE COMPANY MICHIGAN	Ascension Complete	ascensioncomplete.com	Ascension Complete Group Medicare Advantage (HMO)	01	01		1			H0482	802	0	2022	Genesee, Iosco, Kalamazoo, Saginaw Counties		1	100	2			2						https://www.ascensioncomplete.com/drug-pharmacy/coverage-determinations-redeterminations.html	https://www.ascensioncomplete.com/drug-pharmacy/formulary.html	ascensioncomplete.com/mi-findadoctor	(855)848-6940		(855)848-6940		(844)942-0039		(844)942-0039										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H0482	803	0	1	01	01	H0482_803_0	2	1						05/03/2021	2022.01	05/03/2021 01:29:03 PM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	CENTENE VENTURE COMPANY MICHIGAN	Ascension Complete	ascensioncomplete.com	Ascension Complete Group Medicare Advantage (HMO)	01	01		1			H0482	803	0	2022	Genesee, Iosco, Kalamazoo, Saginaw Counties		1	100	2			2						https://www.ascensioncomplete.com/drug-pharmacy/coverage-determinations-redeterminations.html	https://www.ascensioncomplete.com/drug-pharmacy/formulary.html	ascensioncomplete.com/mi-findadoctor	(855)848-6940		(855)848-6940		(844)942-0039		(844)942-0039		(855)848-6940		(855)848-6940		(844)942-0039		(844)942-0039		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H0504	015	0	1	01	01	H0504_015_0	6	1					0	08/05/2021	2022.01	08/05/2021 02:45:23 PM Pacific Daylight Time	08/05/2021 02:48:52 PM Pacific Daylight Time	07/29/2021 07:37:56 PM Pacific Daylight Time			08/05/2021 04:39:20 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	blueshieldca.com/medicare	Blue Shield 65 Plus (HMO)	01	01		1			H0504	015	0	2022	Los Angeles and Orange Counties		2		2			2						blueshieldca.com/medpharmacy2022	blueshieldca.com/medformulary2022	blueshieldca.com/find-a-doctor	(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0504	017	0	1	01	01	H0504_017_0	6	1					0	08/05/2021	2022.01	08/05/2021 02:50:11 PM Pacific Daylight Time	08/05/2021 02:57:40 PM Pacific Daylight Time	07/29/2021 07:38:11 PM Pacific Daylight Time			08/05/2021 04:39:20 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	blueshieldca.com/medicare	Blue Shield 65 Plus (HMO)	01	01		1			H0504	017	0	2022	San Bernardino County		2		2			2						blueshieldca.com/medpharmacy2022	blueshieldca.com/medformulary2022	blueshieldca.com/find-a-doctor	(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0504	021	0	1	01	01	H0504_021_0	6	1					0	08/05/2021	2022.01	08/05/2021 10:15:17 AM Pacific Daylight Time	08/04/2021 03:21:44 PM Pacific Daylight Time	07/29/2021 07:38:24 PM Pacific Daylight Time			08/05/2021 04:39:20 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	blueshieldca.com/medicare	Blue Shield 65 Plus Plan 2 (HMO)	01	01		1			H0504	021	0	2022	Los Angeles and Orange Counties		2		2			2						blueshieldca.com/medpharmacy2022	blueshieldca.com/medformulary2022	blueshieldca.com/find-a-doctor	(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0504	026	0	1	01	01	H0504_026_0	5	1					0	08/05/2021	2022.01	08/05/2021 02:49:20 PM Pacific Daylight Time	08/05/2021 03:00:28 PM Pacific Daylight Time	07/29/2021 07:38:38 PM Pacific Daylight Time			08/05/2021 04:39:20 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	blueshieldca.com/medicare	Blue Shield 65 Plus (HMO)	01	01		1			H0504	026	0	2022	Riverside County		2		2			2						blueshieldca.com/medpharmacy2022	blueshieldca.com/medformulary2022	blueshieldca.com/find-a-doctor	(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0504	028	0	1	01	01	H0504_028_0	5	1					0	08/05/2021	2022.01	08/05/2021 08:43:59 AM Pacific Daylight Time	08/04/2021 03:34:26 PM Pacific Daylight Time	07/29/2021 07:38:52 PM Pacific Daylight Time			08/05/2021 04:42:23 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	blueshieldca.com/medicare	Blue Shield 65 Plus (HMO)	01	01		1			H0504	028	0	2022	San Diego County		2		2			2						blueshieldca.com/medpharmacy2022	blueshieldca.com/medformulary2022	blueshieldca.com/find-a-doctor	(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0504	029	0	1	01	01	H0504_029_0	5	1					0	08/05/2021	2022.01	08/05/2021 08:48:14 AM Pacific Daylight Time	08/04/2021 03:38:18 PM Pacific Daylight Time	07/29/2021 07:39:05 PM Pacific Daylight Time			08/05/2021 04:42:23 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	blueshieldca.com/medicare	Blue Shield 65 Plus (HMO)	01	01		1			H0504	029	0	2022	Ventura County		2		2			2						blueshieldca.com/medpharmacy2022	blueshieldca.com/medformulary2022	blueshieldca.com/find-a-doctor	(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0504	031	0	1	01	01	H0504_031_0	5	1					0	08/05/2021	2022.01	08/05/2021 08:50:42 AM Pacific Daylight Time	08/04/2021 04:57:14 PM Pacific Daylight Time	07/29/2021 07:39:19 PM Pacific Daylight Time			08/05/2021 04:42:23 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	blueshieldca.com/medicare	Blue Shield Inspire (HMO)	01	01		1			H0504	031	0	2022	Fresno and Madera Counties		2		2			2						blueshieldca.com/medpharmacy2022	blueshieldca.com/medformulary2022	blueshieldca.com/find-a-doctor	(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0504	037	0	1	01	01	H0504_037_0	5	1					0	07/19/2021	2022.01	07/19/2021 02:22:42 PM Pacific Daylight Time	08/04/2021 03:40:06 PM Pacific Daylight Time	07/29/2021 07:39:33 PM Pacific Daylight Time			08/05/2021 04:42:23 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	blueshieldca.com/medicare	Blue Shield Inspire (HMO)	01	01		1			H0504	037	0	2022	Sacramento County		2		2			2						blueshieldca.com/medpharmacy2022	blueshieldca.com/medformulary2022	blueshieldca.com/find-a-doctor	(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0504	038	0	1	01	01	H0504_038_0	5	1					0	08/05/2021	2022.01	08/05/2021 08:55:08 AM Pacific Daylight Time	08/04/2021 03:43:34 PM Pacific Daylight Time	07/29/2021 07:39:47 PM Pacific Daylight Time			08/05/2021 04:44:21 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	blueshieldca.com/medicare	Blue Shield 65 Plus (HMO)	01	01		1			H0504	038	0	2022	Kern County		2		2			2						blueshieldca.com/medpharmacy2022	blueshieldca.com/medformulary2022	blueshieldca.com/find-a-doctor	(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0504	039	0	1	01	01	H0504_039_0	5	1					0	08/05/2021	2022.01	08/05/2021 08:58:08 AM Pacific Daylight Time	08/04/2021 03:48:42 PM Pacific Daylight Time	07/29/2021 07:40:01 PM Pacific Daylight Time			08/05/2021 04:44:21 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	blueshieldca.com/medicare	Blue Shield 65 Plus (HMO)	01	01		1			H0504	039	0	2022	San Luis Obispo and Santa Barbara Counties		2		2			2						blueshieldca.com/medpharmacy2022	blueshieldca.com/medformulary2022	blueshieldca.com/find-a-doctor	(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0504	040	0	1	01	01	H0504_040_0	5	1					0	08/05/2021	2022.01	08/05/2021 09:01:24 AM Pacific Daylight Time	08/04/2021 03:55:42 PM Pacific Daylight Time	07/29/2021 07:40:15 PM Pacific Daylight Time			08/05/2021 04:44:21 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	blueshieldca.com/medicare	Blue Shield 65 Plus Choice Plan (HMO)	01	01		1			H0504	040	0	2022	Riverside and San Bernardino Counties		2		2			2						blueshieldca.com/medpharmacy2022	blueshieldca.com/medformulary2022	blueshieldca.com/find-a-doctor	(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0504	041	0	1	01	01	H0504_041_0	5	1					0	08/05/2021	2022.01	08/05/2021 09:02:41 AM Pacific Daylight Time	08/04/2021 04:13:20 PM Pacific Daylight Time	07/29/2021 07:40:29 PM Pacific Daylight Time			08/05/2021 04:44:21 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	blueshieldca.com/medicare	Blue Shield Inspire (HMO)	01	01		1			H0504	041	0	2022	Alameda and San Mateo Counties		2		2			2						blueshieldca.com/medpharmacy2022	blueshieldca.com/medformulary2022	blueshieldca.com/find-a-doctor	(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0504	043	0	1	01	01	H0504_043_0	5	1					0	08/05/2021	2022.01	08/05/2021 09:04:13 AM Pacific Daylight Time	08/04/2021 04:14:40 PM Pacific Daylight Time	07/29/2021 07:40:43 PM Pacific Daylight Time			08/05/2021 04:46:46 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	blueshieldca.com/medicare	Blue Shield Inspire (HMO)	01	01		1			H0504	043	0	2022	Los Angeles and Orange Counties		2		2			2						blueshieldca.com/medpharmacy2022	blueshieldca.com/medformulary2022	blueshieldca.com/find-a-doctor	(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0504	045	0	1	01	01	H0504_045_0	5	1					0	08/05/2021	2022.01	08/05/2021 09:15:04 AM Pacific Daylight Time	08/04/2021 04:15:56 PM Pacific Daylight Time	07/29/2021 07:40:57 PM Pacific Daylight Time			08/05/2021 04:46:46 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	blueshieldca.com/medicare	Blue Shield Vital (HMO)	01	01		1			H0504	045	0	2022	Counties: LA, OR, SB, RIV		2		2			2						blueshieldca.com/medpharmacy2022	blueshieldca.com/medformulary2022	blueshieldca.com/find-a-doctor	(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0504	046	0	1	01	01	H0504_046_0	5	1					0	08/05/2021	2022.01	08/05/2021 10:57:03 AM Pacific Daylight Time	08/04/2021 04:17:16 PM Pacific Daylight Time	07/29/2021 07:41:12 PM Pacific Daylight Time			08/05/2021 04:46:46 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	blueshieldca.com/medicare	Blue Shield Inspire (HMO)	01	01		1			H0504	046	0	2022	Santa Clara County		2		2			2						blueshieldca.com/medpharmacy2022	blueshieldca.com/medformulary2022	blueshieldca.com/find-a-doctor	(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0504	047	0	1	01	01	H0504_047_0	7	1					0	08/05/2021	2022.01	08/05/2021 10:59:08 AM Pacific Daylight Time	08/04/2021 04:19:16 PM Pacific Daylight Time	07/29/2021 07:41:26 PM Pacific Daylight Time			08/05/2021 04:46:46 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	blueshieldca.com/medicare	Blue Shield Inspire (HMO)	01	01		1			H0504	047	0	2022	Merced/San Joaquin/Stanislaus Counties		2		2			2						blueshieldca.com/medpharmacy2022	blueshieldca.com/medformulary2022	blueshieldca.com/find-a-doctor	(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0504	048	0	1	01	01	H0504_048_0	7	1					1	08/05/2021	2022.01	08/05/2021 04:01:10 PM Pacific Daylight Time	08/05/2021 05:07:12 PM Pacific Daylight Time	07/29/2021 07:41:40 PM Pacific Daylight Time			08/05/2021 04:46:46 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	blueshieldca.com/medicare	Blue Shield Balance (HMO)	01	01		1			H0504	048	0	2022	Los Angeles County		2		2			2						blueshieldca.com/medpharmacy2022	blueshieldca.com/medformulary2022	blueshieldca.com/find-a-doctor	(888)802-4423		(888)802-4423		(888)534-4263		(888)534-4263		(888)802-4423		(888)802-4423		(888)534-4263		(888)534-4263		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0504	803	0	1	01	01	H0504_803_0	3	1						05/25/2021	2022.01	05/25/2021 12:04:14 PM Pacific Daylight Time					06/07/2021 09:42:53 AM 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	2022	MA-PD Employer Group Plan		1	15479	2			2						blueshieldca.com/medpharmacy2022	blueshieldca.com/medformulary2022	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	3-1;3-2;3-3;3-4;6;7k;11a;11b;11c;12;14d;15;16b;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;18a;	2					1				
H0504	804	0	1	01	01	H0504_804_0	1	1						05/18/2021	2022.01	05/18/2021 05:31:19 PM Pacific Daylight Time					06/04/2021 10:48:51 AM 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	2022	MA-PD Employer Group Plan		1	3705	2			2						blueshieldca.com/medpharmacy2022	blueshieldca.com/medformulary2022	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	3-1;3-2;3-3;3-4;6;7k;11a;11b;11c;12;14d;15;16b;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;18a;	2					1				
H0504	805	0	1	01	01	H0504_805_0	1	1				0	0	05/25/2021	2022.01	05/25/2021 12:04:28 PM Pacific Daylight Time					06/04/2021 10:48:51 AM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	www.blueshieldca.com/findamedicareplan	Blue Shield 65 Plus without Rx (HMO)	01	01		1			H0504	805	0	2022	MA-Only Employer Group Plan		1	0	2			2						blueshieldca.com/medpharmacy2022	blueshieldca.com/medformulary2022	blueshieldca.com/find-a-doctor	(800)776-4466		(800)776-4466		(800)776-4466		(800)776-4466										(711)-		(711)-		(711)-		(711)-										1	1	3-1;3-2;3-3;3-4;6;7k;11a;11b;11c;12;14d;15;16b;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;18a;	2					1				
H0504	806	0	1	01	01	H0504_806_0	1	1				0	0	05/25/2021	2022.01	05/25/2021 12:00:56 PM Pacific Daylight Time					06/04/2021 10:48:51 AM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	www.blueshieldca.com/findamedicareplan	Blue Shield 65 Plus without Rx (HMO)	01	01		1			H0504	806	0	2022	MA-only Employer Group Plan		1	0	2			2						blueshieldca.com/medpharmacy2022	blueshieldca.com/medformulary2022	blueshieldca.com/find-a-doctor	(800)776-4466		(800)776-4466		(800)776-4466		(800)776-4466										(711)-		(711)-		(711)-		(711)-										1	1	3-1;3-2;3-3;3-4;6;7k;11a;11b;11c;12;14d;15;16b;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;18a;	2					1				
H0523	002	0	1	01	01	H0523_002_0	2	1					0	08/02/2021	2022.01	08/02/2021 10:01:28 AM Eastern Daylight Time	08/02/2021 03:14:45 PM Eastern Daylight Time	08/02/2021 09:21:47 AM Eastern Daylight Time			08/04/2021 03:14:59 PM Eastern Daylight Time	AETNA HEALTH OF CALIFORNIA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	01	01		1			H0523	002	0	2022	Los Angeles and Orange Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0523	022	0	1	01	01	H0523_022_0	2	1					0	08/02/2021	2022.01	08/02/2021 10:04:02 AM Eastern Daylight Time	08/02/2021 03:16:14 PM Eastern Daylight Time	08/02/2021 09:21:51 AM Eastern Daylight Time			08/04/2021 03:14:59 PM Eastern Daylight Time	AETNA HEALTH OF CALIFORNIA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	01	01		1			H0523	022	0	2022	Riverside and San Bernardino Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0523	031	0	1	01	01	H0523_031_0	2	1					0	08/02/2021	2022.01	08/02/2021 10:06:16 AM Eastern Daylight Time	08/03/2021 12:18:48 PM Eastern Daylight Time	08/02/2021 09:21:55 AM Eastern Daylight Time			08/04/2021 03:14:59 PM Eastern Daylight Time	AETNA HEALTH OF CALIFORNIA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	01	01		1			H0523	031	0	2022	Kern County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0523	052	0	1	01	01	H0523_052_0	2	1					0	08/02/2021	2022.01	08/02/2021 10:10:24 AM Eastern Daylight Time	08/02/2021 02:53:00 PM Eastern Daylight Time	08/02/2021 09:21:59 AM Eastern Daylight Time			08/04/2021 03:14:59 PM Eastern Daylight Time	AETNA HEALTH OF CALIFORNIA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	01	01		1			H0523	052	0	2022	San Diego County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0523	061	0	1	01	01	H0523_061_0	3	1					0	08/02/2021	2022.01	08/02/2021 10:12:44 AM Eastern Daylight Time	08/02/2021 02:53:50 PM Eastern Daylight Time	08/02/2021 09:22:03 AM Eastern Daylight Time			08/04/2021 03:14:59 PM Eastern Daylight Time	AETNA HEALTH OF CALIFORNIA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime Plan (HMO)	01	01		1			H0523	061	0	2022	Los Angeles, Orange and San Bernardino Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0523	801	0	1	01	01	H0523_801_0	2	1				0	0	05/27/2021	2022.01	05/27/2021 01:19:14 PM Eastern Daylight Time					06/03/2021 12:29:52 PM Eastern Daylight Time	AETNA HEALTH OF CALIFORNIA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (HMO)	01	01		1			H0523	801	0	2022	California		1	5600	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H0523	805	0	1	01	01	H0523_805_0	1	1						05/27/2021	2022.01	05/27/2021 01:19:39 PM Eastern Daylight Time					06/03/2021 12:29:52 PM Eastern Daylight Time	AETNA HEALTH OF CALIFORNIA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan w/Rx (HMO)	01	01		1			H0523	805	0	2022	California		1	6040	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H0524	002	0	2	01	01	H0524_002_0	10	1			2		0	07/13/2021	2022.01	07/13/2021 11:28:57 AM Pacific Daylight Time	07/30/2021 12:46:39 PM Pacific Daylight Time	07/30/2021 07:20:09 PM Pacific Daylight Time			08/04/2021 04:39:55 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	2022	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	10	1			2		0	07/29/2021	2022.01	07/29/2021 06:16:39 PM Pacific Daylight Time	07/30/2021 12:47:05 PM Pacific Daylight Time	07/30/2021 07:21:11 PM Pacific Daylight Time			08/04/2021 04:39:55 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	2022	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	10	1			2		0	07/14/2021	2022.01	07/14/2021 03:44:33 PM Pacific Daylight Time	07/30/2021 12:37:00 PM Pacific Daylight Time	07/30/2021 06:58:05 PM Pacific Daylight Time			08/04/2021 04:39:55 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Enhanced Solano (HMO)	01	01		1			H0524	008	0	2022	Solano 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	010	0	2	01	01	H0524_010_0	10	1			2		0	07/12/2021	2022.01	07/12/2021 01:38:46 PM Pacific Daylight Time	07/30/2021 12:37:26 PM Pacific Daylight Time	07/30/2021 06:59:05 PM Pacific Daylight Time			08/04/2021 04:39:55 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	2022	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	10	1			2		0	08/04/2021	2022.01	08/04/2021 12:43:04 PM Pacific Daylight Time	08/03/2021 04:36:13 PM Pacific Daylight Time	08/01/2021 09:58:15 AM Pacific Daylight Time			08/04/2021 04:39:55 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	2022	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	10	1			2		0	07/29/2021	2022.01	07/29/2021 06:16:56 PM Pacific Daylight Time	07/30/2021 12:47:31 PM Pacific Daylight Time	07/30/2021 07:22:14 PM Pacific Daylight Time			08/04/2021 04:39:55 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	2022	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	030	0	1	01	01	H0524_030_0	12	1	2	1	2		0	07/12/2021	2022.01	07/12/2021 01:39:17 PM Pacific Daylight Time	07/30/2021 12:49:42 PM Pacific Daylight Time	07/30/2021 07:27:12 PM Pacific Daylight Time			08/04/2021 04:39:55 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Sr Adv Medicare Medi-Cal (HMO D-SNP)	01	01		1			H0524	030	0	2022	Northern and Southern California Plan		2		2			1	3		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	031	0	1	01	01	H0524_031_0	10	1			2		0	07/12/2021	2022.01	07/12/2021 01:39:30 PM Pacific Daylight Time	07/30/2021 12:38:23 PM Pacific Daylight Time	07/30/2021 07:01:04 PM Pacific Daylight Time			08/04/2021 04:39:55 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Sr Adv Enhanced Marin San Mateo (HMO)	01	01		1			H0524	031	0	2022	Marin and San Mateo Counties 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	032	0	1	01	01	H0524_032_0	10	1			2		0	08/04/2021	2022.01	08/04/2021 12:43:30 PM Pacific Daylight Time	08/03/2021 04:37:09 PM Pacific Daylight Time	07/30/2021 07:02:04 PM Pacific Daylight Time			08/04/2021 04:39:55 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	2022	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	10	1			2		0	08/04/2021	2022.01	08/04/2021 02:26:00 PM Pacific Daylight Time	08/03/2021 04:37:36 PM Pacific Daylight Time	07/30/2021 07:03:06 PM Pacific Daylight Time			08/04/2021 04:39:55 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Sr Adv Enhanced Contra Costa (HMO)	01	01		1			H0524	033	0	2022	Contra Costa 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	034	0	1	01	01	H0524_034_0	10	1			1		0	08/02/2021	2022.01	08/02/2021 01:34:44 PM Pacific Daylight Time	07/30/2021 12:47:56 PM Pacific Daylight Time	07/30/2021 07:23:16 PM Pacific Daylight Time			08/04/2021 04:39:55 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	2022	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	10	1			2		0	08/04/2021	2022.01	08/04/2021 03:43:28 PM Pacific Daylight Time	07/30/2021 12:48:24 PM Pacific Daylight Time	07/30/2021 07:24:15 PM Pacific Daylight Time			08/04/2021 04:39:55 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	2022	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	10	1			2		0	08/04/2021	2022.01	08/04/2021 03:43:17 PM Pacific Daylight Time	07/30/2021 12:48:51 PM Pacific Daylight Time	07/30/2021 07:25:13 PM Pacific Daylight Time			08/04/2021 04:39:55 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	2022	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	10	1			2		0	08/04/2021	2022.01	08/04/2021 02:51:38 PM Pacific Daylight Time	07/30/2021 12:49:17 PM Pacific Daylight Time	07/30/2021 07:26:13 PM Pacific Daylight Time			08/04/2021 04:39:55 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	2022	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	10	1			2		0	08/04/2021	2022.01	08/04/2021 04:02:48 PM Pacific Daylight Time	08/03/2021 04:38:03 PM Pacific Daylight Time	07/30/2021 07:04:12 PM Pacific Daylight Time			08/04/2021 04:39:55 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	2022	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	10	1			2		0	08/04/2021	2022.01	08/04/2021 12:44:08 PM Pacific Daylight Time	08/03/2021 04:38:29 PM Pacific Daylight Time	07/30/2021 07:05:15 PM Pacific Daylight Time			08/04/2021 04:39:55 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Sr Adv Enhanced Santa Clara (HMO)	01	01		1			H0524	039	0	2022	Santa Clara 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	040	0	1	01	01	H0524_040_0	10	1			2		0	07/29/2021	2022.01	07/29/2021 05:57:05 PM Pacific Daylight Time	08/03/2021 04:38:55 PM Pacific Daylight Time	07/30/2021 07:06:14 PM Pacific Daylight Time			08/04/2021 04:39:55 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	2022	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	10	1			2		0	08/04/2021	2022.01	08/04/2021 02:52:00 PM Pacific Daylight Time	07/30/2021 12:41:03 PM Pacific Daylight Time	07/30/2021 07:07:14 PM Pacific Daylight Time			08/04/2021 04:39:55 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	2022	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	10	1			2		0	08/04/2021	2022.01	08/04/2021 12:39:02 PM Pacific Daylight Time	08/03/2021 04:39:49 PM Pacific Daylight Time	07/30/2021 07:08:12 PM Pacific Daylight Time			08/04/2021 04:39:55 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	2022	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	10	1			2		0	08/04/2021	2022.01	08/04/2021 02:52:10 PM Pacific Daylight Time	07/30/2021 12:41:55 PM Pacific Daylight Time	07/30/2021 07:09:12 PM Pacific Daylight Time			08/04/2021 04:39:55 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	2022	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	10	1			2		0	08/04/2021	2022.01	08/04/2021 02:52:20 PM Pacific Daylight Time	07/30/2021 12:42:23 PM Pacific Daylight Time	07/30/2021 07:10:10 PM Pacific Daylight Time			08/04/2021 04:39:55 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	2022	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	10	1			2		0	08/04/2021	2022.01	08/04/2021 02:52:31 PM Pacific Daylight Time	07/30/2021 12:42:48 PM Pacific Daylight Time	07/30/2021 07:11:08 PM Pacific Daylight Time			08/04/2021 04:39:55 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	2022	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	10	1			2		0	08/04/2021	2022.01	08/04/2021 02:52:42 PM Pacific Daylight Time	08/03/2021 04:41:35 PM Pacific Daylight Time	07/30/2021 07:12:08 PM Pacific Daylight Time			08/04/2021 04:39:55 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	2022	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	059	0	1	01	01	H0524_059_0	10	1			2		0	08/04/2021	2022.01	08/04/2021 02:52:54 PM Pacific Daylight Time	07/30/2021 12:43:39 PM Pacific Daylight Time	07/30/2021 07:13:07 PM Pacific Daylight Time			08/04/2021 04:39:55 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Basic Alameda (HMO)	01	01		1			H0524	059	0	2022	Alameda 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	060	0	1	01	01	H0524_060_0	10	1			2		0	08/04/2021	2022.01	08/04/2021 02:53:04 PM Pacific Daylight Time	07/30/2021 12:44:06 PM Pacific Daylight Time	07/30/2021 07:14:06 PM Pacific Daylight Time			08/04/2021 04:39:55 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Basic SF (HMO)	01	01		1			H0524	060	0	2022	San Francisco 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	061	0	1	01	01	H0524_061_0	10	1			2		0	08/04/2021	2022.01	08/04/2021 02:53:15 PM Pacific Daylight Time	07/30/2021 12:44:31 PM Pacific Daylight Time	07/30/2021 07:15:08 PM Pacific Daylight Time			08/04/2021 04:39:55 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Sr Adv Basic Contra Costa (HMO)	01	01		1			H0524	061	0	2022	Contra Costa 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	062	0	1	01	01	H0524_062_0	10	1			2		0	07/29/2021	2022.01	07/29/2021 06:15:38 PM Pacific Daylight Time	07/30/2021 12:44:56 PM Pacific Daylight Time	07/30/2021 07:16:10 PM Pacific Daylight Time			08/04/2021 04:39:55 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Sr Adv Basic Santa Clara (HMO)	01	01		1			H0524	062	0	2022	Santa Clara 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	063	0	1	01	01	H0524_063_0	10	1			2		0	07/14/2021	2022.01	07/14/2021 02:58:11 PM Pacific Daylight Time	07/30/2021 12:45:21 PM Pacific Daylight Time	07/30/2021 07:17:11 PM Pacific Daylight Time			08/04/2021 04:39:55 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Basic Solano (HMO)	01	01		1			H0524	063	0	2022	Solano 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	064	0	1	01	01	H0524_064_0	10	1			2		0	07/12/2021	2022.01	07/12/2021 01:57:48 PM Pacific Daylight Time	08/02/2021 05:56:18 PM Pacific Daylight Time	07/30/2021 07:18:10 PM Pacific Daylight Time			08/04/2021 04:39:55 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Basic Marin (HMO)	01	01		1			H0524	064	0	2022	Marin 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	065	0	1	01	01	H0524_065_0	10	1			2		0	07/12/2021	2022.01	07/12/2021 01:57:59 PM Pacific Daylight Time	07/30/2021 12:46:12 PM Pacific Daylight Time	07/30/2021 07:19:09 PM Pacific Daylight Time			08/04/2021 04:39:55 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Basic San Mateo (HMO)	01	01		1			H0524	065	0	2022	San Mateo 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	801	0	1	01	01	H0524_801_0	6	1				0	0	06/03/2021	2022.01	06/03/2021 07:46:58 PM Pacific Daylight Time					06/04/2021 06:58:19 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage (HMO)	01	01		1			H0524	801	0	2022	Southern California Group Part A B		1	24490	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;7g;7k;11a;11b;11c;15;16b;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7c;7d;7f;7g;7i;7k;8a;8b1;8b2;8b3;14a;14d;14e3;16b;17a;18a;	1					2				
H0524	802	0	1	01	01	H0524_802_0	6	1				0	0	06/03/2021	2022.01	06/03/2021 07:40:43 PM Pacific Daylight Time					06/04/2021 06:58:19 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage (HMO)	01	01		1			H0524	802	0	2022	Northern California Group Part A B		1	118395	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;7b;7g;7k;11a;11b;11c;15;16b;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7f;7g;7i;7k;8a;8b1;8b2;8b3;14a;14d;14e3;16b;17a;18a;	1					2				
H0524	803	0	2	01	01	H0524_803_0	6	1				0	0	06/03/2021	2022.01	06/03/2021 07:48:19 PM Pacific Daylight Time					06/04/2021 06:58:19 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	2022	Southern California Group B Only		1	24	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;7g;7k;11a;11b;11c;15;16b;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7c;7d;7f;7g;7i;7k;8a;8b1;8b2;8b3;14a;14d;14e3;16b;17a;18a;	1					2				
H0524	804	0	2	01	01	H0524_804_0	6	1				0	0	06/03/2021	2022.01	06/03/2021 07:41:24 PM Pacific Daylight Time					06/04/2021 06:58:19 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	2022	Northern California Group B Only		1	102	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;7b;7g;7k;11a;11b;11c;15;16b;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7f;7g;7i;7k;8a;8b1;8b2;8b3;14a;14d;14e3;16b;17a;18a;	1					2				
H0524	805	0	1	01	01	H0524_805_0	6	1						06/03/2021	2022.01	06/03/2021 07:48:55 PM Pacific Daylight Time					06/04/2021 06:58:19 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage (HMO)	01	01		1			H0524	805	0	2022	Southern California Group Part A B Part D		1	2253708	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;7g;7k;11a;11b;11c;15;16b;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7c;7d;7f;7g;7i;7k;8a;8b1;8b2;8b3;14a;14d;14e3;16b;17a;18a;	1					2				
H0524	806	0	1	01	01	H0524_806_0	6	1						06/03/2021	2022.01	06/03/2021 07:42:01 PM Pacific Daylight Time					06/04/2021 06:58:19 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage (HMO)	01	01		1			H0524	806	0	2022	Northern California Group Part A B Part D		1	2439237	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;7b;7g;7k;11a;11b;11c;15;16b;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7f;7g;7i;7k;8a;8b1;8b2;8b3;14a;14d;14e3;16b;17a;18a;	1					2				
H0524	807	0	2	01	01	H0524_807_0	6	1						06/03/2021	2022.01	06/03/2021 07:53:20 PM Pacific Daylight Time					06/04/2021 06:58:19 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	2022	Southern California Group Part B only  Part D		1	31072	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;7g;7k;11a;11b;11c;15;16b;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7c;7d;7f;7g;7i;7k;8a;8b1;8b2;8b3;14a;14d;14e3;16b;17a;18a;	1					2				
H0524	808	0	2	01	01	H0524_808_0	6	1						06/03/2021	2022.01	06/03/2021 07:44:53 PM Pacific Daylight Time					06/04/2021 06:58:19 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	2022	Northern California Group Part B only Part D		1	5873	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;7b;7g;7k;11a;11b;11c;15;16b;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7f;7g;7i;7k;8a;8b1;8b2;8b3;14a;14d;14e3;16b;17a;18a;	1					2				
H0524	809	0	1	01	01	H0524_809_0	6	1						06/03/2021	2022.01	06/03/2021 07:54:00 PM Pacific Daylight Time					06/04/2021 06:58:19 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	2022	Southern California Plan		1	136061	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;7g;7k;11a;11b;11c;15;16b;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7c;7d;7f;7g;7i;7k;8a;8b1;8b2;8b3;14a;14d;14e3;16b;17a;18a;	1					2				
H0524	810	0	1	01	01	H0524_810_0	6	1						06/03/2021	2022.01	06/03/2021 07:45:31 PM Pacific Daylight Time					06/04/2021 06:58:19 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	2022	Northern California Plan		1	129272	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;7b;7g;7k;11a;11b;11c;15;16b;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7f;7g;7i;7k;8a;8b1;8b2;8b3;14a;14d;14e3;16b;17a;18a;	1					2				
H0524	811	0	2	01	01	H0524_811_0	6	1						06/03/2021	2022.01	06/03/2021 07:54:38 PM Pacific Daylight Time					06/04/2021 06:58:19 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	2022	Southern California Plan		1	204	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;7g;7k;11a;11b;11c;15;16b;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7c;7d;7f;7g;7i;7k;8a;8b1;8b2;8b3;14a;14d;14e3;16b;17a;18a;	1					2				
H0524	812	0	2	01	01	H0524_812_0	6	1						06/03/2021	2022.01	06/03/2021 07:46:20 PM Pacific Daylight Time					06/04/2021 06:58:19 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	2022	Northern California Plan		1	319	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;7b;7g;7k;11a;11b;11c;15;16b;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7f;7g;7i;7k;8a;8b1;8b2;8b3;14a;14d;14e3;16b;17a;18a;	1					2				
H0542	001	0	1	20	08	H0542_001_0	2	1						06/01/2021	2022.01	06/01/2021 05:27:51 PM Pacific Daylight Time		06/01/2021 05:22:51 PM Pacific Daylight Time			06/01/2021 05:29:17 PM 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	2022	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						06/01/2021	2022.01	06/01/2021 05:28:07 PM Pacific Daylight Time		06/01/2021 05:22:51 PM Pacific Daylight Time			06/01/2021 05:29:17 PM 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	2022	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	3	1					1	08/04/2021	2022.01	08/04/2021 03:45:19 PM Central Daylight Time	08/03/2021 12:14:42 PM Central Daylight Time	07/29/2021 06:54:08 PM Central Daylight Time			08/04/2021 07:24:34 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Plan 1 (HMO)	01	01		1			H0543	001	0	2022	Los Angeles county		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(844)808-4553		(844)808-4553		(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	3	1					1	08/04/2021	2022.01	08/04/2021 03:41:04 PM Central Daylight Time	08/03/2021 12:15:25 PM Central Daylight Time	07/29/2021 06:54:24 PM Central Daylight Time			08/04/2021 07:24:34 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Value (HMO)	01	01		1			H0543	013	0	2022	San Diego county		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(844)808-4553		(844)808-4553		(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	3	1					1	08/04/2021	2022.01	08/04/2021 03:38:25 PM Central Daylight Time	08/03/2021 12:16:06 PM Central Daylight Time	07/29/2021 06:54:39 PM Central Daylight Time			08/04/2021 07:24:34 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons (HMO)	01	01		1			H0543	019	0	2022	Kern county		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(844)808-4553		(844)808-4553		(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	3	1					1	08/04/2021	2022.01	08/04/2021 03:32:50 PM Central Daylight Time	08/03/2021 12:16:46 PM Central Daylight Time	07/29/2021 06:54:55 PM Central Daylight Time			08/04/2021 07:24:34 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons (HMO)	01	01		1			H0543	022	0	2022	Ventura county		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(844)808-4553		(844)808-4553		(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	2	1					1	08/04/2021	2022.01	08/04/2021 03:30:10 PM Central Daylight Time	08/03/2021 12:17:26 PM Central Daylight Time	07/29/2021 06:55:10 PM Central Daylight Time			08/04/2021 07:24:34 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Plan 1 (HMO)	01	01		1			H0543	028	0	2022	San Mateo county		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(844)808-4553		(844)808-4553		(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					1	08/04/2021	2022.01	08/04/2021 03:26:45 PM Central Daylight Time	08/03/2021 12:18:04 PM Central Daylight Time	07/29/2021 06:55:25 PM Central Daylight Time			08/04/2021 07:24:34 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons (HMO)	01	01		1			H0543	029	0	2022	Santa Clara county		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(844)808-4553		(844)808-4553		(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	5	1					1	08/04/2021	2022.01	08/04/2021 03:11:07 PM Central Daylight Time	08/03/2021 12:18:46 PM Central Daylight Time	07/29/2021 06:55:41 PM Central Daylight Time			08/04/2021 07:24:34 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Plan 1 (HMO)	01	01		1			H0543	032	0	2022	Santa Barbara and San Luis Obispo counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(844)808-4553		(844)808-4553		(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					1	08/04/2021	2022.01	08/04/2021 01:58:06 PM Central Daylight Time	08/03/2021 12:19:28 PM Central Daylight Time	07/29/2021 06:55:56 PM Central Daylight Time			08/04/2021 07:24:34 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons (HMO)	01	01		1			H0543	035	0	2022	Fresno, Kings and Madera counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(844)808-4553		(844)808-4553		(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	2	1					1	08/04/2021	2022.01	08/04/2021 01:55:41 PM Central Daylight Time	08/03/2021 12:20:06 PM Central Daylight Time	07/29/2021 06:56:11 PM Central Daylight Time			08/04/2021 07:24:34 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Plan 1 (HMO)	01	01		1			H0543	036	0	2022	Stanislaus county		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(844)808-4553		(844)808-4553		(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	3	1					1	08/04/2021	2022.01	08/04/2021 01:53:07 PM Central Daylight Time	08/03/2021 12:20:45 PM Central Daylight Time	07/29/2021 06:56:26 PM Central Daylight Time			08/04/2021 07:24:34 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Premier (HMO)	01	01		1			H0543	060	0	2022	San Diego county		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(844)808-4553		(844)808-4553		(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					1	08/04/2021	2022.01	08/04/2021 01:50:29 PM Central Daylight Time	08/03/2021 12:21:27 PM Central Daylight Time	07/29/2021 06:56:42 PM Central Daylight Time			08/04/2021 07:24:34 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Plan 1 (HMO)	01	01		1			H0543	070	0	2022	Alameda and Contra Costa counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(844)808-4553		(844)808-4553		(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	3	1					1	08/04/2021	2022.01	08/04/2021 01:47:34 PM Central Daylight Time	08/03/2021 12:22:06 PM Central Daylight Time	07/29/2021 06:56:57 PM Central Daylight Time			08/04/2021 08:02:43 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons (HMO)	01	01		1			H0543	086	0	2022	Nevada county		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(844)808-4553		(844)808-4553		(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	6	1					1	08/04/2021	2022.01	08/04/2021 01:44:33 PM Central Daylight Time	08/03/2021 12:22:49 PM Central Daylight Time	07/29/2021 06:57:14 PM Central Daylight Time			08/04/2021 08:02:43 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons (HMO)	01	01		1			H0543	089	0	2022	Placer, Sacramento, and Yolo counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(844)808-4553		(844)808-4553		(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				0	0	07/14/2021	2022.01	07/14/2021 08:10:45 PM Central Daylight Time	06/03/2021 03:02:44 PM Central Daylight Time				07/15/2021 05:21:41 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (HMO)	01	01		1			H0543	121	0	2022	Select Counties in Southern California		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H0543	138	0	1	01	01	H0543_138_0	7	1					1	08/04/2021	2022.01	08/04/2021 01:39:21 PM Central Daylight Time	08/03/2021 12:23:31 PM Central Daylight Time	07/29/2021 06:57:30 PM Central Daylight Time			08/04/2021 08:02:43 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Plan 2 (HMO)	01	01		1			H0543	138	0	2022	Orange county		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(844)808-4553		(844)808-4553		(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	3	1					1	08/04/2021	2022.01	08/04/2021 01:36:48 PM Central Daylight Time	08/03/2021 12:24:11 PM Central Daylight Time	07/29/2021 06:57:45 PM Central Daylight Time			08/04/2021 08:02:43 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons (HMO)	01	01		1			H0543	140	0	2022	Amador, El Dorado, Mendocino, Merced, Tulare		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(844)808-4553		(844)808-4553		(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	4	1					1	08/04/2021	2022.01	08/04/2021 01:34:24 PM Central Daylight Time	08/03/2021 12:24:54 PM Central Daylight Time	07/29/2021 06:58:01 PM Central Daylight Time			08/04/2021 08:02:43 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Plan 2 (HMO)	01	01		1			H0543	144	0	2022	Riverside and San Bernardino counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(844)808-4553		(844)808-4553		(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	4	1					1	08/04/2021	2022.01	08/04/2021 01:31:58 PM Central Daylight Time	08/03/2021 12:25:32 PM Central Daylight Time	07/29/2021 06:58:16 PM Central Daylight Time			08/04/2021 08:02:43 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.UHCMedicareSolutions.com	Sharp SecureHorizons Plan by UnitedHealthcare (HMO)	01	01		1			H0543	145	0	2022	San Diego county		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(844)808-4553		(844)808-4553		(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					1	08/04/2021	2022.01	08/04/2021 01:29:21 PM Central Daylight Time	08/03/2021 12:26:15 PM Central Daylight Time	07/29/2021 06:58:32 PM Central Daylight Time			08/04/2021 08:02:43 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Focus 1 (HMO)	01	01		1			H0543	146	0	2022	Placer, Sacramento, and Yolo counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(844)808-4553		(844)808-4553		(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	3	1					1	08/04/2021	2022.01	08/04/2021 01:26:03 PM Central Daylight Time	08/03/2021 12:26:55 PM Central Daylight Time	07/29/2021 06:58:48 PM Central Daylight Time			08/04/2021 08:02:43 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Plan 2 (HMO)	01	01		1			H0543	147	0	2022	Stanislaus county		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(844)808-4553		(844)808-4553		(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					1	08/04/2021	2022.01	08/04/2021 01:22:52 PM Central Daylight Time	08/03/2021 12:27:33 PM Central Daylight Time	07/29/2021 06:59:04 PM Central Daylight Time			08/04/2021 08:02:43 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons (HMO)	01	01		1			H0543	148	0	2022	Sonoma county		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(844)808-4553		(844)808-4553		(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	4	1					1	08/04/2021	2022.01	08/04/2021 01:20:34 PM Central Daylight Time	08/03/2021 08:47:04 PM Central Daylight Time	07/29/2021 06:59:19 PM Central Daylight Time			08/04/2021 08:02:43 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Harmony (HMO)	01	01		1			H0543	151	0	2022	Los Angeles county		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(844)808-4553		(844)808-4553		(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	4	1					1	08/04/2021	2022.01	08/04/2021 01:17:48 PM Central Daylight Time	08/03/2021 12:28:59 PM Central Daylight Time	07/29/2021 06:59:33 PM Central Daylight Time			08/04/2021 08:02:43 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Plan 4 (HMO)	01	01		1			H0543	152	0	2022	San Diego county		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(844)808-4553		(844)808-4553		(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	4	1					0	08/04/2021	2022.01	08/04/2021 01:14:33 PM Central Daylight Time	08/03/2021 12:29:38 PM Central Daylight Time	07/29/2021 06:59:49 PM Central Daylight Time			08/04/2021 08:02:43 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Assure (HMO)	01	01		1			H0543	153	0	2022	Los Angeles, Orange, Riverside, and San Bernardino		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(844)808-4553		(844)808-4553		(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	4	1					1	08/04/2021	2022.01	08/04/2021 01:05:47 PM Central Daylight Time	08/03/2021 12:30:19 PM Central Daylight Time	07/29/2021 07:00:08 PM Central Daylight Time			08/04/2021 08:02:43 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Focus (HMO)	01	01		1			H0543	163	0	2022	Contra Costa county		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(844)808-4553		(844)808-4553		(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	3	1					1	08/04/2021	2022.01	08/04/2021 01:03:21 PM Central Daylight Time	08/03/2021 12:30:57 PM Central Daylight Time	07/29/2021 07:00:23 PM Central Daylight Time			08/04/2021 08:33:13 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Premier (HMO)	01	01		1			H0543	164	0	2022	Los Angeles county		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(844)808-4553		(844)808-4553		(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	3	1					1	08/04/2021	2022.01	08/04/2021 01:00:53 PM Central Daylight Time	08/03/2021 12:31:40 PM Central Daylight Time	07/29/2021 07:00:39 PM Central Daylight Time			08/04/2021 08:33:13 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Premier (HMO)	01	01		1			H0543	165	0	2022	Orange County		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(844)808-4553		(844)808-4553		(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	3	1					1	08/04/2021	2022.01	08/04/2021 12:57:53 PM Central Daylight Time	08/03/2021 12:32:22 PM Central Daylight Time	07/29/2021 07:00:55 PM Central Daylight Time			08/04/2021 08:33:13 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Premier (HMO)	01	01		1			H0543	166	0	2022	Riverside and San Bernardino Counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(844)808-4553		(844)808-4553		(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	4	1					1	08/04/2021	2022.01	08/04/2021 12:49:56 PM Central Daylight Time	08/03/2021 12:33:03 PM Central Daylight Time	07/29/2021 07:01:10 PM Central Daylight Time			08/04/2021 08:02:43 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Plan 2 (HMO)	01	01		1			H0543	167	0	2022	San Luis Obispo county		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(844)808-4553		(844)808-4553		(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					1	08/04/2021	2022.01	08/04/2021 12:47:31 PM Central Daylight Time	08/03/2021 12:33:45 PM Central Daylight Time	07/29/2021 07:01:25 PM Central Daylight Time			08/04/2021 08:02:43 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Focus (HMO)	01	01		1			H0543	168	0	2022	Los Angeles county		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(844)808-4553		(844)808-4553		(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					1	08/04/2021	2022.01	08/04/2021 12:02:00 PM Central Daylight Time	08/03/2021 12:34:24 PM Central Daylight Time	07/29/2021 07:01:40 PM Central Daylight Time			08/04/2021 08:02:43 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Focus (HMO)	01	01		1			H0543	169	0	2022	Orange County		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(844)808-4553		(844)808-4553		(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					1	08/04/2021	2022.01	08/04/2021 11:58:47 AM Central Daylight Time	08/03/2021 12:35:07 PM Central Daylight Time	07/29/2021 07:01:55 PM Central Daylight Time			08/04/2021 08:02:43 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Focus (HMO)	01	01		1			H0543	170	0	2022	Riverside and San Bernardino county		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(844)808-4553		(844)808-4553		(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	3	1					0	08/04/2021	2022.01	08/04/2021 11:55:14 AM Central Daylight Time	08/03/2021 12:35:49 PM Central Daylight Time	07/29/2021 07:02:13 PM Central Daylight Time			08/04/2021 08:33:13 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Assure (HMO)	01	01		1			H0543	172	0	2022	San Diego County		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(844)808-4553		(844)808-4553		(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	4	1					1	08/04/2021	2022.01	08/04/2021 11:52:15 AM Central Daylight Time	08/03/2021 12:36:29 PM Central Daylight Time	07/29/2021 07:02:29 PM Central Daylight Time			08/04/2021 08:02:43 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons (HMO)	01	01		1			H0543	176	0	2022	Marin county		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(844)808-4553		(844)808-4553		(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	3	1					1	08/04/2021	2022.01	08/04/2021 11:49:01 AM Central Daylight Time	08/03/2021 12:37:11 PM Central Daylight Time	07/29/2021 07:02:44 PM Central Daylight Time			08/04/2021 08:02:43 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons (HMO)	01	01		1			H0543	177	0	2022	San Joaquin county		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(844)808-4553		(844)808-4553		(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	3	1					1	08/04/2021	2022.01	08/04/2021 11:46:17 AM Central Daylight Time	08/03/2021 12:37:53 PM Central Daylight Time	07/29/2021 07:03:00 PM Central Daylight Time			08/04/2021 08:02:43 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons (HMO)	01	01		1			H0543	178	0	2022	Santa Cruz county		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(844)808-4553		(844)808-4553		(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	3	1					1	08/04/2021	2022.01	08/04/2021 11:40:26 AM Central Daylight Time	08/03/2021 12:38:33 PM Central Daylight Time	07/29/2021 07:03:15 PM Central Daylight Time			08/04/2021 08:02:43 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons (HMO)	01	01		1			H0543	179	0	2022	Solano County		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(844)808-4553		(844)808-4553		(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					0	08/04/2021	2022.01	08/04/2021 11:35:38 AM Central Daylight Time	08/03/2021 12:39:13 PM Central Daylight Time	07/29/2021 07:03:31 PM Central Daylight Time			08/04/2021 08:02:43 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Assure (HMO)	01	01		1			H0543	183	0	2022	Select Counties in Northern California		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(844)808-4553		(844)808-4553		(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					0	08/04/2021	2022.01	08/04/2021 11:32:54 AM Central Daylight Time	08/03/2021 12:39:55 PM Central Daylight Time	07/29/2021 07:03:46 PM Central Daylight Time			08/04/2021 08:02:43 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Assure (HMO)	01	01		1			H0543	185	0	2022	Select counties in Northern California		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	188	0	1	01	01	H0543_188_0	3	1					1	08/04/2021	2022.01	08/04/2021 11:30:15 AM Central Daylight Time	08/03/2021 12:40:33 PM Central Daylight Time	07/29/2021 07:04:02 PM Central Daylight Time			08/04/2021 08:33:13 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Canopy Health Medicare Advantage (HMO)	01	01		1			H0543	188	0	2022	Alameda county		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)810-1498		(866)810-1498		(800)555-5757		(800)555-5757		(866)810-1498		(866)810-1498		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	189	0	1	01	01	H0543_189_0	3	1					1	08/04/2021	2022.01	08/04/2021 11:25:53 AM Central Daylight Time	08/03/2021 12:41:16 PM Central Daylight Time	07/29/2021 07:04:17 PM Central Daylight Time			08/04/2021 08:33:13 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Canopy Health Medicare Advantage (HMO)	01	01		1			H0543	189	0	2022	Contra Costa county		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)810-1498		(866)810-1498		(800)555-5757		(800)555-5757		(866)810-1498		(866)810-1498		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	191	0	1	01	01	H0543_191_0	3	1					1	08/04/2021	2022.01	08/04/2021 11:23:09 AM Central Daylight Time	08/03/2021 12:41:56 PM Central Daylight Time	07/29/2021 07:04:33 PM Central Daylight Time			08/04/2021 08:33:13 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Canopy Health Medicare Advantage (HMO)	01	01		1			H0543	191	0	2022	San Francisco county		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)810-1498		(866)810-1498		(800)555-5757		(800)555-5757		(866)810-1498		(866)810-1498		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	193	0	1	01	01	H0543_193_0	3	1					1	08/04/2021	2022.01	08/04/2021 11:20:21 AM Central Daylight Time	08/03/2021 12:42:36 PM Central Daylight Time	07/29/2021 07:04:48 PM Central Daylight Time			08/04/2021 08:33:13 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Focus (HMO)	01	01		1			H0543	193	0	2022	Santa Clara county		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	194	0	1	01	01	H0543_194_0	3	1					1	08/04/2021	2022.01	08/04/2021 11:17:52 AM Central Daylight Time	08/03/2021 12:43:17 PM Central Daylight Time	07/29/2021 07:05:02 PM Central Daylight Time			08/04/2021 08:33:13 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons (HMO)	01	01		1			H0543	194	0	2022	Napa county		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	195	0	1	01	01	H0543_195_0	3	1					1	08/04/2021	2022.01	08/04/2021 11:15:16 AM Central Daylight Time	08/03/2021 12:43:59 PM Central Daylight Time	07/29/2021 07:05:17 PM Central Daylight Time			08/04/2021 08:33:13 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons (HMO)	01	01		1			H0543	195	0	2022	Shasta and Tehama county		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	196	0	1	01	01	H0543_196_0	3	1					1	08/04/2021	2022.01	08/04/2021 11:08:02 AM Central Daylight Time	08/03/2021 12:44:36 PM Central Daylight Time	07/29/2021 07:05:32 PM Central Daylight Time			08/04/2021 08:33:13 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Focus (HMO)	01	01		1			H0543	196	0	2022	San Joaquin and Stanislaus counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	202	0	1	01	01	H0543_202_0	3	1					0	08/04/2021	2022.01	08/04/2021 11:03:41 AM Central Daylight Time	08/03/2021 12:45:11 PM Central Daylight Time	07/29/2021 07:05:47 PM Central Daylight Time			08/04/2021 08:33:13 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Assure (HMO)	01	01		1			H0543	202	0	2022	Select counties in Northern California		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	204	0	1	01	01	H0543_204_0	4	1					1	08/04/2021	2022.01	08/04/2021 11:01:24 AM Central Daylight Time	08/03/2021 12:45:51 PM Central Daylight Time	07/29/2021 07:06:02 PM Central Daylight Time			08/04/2021 08:33:13 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.UHCMedicareSolutions.com	Sharp Walgreens by UnitedHealthcare (HMO)	01	01		1			H0543	204	0	2022	San Diego County		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	205	0	1	01	01	H0543_205_0	3	1					1	08/04/2021	2022.01	08/04/2021 10:58:40 AM Central Daylight Time	08/03/2021 12:46:27 PM Central Daylight Time	07/29/2021 07:06:17 PM Central Daylight Time			08/04/2021 08:33:13 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Canopy Health Medicare Advantage (HMO)	01	01		1			H0543	205	0	2022	Marin county		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)810-1498		(866)810-1498		(800)555-5757		(800)555-5757		(866)810-1498		(866)810-1498		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	209	0	1	01	01	H0543_209_0	3	1					1	08/04/2021	2022.01	08/04/2021 10:56:25 AM Central Daylight Time	08/03/2021 12:47:07 PM Central Daylight Time	07/29/2021 07:06:31 PM Central Daylight Time			08/04/2021 08:33:13 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Canopy Health Medicare Advantage (HMO)	01	01		1			H0543	209	0	2022	Santa Cruz county		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)810-1498		(866)810-1498		(800)555-5757		(800)555-5757		(866)810-1498		(866)810-1498		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	210	0	1	02	01	H0543_210_0	3	1					1	08/04/2021	2022.01	08/04/2021 10:54:05 AM Central Daylight Time	08/03/2021 12:47:51 PM Central Daylight Time	07/29/2021 07:06:46 PM Central Daylight Time			08/04/2021 08:33:13 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Freedom Plus (HMO-POS)	01	02		1			H0543	210	0	2022	Los Angeles county		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	214	0	1	01	01	H0543_214_0	3	1		1			1	08/04/2021	2022.01	08/04/2021 10:51:21 AM Central Daylight Time	08/03/2021 12:48:32 PM Central Daylight Time	07/29/2021 07:07:03 PM Central Daylight Time			08/04/2021 08:33:13 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Chronic Complete Focus (HMO C-SNP)	01	01		1			H0543	214	0	2022	San Diego County		2		2			1	4			00000000000000000010		www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	215	0	1	02	01	H0543_215_0	3	1					1	08/04/2021	2022.01	08/04/2021 10:48:36 AM Central Daylight Time	08/03/2021 12:49:11 PM Central Daylight Time	07/29/2021 07:07:19 PM Central Daylight Time			08/04/2021 08:33:13 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Freedom Plus (HMO-POS)	01	02		1			H0543	215	0	2022	Orange County		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	216	0	1	02	01	H0543_216_0	3	1					1	08/04/2021	2022.01	08/04/2021 10:45:04 AM Central Daylight Time	08/03/2021 12:49:51 PM Central Daylight Time	07/29/2021 07:07:34 PM Central Daylight Time			08/04/2021 08:33:13 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Freedom Plus (HMO-POS)	01	02		1			H0543	216	0	2022	Riverside and San Bernardino counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	217	0	1	01	01	H0543_217_0	3	1		1			1	08/04/2021	2022.01	08/04/2021 10:42:39 AM Central Daylight Time	08/03/2021 12:50:34 PM Central Daylight Time	07/29/2021 07:07:49 PM Central Daylight Time			08/04/2021 08:33:13 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Chronic Complete (HMO C-SNP)	01	01		1			H0543	217	0	2022	Los Angeles county		2		2			1	4			00000000000000000010		www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	218	0	1	01	01	H0543_218_0	3	1		1			1	08/04/2021	2022.01	08/04/2021 09:59:05 AM Central Daylight Time	08/03/2021 12:51:14 PM Central Daylight Time	07/29/2021 07:08:04 PM Central Daylight Time			08/04/2021 08:33:13 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Chronic Complete (HMO C-SNP)	01	01		1			H0543	218	0	2022	Orange County		2		2			1	4			00000000000000000010		www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	219	0	1	01	01	H0543_219_0	3	1		1			1	08/04/2021	2022.01	08/04/2021 10:40:13 AM Central Daylight Time	08/03/2021 12:51:55 PM Central Daylight Time	07/29/2021 07:08:20 PM Central Daylight Time			08/04/2021 08:33:13 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Chronic Complete (HMO C-SNP)	01	01		1			H0543	219	0	2022	Riverside and San Bernardino counties		2		2			1	4			00000000000000000010		www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	220	0	1	01	01	H0543_220_0	3	1					1	08/04/2021	2022.01	08/04/2021 10:22:44 AM Central Daylight Time	08/03/2021 12:52:34 PM Central Daylight Time	07/29/2021 07:08:34 PM Central Daylight Time			08/04/2021 08:33:13 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Harmony (HMO)	01	01		1			H0543	220	0	2022	Orange county		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	221	0	1	01	01	H0543_221_0	3	1					1	08/04/2021	2022.01	08/04/2021 10:20:13 AM Central Daylight Time	08/03/2021 12:53:18 PM Central Daylight Time	07/29/2021 07:08:49 PM Central Daylight Time			08/04/2021 08:33:13 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Harmony (HMO)	01	01		1			H0543	221	0	2022	Riverside and San Bernardino counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	222	0	1	01	01	H0543_222_0	3	1					1	08/04/2021	2022.01	08/04/2021 10:17:35 AM Central Daylight Time	08/03/2021 12:54:00 PM Central Daylight Time	07/29/2021 07:09:04 PM Central Daylight Time			08/04/2021 08:33:13 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Focus 2 (HMO)	01	01		1			H0543	222	0	2022	Placer and Sacramento counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	223	0	1	01	01	H0543_223_0	3	1					1	08/04/2021	2022.01	08/04/2021 10:15:04 AM Central Daylight Time	08/03/2021 12:54:42 PM Central Daylight Time	07/29/2021 07:09:20 PM Central Daylight Time			08/04/2021 08:33:13 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Focus (HMO)	01	01		1			H0543	223	0	2022	Fresno and Madera counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	224	0	1	01	01	H0543_224_0	3	1		1			1	08/04/2021	2022.01	08/04/2021 09:15:30 AM Central Daylight Time	08/03/2021 12:55:20 PM Central Daylight Time	07/29/2021 07:09:35 PM Central Daylight Time			08/04/2021 08:33:13 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Chronic Complete (HMO C-SNP)	01	01		1			H0543	224	0	2022	Marin county		2		2			1	4			00000000000000000010		www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(844)808-4553		(844)808-4553		(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				0	0	06/02/2021	2022.01	06/02/2021 09:00:05 AM Central Daylight Time					06/02/2021 09:15:14 AM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0543	802	0	2022	CA Employer Sponsored Plan Service Area		1	16068	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H0543	805	0	1	01	01	H0543_805_0	1	1						05/24/2021	2022.01	05/24/2021 10:30:26 AM Central Daylight Time					06/02/2021 09:15:14 AM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0543	805	0	2022	CA Employer Sponsored Plan Service Area		1	149892	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H0543	806	0	1	01	01	H0543_806_0	1	1						05/24/2021	2022.01	05/24/2021 10:30:46 AM Central Daylight Time					06/02/2021 09:15:14 AM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0543	806	0	2022	CA Employer Sponsored Plan Service Area		1	56664	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H0544	002	0	1	01	01	H0544_002_0	8	1			2		0	07/18/2021	2022.01	07/18/2021 08:52:57 AM Pacific Daylight Time	08/03/2021 03:03:56 PM Pacific Daylight Time	08/03/2021 03:03:56 PM Pacific Daylight Time			08/04/2021 10:20:02 AM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare	Anthem MediBlue Value Plus (HMO)	01	01		1			H0544	002	0	2022	Los Angeles and Orange Counties		2		2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare	(800)499-2793		(800)499-2793		(855)593-0898		(855)593-0898		(833)293-5467		(833)293-5467		(855)948-5570		(855)948-5570		(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	2		0	08/03/2021	2022.01	08/03/2021 12:33:40 PM Eastern Daylight Time	08/03/2021 06:03:57 PM Eastern Daylight Time	08/03/2021 06:03:57 PM Eastern Daylight Time			08/04/2021 03:50:55 PM Eastern Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare	Anthem MediBlue Connect (HMO D-SNP)	01	01		1			H0544	003	0	2022	Los Angeles and Santa Clara counties		2		2			1	3		2		2	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare	(800)499-2793		(800)499-2793		(855)593-0899		(855)593-0899		(833)293-5467		(833)293-5467		(855)948-5571		(855)948-5571		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	004	0	1	01	01	H0544_004_0	9	1		1	2		1	07/18/2021	2022.01	07/18/2021 05:38:14 PM Pacific Daylight Time	08/03/2021 03:03:56 PM Pacific Daylight Time	08/03/2021 03:03:56 PM Pacific Daylight Time			08/04/2021 10:20:02 AM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare	Anthem MediBlue Diabetes Care (HMO C-SNP)	01	01		1			H0544	004	0	2022	Los Angeles and Orange Counties		2		2			1	4			00000010000000000000		https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare	(800)499-2793		(800)499-2793		(855)593-0901		(855)593-0901		(833)293-5467		(833)293-5467		(855)948-5572		(855)948-5572		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	005	0	1	01	01	H0544_005_0	8	1		1	2		0	06/02/2021	2022.01	06/02/2021 11:16:28 PM Pacific Daylight Time	08/03/2021 03:03:56 PM Pacific Daylight Time	08/03/2021 03:03:56 PM Pacific Daylight Time			08/04/2021 10:20:02 AM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare	Anthem MediBlue Care On Site (HMO I-SNP)	01	01		1			H0544	005	0	2022	Los Angeles, Orange, and San Bernardino counties		2		2			1	1	3				https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare	(800)499-2793		(800)499-2793		(855)593-0902		(855)593-0902		(833)293-5467		(833)293-5467		(855)948-5573		(855)948-5573		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	007	0	1	01	01	H0544_007_0	10	1			2		0	07/18/2021	2022.01	07/18/2021 05:38:55 PM Pacific Daylight Time	08/03/2021 03:03:56 PM Pacific Daylight Time	08/03/2021 03:03:56 PM Pacific Daylight Time			08/04/2021 10:20:02 AM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare	Anthem MediBlue StartSmart Plus (HMO)	01	01		1			H0544	007	0	2022	Los Angeles, Orange, and San Bernardino Counties		2		2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare	(800)499-2793		(800)499-2793		(855)593-0898		(855)593-0898		(833)293-5467		(833)293-5467		(855)948-5570		(855)948-5570		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	008	0	1	01	01	H0544_008_0	8	1			2		0	07/18/2021	2022.01	07/18/2021 02:24:02 PM Pacific Daylight Time	08/03/2021 03:03:56 PM Pacific Daylight Time	08/03/2021 03:03:56 PM Pacific Daylight Time			08/04/2021 10:20:02 AM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare	Anthem MediBlue Value Plus (HMO)	01	01		1			H0544	008	0	2022	San Bernardino County		2		2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare	(800)499-2793		(800)499-2793		(855)593-0898		(855)593-0898		(833)293-5467		(833)293-5467		(855)948-5570		(855)948-5570		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	010	0	1	01	01	H0544_010_0	8	1		1	2		1	07/18/2021	2022.01	07/18/2021 02:24:17 PM Pacific Daylight Time	08/03/2021 03:03:57 PM Pacific Daylight Time	08/03/2021 03:03:57 PM Pacific Daylight Time			08/04/2021 10:20:02 AM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare	Anthem MediBlue Diabetes Care (HMO C-SNP)	01	01		1			H0544	010	0	2022	San Bernardino County		2		2			1	4			00000010000000000000		https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare	(800)499-2793		(800)499-2793		(855)593-0901		(855)593-0901		(833)293-5467		(833)293-5467		(855)948-5572		(855)948-5572		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	013	0	1	01	01	H0544_013_0	8	1		1	2		0	07/18/2021	2022.01	07/18/2021 05:57:49 PM Pacific Daylight Time	08/03/2021 03:03:57 PM Pacific Daylight Time	08/03/2021 03:03:57 PM Pacific Daylight Time			08/04/2021 10:20:02 AM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare	Anthem MediBlue Heart Care (HMO C-SNP)	01	01		1			H0544	013	0	2022	Los Angeles and Orange Counties		2		2			1	4			00000000000000010000		https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare	(800)499-2793		(800)499-2793		(855)593-0901		(855)593-0901		(833)293-5467		(833)293-5467		(855)948-5572		(855)948-5572		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	014	0	1	01	01	H0544_014_0	8	1		1	2		0	07/18/2021	2022.01	07/18/2021 02:59:32 PM Pacific Daylight Time	08/03/2021 03:03:57 PM Pacific Daylight Time	08/03/2021 03:03:57 PM Pacific Daylight Time			08/04/2021 10:20:02 AM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare	Anthem MediBlue Lung Care (HMO C-SNP)	01	01		1			H0544	014	0	2022	Los Angeles and Orange Counties		2		2			1	4			00000000000100000000		https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare	(800)499-2793		(800)499-2793		(855)593-0901		(855)593-0901		(833)293-5467		(833)293-5467		(855)948-5572		(855)948-5572		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	015	0	1	01	01	H0544_015_0	8	1		1	2		0	07/18/2021	2022.01	07/18/2021 03:17:40 PM Pacific Daylight Time		08/03/2021 03:03:57 PM Pacific Daylight Time		08/03/2021 03:03:57 PM Pacific Daylight Time	08/04/2021 10:20:02 AM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare	Anthem MediBlue ESRD Care (HMO C-SNP)	01	01		1			H0544	015	0	2022	Los Angeles and Orange Counties		2		2			1	4			00000000100000000000		https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare	(800)499-2793		(800)499-2793		(855)593-0901		(855)593-0901		(833)293-5467		(833)293-5467		(855)948-5572		(855)948-5572		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	019	0	1	01	01	H0544_019_0	8	1		1	2		0	07/18/2021	2022.01	07/18/2021 06:17:52 PM Pacific Daylight Time	08/03/2021 03:03:57 PM Pacific Daylight Time	08/03/2021 03:03:57 PM Pacific Daylight Time			08/04/2021 10:20:02 AM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare	Anthem MediBlue Lung Care (HMO C-SNP)	01	01		1			H0544	019	0	2022	San Bernardino County		2		2			1	4			00000000000100000000		https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare	(800)499-2793		(800)499-2793		(855)593-0901		(855)593-0901		(833)293-5467		(833)293-5467		(855)948-5572		(855)948-5572		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	020	0	1	01	01	H0544_020_0	8	1		1	2		0	07/18/2021	2022.01	07/18/2021 04:36:37 PM Pacific Daylight Time		08/03/2021 03:03:57 PM Pacific Daylight Time		08/03/2021 03:03:57 PM Pacific Daylight Time	08/04/2021 10:20:02 AM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare	Anthem MediBlue ESRD Care (HMO C-SNP)	01	01		1			H0544	020	0	2022	San Bernardino County		2		2			1	4			00000000100000000000		https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare	(800)499-2793		(800)499-2793		(855)593-0901		(855)593-0901		(833)293-5467		(833)293-5467		(855)948-5572		(855)948-5572		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	027	0	1	01	01	H0544_027_0	8	1			2		0	07/14/2021	2022.01	07/14/2021 05:59:44 PM Pacific Daylight Time	08/03/2021 03:03:57 PM Pacific Daylight Time	08/03/2021 03:03:57 PM Pacific Daylight Time			08/04/2021 10:20:02 AM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare	Anthem MediBlue Value Plus (HMO)	01	01		1			H0544	027	0	2022	Stanislaus County		2		2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare	(800)499-2793		(800)499-2793		(855)593-0898		(855)593-0898		(833)293-5467		(833)293-5467		(855)948-5570		(855)948-5570		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	031	0	1	01	01	H0544_031_0	8	1		1	2		0	07/14/2021	2022.01	07/14/2021 06:00:42 PM Pacific Daylight Time	08/03/2021 03:03:57 PM Pacific Daylight Time	08/03/2021 03:03:57 PM Pacific Daylight Time			08/04/2021 10:20:02 AM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare	Anthem MediBlue Lung (HMO C-SNP)	01	01		1			H0544	031	0	2022	Stanislaus County		2		2			1	4			00000000000100000000		https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare	(800)499-2793		(800)499-2793		(855)593-0901		(855)593-0901		(833)293-5467		(833)293-5467		(855)948-5572		(855)948-5572		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	032	0	1	01	01	H0544_032_0	7	1		1	2		1	07/14/2021	2022.01	07/14/2021 06:01:39 PM Pacific Daylight Time	08/03/2021 03:03:57 PM Pacific Daylight Time	08/03/2021 03:03:57 PM Pacific Daylight Time			08/04/2021 10:20:02 AM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare	Anthem MediBlue Diabetes (HMO C-SNP)	01	01		1			H0544	032	0	2022	Stanislaus County		2		2			1	4			00000010000000000000		https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare	(800)499-2793		(800)499-2793		(855)593-0901		(855)593-0901		(833)293-5467		(833)293-5467		(855)948-5572		(855)948-5572		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	036	0	1	01	01	H0544_036_0	8	1		1	2		0	07/14/2021	2022.01	07/14/2021 06:02:23 PM Pacific Daylight Time	08/03/2021 03:03:57 PM Pacific Daylight Time	08/03/2021 03:03:57 PM Pacific Daylight Time			08/04/2021 10:20:02 AM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare	Anthem MediBlue Heart (HMO C-SNP)	01	01		1			H0544	036	0	2022	Stanislaus County		2		2			1	4			00000000000000010000		https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare	(800)499-2793		(800)499-2793		(855)593-0901		(855)593-0901		(833)293-5467		(833)293-5467		(855)948-5572		(855)948-5572		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	038	0	1	01	01	H0544_038_0	8	1		1	2		0	07/18/2021	2022.01	07/18/2021 06:28:52 PM Pacific Daylight Time	08/03/2021 03:03:57 PM Pacific Daylight Time	08/03/2021 03:03:57 PM Pacific Daylight Time			08/04/2021 10:20:02 AM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare	Anthem MediBlue Heart Care (HMO C-SNP)	01	01		1			H0544	038	0	2022	San Bernardino County		2		2			1	4			00000000000000010000		https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare	(800)499-2793		(800)499-2793		(855)593-0901		(855)593-0901		(833)293-5467		(833)293-5467		(855)948-5572		(855)948-5572		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	050	0	1	01	01	H0544_050_0	8	1		1	2		0	06/02/2021	2022.01	06/02/2021 11:19:47 PM Pacific Daylight Time	08/03/2021 03:03:57 PM Pacific Daylight Time	08/03/2021 03:03:57 PM Pacific Daylight Time			08/04/2021 10:20:02 AM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare	Anthem MediBlue Care On Site (HMO I-SNP)	01	01		1			H0544	050	0	2022	Santa Clara and Stanislaus Counties		2		2			1	1	3				https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare	(800)499-2793		(800)499-2793		(855)593-0902		(855)593-0902		(833)293-5467		(833)293-5467		(855)948-5573		(855)948-5573		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	052	0	1	01	01	H0544_052_0	10	1	2	1	1		0	07/19/2021	2022.01	07/19/2021 03:08:55 PM Eastern Daylight Time	08/03/2021 06:03:57 PM Eastern Daylight Time	08/03/2021 06:03:57 PM Eastern Daylight Time			08/04/2021 03:50:55 PM Eastern Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare	Anthem MediBlue Dual Advantage (HMO D-SNP)	01	01		1			H0544	052	0	2022	Fresno, Kings, Madera, and Tulare Counties		2		2			1	3		2		2	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare	(844)469-6831		(844)469-6831		(855)593-0899		(855)593-0899		(833)293-5468		(833)293-5468		(855)948-5571		(855)948-5571		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	053	0	1	01	01	H0544_053_0	8	1	2	1	1		0	07/19/2021	2022.01	07/19/2021 03:09:04 PM Eastern Daylight Time	08/03/2021 06:03:57 PM Eastern Daylight Time	08/03/2021 06:03:57 PM Eastern Daylight Time			08/04/2021 03:50:55 PM Eastern Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare	Anthem MediBlue Dual Advantage (HMO D-SNP)	01	01		1			H0544	053	0	2022	Kern County		2		2			1	3		2		2	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare	(844)469-6831		(844)469-6831		(855)593-0899		(855)593-0899		(833)293-5468		(833)293-5468		(855)948-5571		(855)948-5571		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	054	0	1	01	01	H0544_054_0	6	1	2	1	2		0	07/19/2021	2022.01	07/19/2021 03:33:31 PM Eastern Daylight Time	08/03/2021 06:03:57 PM Eastern Daylight Time	08/03/2021 06:03:57 PM Eastern Daylight Time			08/04/2021 03:50:55 PM Eastern Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare	Anthem MediBlue Dual Advantage (HMO D-SNP)	01	01		1			H0544	054	0	2022	San Francisco and Sacramento Counties		2		2			1	3		2		2	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare	(844)469-6831		(844)469-6831		(855)593-0899		(855)593-0899		(833)293-5468		(833)293-5468		(855)948-5571		(855)948-5571		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	055	0	1	01	01	H0544_055_0	6	1	2	1	1		0	07/19/2021	2022.01	07/19/2021 03:09:12 PM Eastern Daylight Time	08/03/2021 06:03:57 PM Eastern Daylight Time	08/03/2021 06:03:57 PM Eastern Daylight Time			08/04/2021 03:50:55 PM Eastern Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare	Anthem MediBlue Dual Advantage (HMO D-SNP)	01	01		1			H0544	055	0	2022	Ventura County		2		2			1	3		2		2	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare	(844)469-6831		(844)469-6831		(855)593-0899		(855)593-0899		(833)293-5468		(833)293-5468		(855)948-5571		(855)948-5571		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	056	0	1	01	01	H0544_056_0	6	1			2		0	06/03/2021	2022.01	06/03/2021 06:28:42 PM Pacific Daylight Time	08/03/2021 03:03:58 PM Pacific Daylight Time	08/03/2021 03:03:58 PM Pacific Daylight Time			08/04/2021 10:54:45 AM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare	Anthem MediBlue Plus (HMO)	01	01		1			H0544	056	0	2022	Fresno, Kings, Madera and Tulare Counties		2		2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare	(888)230-7338		(888)230-7338		(855)593-0898		(855)593-0898		(833)293-5470		(833)293-5470		(855)948-5570		(855)948-5570		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	058	0	1	01	01	H0544_058_0	6	1			2		0	07/18/2021	2022.01	07/18/2021 03:05:29 PM Pacific Daylight Time	08/03/2021 03:03:58 PM Pacific Daylight Time	08/03/2021 03:03:58 PM Pacific Daylight Time			08/04/2021 10:54:45 AM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare	Anthem MediBlue Select (HMO)	01	01		1			H0544	058	0	2022	Orange and Los Angeles Counties		2		2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare	(888)230-7338		(888)230-7338		(855)593-0898		(855)593-0898		(833)293-5470		(833)293-5470		(855)948-5570		(855)948-5570		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	061	0	1	01	01	H0544_061_0	6	1			2		0	06/02/2021	2022.01	06/02/2021 04:30:21 PM Pacific Daylight Time	08/03/2021 03:03:58 PM Pacific Daylight Time	08/03/2021 03:03:58 PM Pacific Daylight Time			08/04/2021 10:54:45 AM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare	Anthem MediBlue Plus (HMO)	01	01		1			H0544	061	0	2022	Orange and Los Angeles Counties		2		2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare	(888)230-7338		(888)230-7338		(855)593-0898		(855)593-0898		(833)293-5470		(833)293-5470		(855)948-5570		(855)948-5570		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	062	0	1	01	01	H0544_062_0	6	1			2		0	06/02/2021	2022.01	06/02/2021 04:30:29 PM Pacific Daylight Time	08/03/2021 03:03:58 PM Pacific Daylight Time	08/03/2021 03:03:58 PM Pacific Daylight Time			08/04/2021 10:54:45 AM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare	Anthem MediBlue Plus (HMO)	01	01		1			H0544	062	0	2022	Kern County		2		2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare	(888)230-7338		(888)230-7338		(855)593-0898		(855)593-0898		(833)293-5470		(833)293-5470		(855)948-5570		(855)948-5570		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	063	0	1	01	01	H0544_063_0	6	1			2		0	06/02/2021	2022.01	06/02/2021 04:30:43 PM Pacific Daylight Time	08/03/2021 03:03:58 PM Pacific Daylight Time	08/03/2021 03:03:58 PM Pacific Daylight Time			08/04/2021 10:54:45 AM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare	Anthem MediBlue Plus (HMO)	01	01		1			H0544	063	0	2022	Ventura County		2		2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare	(888)230-7338		(888)230-7338		(855)593-0898		(855)593-0898		(833)293-5470		(833)293-5470		(855)948-5570		(855)948-5570		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	064	0	1	01	01	H0544_064_0	6	1			2		0	06/02/2021	2022.01	06/02/2021 04:30:54 PM Pacific Daylight Time	08/03/2021 03:03:58 PM Pacific Daylight Time	08/03/2021 03:03:58 PM Pacific Daylight Time			08/04/2021 10:54:45 AM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare	Anthem MediBlue Plus (HMO)	01	01		1			H0544	064	0	2022	Sacramento and Yolo Counties		2		2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare	(888)230-7338		(888)230-7338		(855)593-0898		(855)593-0898		(833)293-5470		(833)293-5470		(855)948-5570		(855)948-5570		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	065	0	1	01	01	H0544_065_0	6	1			2		0	06/02/2021	2022.01	06/02/2021 04:31:04 PM Pacific Daylight Time	08/03/2021 03:03:58 PM Pacific Daylight Time	08/03/2021 03:03:58 PM Pacific Daylight Time			08/04/2021 10:54:45 AM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare	Anthem MediBlue Plus (HMO)	01	01		1			H0544	065	0	2022	San Diego County		2		2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare	(888)230-7338		(888)230-7338		(855)593-0898		(855)593-0898		(833)293-5470		(833)293-5470		(855)948-5570		(855)948-5570		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	066	0	1	01	01	H0544_066_0	6	1			2		0	07/17/2021	2022.01	07/17/2021 07:26:19 PM Pacific Daylight Time	08/03/2021 03:03:58 PM Pacific Daylight Time	08/03/2021 03:03:58 PM Pacific Daylight Time			08/04/2021 10:54:45 AM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare	Anthem MediBlue Select (HMO)	01	01		1			H0544	066	0	2022	Riverside and San Bernardino Counties		2		2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare	(888)230-7338		(888)230-7338		(855)593-0898		(855)593-0898		(833)293-5470		(833)293-5470		(855)948-5570		(855)948-5570		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	069	0	1	01	01	H0544_069_0	6	1			2		0	06/02/2021	2022.01	06/02/2021 04:31:23 PM Pacific Daylight Time	08/03/2021 03:03:58 PM Pacific Daylight Time	08/03/2021 03:03:58 PM Pacific Daylight Time			08/04/2021 10:54:45 AM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare	Anthem MediBlue Select (HMO)	01	01		1			H0544	069	0	2022	San Francisco County		2		2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare	(888)230-7338		(888)230-7338		(855)593-0898		(855)593-0898		(833)293-5470		(833)293-5470		(855)948-5570		(855)948-5570		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	070	0	1	01	01	H0544_070_0	6	1			2		0	07/17/2021	2022.01	07/17/2021 07:49:03 PM Pacific Daylight Time	08/03/2021 03:03:58 PM Pacific Daylight Time	08/03/2021 03:03:58 PM Pacific Daylight Time			08/04/2021 10:54:45 AM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare	Anthem MediBlue Coordination Plus (HMO)	01	01		1			H0544	070	0	2022	San Diego County		2		2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare	(888)230-7338		(888)230-7338		(855)593-0898		(855)593-0898		(833)293-5470		(833)293-5470		(855)948-5570		(855)948-5570		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	071	0	1	01	01	H0544_071_0	6	1			2		0	07/17/2021	2022.01	07/17/2021 07:49:27 PM Pacific Daylight Time	08/03/2021 03:03:58 PM Pacific Daylight Time	08/03/2021 03:03:58 PM Pacific Daylight Time			08/04/2021 10:54:45 AM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare	Anthem MediBlue Coordination Plus (HMO)	01	01		1			H0544	071	0	2022	Riverside and San Bernardino Counties		2		2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare	(888)230-7338		(888)230-7338		(855)593-0898		(855)593-0898		(833)293-5470		(833)293-5470		(855)948-5570		(855)948-5570		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	072	0	1	01	01	H0544_072_0	6	1			2		0	07/17/2021	2022.01	07/17/2021 07:49:47 PM Pacific Daylight Time	08/03/2021 03:03:58 PM Pacific Daylight Time	08/03/2021 03:03:58 PM Pacific Daylight Time			08/04/2021 10:54:45 AM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare	Anthem MediBlue Coordination Plus (HMO)	01	01		1			H0544	072	0	2022	Los Angeles and Orange Counties		2		2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare	(888)230-7338		(888)230-7338		(855)593-0898		(855)593-0898		(833)293-5470		(833)293-5470		(855)948-5570		(855)948-5570		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	081	0	1	01	01	H0544_081_0	6	1			2		0	07/17/2021	2022.01	07/17/2021 07:50:37 PM Pacific Daylight Time	08/03/2021 03:03:58 PM Pacific Daylight Time	08/03/2021 03:03:58 PM Pacific Daylight Time			08/04/2021 10:54:45 AM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare	Anthem MediBlue Extra (HMO)	01	01		1			H0544	081	0	2022	Counties: LA, Orange, San Bern., Riv, San Diego		2		2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare	(844)487-9286		(844)487-9286		(855)593-0898		(855)593-0898		(833)293-5469		(833)293-5469		(855)948-5570		(855)948-5570		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	087	0	1	01	01	H0544_087_0	7	1	2	1	1		0	07/19/2021	2022.01	07/19/2021 03:09:19 PM Eastern Daylight Time	08/03/2021 06:03:57 PM Eastern Daylight Time	08/03/2021 06:03:57 PM Eastern Daylight Time			08/04/2021 03:50:55 PM Eastern Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare	Anthem MediBlue Dual Plus (HMO D-SNP)	01	01		1			H0544	087	0	2022	Fresno, Kings, Madera, and Tulare Counties		2		2			1	3		2		2	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare	(844)469-6831		(844)469-6831		(855)593-0899		(855)593-0899		(833)293-5468		(833)293-5468		(855)948-5571		(855)948-5571		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	088	0	1	01	01	H0544_088_0	6	1	2	1	1		0	07/19/2021	2022.01	07/19/2021 03:33:40 PM Eastern Daylight Time	08/03/2021 06:03:57 PM Eastern Daylight Time	08/03/2021 06:03:57 PM Eastern Daylight Time			08/04/2021 03:50:55 PM Eastern Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare	Anthem MediBlue Dual Plus (HMO D-SNP)	01	01		1			H0544	088	0	2022	Kern County		2		2			1	3		2		2	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare	(844)469-6831		(844)469-6831		(855)593-0899		(855)593-0899		(833)293-5468		(833)293-5468		(855)948-5571		(855)948-5571		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	089	0	1	01	01	H0544_089_0	6	1	2	1	2		0	07/19/2021	2022.01	07/19/2021 03:33:46 PM Eastern Daylight Time	08/03/2021 06:03:57 PM Eastern Daylight Time	08/03/2021 06:03:57 PM Eastern Daylight Time			08/04/2021 03:50:55 PM Eastern Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare	Anthem MediBlue Dual Plus (HMO D-SNP)	01	01		1			H0544	089	0	2022	San Francisco and Sacramento Counties		2		2			1	3		2		2	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare	(844)469-6831		(844)469-6831		(855)593-0899		(855)593-0899		(833)293-5468		(833)293-5468		(855)948-5571		(855)948-5571		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	090	0	1	01	01	H0544_090_0	6	1	2	1	1		0	07/19/2021	2022.01	07/19/2021 03:09:27 PM Eastern Daylight Time	08/03/2021 06:03:57 PM Eastern Daylight Time	08/03/2021 06:03:57 PM Eastern Daylight Time			08/04/2021 03:50:55 PM Eastern Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare	Anthem MediBlue Dual Plus (HMO D-SNP)	01	01		1			H0544	090	0	2022	Ventura County		2		2			1	3		2		2	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare	(844)469-6831		(844)469-6831		(855)593-0899		(855)593-0899		(833)293-5468		(833)293-5468		(855)948-5571		(855)948-5571		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	091	0	1	01	01	H0544_091_0	6	1			2		0	06/02/2021	2022.01	06/02/2021 04:32:12 PM Pacific Daylight Time	08/03/2021 03:03:58 PM Pacific Daylight Time	08/03/2021 03:03:58 PM Pacific Daylight Time			08/04/2021 10:54:45 AM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare	Anthem MediBlue Select (HMO)	01	01		1			H0544	091	0	2022	San Diego County		2		2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare	(888)230-7338		(888)230-7338		(855)593-0898		(855)593-0898		(833)293-5470		(833)293-5470		(855)948-5570		(855)948-5570		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	093	0	1	01	01	H0544_093_0	8	1		1	2		0	08/02/2021	2022.01	08/02/2021 11:31:04 PM Pacific Daylight Time	08/03/2021 03:04:03 PM Pacific Daylight Time	08/03/2021 03:04:03 PM Pacific Daylight Time			08/04/2021 12:07:42 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare	Anthem MediBlue Care To You (HMO I-SNP)	01	01		1			H0544	093	0	2022	Sacramento County		2		2			1	1	3				https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare	(844)209-5408		(844)209-5408		(855)593-0902		(855)593-0902		(833)385-9047		(833)385-9047		(855)948-5573		(855)948-5573		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	094	0	1	01	01	H0544_094_0	8	1		1	2		1	07/16/2021	2022.01	07/16/2021 08:33:43 AM Pacific Daylight Time	08/03/2021 03:04:03 PM Pacific Daylight Time	08/03/2021 03:04:03 PM Pacific Daylight Time			08/04/2021 12:07:42 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare	Anthem MediBlue Diabetes Care Plus (HMO C-SNP)	01	01		1			H0544	094	0	2022	Sacramento County		2		2			1	4			00000010000000000000		https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare	(844)286-1322		(844)286-1322		(855)593-0901		(855)593-0901		(833)385-9048		(833)385-9048		(855)948-5572		(855)948-5572		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	095	0	1	01	01	H0544_095_0	6	1			2		0	07/15/2021	2022.01	07/15/2021 12:21:31 PM Pacific Daylight Time	08/03/2021 03:03:58 PM Pacific Daylight Time	08/03/2021 03:03:58 PM Pacific Daylight Time			08/04/2021 10:54:45 AM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare	Anthem MediBlue Plus (HMO)	01	01		1			H0544	095	0	2022	San Joaquin County		2		2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare	(888)230-7338		(888)230-7338		(855)593-0898		(855)593-0898		(833)293-5470		(833)293-5470		(855)948-5570		(855)948-5570		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	096	0	1	01	01	H0544_096_0	6	1			2		0	06/02/2021	2022.01	06/02/2021 04:32:30 PM Pacific Daylight Time	08/03/2021 03:03:58 PM Pacific Daylight Time	08/03/2021 03:03:58 PM Pacific Daylight Time			08/04/2021 10:54:45 AM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare	Anthem MediBlue Plus (HMO)	01	01		1			H0544	096	0	2022	San Mateo County		2		2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare	(888)230-7338		(888)230-7338		(855)593-0898		(855)593-0898		(833)293-5470		(833)293-5470		(855)948-5570		(855)948-5570		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	097	0	1	01	01	H0544_097_0	6	1			2		0	06/02/2021	2022.01	06/02/2021 04:32:38 PM Pacific Daylight Time	08/03/2021 03:03:58 PM Pacific Daylight Time	08/03/2021 03:03:58 PM Pacific Daylight Time			08/04/2021 10:54:45 AM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare	Anthem MediBlue Plus (HMO)	01	01		1			H0544	097	0	2022	Alameda County		2		2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare	(888)230-7338		(888)230-7338		(855)593-0898		(855)593-0898		(833)293-5470		(833)293-5470		(855)948-5570		(855)948-5570		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	098	0	1	01	01	H0544_098_0	6	1			2		0	06/02/2021	2022.01	06/02/2021 04:32:47 PM Pacific Daylight Time	08/03/2021 03:03:58 PM Pacific Daylight Time	08/03/2021 03:03:58 PM Pacific Daylight Time			08/04/2021 10:54:45 AM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare	Anthem MediBlue Select (HMO)	01	01		1			H0544	098	0	2022	Alameda County		2		2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare	(888)230-7338		(888)230-7338		(855)593-0898		(855)593-0898		(833)293-5470		(833)293-5470		(855)948-5570		(855)948-5570		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	099	0	1	01	01	H0544_099_0	8	1			2		0	07/17/2021	2022.01	07/17/2021 07:51:41 PM Pacific Daylight Time	08/03/2021 03:03:58 PM Pacific Daylight Time	08/03/2021 03:03:59 PM Pacific Daylight Time			08/04/2021 10:54:45 AM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare	Anthem MediBlue Coordination Plus (HMO)	01	01		1			H0544	099	0	2022	Alameda and San Mateo Counties		2		2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare	(888)230-7338		(888)230-7338		(855)593-0898		(855)593-0898		(833)293-5470		(833)293-5470		(855)948-5570		(855)948-5570		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	100	0	1	01	01	H0544_100_0	6	1	2	1	2		0	07/19/2021	2022.01	07/19/2021 03:33:58 PM Eastern Daylight Time	08/03/2021 06:03:57 PM Eastern Daylight Time	08/03/2021 06:03:57 PM Eastern Daylight Time			08/04/2021 03:50:55 PM Eastern Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare	Anthem MediBlue Dual Advantage (HMO D-SNP)	01	01		1			H0544	100	0	2022	San Joaquin County		2		2			1	3		2		2	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare	(844)286-1322		(844)286-1322		(855)593-0899		(855)593-0899		(833)293-5467		(833)293-5467		(855)948-5571		(855)948-5571		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	101	0	1	01	01	H0544_101_0	8	1		1	2		0	07/14/2021	2022.01	07/14/2021 06:03:25 PM Pacific Daylight Time	08/03/2021 03:03:57 PM Pacific Daylight Time	08/03/2021 03:03:57 PM Pacific Daylight Time			08/04/2021 10:20:02 AM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare	Anthem MediBlue Lung Care (HMO C-SNP)	01	01		1			H0544	101	0	2022	Santa Clara County		2		2			1	4			00000000000100000000		https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare	(800)499-2793		(800)499-2793		(855)593-0901		(855)593-0901		(833)293-5467		(833)293-5467		(855)948-5572		(855)948-5572		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	102	0	1	01	01	H0544_102_0	7	1		1	2		1	07/14/2021	2022.01	07/14/2021 06:03:48 PM Pacific Daylight Time	08/03/2021 03:03:57 PM Pacific Daylight Time	08/03/2021 03:03:57 PM Pacific Daylight Time			08/04/2021 10:20:02 AM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare	Anthem MediBlue Diabetes Care (HMO C-SNP)	01	01		1			H0544	102	0	2022	Santa Clara County		2		2			1	4			00000010000000000000		https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare	(800)499-2793		(800)499-2793		(855)593-0901		(855)593-0901		(833)293-5467		(833)293-5467		(855)948-5572		(855)948-5572		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	103	0	1	01	01	H0544_103_0	8	1		1	2		0	07/14/2021	2022.01	07/14/2021 06:05:03 PM Pacific Daylight Time	08/03/2021 03:03:57 PM Pacific Daylight Time	08/03/2021 03:03:57 PM Pacific Daylight Time			08/04/2021 10:20:02 AM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare	Anthem MediBlue Lung Care (HMO C-SNP)	01	01		1			H0544	103	0	2022	Stanislaus County		2		2			1	4			00000000000100000000		https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare	(800)499-2793		(800)499-2793		(855)593-0901		(855)593-0901		(833)293-5467		(833)293-5467		(855)948-5572		(855)948-5572		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	104	0	1	01	01	H0544_104_0	7	1		1	2		1	06/04/2021	2022.01	06/04/2021 08:21:10 AM Pacific Daylight Time	08/03/2021 03:03:57 PM Pacific Daylight Time	08/03/2021 03:03:57 PM Pacific Daylight Time			08/04/2021 10:20:02 AM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare	Anthem MediBlue Diabetes Care (HMO C-SNP)	01	01		1			H0544	104	0	2022	Stanislaus County		2		2			1	4			00000010000000000000		https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare	(800)499-2793		(800)499-2793		(855)593-0901		(855)593-0901		(833)293-5467		(833)293-5467		(855)948-5572		(855)948-5572		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	105	0	1	01	01	H0544_105_0	8	1		1	2		0	06/02/2021	2022.01	06/02/2021 11:20:59 PM Pacific Daylight Time	08/03/2021 03:03:57 PM Pacific Daylight Time	08/03/2021 03:03:57 PM Pacific Daylight Time			08/04/2021 10:20:02 AM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare	Anthem MediBlue Heart Care (HMO C-SNP)	01	01		1			H0544	105	0	2022	Stanislaus County		2		2			1	4			00000000000000010000		https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare	(800)499-2793		(800)499-2793		(855)593-0901		(855)593-0901		(833)293-5467		(833)293-5467		(855)948-5572		(855)948-5572		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	106	0	1	01	01	H0544_106_0	8	1		1	2		0	07/14/2021	2022.01	07/14/2021 06:05:33 PM Pacific Daylight Time	08/03/2021 03:03:57 PM Pacific Daylight Time	08/03/2021 03:03:57 PM Pacific Daylight Time			08/04/2021 10:20:02 AM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare	Anthem MediBlue Heart Care (HMO C-SNP)	01	01		1			H0544	106	0	2022	Santa Clara County		2		2			1	4			00000000000000010000		https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare	(800)499-2793		(800)499-2793		(855)593-0901		(855)593-0901		(833)293-5467		(833)293-5467		(855)948-5572		(855)948-5572		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	107	0	1	01	01	H0544_107_0	8	1			2		0	06/03/2021	2022.01	06/03/2021 10:55:14 PM Pacific Daylight Time	08/03/2021 03:03:57 PM Pacific Daylight Time	08/03/2021 03:03:57 PM Pacific Daylight Time			08/04/2021 10:20:02 AM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare	Anthem MediBlue Value (HMO)	01	01		1			H0544	107	0	2022	Stanislaus County		2		2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare	(800)499-2793		(800)499-2793		(855)593-0898		(855)593-0898		(833)293-5470		(833)293-5470		(855)948-5570		(855)948-5570		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	108	0	1	01	01	H0544_108_0	6	1			2		0	06/02/2021	2022.01	06/02/2021 04:33:06 PM Pacific Daylight Time	08/03/2021 03:03:59 PM Pacific Daylight Time	08/03/2021 03:03:59 PM Pacific Daylight Time			08/04/2021 10:54:45 AM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare	Anthem MediBlue Plus (HMO)	01	01		1			H0544	108	0	2022	Santa Clara County		2		2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare	(888)230-7338		(888)230-7338		(855)593-0898		(855)593-0898		(833)293-5470		(833)293-5470		(855)948-5570		(855)948-5570		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	110	0	1	01	01	H0544_110_0	6	1			2		0	07/17/2021	2022.01	07/17/2021 07:52:11 PM Pacific Daylight Time	08/03/2021 03:03:59 PM Pacific Daylight Time	08/03/2021 03:03:59 PM Pacific Daylight Time			08/04/2021 10:54:45 AM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare	Anthem MediBlue Coordination Plus (HMO)	01	01		1			H0544	110	0	2022	Santa Clara County		2		2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare	(888)230-7338		(888)230-7338		(855)593-0898		(855)593-0898		(833)293-5470		(833)293-5470		(855)948-5570		(855)948-5570		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	117	1	1	01	01	H0544_117_1	7	1		1	2		0	07/14/2021	2022.01	07/14/2021 06:06:22 PM Pacific Daylight Time	08/03/2021 03:03:57 PM Pacific Daylight Time	08/03/2021 03:03:57 PM Pacific Daylight Time			08/04/2021 10:20:02 AM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare	Anthem MediBlue Lung (HMO C-SNP)	01	01		1			H0544	117	1	2022	Santa Clara and San Benito Counties	Santa Clara County	2		2			1	4			00000000000100000000		https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare	(800)499-2793		(800)499-2793		(855)593-0901		(855)593-0901		(833)293-5467		(833)293-5467		(855)948-5572		(855)948-5572		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	117	2	1	01	01	H0544_117_2	7	1		1	2		0	07/14/2021	2022.01	07/14/2021 06:06:52 PM Pacific Daylight Time	08/03/2021 03:03:57 PM Pacific Daylight Time	08/03/2021 03:03:57 PM Pacific Daylight Time			08/04/2021 10:20:02 AM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare	Anthem MediBlue Lung (HMO C-SNP)	01	01		1			H0544	117	2	2022	Santa Clara and San Benito Counties	San Benito County	2		2			1	4			00000000000100000000		https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare	(800)499-2793		(800)499-2793		(855)593-0901		(855)593-0901		(833)293-5467		(833)293-5467		(855)948-5572		(855)948-5572		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	118	1	1	01	01	H0544_118_1	7	1		1	2		1	07/14/2021	2022.01	07/14/2021 06:07:16 PM Pacific Daylight Time	08/03/2021 03:03:57 PM Pacific Daylight Time	08/03/2021 03:03:57 PM Pacific Daylight Time			08/04/2021 10:20:02 AM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare	Anthem MediBlue Diabetes (HMO C-SNP)	01	01		1			H0544	118	1	2022	Santa Clara and San Benito Counties	San Benito County	2		2			1	4			00000010000000000000		https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare	(800)499-2793		(800)499-2793		(855)593-0901		(855)593-0901		(833)293-5467		(833)293-5467		(855)948-5572		(855)948-5572		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	118	2	1	01	01	H0544_118_2	7	1		1	2		1	07/14/2021	2022.01	07/14/2021 06:07:42 PM Pacific Daylight Time	08/03/2021 03:03:57 PM Pacific Daylight Time	08/03/2021 03:03:57 PM Pacific Daylight Time			08/04/2021 10:20:02 AM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare	Anthem MediBlue Diabetes (HMO C-SNP)	01	01		1			H0544	118	2	2022	Santa Clara and San Benito Counties	Santa Clara County	2		2			1	4			00000010000000000000		https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare	(800)499-2793		(800)499-2793		(855)593-0901		(855)593-0901		(833)293-5467		(833)293-5467		(855)948-5572		(855)948-5572		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	119	1	1	01	01	H0544_119_1	8	1		1	2		0	07/14/2021	2022.01	07/14/2021 06:08:05 PM Pacific Daylight Time	08/03/2021 03:03:57 PM Pacific Daylight Time	08/03/2021 03:03:57 PM Pacific Daylight Time			08/04/2021 10:20:02 AM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare	Anthem MediBlue Heart (HMO C-SNP)	01	01		1			H0544	119	1	2022	Santa Clara and San Benito Counties	San Benito County	2		2			1	4			00000000000000010000		https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare	(800)499-2793		(800)499-2793		(855)593-0901		(855)593-0901		(833)293-5467		(833)293-5467		(855)948-5572		(855)948-5572		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	119	2	1	01	01	H0544_119_2	8	1		1	2		0	07/14/2021	2022.01	07/14/2021 06:08:32 PM Pacific Daylight Time	08/03/2021 03:03:57 PM Pacific Daylight Time	08/03/2021 03:03:57 PM Pacific Daylight Time			08/04/2021 10:20:02 AM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare	Anthem MediBlue Heart (HMO C-SNP)	01	01		1			H0544	119	2	2022	Santa Clara and San Benito Counties	Santa Clara County	2		2			1	4			00000000000000010000		https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare	(800)499-2793		(800)499-2793		(855)593-0901		(855)593-0901		(833)293-5467		(833)293-5467		(855)948-5572		(855)948-5572		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	120	1	1	01	01	H0544_120_1	8	1			2		0	07/14/2021	2022.01	07/14/2021 06:09:03 PM Pacific Daylight Time	08/03/2021 03:03:57 PM Pacific Daylight Time	08/03/2021 03:03:57 PM Pacific Daylight Time			08/04/2021 10:20:02 AM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare	Anthem MediBlue Value Plus (HMO)	01	01		1			H0544	120	1	2022	Santa Clara and San Benito Counties	San Benito County	2		2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare	(800)499-2793		(800)499-2793		(855)593-0898		(855)593-0898		(833)293-5467		(833)293-5467		(855)948-5570		(855)948-5570		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	120	2	1	01	01	H0544_120_2	8	1			2		0	07/14/2021	2022.01	07/14/2021 06:09:29 PM Pacific Daylight Time	08/03/2021 03:03:57 PM Pacific Daylight Time	08/03/2021 03:03:57 PM Pacific Daylight Time			08/04/2021 10:20:02 AM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare	Anthem MediBlue Value Plus (HMO)	01	01		1			H0544	120	2	2022	Santa Clara and San Benito Counties	Santa Clara County	2		2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare	(800)499-2793		(800)499-2793		(855)593-0898		(855)593-0898		(833)293-5467		(833)293-5467		(855)948-5570		(855)948-5570		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	121	1	1	01	01	H0544_121_1	10	1			2		0	07/14/2021	2022.01	07/14/2021 06:13:25 PM Pacific Daylight Time	08/03/2021 03:03:57 PM Pacific Daylight Time	08/03/2021 03:03:57 PM Pacific Daylight Time			08/04/2021 10:20:02 AM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare	Anthem MediBlue StartSmart Plus (HMO)	01	01		1			H0544	121	1	2022	Select counties in California	San Benito County	2		2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare	(800)499-2793		(800)499-2793		(855)593-0898		(855)593-0898		(833)293-5467		(833)293-5467		(855)948-5570		(855)948-5570		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	121	2	1	01	01	H0544_121_2	8	1			2		0	07/14/2021	2022.01	07/14/2021 06:13:51 PM Pacific Daylight Time	08/03/2021 03:03:57 PM Pacific Daylight Time	08/03/2021 03:03:57 PM Pacific Daylight Time			08/04/2021 10:20:02 AM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare	Anthem MediBlue StartSmart Plus (HMO)	01	01		1			H0544	121	2	2022	Select counties in California	Santa Clara and Stanislaus Counties	2		2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare	(800)499-2793		(800)499-2793		(855)593-0898		(855)593-0898		(833)293-5467		(833)293-5467		(855)948-5570		(855)948-5570		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	125	0	1	01	01	H0544_125_0	6	1	2	1	1		0	07/19/2021	2022.01	07/19/2021 03:09:34 PM Eastern Daylight Time	08/03/2021 06:03:57 PM Eastern Daylight Time	08/03/2021 06:03:57 PM Eastern Daylight Time			08/04/2021 03:50:55 PM Eastern Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare	Anthem MediBlue Dual Advantage (HMO D-SNP)	01	01		1			H0544	125	0	2022	Alemeda County		2		2			1	3		2		2	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare	(844)286-1322		(844)286-1322		(855)593-0899		(855)593-0899		(833)293-5467		(833)293-5467		(855)948-5571		(855)948-5571		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	126	0	1	01	01	H0544_126_0	6	1	2	1	2		0	07/29/2021	2022.01	07/29/2021 04:18:42 PM Eastern Daylight Time	08/03/2021 06:03:57 PM Eastern Daylight Time	08/03/2021 06:03:58 PM Eastern Daylight Time			08/04/2021 03:50:55 PM Eastern Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare	Anthem MediBlue Connect (HMO D-SNP)	01	01		1			H0544	126	0	2022	Stanislaus and San Benito Counties		2		2			1	3		2		2	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare	(844)286-1322		(844)286-1322		(855)593-0899		(855)593-0899		(833)293-5467		(833)293-5467		(855)948-5571		(855)948-5571		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	127	0	1	01	01	H0544_127_0	6	1			2		0	06/02/2021	2022.01	06/02/2021 04:52:15 PM Pacific Daylight Time	08/03/2021 03:03:59 PM Pacific Daylight Time	08/03/2021 03:03:59 PM Pacific Daylight Time			08/04/2021 10:54:45 AM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare	Anthem MediBlue Plus (HMO)	01	01		1			H0544	127	0	2022	Riverside and San Bernardino Counties		2		2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare	(888)230-7338		(888)230-7338		(855)593-0898		(855)593-0898		(833)293-5470		(833)293-5470		(855)948-5570		(855)948-5570		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	128	0	1	01	01	H0544_128_0	10	1			2		0	07/18/2021	2022.01	07/18/2021 10:58:53 AM Pacific Daylight Time	08/03/2021 03:03:57 PM Pacific Daylight Time	08/03/2021 03:03:57 PM Pacific Daylight Time			08/04/2021 10:20:02 AM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare	Anthem MediBlue Connect Plus (HMO)	01	01		1			H0544	128	0	2022	Select counties in California		2		2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare	(800)499-2793		(800)499-2793		(855)593-0898		(855)593-0898		(833)293-5467		(833)293-5467		(855)948-5570		(855)948-5570		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	129	0	1	01	01	H0544_129_0	7	1	2	1	2		0	07/19/2021	2022.01	07/19/2021 03:09:42 PM Eastern Daylight Time	08/03/2021 06:03:58 PM Eastern Daylight Time	08/03/2021 06:03:58 PM Eastern Daylight Time			08/04/2021 03:50:55 PM Eastern Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare	Anthem MediBlue Dual Advantage (HMO D-SNP)	01	01		1			H0544	129	0	2022	Los Angeles County		2		2			1	3		2		2	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare	(844)286-1322		(844)286-1322		(855)593-0899		(855)593-0899		(833)293-5467		(833)293-5467		(855)948-5571		(855)948-5571		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	130	0	1	01	01	H0544_130_0	7	1	2	1	2		0	07/19/2021	2022.01	07/19/2021 03:13:37 PM Eastern Daylight Time	08/03/2021 06:03:58 PM Eastern Daylight Time	08/03/2021 06:03:58 PM Eastern Daylight Time			08/04/2021 03:50:55 PM Eastern Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare	Anthem MediBlue Dual Advantage (HMO D-SNP)	01	01		1			H0544	130	0	2022	Santa Clara County		2		2			1	3		2		2	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare	(844)286-1322		(844)286-1322		(855)593-0899		(855)593-0899		(833)293-5467		(833)293-5467		(855)948-5571		(855)948-5571		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	801	0	1	01	01	H0544_801_0	1	1				0	0	06/03/2021	2022.01	06/03/2021 09:44:14 AM Pacific Daylight Time					06/04/2021 10:02:43 AM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	www.anthem.com/ca/medicare	Anthem EGWP (HMO)	01	01		1			H0544	801	0	2022	California		1	600	2			2						www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	www.anthem.com/ca/medicare			(833)848-8730		(844)309-6996		(844)309-6996										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	1	6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;14d;14e1;14e2;14e3;14e4;14e5;18a;	1					1				
H0544	802	0	1	01	01	H0544_802_0	1	1						06/04/2021	2022.01	06/04/2021 10:00:37 AM Pacific Daylight Time					06/04/2021 10:02:43 AM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	www.anthem.com/ca/medicare	Anthem EGWP MAPD (HMO)	01	01		1			H0544	802	0	2022	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		(833)848-8730		(833)848-8730		(833)279-0467		(833)279-0467		(833)848-8730		(833)848-8730		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	1	6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;14d;14e1;14e2;14e3;14e4;14e5;18a;	1					1				
H0544	805	0	1	01	01	H0544_805_0	1	1						06/04/2021	2022.01	06/04/2021 10:01:00 AM Pacific Daylight Time					06/04/2021 10:02:43 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	2022	California, select counties		1	10911	2			2						www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)279-0467		(833)279-0467		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	1	6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;14d;14e1;14e2;14e3;14e4;14e5;18a;	1					1				
H0544	806	0	1	01	01	H0544_806_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 03:37:51 PM Pacific Daylight Time					06/04/2021 10:02:43 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	2022	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		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	1	6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;14d;14e1;14e2;14e3;14e4;14e5;18a;	1					1				
H0544	808	0	2	01	01	H0544_808_0	1	1						06/02/2021	2022.01	06/02/2021 03:38:21 PM Pacific Daylight Time					06/04/2021 10:02:43 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	2022	Select counties in California		1	36	2			2						www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)279-0467		(833)279-0467		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	1	6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;14d;14e1;14e2;14e3;14e4;14e5;18a;	1					1				
H0544	809	0	2	01	01	H0544_809_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 03:38:33 PM Pacific Daylight Time					06/04/2021 10:02:43 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	2022	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		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	1	6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;14d;14e1;14e2;14e3;14e4;14e5;18a;	1					1				
H0544	810	0	1	01	01	H0544_810_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 03:38:45 PM Pacific Daylight Time					06/04/2021 10:02:43 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	2022	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		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	1	6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;14d;14e1;14e2;14e3;14e4;14e5;18a;	1					1				
H0544	812	0	2	01	01	H0544_812_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 03:39:08 PM Pacific Daylight Time					06/04/2021 10:02:43 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	2022	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		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	1	6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;14d;14e1;14e2;14e3;14e4;14e5;18a;	1					1				
H0545	001	0	1	01	01	H0545_001_0	5	1					1	08/04/2021	2022.01	08/04/2021 01:03:27 PM Pacific Daylight Time	08/04/2021 04:30:14 PM Pacific Daylight Time	08/04/2021 04:30:14 PM Pacific Daylight Time			08/04/2021 04:39:05 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	2022	Counties: LA, RV, OC and SB		2	151955	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	5	1					1	07/12/2021	2022.01	07/12/2021 02:09:52 PM Pacific Daylight Time	08/04/2021 04:30:14 PM Pacific Daylight Time	08/04/2021 04:30:14 PM Pacific Daylight Time			08/04/2021 04:39:05 PM 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	2022	Riverside County		2	62400	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	015	0	1	01	01	H0545_015_0	4	1					0	06/07/2021	2022.01	06/07/2021 02:40:50 PM Pacific Daylight Time	08/04/2021 04:30:15 PM Pacific Daylight Time	08/04/2021 04:30:15 PM Pacific Daylight Time			08/04/2021 04:39:05 PM Pacific Daylight Time	INTER VALLEY HEALTH PLAN, INC.	Inter Valley Health Plan	www.ivhp.com	Inter Valley Health Plan Vitality Plus (HMO)	01	01		1			H0545	015	0	2022	LA, San Bernardino, Riverside and Orange Counties		2	3456	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						05/10/2021	2022.01	05/10/2021 05:03:49 PM Pacific Daylight Time					06/02/2021 01:11:51 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	2022	Counties: LA, OC, RV SB		1	600	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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H0545	802	0	1	01	01	H0545_802_0	1	1						06/02/2021	2022.01	06/02/2021 12:47:38 PM Pacific Daylight Time					06/02/2021 01:11:51 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	2022	Counties: LA, OC, RV SB		1	600	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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H0562	009	0	1	01	01	H0562_009_0	4	1					0	07/16/2021	2022.01	07/16/2021 04:50:33 PM Eastern Daylight Time	08/03/2021 10:26:37 PM Eastern Daylight Time	07/30/2021 09:00:55 AM Eastern Daylight Time			08/04/2021 11:49:10 PM Eastern Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net	www.wellcare.com/healthnetCA	Wellcare Premium Ultra (HMO)	01	01		1			H0562	009	0	2022	Select counties in CA		2	41726	2			2						www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	(800)275-4737		(800)275-4737		(866)277-6583		(866)277-6583		(800)275-4737		(800)275-4737		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	012	0	1	01	01	H0562_012_0	4	1					0	08/02/2021	2022.01	08/02/2021 08:55:33 PM Eastern Daylight Time	08/03/2021 10:27:05 PM Eastern Daylight Time	07/30/2021 09:01:49 AM Eastern Daylight Time			08/04/2021 11:49:10 PM Eastern Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net	www.wellcare.com/healthnetCA	Wellcare No Premium (HMO)	01	01		1			H0562	012	0	2022	Select counties in CA		2	25712	2			2						www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	(800)275-4737		(800)275-4737		(866)277-6583		(866)277-6583		(800)275-4737		(800)275-4737		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	039	0	1	01	01	H0562_039_0	4	1					0	07/16/2021	2022.01	07/16/2021 05:14:40 PM Eastern Daylight Time	08/03/2021 10:27:35 PM Eastern Daylight Time	07/30/2021 09:02:43 AM Eastern Daylight Time			08/04/2021 11:49:10 PM Eastern Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net	www.wellcare.com/healthnetCA	Wellcare Premium Enhanced (HMO)	01	01		1			H0562	039	0	2022	Select counties in CA		2	10235	2			2						www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	(800)275-4737		(800)275-4737		(866)277-6583		(866)277-6583		(800)275-4737		(800)275-4737		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	044	0	1	01	01	H0562_044_0	4	1				0	0	07/16/2021	2022.01	07/16/2021 04:58:31 PM Eastern Daylight Time	06/06/2021 12:27:42 PM Eastern Daylight Time				07/19/2021 04:30:56 PM Eastern Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net	www.wellcare.com/healthnetCA	Wellcare Patriot Giveback (HMO)	01	01		1			H0562	044	0	2022	Select counties in CA		2	5367	2			2						www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	(800)275-4737		(800)275-4737		(866)277-6583		(866)277-6583										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H0562	079	0	1	01	01	H0562_079_0	4	1					0	08/02/2021	2022.01	08/02/2021 08:59:55 PM Eastern Daylight Time	08/03/2021 10:28:34 PM Eastern Daylight Time	07/30/2021 09:03:30 AM Eastern Daylight Time			08/04/2021 11:49:10 PM Eastern Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net	www.wellcare.com/healthnetCA	Wellcare No Premium Ruby (HMO)	01	01		1			H0562	079	0	2022	Select counties in CA		2	47187	2			2						www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	(800)275-4737		(800)275-4737		(866)277-6583		(866)277-6583		(800)275-4737		(800)275-4737		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	084	0	1	01	01	H0562_084_0	4	1					0	07/16/2021	2022.01	07/16/2021 05:17:21 PM Eastern Daylight Time	08/03/2021 10:29:02 PM Eastern Daylight Time	07/30/2021 09:04:15 AM Eastern Daylight Time			08/04/2021 11:49:10 PM Eastern Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net	www.wellcare.com/healthnetCA	Wellcare Premium Ultra (HMO)	01	01		1			H0562	084	0	2022	Select counties in CA		2	20964	2			2						www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	(800)275-4737		(800)275-4737		(866)277-6583		(866)277-6583		(800)275-4737		(800)275-4737		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	090	0	1	01	01	H0562_090_0	4	1					0	08/02/2021	2022.01	08/02/2021 09:07:30 PM Eastern Daylight Time	08/03/2021 10:29:31 PM Eastern Daylight Time	07/30/2021 09:05:03 AM Eastern Daylight Time			08/04/2021 11:49:10 PM Eastern Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net	www.wellcare.com/healthnetCA	Wellcare No Premium (HMO)	01	01		1			H0562	090	0	2022	Select counties in CA		2	37838	2			2						www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	(800)275-4737		(800)275-4737		(866)277-6583		(866)277-6583		(800)275-4737		(800)275-4737		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	092	0	1	01	01	H0562_092_0	4	1		1			1	08/02/2021	2022.01	08/02/2021 09:14:32 PM Eastern Daylight Time	08/03/2021 10:29:58 PM Eastern Daylight Time	07/30/2021 09:05:52 AM Eastern Daylight Time			08/04/2021 11:49:10 PM Eastern Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net	www.wellcare.com/healthnetCA	Wellcare Specialty No Premium (HMO C-SNP)	01	01		1			H0562	092	0	2022	Select counties in CA		2	57260	2			1	4			00000000000000000010		www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	(800)275-4737		(800)275-4737		(866)277-6583		(866)277-6583		(800)275-4737		(800)275-4737		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	097	0	1	01	01	H0562_097_0	4	1					0	08/02/2021	2022.01	08/02/2021 09:15:44 PM Eastern Daylight Time	08/03/2021 10:30:27 PM Eastern Daylight Time	07/30/2021 09:54:18 AM Eastern Daylight Time			08/04/2021 11:49:10 PM Eastern Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net	www.wellcare.com/healthnetCA	Wellcare No Premium (HMO)	01	01		1			H0562	097	0	2022	Select counties in CA		2	28208	2			2						www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	(800)275-4737		(800)275-4737		(866)277-6583		(866)277-6583		(800)275-4737		(800)275-4737		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	103	0	1	01	01	H0562_103_0	4	1					0	08/03/2021	2022.01	08/03/2021 12:41:47 PM Eastern Daylight Time	08/04/2021 03:17:36 PM Eastern Daylight Time	07/30/2021 09:54:40 AM Eastern Daylight Time			08/04/2021 11:49:10 PM Eastern Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net	www.wellcare.com/healthnetCA	Wellcare No Premium (HMO)	01	01		1			H0562	103	0	2022	Select counties in CA		2	17975	2			2						www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	(800)275-4737		(800)275-4737		(866)277-6583		(866)277-6583		(800)275-4737		(800)275-4737		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	113	0	1	01	01	H0562_113_0	4	1					0	08/02/2021	2022.01	08/02/2021 09:17:25 PM Eastern Daylight Time	08/03/2021 10:31:27 PM Eastern Daylight Time	07/30/2021 09:55:00 AM Eastern Daylight Time			08/04/2021 11:49:10 PM Eastern Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net	www.wellcare.com/healthnetCA	Wellcare No Premium (HMO)	01	01		1			H0562	113	0	2022	Select counties in CA		2	44532	2			2						www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	(800)275-4737		(800)275-4737		(866)277-6583		(866)277-6583		(800)275-4737		(800)275-4737		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	114	0	1	01	01	H0562_114_0	5	1		1			1	08/02/2021	2022.01	08/02/2021 09:18:28 PM Eastern Daylight Time	08/03/2021 10:31:56 PM Eastern Daylight Time	07/30/2021 09:55:30 AM Eastern Daylight Time			08/04/2021 11:49:10 PM Eastern Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net	www.wellcare.com/healthnetCA	Wellcare Specialty No Premium (HMO C-SNP)	01	01		1			H0562	114	0	2022	Select counties in CA		2	3802	2			1	4			00000000000000000010		www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	(800)275-4737		(800)275-4737		(866)277-6583		(866)277-6583		(800)275-4737		(800)275-4737		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	118	0	1	01	01	H0562_118_0	4	1		1			1	08/02/2021	2022.01	08/02/2021 09:18:55 PM Eastern Daylight Time	08/03/2021 10:32:23 PM Eastern Daylight Time	07/30/2021 09:55:54 AM Eastern Daylight Time			08/04/2021 11:49:10 PM Eastern Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net	www.wellcare.com/healthnetCA	Wellcare Specialty No Premium (HMO C-SNP)	01	01		1			H0562	118	0	2022	Select counties in CA		2	6556	2			1	4			00000000000000000010		www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	(800)275-4737		(800)275-4737		(866)277-6583		(866)277-6583		(800)275-4737		(800)275-4737		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	120	0	1	01	01	H0562_120_0	4	1					0	08/02/2021	2022.01	08/02/2021 09:19:35 PM Eastern Daylight Time	08/03/2021 10:32:52 PM Eastern Daylight Time	07/30/2021 09:56:58 AM Eastern Daylight Time			08/04/2021 11:49:10 PM Eastern Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net	www.wellcare.com/healthnetCA	Wellcare No Premium (HMO)	01	01		1			H0562	120	0	2022	Select counties in CA		2	8204	2			2						www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	(800)275-4737		(800)275-4737		(866)277-6583		(866)277-6583		(800)275-4737		(800)275-4737		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	121	0	1	01	01	H0562_121_0	4	1	2	1			0	08/02/2021	2022.01	08/02/2021 09:27:38 PM Eastern Daylight Time	08/03/2021 10:33:21 PM Eastern Daylight Time	07/30/2021 09:57:48 AM Eastern Daylight Time			08/04/2021 11:49:10 PM Eastern Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net	www.wellcare.com/healthnetCA	Wellcare Dual Liberty (HMO D-SNP)	01	01		1			H0562	121	0	2022	Select counties in CA		2	46517	2			1	3		1		1	www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	(800)275-4737		(800)275-4737		(866)277-6583		(866)277-6583		(800)275-4737		(800)275-4737		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	122	0	1	01	01	H0562_122_0	4	1					0	08/02/2021	2022.01	08/02/2021 09:27:59 PM Eastern Daylight Time	08/03/2021 10:33:48 PM Eastern Daylight Time	07/30/2021 09:58:08 AM Eastern Daylight Time			08/04/2021 11:49:10 PM Eastern Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net	www.wellcare.com/healthnetCA	Wellcare Plus Sapphire I (HMO)	01	01		1			H0562	122	0	2022	Select counties in CA		2	55371	2			2						www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	(800)275-4737		(800)275-4737		(866)277-6583		(866)277-6583		(800)275-4737		(800)275-4737		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	123	0	1	01	01	H0562_123_0	4	1					0	07/16/2021	2022.01	07/16/2021 05:10:24 PM Eastern Daylight Time	08/03/2021 10:34:19 PM Eastern Daylight Time	07/30/2021 09:58:28 AM Eastern Daylight Time			08/04/2021 11:49:10 PM Eastern Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net	www.wellcare.com/healthnetCA	Wellcare Low Premium (HMO)	01	01		1			H0562	123	0	2022	Select counties in CA		2	64284	2			2						www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	(800)275-4737		(800)275-4737		(866)277-6583		(866)277-6583		(800)275-4737		(800)275-4737		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	124	0	1	01	01	H0562_124_0	4	1					0	08/02/2021	2022.01	08/02/2021 09:20:50 PM Eastern Daylight Time	08/03/2021 10:34:51 PM Eastern Daylight Time	07/30/2021 09:58:52 AM Eastern Daylight Time			08/04/2021 11:49:10 PM Eastern Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net	www.wellcare.com/healthnetCA	Wellcare No Premium (HMO)	01	01		1			H0562	124	0	2022	Select counties in CA		2	22193	2			2						www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	(800)275-4737		(800)275-4737		(866)277-6583		(866)277-6583		(800)275-4737		(800)275-4737		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	125	0	1	01	01	H0562_125_0	4	1					0	08/02/2021	2022.01	08/02/2021 09:21:19 PM Eastern Daylight Time	08/03/2021 10:35:25 PM Eastern Daylight Time	07/30/2021 09:59:16 AM Eastern Daylight Time			08/04/2021 11:49:10 PM Eastern Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net	www.wellcare.com/healthnetCA	Wellcare No Premium (HMO)	01	01		1			H0562	125	0	2022	Select counties in CA		2	209093	2			2						www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	(800)275-4737		(800)275-4737		(866)277-6583		(866)277-6583		(800)275-4737		(800)275-4737		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	126	0	1	01	01	H0562_126_0	4	1					0	08/02/2021	2022.01	08/02/2021 09:28:40 PM Eastern Daylight Time	08/03/2021 10:35:51 PM Eastern Daylight Time	07/30/2021 09:59:38 AM Eastern Daylight Time			08/04/2021 11:49:10 PM Eastern Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net	www.wellcare.com/healthnetCA	Wellcare No Premium (HMO)	01	01		1			H0562	126	0	2022	Select counties in CA		2	172068	2			2						www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	(800)275-4737		(800)275-4737		(866)277-6583		(866)277-6583		(800)275-4737		(800)275-4737		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	127	0	1	01	01	H0562_127_0	4	1					0	06/04/2021	2022.01	06/04/2021 01:08:41 PM Eastern Daylight Time	08/04/2021 03:18:04 PM Eastern Daylight Time	07/30/2021 10:00:00 AM Eastern Daylight Time			08/04/2021 11:49:10 PM Eastern Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net	www.wellcare.com/healthnetCA	Wellcare Assist (HMO)	01	01		1			H0562	127	0	2022	Select counties in CA		2	2191	2			2						www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	(800)275-4737		(800)275-4737		(866)277-6583		(866)277-6583		(800)275-4737		(800)275-4737		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	801	0	1	01	01	H0562_801_0	2	1						05/03/2021	2022.01	05/03/2021 02:17:52 PM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Wellcare by Health Net	healthnet.com	Health Net Seniority Plus Employer (HMO)	01	01		1			H0562	801	0	2022	California		1	55000	2			2						ca.healthnetadvantage.com/findadoctor	ca.healthnetadvantage.com/formulary	ca.healthnetadvantage.com/findadoctor	(800)275-4737		(800)275-4737		(844)942-0039		(844)942-0039		(800)275-4737		(800)275-4737		(844)942-0039		(844)942-0039		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H0562	803	0	1	01	01	H0562_803_0	2	1				0	0	05/03/2021	2022.01	05/03/2021 02:20:36 PM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Wellcare by Health Net	healthnet.com	Health Net Seniority Plus Employer (HMO)	01	01		1			H0562	803	0	2022	California		1	53200	2			2						ca.healthnetadvantage.com/findadoctor	ca.healthnetadvantage.com/formulary	ca.healthnetadvantage.com/findadoctor	(800)275-4737		(800)275-4737		(844)942-0039		(844)942-0039										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H0562	804	0	1	01	01	H0562_804_0	2	1						05/03/2021	2022.01	05/03/2021 02:20:47 PM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Wellcare by Health Net	healthnet.com	Health Net Seniority Plus Employer (HMO)	01	01		1			H0562	804	0	2022	California		1	20200	2			2						ca.healthnetadvantage.com/findadoctor	ca.healthnetadvantage.com/formulary	ca.healthnetadvantage.com/findadoctor	(800)275-4737		(800)275-4737		(844)942-0039		(844)942-0039		(800)275-4737		(800)275-4737		(844)942-0039		(844)942-0039		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H0571	001	0	1	01	01	H0571_001_0	8	1					1	08/12/2021	2022.01	08/12/2021 05:43:55 PM Eastern Daylight Time	08/05/2021 12:12:03 AM Eastern Daylight Time	08/05/2021 04:44:56 PM Eastern Daylight Time			08/12/2021 05:56:19 PM Eastern Daylight Time	CHINESE COMMUNITY HEALTH PLAN	Chinese Community Health Plan	www.cchphealthplan.com/medicare	CCHP Senior Program (HMO)	01	01		1			H0571	001	0	2022	San Francisco and San Mateo Counties		2	25756	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)955-8831		(888)775-7888		(415)834-2118		(888)681-3888		(415)955-8831		(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	7	1	2	1			0	06/07/2021	2022.01	06/07/2021 12:45:12 PM Eastern Daylight Time	08/04/2021 11:53:43 PM Eastern Daylight Time	08/05/2021 04:45:15 PM Eastern Daylight Time			08/05/2021 04:52:10 PM Eastern Daylight Time	CHINESE COMMUNITY HEALTH PLAN	Chinese Community Health Plan	www.cchphealthplan.com/medicare	CCHP Senior Select Program (HMO D-SNP)	01	01		1			H0571	005	0	2022	San Francisco County		2	33368	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)955-8831		(888)775-7888		(415)834-2118		(888)681-3888		(415)955-8831		(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			
H0571	007	0	1	01	01	H0571_007_0	9	1					1	08/12/2021	2022.01	08/12/2021 05:39:14 PM Eastern Daylight Time	08/04/2021 11:54:17 PM Eastern Daylight Time	08/05/2021 04:45:34 PM Eastern Daylight Time			08/12/2021 05:56:19 PM Eastern Daylight Time	CHINESE COMMUNITY HEALTH PLAN	Chinese Community Health Plan	www.cchphealthplan.com/medicare	CCHP Senior Value Program (HMO)	01	01		1			H0571	007	0	2022	San Francisco and San Mateo Counties		2	25756	2			2						https://cchphealthplan.com/medicare-member/	https://cchphealthplan.com/medicare-rx	https://cchphealthplan.com/find-a-provider	(888)775-7888		(415)834-2118		(888)681-3888		(415)955-8831		(888)775-7888		(415)834-2118		(888)681-3888		(415)955-8831		(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;	
H0609	007	0	1	01	01	H0609_007_0	3	1					1	08/04/2021	2022.01	08/04/2021 09:33:44 AM Central Daylight Time	08/03/2021 12:54:54 PM Central Daylight Time	07/29/2021 07:09:49 PM Central Daylight Time			08/04/2021 06:48:07 PM Central Daylight Time	PACIFICARE OF COLORADO, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Plan 1 (HMO)	01	01		1			H0609	007	0	2022	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					1	08/04/2021	2022.01	08/04/2021 09:36:09 AM Central Daylight Time	08/03/2021 12:55:25 PM Central Daylight Time	07/29/2021 07:10:04 PM Central Daylight Time			08/04/2021 06:48:07 PM Central Daylight Time	PACIFICARE OF COLORADO, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Plan 2 (HMO)	01	01		1			H0609	012	0	2022	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	018	0	1	01	01	H0609_018_0	2	1				0	0	07/14/2021	2022.01	07/14/2021 04:40:02 PM Central Daylight Time	06/03/2021 03:09:32 PM Central Daylight Time				07/15/2021 06:26:01 PM Central Daylight Time	PACIFICARE OF COLORADO, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (HMO)	01	01		1			H0609	018	0	2022	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	025	0	1	01	01	H0609_025_0	3	1					1	08/04/2021	2022.01	08/04/2021 09:39:32 AM Central Daylight Time	08/03/2021 12:55:55 PM Central Daylight Time	07/29/2021 07:10:19 PM Central Daylight Time			08/04/2021 06:48:07 PM Central Daylight Time	PACIFICARE OF COLORADO, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO)	01	01		1			H0609	025	0	2022	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					1	08/04/2021	2022.01	08/04/2021 09:40:34 AM Central Daylight Time	08/03/2021 12:56:25 PM Central Daylight Time	07/29/2021 07:10:34 PM Central Daylight Time			08/04/2021 06:48:07 PM Central Daylight Time	PACIFICARE OF COLORADO, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO)	01	01		1			H0609	026	0	2022	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					1	08/04/2021	2022.01	08/04/2021 09:41:39 AM Central Daylight Time	08/03/2021 12:56:55 PM Central Daylight Time	07/29/2021 07:10:49 PM Central Daylight Time			08/04/2021 06:48:07 PM Central Daylight Time	PACIFICARE OF COLORADO, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO)	01	01		1			H0609	027	0	2022	Maricopa and Pinal 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			
H0609	028	0	1	01	01	H0609_028_0	3	1					1	08/04/2021	2022.01	08/04/2021 10:29:57 AM Central Daylight Time	08/03/2021 12:57:26 PM Central Daylight Time	07/29/2021 07:11:03 PM Central Daylight Time			08/04/2021 09:03:19 PM Central Daylight Time	PACIFICARE OF COLORADO, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO)	01	01		1			H0609	028	0	2022	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	3	1					1	08/04/2021	2022.01	08/04/2021 10:31:44 AM Central Daylight Time	08/03/2021 12:57:57 PM Central Daylight Time	07/29/2021 07:11:19 PM Central Daylight Time			08/04/2021 09:03:19 PM Central Daylight Time	PACIFICARE OF COLORADO, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Premier (HMO)	01	01		1			H0609	031	0	2022	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					1	08/04/2021	2022.01	08/04/2021 10:35:03 AM Central Daylight Time	08/03/2021 12:58:27 PM Central Daylight Time	07/29/2021 07:11:33 PM Central Daylight Time			08/04/2021 09:03:19 PM Central Daylight Time	PACIFICARE OF COLORADO, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Focus (HMO)	01	01		1			H0609	032	0	2022	Clark and Nye counties		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(844)876-6176		(844)876-6176		(800)555-5757		(800)555-5757		(844)876-6176		(844)876-6176		(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					1	08/04/2021	2022.01	08/04/2021 10:38:46 AM Central Daylight Time	08/03/2021 12:58:58 PM Central Daylight Time	07/29/2021 07:11:49 PM Central Daylight Time			08/04/2021 09:03:19 PM Central Daylight Time	PACIFICARE OF COLORADO, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO)	01	01		1			H0609	033	0	2022	Lyon and Washoe counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(844)876-6176		(844)876-6176		(800)555-5757		(800)555-5757		(844)876-6176		(844)876-6176		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0609	034	1	1	01	01	H0609_034_1	3	1					1	08/04/2021	2022.01	08/04/2021 09:42:42 AM Central Daylight Time	08/03/2021 12:59:29 PM Central Daylight Time	07/29/2021 07:12:05 PM Central Daylight Time			08/04/2021 06:48:07 PM Central Daylight Time	PACIFICARE OF COLORADO, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Plan 1 (HMO)	01	01		1			H0609	034	1	2022	Select Counties in Colorado	Larimer and Weld 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			
H0609	034	2	1	01	01	H0609_034_2	3	1					1	08/04/2021	2022.01	08/04/2021 09:43:56 AM Central Daylight Time	08/03/2021 01:00:00 PM Central Daylight Time	07/29/2021 07:12:20 PM Central Daylight Time			08/04/2021 06:48:07 PM Central Daylight Time	PACIFICARE OF COLORADO, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Plan 1 (HMO)	01	01		1			H0609	034	2	2022	Select Counties in Colorado	El Paso, Fremont, Pueblo, and Teller 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			
H0609	036	1	1	01	01	H0609_036_1	3	1					1	08/04/2021	2022.01	08/04/2021 09:45:02 AM Central Daylight Time	08/03/2021 01:00:30 PM Central Daylight Time	07/29/2021 07:12:35 PM Central Daylight Time			08/04/2021 06:48:07 PM Central Daylight Time	PACIFICARE OF COLORADO, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Plan 2 (HMO)	01	01		1			H0609	036	1	2022	Colorado Springs Metro Area	Larimer and Weld 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			
H0609	036	2	1	01	01	H0609_036_2	3	1					1	08/04/2021	2022.01	08/04/2021 09:46:03 AM Central Daylight Time	08/03/2021 01:01:00 PM Central Daylight Time	07/29/2021 07:12:51 PM Central Daylight Time			08/04/2021 06:48:07 PM Central Daylight Time	PACIFICARE OF COLORADO, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Plan 2 (HMO)	01	01		1			H0609	036	2	2022	Colorado Springs Metro Area	El Paso, Fremont, Pueblo, and Teller 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			
H0609	037	0	1	01	01	H0609_037_0	3	1		1			1	08/04/2021	2022.01	08/04/2021 10:42:06 AM Central Daylight Time	08/03/2021 01:01:31 PM Central Daylight Time	07/29/2021 07:13:06 PM Central Daylight Time			08/04/2021 09:03:19 PM Central Daylight Time	PACIFICARE OF COLORADO, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Assist (HMO C-SNP)	01	01		1			H0609	037	0	2022	Clark and Nye counties		2		2			1	4			00000000000000000010		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			
H0609	038	0	1	01	01	H0609_038_0	3	1					1	08/04/2021	2022.01	08/04/2021 10:44:54 AM Central Daylight Time	08/03/2021 01:02:01 PM Central Daylight Time	07/29/2021 07:13:21 PM Central Daylight Time			08/04/2021 09:03:19 PM Central Daylight Time	PACIFICARE OF COLORADO, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Walgreens Plan 1 (HMO)	01	01		1			H0609	038	0	2022	Clark and Nye 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			
H0609	040	0	1	01	01	H0609_040_0	3	1					1	08/04/2021	2022.01	08/04/2021 10:53:26 AM Central Daylight Time	08/03/2021 01:02:32 PM Central Daylight Time	07/29/2021 07:13:36 PM Central Daylight Time			08/04/2021 09:03:19 PM Central Daylight Time	PACIFICARE OF COLORADO, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO)	01	01		1			H0609	040	0	2022	Lyon and Washoe counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(844)876-6176		(844)876-6176		(800)555-5757		(800)555-5757		(844)876-6176		(844)876-6176		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0609	041	0	1	01	01	H0609_041_0	2	1				0	0	07/14/2021	2022.01	07/14/2021 04:40:10 PM Central Daylight Time	06/03/2021 03:15:14 PM Central Daylight Time				07/15/2021 06:26:01 PM Central Daylight Time	PACIFICARE OF COLORADO, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (HMO)	01	01		1			H0609	041	0	2022	Select Counties in CO 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	042	0	1	01	01	H0609_042_0	3	1		1			1	08/04/2021	2022.01	08/04/2021 09:47:13 AM Central Daylight Time	08/03/2021 01:03:03 PM Central Daylight Time	07/29/2021 07:13:51 PM Central Daylight Time			08/04/2021 06:48:07 PM Central Daylight Time	PACIFICARE OF COLORADO, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	UnitedHealthcare Chronic Complete (HMO C-SNP)	01	01		1			H0609	042	0	2022	Maricopa and Pinal Counties		2		2			1	4			00000000000000000010		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	043	0	1	01	01	H0609_043_0	3	1		1			1	08/04/2021	2022.01	08/04/2021 09:49:19 AM Central Daylight Time	08/03/2021 01:03:33 PM Central Daylight Time	07/29/2021 07:14:07 PM Central Daylight Time			08/04/2021 06:48:07 PM Central Daylight Time	PACIFICARE OF COLORADO, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	UnitedHealthcare Chronic Complete (HMO C-SNP)	01	01		1			H0609	043	0	2022	Pima County		2		2			1	4			00000000000000000010		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	044	0	1	01	01	H0609_044_0	3	1					1	08/04/2021	2022.01	08/04/2021 09:50:24 AM Central Daylight Time	08/03/2021 01:04:02 PM Central Daylight Time	07/29/2021 07:14:22 PM Central Daylight Time			08/04/2021 06:48:07 PM Central Daylight Time	PACIFICARE OF COLORADO, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 3 (HMO)	01	01		1			H0609	044	0	2022	Maricopa and Pinal 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			
H0609	045	0	1	01	01	H0609_045_0	3	1					1	08/04/2021	2022.01	08/04/2021 09:51:35 AM Central Daylight Time	08/03/2021 01:04:33 PM Central Daylight Time	07/29/2021 07:14:37 PM Central Daylight Time			08/04/2021 06:48:07 PM Central Daylight Time	PACIFICARE OF COLORADO, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO)	01	01		1			H0609	045	0	2022	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	046	0	1	01	01	H0609_046_0	3	1					1	08/04/2021	2022.01	08/04/2021 09:52:55 AM Central Daylight Time	08/03/2021 01:05:04 PM Central Daylight Time	07/29/2021 07:14:52 PM Central Daylight Time			08/04/2021 06:48:07 PM Central Daylight Time	PACIFICARE OF COLORADO, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 4 (HMO)	01	01		1			H0609	046	0	2022	Maricopa and Pinal 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			
H0609	047	0	1	01	01	H0609_047_0	3	1		1			1	08/04/2021	2022.01	08/04/2021 09:55:33 AM Central Daylight Time	08/03/2021 01:05:34 PM Central Daylight Time	07/29/2021 07:15:07 PM Central Daylight Time			08/04/2021 06:48:07 PM Central Daylight Time	PACIFICARE OF COLORADO, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	UnitedHealthcare Chronic Complete (HMO C-SNP)	01	01		1			H0609	047	0	2022	Denver Metro area		2		2			1	4			00000000000000000010		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	048	0	1	01	01	H0609_048_0	3	1					1	08/04/2021	2022.01	08/04/2021 09:56:54 AM Central Daylight Time	08/03/2021 01:06:05 PM Central Daylight Time	07/29/2021 07:15:21 PM Central Daylight Time			08/04/2021 06:48:07 PM Central Daylight Time	PACIFICARE OF COLORADO, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO)	01	01		1			H0609	048	0	2022	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	801	0	1	01	01	H0609_801_0	2	1				0	0	06/02/2021	2022.01	06/02/2021 08:25:05 AM Central Daylight Time					06/02/2021 09:27:39 AM Central Daylight Time	PACIFICARE OF COLORADO, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0609	801	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H0609	804	0	1	01	01	H0609_804_0	2	1						05/24/2021	2022.01	05/24/2021 01:35:02 PM Central Daylight Time					06/02/2021 09:27:39 AM Central Daylight Time	PACIFICARE OF COLORADO, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0609	804	0	2022	CO Employer Sponsored Plan Service Area		1	5304	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H0609	805	0	1	01	01	H0609_805_0	2	1						05/24/2021	2022.01	05/24/2021 01:35:20 PM Central Daylight Time					06/02/2021 09:27:39 AM Central Daylight Time	PACIFICARE OF COLORADO, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0609	805	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H0609	806	0	2	01	01	H0609_806_0	2	1						05/24/2021	2022.01	05/24/2021 01:35:35 PM Central Daylight Time					06/02/2021 09:27:39 AM Central Daylight Time	PACIFICARE OF COLORADO, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		2	2		H0609	806	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H0609	807	0	1	01	01	H0609_807_0	3	1				0	0	06/02/2021	2022.01	06/02/2021 09:58:00 AM Central Daylight Time					06/02/2021 10:08:18 AM Central Daylight Time	PACIFICARE OF COLORADO, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0609	807	0	2022	Arizona		1	984	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H0609	808	0	1	01	01	H0609_808_0	2	1						05/24/2021	2022.01	05/24/2021 01:36:09 PM Central Daylight Time					06/02/2021 09:27:39 AM Central Daylight Time	PACIFICARE OF COLORADO, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0609	808	0	2022	Arizona		1	246312	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H0609	809	0	1	01	01	H0609_809_0	2	1						05/24/2021	2022.01	05/24/2021 01:36:27 PM Central Daylight Time					06/02/2021 09:27:39 AM Central Daylight Time	PACIFICARE OF COLORADO, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0609	809	0	2022	Arizona		1	36	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H0609	810	0	1	01	01	H0609_810_0	3	1				0	0	06/02/2021	2022.01	06/02/2021 09:58:27 AM Central Daylight Time					06/02/2021 10:08:18 AM Central Daylight Time	PACIFICARE OF COLORADO, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0609	810	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H0609	811	0	1	01	01	H0609_811_0	2	1						05/24/2021	2022.01	05/24/2021 01:37:00 PM Central Daylight Time					06/02/2021 09:27:39 AM Central Daylight Time	PACIFICARE OF COLORADO, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0609	811	0	2022	Clark and Nye counties		1	4932	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H0609	812	0	1	01	01	H0609_812_0	2	1						05/24/2021	2022.01	05/24/2021 01:37:15 PM Central Daylight Time					06/02/2021 09:27:39 AM Central Daylight Time	PACIFICARE OF COLORADO, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0609	812	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H0609	813	0	1	01	01	H0609_813_0	2	1						05/24/2021	2022.01	05/24/2021 01:37:30 PM Central Daylight Time					06/02/2021 09:27:39 AM Central Daylight Time	PACIFICARE OF COLORADO, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0609	813	0	2022	NV Employer Sponsored Plan Service Area		1	8604	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H0609	814	0	1	01	01	H0609_814_0	3	1				0	0	06/02/2021	2022.01	06/02/2021 09:59:02 AM Central Daylight Time					06/02/2021 10:08:18 AM Central Daylight Time	PACIFICARE OF COLORADO, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0609	814	0	2022	NV 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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H0609	815	0	1	01	01	H0609_815_0	2	1						05/24/2021	2022.01	05/24/2021 01:38:03 PM Central Daylight Time					06/02/2021 09:27:39 AM Central Daylight Time	PACIFICARE OF COLORADO, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0609	815	0	2022	NV 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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H0609	816	0	1	01	01	H0609_816_0	2	1						05/24/2021	2022.01	05/24/2021 01:38:16 PM Central Daylight Time					06/02/2021 09:27:39 AM Central Daylight Time	PACIFICARE OF COLORADO, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0609	816	0	2022	NV 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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H0609	817	0	1	01	01	H0609_817_0	2	1						05/24/2021	2022.01	05/24/2021 01:38:31 PM Central Daylight Time					06/02/2021 09:27:39 AM Central Daylight Time	PACIFICARE OF COLORADO, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0609	817	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H0609	818	0	1	01	01	H0609_818_0	3	1				0	0	06/02/2021	2022.01	06/02/2021 10:07:41 AM Central Daylight Time					06/02/2021 10:08:18 AM Central Daylight Time	PACIFICARE OF COLORADO, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0609	818	0	2022	AZ		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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					2				
H0609	819	0	1	01	01	H0609_819_0	2	1				0	0	06/02/2021	2022.01	06/02/2021 10:06:31 AM Central Daylight Time					06/02/2021 10:08:18 AM Central Daylight Time	PACIFICARE OF COLORADO, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0609	819	0	2022	AZ		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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					2				
H0609	820	0	1	01	01	H0609_820_0	2	1				0	0	06/02/2021	2022.01	06/02/2021 10:06:55 AM Central Daylight Time					06/02/2021 10:08:18 AM Central Daylight Time	PACIFICARE OF COLORADO, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0609	820	0	2022	AZ		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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					2				
H0609	821	0	1	01	01	H0609_821_0	2	1				0	0	06/02/2021	2022.01	06/02/2021 10:07:19 AM Central Daylight Time					06/02/2021 10:08:18 AM Central Daylight Time	PACIFICARE OF COLORADO, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0609	821	0	2022	AZ		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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					2				
H0613	001	0	1	20	08	H0613_001_0	1	1						05/27/2021	2022.01	05/27/2021 08:58:22 AM Mountain Daylight Time		05/27/2021 08:41:42 AM Mountain Daylight Time			05/27/2021 09:04:07 AM 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	2022	Metro Denver,Pueblo,Loveland,Fort Collins,Greeley		2		2			2						http://www.granerx.com	http://www.totallongtermcare.org										(844)704-9613		(844)704-9613		(844)704-9613		(844)704-9613										(844)704-9613		(844)704-9613		(844)704-9613		(844)704-9613																
H0613	003	0	1	20	08	H0613_003_0	1	1						05/27/2021	2022.01	05/27/2021 08:59:20 AM Mountain Daylight Time		05/27/2021 08:41:42 AM Mountain Daylight Time			05/27/2021 09:04:07 AM 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	2022	Metro Denver,Pueblo,Loveland,Fort Collins,Greeley		2		2			2						http://www.granerx.com	http://www.totallongtermcare.org										(844)704-9613	711	(844)704-9613		(877)277-6163		(303)869-4664										(844)704-9613	711	(844)704-9613	711	(877)277-6163		(303)869-4664																
H0624	001	0	1	01	01	H0624_001_0	4	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 09:58:17 AM Central Daylight Time	08/03/2021 12:28:42 PM Central Daylight Time	07/29/2021 07:15:42 PM Central Daylight Time			08/04/2021 06:48:07 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO D-SNP)	01	01		1			H0624	001	0	2022	Denver and Colorado Springs metro areas		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			
H0628	001	0	1	02	01	H0628_001_0	3	1			1		0	08/02/2021	2022.01	08/02/2021 04:14:06 PM Eastern Daylight Time	08/03/2021 12:20:13 PM Eastern Daylight Time	08/02/2021 09:22:07 AM Eastern Daylight Time			08/04/2021 12:08:11 PM Eastern Daylight Time	AETNA HEALTH OF OHIO INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (HMO-POS)	01	02		1			H0628	001	0	2022	Toledo Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0628	003	0	1	02	01	H0628_003_0	2	1			2		0	08/02/2021	2022.01	08/02/2021 04:14:54 PM Eastern Daylight Time	08/03/2021 12:21:36 PM Eastern Daylight Time	08/02/2021 09:22:11 AM Eastern Daylight Time			08/04/2021 12:08:11 PM Eastern Daylight Time	AETNA HEALTH OF OHIO INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (HMO-POS)	01	02		1			H0628	003	0	2022	Dayton and Cincinnati OH		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0628	005	0	1	02	01	H0628_005_0	3	1			1		0	08/02/2021	2022.01	08/02/2021 01:05:06 PM Eastern Daylight Time	08/03/2021 12:22:55 PM Eastern Daylight Time	08/02/2021 09:22:15 AM Eastern Daylight Time			08/04/2021 12:08:11 PM Eastern Daylight Time	AETNA HEALTH OF OHIO INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (HMO-POS)	01	02		1			H0628	005	0	2022	Greater Cleveland Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0628	006	0	1	02	01	H0628_006_0	2	1			2		0	08/02/2021	2022.01	08/02/2021 04:15:36 PM Eastern Daylight Time	08/03/2021 12:24:16 PM Eastern Daylight Time	08/02/2021 09:22:19 AM Eastern Daylight Time			08/04/2021 12:08:11 PM Eastern Daylight Time	AETNA HEALTH OF OHIO INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (HMO-POS)	01	02		1			H0628	006	0	2022	Northern Kentucky		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0628	007	0	1	02	01	H0628_007_0	2	1			2		0	08/02/2021	2022.01	08/02/2021 01:07:04 PM Eastern Daylight Time	08/03/2021 12:25:38 PM Eastern Daylight Time	08/02/2021 09:22:24 AM Eastern Daylight Time			08/04/2021 12:08:11 PM Eastern Daylight Time	AETNA HEALTH OF OHIO INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (HMO-POS)	01	02		1			H0628	007	0	2022	Bowling Green and Southwest Kentucky Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0628	008	0	1	02	01	H0628_008_0	3	1			2		0	08/02/2021	2022.01	08/02/2021 01:07:30 PM Eastern Daylight Time	08/03/2021 12:26:56 PM Eastern Daylight Time	08/05/2021 01:19:56 PM Eastern Daylight Time			08/05/2021 02:56:09 PM Eastern Daylight Time	AETNA HEALTH OF OHIO INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (HMO-POS)	01	02		1			H0628	008	0	2022	Lexington Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0628	009	0	1	02	01	H0628_009_0	2	1			2		0	08/02/2021	2022.01	08/02/2021 04:16:24 PM Eastern Daylight Time	08/03/2021 12:28:18 PM Eastern Daylight Time	08/02/2021 09:22:32 AM Eastern Daylight Time			08/04/2021 12:08:11 PM Eastern Daylight Time	AETNA HEALTH OF OHIO INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (HMO-POS)	01	02		1			H0628	009	0	2022	Louisville Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0628	010	0	1	02	01	H0628_010_0	2	1			2		0	08/02/2021	2022.01	08/02/2021 01:08:51 PM Eastern Daylight Time	08/03/2021 12:29:55 PM Eastern Daylight Time	08/02/2021 09:22:36 AM Eastern Daylight Time			08/04/2021 12:08:11 PM Eastern Daylight Time	AETNA HEALTH OF OHIO INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (HMO-POS)	01	02		1			H0628	010	0	2022	Ashland Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0628	011	0	1	01	01	H0628_011_0	2	1			2		0	08/02/2021	2022.01	08/02/2021 03:38:10 PM Eastern Daylight Time	08/03/2021 12:31:14 PM Eastern Daylight Time	08/02/2021 09:22:40 AM Eastern Daylight Time			08/04/2021 12:08:11 PM Eastern Daylight Time	AETNA HEALTH OF OHIO INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (HMO)	01	01		1			H0628	011	0	2022	Eastern Kentucky Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0628	012	0	1	01	01	H0628_012_0	3	1	2	1	1		0	07/08/2021	2022.01	07/08/2021 10:22:33 AM Eastern Daylight Time	08/03/2021 03:29:52 PM Eastern Daylight Time	08/02/2021 09:22:44 AM Eastern Daylight Time			08/04/2021 12:08:11 PM Eastern Daylight Time	AETNA HEALTH OF OHIO INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Assure 1 (HMO D-SNP)	01	01		1			H0628	012	0	2022	Select Counties in Kentucky		2		2			1	3		1		1	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0628	013	0	1	01	01	H0628_013_0	3	1	2	1	1		0	07/08/2021	2022.01	07/08/2021 10:23:01 AM Eastern Daylight Time	08/03/2021 03:30:55 PM Eastern Daylight Time	08/02/2021 09:22:48 AM Eastern Daylight Time			08/04/2021 12:08:11 PM Eastern Daylight Time	AETNA HEALTH OF OHIO INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Assure 1 (HMO D-SNP)	01	01		1			H0628	013	0	2022	Select Counties in Ohio		2		2			1	3		1		1	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0628	014	0	1	01	01	H0628_014_0	1	1			2	0	0	05/26/2021	2022.01	05/26/2021 03:51:35 PM Eastern Daylight Time	06/01/2021 07:00:27 PM Eastern Daylight Time				06/03/2021 10:29:22 AM Eastern Daylight Time	AETNA HEALTH OF OHIO INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Eagle (HMO)	01	01		1			H0628	014	0	2022	Select Counties in KY		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H0628	015	0	1	01	01	H0628_015_0	1	1			2	0	0	05/28/2021	2022.01	05/28/2021 10:00:26 AM Eastern Daylight Time	06/01/2021 07:01:18 PM Eastern Daylight Time				06/03/2021 10:29:22 AM Eastern Daylight Time	AETNA HEALTH OF OHIO INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Eagle (HMO)	01	01		1			H0628	015	0	2022	Select Counties in OH		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H0628	017	0	1	02	01	H0628_017_0	4	1			1		0	08/02/2021	2022.01	08/02/2021 01:11:43 PM Eastern Daylight Time	08/03/2021 12:38:17 PM Eastern Daylight Time	08/02/2021 09:22:53 AM Eastern Daylight Time			08/04/2021 12:08:11 PM Eastern Daylight Time	AETNA HEALTH OF OHIO INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (HMO-POS)	01	02		1			H0628	017	0	2022	Greater Central Ohio Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0628	801	0	1	01	01	H0628_801_0	1	1				0	0	05/27/2021	2022.01	05/27/2021 01:55:23 PM Eastern Daylight Time					06/03/2021 12:29:52 PM Eastern Daylight Time	AETNA HEALTH OF OHIO INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (HMO)	01	01		1			H0628	801	0	2022	Ohio		1	120	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H0628	802	0	1	01	01	H0628_802_0	1	1						05/27/2021	2022.01	05/27/2021 01:55:43 PM Eastern Daylight Time					06/03/2021 12:29:52 PM Eastern Daylight Time	AETNA HEALTH OF OHIO INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan w/Rx (HMO)	01	01		1			H0628	802	0	2022	Ohio		1	120	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H0630	013	0	1	01	01	H0630_013_0	8	1					0	07/29/2021	2022.01	07/29/2021 03:36:27 PM Mountain Daylight Time	07/30/2021 02:06:44 PM Mountain Daylight Time	07/30/2021 02:13:22 PM Mountain Daylight Time			08/04/2021 02:21:25 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	2022	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			0	07/14/2021	2022.01	07/14/2021 08:37:43 PM Mountain Daylight Time	07/30/2021 02:07:20 PM Mountain Daylight Time	07/30/2021 02:14:15 PM Mountain Daylight Time			08/04/2021 02:21:25 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	Senior Advantage Medicare Medicaid (HMO D-SNP)	01	01		1			H0630	014	0	2022	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					0	07/16/2021	2022.01	07/16/2021 04:12:11 PM Mountain Daylight Time	07/30/2021 02:07:56 PM Mountain Daylight Time	07/30/2021 02:15:08 PM Mountain Daylight Time			08/04/2021 02:21:25 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	2022	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					0	07/16/2021	2022.01	07/16/2021 04:12:46 PM Mountain Daylight Time	07/30/2021 02:08:30 PM Mountain Daylight Time	07/30/2021 02:16:00 PM Mountain Daylight Time			08/04/2021 02:21:25 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	2022	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					0	07/29/2021	2022.01	07/29/2021 03:39:58 PM Mountain Daylight Time	07/30/2021 02:09:04 PM Mountain Daylight Time	07/30/2021 02:16:58 PM Mountain Daylight Time			08/04/2021 02:21:25 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	2022	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	1	01	7a;7g;14d;14e2;	
H0630	020	0	1	01	01	H0630_020_0	8	1					0	07/29/2021	2022.01	07/29/2021 03:48:46 PM Mountain Daylight Time	07/30/2021 02:09:38 PM Mountain Daylight Time	07/30/2021 02:17:49 PM Mountain Daylight Time			08/04/2021 02:21:25 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	2022	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					0	07/29/2021	2022.01	07/29/2021 03:49:19 PM Mountain Daylight Time	07/30/2021 02:10:11 PM Mountain Daylight Time	07/30/2021 02:18:41 PM Mountain Daylight Time			08/04/2021 02:21:25 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	2022	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	023	0	1	01	01	H0630_023_0	9	1					0	07/16/2021	2022.01	07/16/2021 04:13:48 PM Mountain Daylight Time	07/30/2021 02:10:43 PM Mountain Daylight Time	07/30/2021 02:19:31 PM Mountain Daylight Time			08/04/2021 02:21:25 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Enhanced (HMO)	01	01		1			H0630	023	0	2022	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	1	01	7a;7g;14d;14e2;	
H0630	024	0	1	01	01	H0630_024_0	8	1	2	1			0	07/14/2021	2022.01	07/14/2021 08:49:25 PM Mountain Daylight Time	07/30/2021 02:11:15 PM Mountain Daylight Time	07/30/2021 02:20:22 PM Mountain Daylight Time			08/04/2021 02:21:25 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	Senior Advantage Medicare Medicaid Pueblo (HMO D-SNP)	01	01		1			H0630	024	0	2022	Southern Colorado - Pueblo County		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	805	0	2	01	01	H0630_805_0	3	1						05/14/2021	2022.01	05/14/2021 08:11:58 AM Mountain Daylight Time					06/07/2021 10:57:15 AM 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	2022	Denver Metro Area		1	10101	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;7k;9a1;10a;11a;11b;15;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7c;7f;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9d;12;14e3;	1					2				
H0630	806	0	2	01	01	H0630_806_0	3	1				0	0	05/14/2021	2022.01	05/14/2021 08:46:58 AM Mountain Daylight Time					06/07/2021 10:57:15 AM 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	2022	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;7k;9a1;10a;11a;11b;15;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7c;7f;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9d;12;14e3;	1					2				
H0630	807	0	1	01	01	H0630_807_0	3	1						05/14/2021	2022.01	05/14/2021 08:47:15 AM Mountain Daylight Time					06/07/2021 10:57:15 AM 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	2022	Denver Metro Area		1	265388	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;7k;9a1;10a;11a;11b;15;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7c;7f;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9d;12;14e3;	1					2				
H0630	808	0	1	01	01	H0630_808_0	3	1				0	0	05/14/2021	2022.01	05/14/2021 08:51:22 AM Mountain Daylight Time					06/07/2021 10:57:15 AM 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	2022	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;7k;9a1;10a;11a;11b;15;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7c;7f;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9d;12;14e3;	1					2				
H0630	809	0	2	01	01	H0630_809_0	3	1						05/14/2021	2022.01	05/14/2021 08:53:01 AM Mountain Daylight Time					06/07/2021 10:57:15 AM 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	2022	Denver Metro Area		1	46	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;7k;9a1;10a;11a;11b;15;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7c;7f;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9d;12;14e3;	1					2				
H0630	810	0	1	01	01	H0630_810_0	3	1						05/14/2021	2022.01	05/14/2021 08:53:16 AM Mountain Daylight Time					06/07/2021 10:57:15 AM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	FEHB AB with D (HMO)	01	01		1			H0630	810	0	2022	Denver Metro Area		1	35444	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;7k;9a1;10a;11a;11b;15;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7c;7f;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9d;12;14e3;	1					2				
H0630	811	0	2	01	01	H0630_811_0	3	1						05/14/2021	2022.01	05/14/2021 08:53:32 AM Mountain Daylight Time					06/07/2021 10:57:15 AM 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	2022	Southern Colorado		1	1739	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;7k;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;15;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7k;8a;8b1;8b2;8b3;9a1;9b;9d;12;14e3;	1					2				
H0630	812	0	2	01	01	H0630_812_0	3	1				0	0	05/14/2021	2022.01	05/14/2021 08:55:08 AM Mountain Daylight Time					06/07/2021 10:57:15 AM 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	2022	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;7k;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;15;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7k;8a;8b1;8b2;8b3;9a1;9b;9d;12;14e3;	1					2				
H0630	813	0	1	01	01	H0630_813_0	3	1						05/14/2021	2022.01	05/14/2021 08:56:39 AM Mountain Daylight Time					06/07/2021 10:57:15 AM 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	2022	Southern Colorado		1	29414	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;7k;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;15;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7k;8a;8b1;8b2;8b3;9a1;9b;9d;12;14e3;	1					2				
H0630	814	0	1	01	01	H0630_814_0	3	1				0	0	05/14/2021	2022.01	05/14/2021 09:00:33 AM Mountain Daylight Time					06/07/2021 10:57:15 AM 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	2022	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;7k;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;15;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7k;8a;8b1;8b2;8b3;9a1;9b;9d;12;14e3;	1					2				
H0630	815	0	2	01	01	H0630_815_0	3	1						05/14/2021	2022.01	05/14/2021 09:00:48 AM Mountain Daylight Time					06/07/2021 10:57:15 AM 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	2022	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;7k;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;15;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7k;8a;8b1;8b2;8b3;9a1;9b;9d;12;14e3;	1					2				
H0630	816	0	1	01	01	H0630_816_0	3	1						05/14/2021	2022.01	05/14/2021 09:01:04 AM Mountain Daylight Time					06/07/2021 10:57:15 AM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	FEHB AB with D (HMO)	01	01		1			H0630	816	0	2022	Southern Colorado		1	5896	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;7k;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;15;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7k;8a;8b1;8b2;8b3;9a1;9b;9d;12;14e3;	1					2				
H0630	817	0	2	01	01	H0630_817_0	3	1						05/14/2021	2022.01	05/14/2021 09:01:17 AM Mountain Daylight Time					06/07/2021 10:57:15 AM 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	2022	Northern Colorado		1	396	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;7k;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;15;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7k;8a;8b1;8b2;8b3;9a1;9b;9d;12;14e3;	1					2				
H0630	818	0	2	01	01	H0630_818_0	3	1				0	0	05/14/2021	2022.01	05/14/2021 09:01:31 AM Mountain Daylight Time					06/07/2021 10:57:15 AM 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	2022	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;7k;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;15;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7k;8a;8b1;8b2;8b3;9a1;9b;9d;12;14e3;	1					2				
H0630	819	0	1	01	01	H0630_819_0	3	1						05/14/2021	2022.01	05/14/2021 09:01:46 AM Mountain Daylight Time					06/07/2021 10:57:15 AM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	Senior Advantage Group MAPD (HMO)	01	01		1			H0630	819	0	2022	Northern Colorado		1	12607	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;7k;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;15;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7k;8a;8b1;8b2;8b3;9a1;9b;9d;12;14e3;	1					2				
H0630	820	0	1	01	01	H0630_820_0	3	1				0	0	05/14/2021	2022.01	05/14/2021 09:01:58 AM Mountain Daylight Time					06/07/2021 10:57:15 AM 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	2022	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;7k;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;15;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7k;8a;8b1;8b2;8b3;9a1;9b;9d;12;14e3;	1					2				
H0630	821	0	2	01	01	H0630_821_0	3	1						05/14/2021	2022.01	05/14/2021 09:02:25 AM Mountain Daylight Time					06/07/2021 10:57:15 AM 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	2022	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;7k;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;15;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7k;8a;8b1;8b2;8b3;9a1;9b;9d;12;14e3;	1					2				
H0630	822	0	1	01	01	H0630_822_0	3	1						05/14/2021	2022.01	05/14/2021 09:02:39 AM Mountain Daylight Time					06/07/2021 10:57:15 AM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	FEHB AB with D (HMO)	01	01		1			H0630	822	0	2022	Northern Colorado		1	2076	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;7k;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;15;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7k;8a;8b1;8b2;8b3;9a1;9b;9d;12;14e3;	1					2				
H0672	001	0	1	01	01	H0672_001_0	6	1					1	08/02/2021	2022.01	08/02/2021 05:37:18 PM Central Daylight Time	08/02/2021 03:48:17 PM Central Daylight Time	07/30/2021 11:24:46 AM Central Daylight Time			08/04/2021 10:01:31 AM Central Daylight Time	CIGNA HEALTHCARE OF COLORADO, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H0672	001	0	2022	Denver Area		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)952-0786		(855)952-0786		(800)668-3813		(800)668-3813		(855)952-0786		(855)952-0786		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0672	002	0	1	01	01	H0672_002_0	6	1					1	08/02/2021	2022.01	08/02/2021 05:37:38 PM Central Daylight Time	08/02/2021 03:49:55 PM Central Daylight Time	07/30/2021 11:25:10 AM Central Daylight Time			08/04/2021 10:01:31 AM Central Daylight Time	CIGNA HEALTHCARE OF COLORADO, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H0672	002	0	2022	Boulder Area		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)952-0786		(855)952-0786		(800)668-3813		(800)668-3813		(855)952-0786		(855)952-0786		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0672	003	0	1	01	01	H0672_003_0	6	1					1	08/02/2021	2022.01	08/02/2021 05:38:29 PM Central Daylight Time	08/02/2021 03:51:28 PM Central Daylight Time	07/30/2021 11:25:33 AM Central Daylight Time			08/04/2021 10:01:31 AM Central Daylight Time	CIGNA HEALTHCARE OF COLORADO, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H0672	003	0	2022	Fort Collins Area		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)952-0786		(855)952-0786		(800)668-3813		(800)668-3813		(855)952-0786		(855)952-0786		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0672	004	0	1	01	01	H0672_004_0	6	1					1	08/02/2021	2022.01	08/02/2021 05:38:20 PM Central Daylight Time	08/02/2021 03:53:00 PM Central Daylight Time	07/30/2021 11:25:56 AM Central Daylight Time			08/04/2021 10:01:31 AM Central Daylight Time	CIGNA HEALTHCARE OF COLORADO, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H0672	004	0	2022	Colorado Springs Area		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)952-0786		(855)952-0786		(800)668-3813		(800)668-3813		(855)952-0786		(855)952-0786		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0672	005	0	1	01	01	H0672_005_0	6	1					0	08/02/2021	2022.01	08/02/2021 05:38:49 PM Central Daylight Time	08/02/2021 03:54:33 PM Central Daylight Time	07/30/2021 11:26:19 AM Central Daylight Time			08/04/2021 10:01:31 AM Central Daylight Time	CIGNA HEALTHCARE OF COLORADO, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H0672	005	0	2022	Albuquerque Area		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)343-8992		(855)343-8992		(800)668-3813		(800)668-3813		(855)343-8992		(855)343-8992		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0672	006	0	1	01	01	H0672_006_0	4	1					0	08/03/2021	2022.01	08/03/2021 09:11:19 AM Central Daylight Time	08/03/2021 09:39:50 AM Central Daylight Time	07/30/2021 11:26:44 AM Central Daylight Time			08/04/2021 10:01:31 AM Central Daylight Time	CIGNA HEALTHCARE OF COLORADO, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H0672	006	0	2022	Ohio		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)394-0157		(855)394-0157		(800)668-3813		(800)668-3813		(855)394-0157		(855)394-0157		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0672	007	0	1	01	01	H0672_007_0	6	1					1	08/02/2021	2022.01	08/02/2021 05:39:09 PM Central Daylight Time	08/02/2021 03:56:47 PM Central Daylight Time	07/30/2021 11:27:08 AM Central Daylight Time			08/04/2021 10:01:31 AM Central Daylight Time	CIGNA HEALTHCARE OF COLORADO, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H0672	007	0	2022	Colorado SW Corner Area		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101		(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0672	008	0	1	01	01	H0672_008_0	6	1					1	08/02/2021	2022.01	08/02/2021 05:39:25 PM Central Daylight Time	08/02/2021 03:58:36 PM Central Daylight Time	07/30/2021 11:27:31 AM Central Daylight Time			08/04/2021 10:01:31 AM Central Daylight Time	CIGNA HEALTHCARE OF COLORADO, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H0672	008	0	2022	Colorado Western Slope Area		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101		(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0672	009	0	1	01	01	H0672_009_0	7	1	2	1			0	08/17/2021	2022.01	08/17/2021 03:44:51 PM Central Daylight Time	08/02/2021 03:59:58 PM Central Daylight Time	07/30/2021 11:27:55 AM Central Daylight Time			08/17/2021 04:34:17 PM Central Daylight Time	CIGNA HEALTHCARE OF COLORADO, INC.	Cigna	www.cignamedicare.com	Cigna TotalCare (HMO D-SNP)	01	01		1			H0672	009	0	2022	Colorado Front Range Area		2		2			1	3		2		2	www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101		(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0672	801	0	1	01	01	H0672_801_0	3	1						05/10/2021	2022.01	05/10/2021 10:20:10 AM Central Daylight Time					06/02/2021 01:59:33 PM Central Daylight Time	CIGNA HEALTHCARE OF COLORADO, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H0672	801	0	2022	Statewide CO		1	600	2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.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)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H0710	004	0	1	04	01	H0710_004_0	3	1		1			0	08/04/2021	2022.01	08/04/2021 07:59:19 AM Central Daylight Time	08/03/2021 12:03:09 PM Central Daylight Time	07/29/2021 07:15:57 PM Central Daylight Time			08/04/2021 02:07:30 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (PPO I-SNP)	01	04		1			H0710	004	0	2022	Select Counties in AL, FL, MS and TN		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			0	08/04/2021	2022.01	08/04/2021 08:00:54 AM Central Daylight Time	08/03/2021 12:03:39 PM Central Daylight Time	07/29/2021 07:16:12 PM Central Daylight Time			08/04/2021 02:07:30 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (PPO I-SNP)	01	04		1			H0710	005	0	2022	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			0	08/04/2021	2022.01	08/04/2021 08:02:32 AM Central Daylight Time	08/03/2021 12:04:10 PM Central Daylight Time	07/29/2021 07:16:28 PM Central Daylight Time			08/04/2021 02:07:30 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (PPO I-SNP)	01	04		1			H0710	007	0	2022	Select Counties in Colorado		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			1	08/04/2021	2022.01	08/04/2021 08:04:16 AM Central Daylight Time	08/03/2021 12:04:43 PM Central Daylight Time	07/29/2021 07:16:42 PM Central Daylight Time			08/04/2021 02:07:30 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Assisted Living Plan (PPO I-SNP)	01	04		1			H0710	008	0	2022	Select Counties in Colorado		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			1	08/04/2021	2022.01	08/04/2021 08:06:06 AM Central Daylight Time	08/03/2021 12:05:15 PM Central Daylight Time	07/29/2021 07:16:57 PM Central Daylight Time			08/04/2021 02:07:30 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Assisted Living Plan (PPO I-SNP)	01	04		1			H0710	009	0	2022	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	3	1		1			0	08/04/2021	2022.01	08/04/2021 08:08:00 AM Central Daylight Time	08/03/2021 12:05:48 PM Central Daylight Time	07/29/2021 07:17:12 PM Central Daylight Time			08/04/2021 02:07:30 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (PPO I-SNP)	01	04		1			H0710	010	0	2022	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	3	1		1			1	08/04/2021	2022.01	08/04/2021 08:09:44 AM Central Daylight Time	08/03/2021 12:06:20 PM Central Daylight Time	07/29/2021 07:17:26 PM Central Daylight Time			08/04/2021 02:07:30 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Assisted Living Plan (PPO I-SNP)	01	04		1			H0710	012	0	2022	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	3	1		1			0	08/04/2021	2022.01	08/04/2021 08:11:28 AM Central Daylight Time	08/03/2021 12:06:53 PM Central Daylight Time	07/29/2021 07:17:41 PM Central Daylight Time			08/04/2021 02:07:30 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (PPO I-SNP)	01	04		1			H0710	013	0	2022	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	3	1		1			0	08/04/2021	2022.01	08/04/2021 08:13:18 AM Central Daylight Time	08/03/2021 12:07:28 PM Central Daylight Time	07/29/2021 07:17:56 PM Central Daylight Time			08/04/2021 02:07:30 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (PPO I-SNP)	01	04		1			H0710	015	0	2022	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	3	1		1			0	08/04/2021	2022.01	08/04/2021 08:15:36 AM Central Daylight Time	08/03/2021 12:08:01 PM Central Daylight Time	07/29/2021 07:18:11 PM Central Daylight Time			08/04/2021 02:07:30 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (PPO I-SNP)	01	04		1			H0710	016	0	2022	Select Counties in Missouri		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	3	1		1			0	08/04/2021	2022.01	08/04/2021 08:17:23 AM Central Daylight Time	08/03/2021 12:08:34 PM Central Daylight Time	07/29/2021 07:18:27 PM Central Daylight Time			08/04/2021 02:14:53 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan 2 (PPO I-SNP)	01	04		1			H0710	017	0	2022	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	3	1		1			0	08/04/2021	2022.01	08/04/2021 08:19:05 AM Central Daylight Time	08/03/2021 12:09:06 PM Central Daylight Time	07/29/2021 07:18:42 PM Central Daylight Time			08/04/2021 02:14:53 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (PPO I-SNP)	01	04		1			H0710	020	0	2022	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	3	1		1			0	08/04/2021	2022.01	08/04/2021 08:20:50 AM Central Daylight Time	08/03/2021 12:09:39 PM Central Daylight Time	07/29/2021 07:18:57 PM Central Daylight Time			08/04/2021 02:14:53 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (PPO I-SNP)	01	04		1			H0710	026	0	2022	Select Counties in Connecticut and 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	3	1		1			0	08/04/2021	2022.01	08/04/2021 08:22:51 AM Central Daylight Time	08/03/2021 12:10:13 PM Central Daylight Time	07/29/2021 07:19:13 PM Central Daylight Time			08/04/2021 02:14:53 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan 2 (PPO I-SNP)	01	04		1			H0710	027	0	2022	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			1	08/04/2021	2022.01	08/04/2021 08:25:06 AM Central Daylight Time	08/03/2021 12:10:47 PM Central Daylight Time	07/29/2021 07:19:29 PM Central Daylight Time			08/04/2021 02:14:53 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Assisted Living Plan (PPO I-SNP)	01	04		1			H0710	030	0	2022	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	3	1		1			0	08/04/2021	2022.01	08/04/2021 08:26:55 AM Central Daylight Time	08/03/2021 12:11:19 PM Central Daylight Time	07/29/2021 07:19:44 PM Central Daylight Time			08/04/2021 02:14:53 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (PPO I-SNP)	01	04		1			H0710	031	0	2022	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	3	1		1			0	08/04/2021	2022.01	08/04/2021 08:29:06 AM Central Daylight Time	08/03/2021 12:11:52 PM Central Daylight Time	07/29/2021 07:19:59 PM Central Daylight Time			08/04/2021 02:14:53 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan 2 (PPO I-SNP)	01	04		1			H0710	032	0	2022	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			0	08/04/2021	2022.01	08/04/2021 08:31:00 AM Central Daylight Time	08/03/2021 12:12:26 PM Central Daylight Time	07/29/2021 07:20:14 PM Central Daylight Time			08/04/2021 02:14:53 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan 2 (PPO I-SNP)	01	04		1			H0710	033	0	2022	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			0	08/04/2021	2022.01	08/04/2021 08:36:23 AM Central Daylight Time	08/03/2021 12:12:59 PM Central Daylight Time	07/29/2021 07:20:34 PM Central Daylight Time			08/04/2021 02:14:53 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (PPO I-SNP)	01	04		1			H0710	034	0	2022	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	2	1		1			0	08/04/2021	2022.01	08/04/2021 08:38:15 AM Central Daylight Time	08/03/2021 12:13:32 PM Central Daylight Time	07/29/2021 07:20:49 PM Central Daylight Time			08/04/2021 02:14:53 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan 2 (PPO I-SNP)	01	04		1			H0710	035	0	2022	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	4	1		1			0	08/04/2021	2022.01	08/04/2021 08:42:39 AM Central Daylight Time	08/03/2021 12:14:07 PM Central Daylight Time	07/29/2021 07:21:05 PM Central Daylight Time			08/04/2021 02:21:49 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan 2 (PPO I-SNP)	01	04		1			H0710	036	0	2022	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	4	1		1			1	08/04/2021	2022.01	08/04/2021 08:44:25 AM Central Daylight Time	08/03/2021 12:14:39 PM Central Daylight Time	07/29/2021 07:21:21 PM Central Daylight Time			08/04/2021 02:21:49 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Assisted Living Plan 2 (PPO I-SNP)	01	04		1			H0710	037	0	2022	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			0	08/04/2021	2022.01	08/04/2021 08:46:24 AM Central Daylight Time	08/03/2021 12:15:12 PM Central Daylight Time	07/29/2021 07:21:36 PM Central Daylight Time			08/04/2021 02:21:49 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (PPO I-SNP)	01	04		1			H0710	038	0	2022	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			0	08/04/2021	2022.01	08/04/2021 08:48:07 AM Central Daylight Time	08/03/2021 12:15:45 PM Central Daylight Time	07/29/2021 07:21:51 PM Central Daylight Time			08/04/2021 02:21:49 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan 2 (PPO I-SNP)	01	04		1			H0710	039	0	2022	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	041	0	1	04	01	H0710_041_0	3	1		1			0	08/04/2021	2022.01	08/04/2021 11:02:41 AM Central Daylight Time	08/04/2021 02:22:51 PM Central Daylight Time	07/29/2021 07:22:07 PM Central Daylight Time			08/04/2021 02:45:56 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (PPO I-SNP)	01	04		1			H0710	041	0	2022	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	046	0	1	04	01	H0710_046_0	3	1		1			0	08/04/2021	2022.01	08/04/2021 08:51:51 AM Central Daylight Time	08/03/2021 12:16:50 PM Central Daylight Time	07/29/2021 07:22:23 PM Central Daylight Time			08/04/2021 02:21:49 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (PPO I-SNP)	01	04		1			H0710	046	0	2022	Select Counties in Iowa		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	047	0	1	04	01	H0710_047_0	3	1		1			1	08/04/2021	2022.01	08/04/2021 08:53:46 AM Central Daylight Time	08/03/2021 12:17:22 PM Central Daylight Time	07/29/2021 07:22:38 PM Central Daylight Time			08/04/2021 02:21:49 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Assisted Living Plan (PPO I-SNP)	01	04		1			H0710	047	0	2022	Select Counties in Minnesota		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	050	0	1	04	01	H0710_050_0	3	1		1			1	08/04/2021	2022.01	08/04/2021 08:59:08 AM Central Daylight Time	08/03/2021 12:17:54 PM Central Daylight Time	07/29/2021 07:22:54 PM Central Daylight Time			08/04/2021 02:21:49 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Assisted Living Plan 2 (PPO I-SNP)	01	04		1			H0710	050	0	2022	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			
H0710	051	0	1	04	01	H0710_051_0	3	1		1			0	08/04/2021	2022.01	08/04/2021 09:00:53 AM Central Daylight Time	08/03/2021 12:18:26 PM Central Daylight Time	07/29/2021 07:23:09 PM Central Daylight Time			08/04/2021 02:21:49 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (PPO I-SNP)	01	04		1			H0710	051	0	2022	Select Counties in Utah		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	052	0	1	04	01	H0710_052_0	3	1		1			0	08/04/2021	2022.01	08/04/2021 09:03:20 AM Central Daylight Time	08/03/2021 12:18:57 PM Central Daylight Time	07/29/2021 07:23:26 PM Central Daylight Time			08/04/2021 02:21:49 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (PPO I-SNP)	01	04		1			H0710	052	0	2022	Select Counties in OK		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	053	0	1	04	01	H0710_053_0	3	1		1			0	08/04/2021	2022.01	08/04/2021 09:05:37 AM Central Daylight Time	08/03/2021 07:31:35 PM Central Daylight Time	07/29/2021 07:23:42 PM Central Daylight Time			08/04/2021 02:21:49 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (PPO I-SNP)	01	04		1			H0710	053	0	2022	Select Counties in SC		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	054	0	1	04	01	H0710_054_0	3	1		1			1	08/04/2021	2022.01	08/04/2021 09:07:25 AM Central Daylight Time	08/03/2021 12:20:02 PM Central Daylight Time	07/29/2021 07:23:57 PM Central Daylight Time			08/04/2021 02:27:27 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Assisted Living Plan (PPO I-SNP)	01	04		1			H0710	054	0	2022	Select Counties in Georgia		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	055	0	1	04	01	H0710_055_0	3	1		1			1	08/04/2021	2022.01	08/04/2021 09:09:46 AM Central Daylight Time	08/03/2021 12:20:34 PM Central Daylight Time	07/29/2021 07:24:12 PM Central Daylight Time			08/04/2021 02:27:27 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Assisted Living Plan (PPO I-SNP)	01	04		1			H0710	055	0	2022	Select Counties in Illinois		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	056	0	1	04	01	H0710_056_0	3	1		1			1	08/04/2021	2022.01	08/04/2021 09:12:05 AM Central Daylight Time	08/03/2021 12:21:08 PM Central Daylight Time	07/29/2021 07:24:28 PM Central Daylight Time			08/04/2021 02:27:27 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Assisted Living Plan (PPO I-SNP)	01	04		1			H0710	056	0	2022	Select Counties in New Jersey		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	057	0	1	04	01	H0710_057_0	3	1		1			1	08/04/2021	2022.01	08/04/2021 09:14:33 AM Central Daylight Time	08/03/2021 12:21:40 PM Central Daylight Time	07/29/2021 07:24:43 PM Central Daylight Time			08/04/2021 02:27:27 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Assisted Living Plan (PPO I-SNP)	01	04		1			H0710	057	0	2022	Select Counties in Ohio		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	058	0	1	04	01	H0710_058_0	3	1		1			1	08/04/2021	2022.01	08/04/2021 09:18:22 AM Central Daylight Time	08/03/2021 12:22:15 PM Central Daylight Time	07/29/2021 07:24:58 PM Central Daylight Time			08/04/2021 02:27:27 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Assisted Living Plan (PPO I-SNP)	01	04		1			H0710	058	0	2022	Select Counties in Texas		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	059	0	1	04	01	H0710_059_0	3	1		1			1	08/04/2021	2022.01	08/04/2021 09:19:58 AM Central Daylight Time	08/03/2021 12:22:48 PM Central Daylight Time	07/29/2021 07:25:14 PM Central Daylight Time			08/04/2021 02:27:27 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Assisted Living Plan (PPO I-SNP)	01	04		1			H0710	059	0	2022	Select Counties in Virginia		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	801	0	1	04	01	H0710_801_0	1	1						05/24/2021	2022.01	05/24/2021 03:08:13 PM Central Daylight Time					06/02/2021 09:15:19 AM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H0710	801	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H0710	802	0	1	04	01	H0710_802_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 08:58:08 AM Central Daylight Time					06/02/2021 09:15:19 AM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H0710	802	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H0710	803	0	1	04	01	H0710_803_0	1	1						05/24/2021	2022.01	05/24/2021 03:09:02 PM Central Daylight Time					06/02/2021 09:15:19 AM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H0710	803	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H0710	804	0	2	04	01	H0710_804_0	1	1						05/24/2021	2022.01	05/24/2021 03:09:50 PM Central Daylight Time					06/02/2021 09:15:19 AM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H0710	804	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H0710	805	0	2	04	01	H0710_805_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 08:58:31 AM Central Daylight Time					06/02/2021 09:15:19 AM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H0710	805	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H0710	806	0	2	04	01	H0710_806_0	1	1						05/24/2021	2022.01	05/24/2021 03:10:09 PM Central Daylight Time					06/02/2021 09:15:19 AM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H0710	806	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H0710	807	0	1	04	01	H0710_807_0	1	1						05/24/2021	2022.01	05/24/2021 03:10:25 PM Central Daylight Time					06/02/2021 09:15:19 AM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H0710	807	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H0710	808	0	1	04	01	H0710_808_0	1	1						05/24/2021	2022.01	05/24/2021 03:11:34 PM Central Daylight Time					06/02/2021 09:15:19 AM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H0710	808	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H0710	809	0	1	04	01	H0710_809_0	1	1						05/24/2021	2022.01	05/24/2021 03:12:02 PM Central Daylight Time					06/02/2021 09:15:19 AM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H0710	809	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H0710	810	0	1	04	01	H0710_810_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 08:58:48 AM Central Daylight Time					06/02/2021 09:15:19 AM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H0710	810	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H0710	811	0	1	04	01	H0710_811_0	1	1						05/24/2021	2022.01	05/24/2021 03:12:55 PM Central Daylight Time					06/02/2021 09:15:19 AM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H0710	811	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H0710	812	0	2	04	01	H0710_812_0	1	1						05/24/2021	2022.01	05/24/2021 03:13:22 PM Central Daylight Time					06/02/2021 09:15:19 AM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H0710	812	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H0710	813	0	2	04	01	H0710_813_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 08:59:05 AM Central Daylight Time					06/02/2021 09:15:19 AM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H0710	813	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H0710	814	0	2	04	01	H0710_814_0	1	1						05/24/2021	2022.01	05/24/2021 03:14:03 PM Central Daylight Time					06/02/2021 09:15:19 AM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H0710	814	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H0710	815	0	1	04	01	H0710_815_0	1	1						05/24/2021	2022.01	05/24/2021 03:14:19 PM Central Daylight Time					06/02/2021 09:15:19 AM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H0710	815	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H0710	816	0	1	04	01	H0710_816_0	1	1						05/24/2021	2022.01	05/24/2021 03:14:46 PM Central Daylight Time					06/02/2021 09:15:19 AM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H0710	816	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H0710	817	0	1	04	01	H0710_817_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 08:59:21 AM Central Daylight Time					06/02/2021 09:15:19 AM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H0710	817	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H0710	818	0	1	04	01	H0710_818_0	1	1						05/24/2021	2022.01	05/24/2021 03:15:27 PM Central Daylight Time					06/02/2021 09:15:19 AM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H0710	818	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H0710	819	0	1	04	01	H0710_819_0	1	1						05/24/2021	2022.01	05/24/2021 03:15:44 PM Central Daylight Time					06/02/2021 09:15:19 AM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H0710	819	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H0710	820	0	1	04	01	H0710_820_0	1	1						05/24/2021	2022.01	05/24/2021 03:16:00 PM Central Daylight Time					06/02/2021 09:15:19 AM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H0710	820	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H0710	821	0	1	04	01	H0710_821_0	1	1						05/24/2021	2022.01	05/24/2021 03:16:15 PM Central Daylight Time					06/02/2021 09:15:19 AM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H0710	821	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H0710	822	0	1	04	01	H0710_822_0	1	1						05/24/2021	2022.01	05/24/2021 03:16:31 PM Central Daylight Time					06/02/2021 09:15:19 AM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H0710	822	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H0710	823	0	1	04	01	H0710_823_0	1	1						05/24/2021	2022.01	05/24/2021 03:16:46 PM Central Daylight Time					06/02/2021 09:15:19 AM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H0710	823	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H0710	824	0	2	04	01	H0710_824_0	1	1						05/24/2021	2022.01	05/24/2021 03:17:05 PM Central Daylight Time					06/02/2021 09:15:19 AM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H0710	824	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H0710	825	0	1	04	01	H0710_825_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 08:59:37 AM Central Daylight Time					06/02/2021 09:15:19 AM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H0710	825	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H0710	826	0	1	04	01	H0710_826_0	1	1						05/24/2021	2022.01	05/24/2021 03:20:54 PM Central Daylight Time					06/02/2021 09:15:19 AM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H0710	826	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H0710	827	0	1	04	01	H0710_827_0	1	1						05/24/2021	2022.01	05/24/2021 03:21:12 PM Central Daylight Time					06/02/2021 09:15:19 AM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H0710	827	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H0710	829	0	1	04	01	H0710_829_0	1	1						05/24/2021	2022.01	05/24/2021 03:21:28 PM Central Daylight Time					06/02/2021 09:15:19 AM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H0710	829	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H0710	830	0	1	04	01	H0710_830_0	1	1						05/24/2021	2022.01	05/24/2021 03:21:46 PM Central Daylight Time					06/02/2021 09:15:19 AM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H0710	830	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H0710	831	0	1	04	01	H0710_831_0	1	1						05/24/2021	2022.01	05/24/2021 03:25:57 PM Central Daylight Time					06/02/2021 09:15:19 AM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H0710	831	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H0712	005	0	1	01	01	H0712_005_0	6	1	2	1			0	07/19/2021	2022.01	07/19/2021 05:33:51 PM Eastern Daylight Time	08/03/2021 10:36:48 PM Eastern Daylight Time	07/30/2021 10:00:18 AM Eastern Daylight Time			08/04/2021 11:21:47 PM Eastern Daylight Time	WELLCARE OF CONNECTICUT, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Access (HMO D-SNP)	01	01		1			H0712	005	0	2022	All counties in CT		2	45978	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0712	019	0	1	01	01	H0712_019_0	5	1					0	08/02/2021	2022.01	08/02/2021 09:23:58 AM Eastern Daylight Time	08/03/2021 10:37:15 PM Eastern Daylight Time	07/30/2021 10:00:40 AM Eastern Daylight Time			08/04/2021 11:21:47 PM Eastern Daylight Time	WELLCARE OF CONNECTICUT, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO)	01	01		1			H0712	019	0	2022	All counties in CT		2	15473	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0712	020	0	1	01	01	H0712_020_0	5	1					0	05/30/2021	2022.01	05/30/2021 05:03:01 PM Eastern Daylight Time	08/04/2021 03:18:32 PM Eastern Daylight Time	07/30/2021 10:01:10 AM Eastern Daylight Time			08/04/2021 11:21:47 PM Eastern Daylight Time	WELLCARE OF CONNECTICUT, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Assist (HMO)	01	01		1			H0712	020	0	2022	All counties in CT		2	14124	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0712	023	0	1	01	01	H0712_023_0	5	1					0	08/03/2021	2022.01	08/03/2021 12:12:30 PM Eastern Daylight Time	08/03/2021 10:38:16 PM Eastern Daylight Time	07/30/2021 10:01:32 AM Eastern Daylight Time			08/04/2021 10:12:55 PM Eastern Daylight Time	WELLCARE OF CONNECTICUT, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium Value (HMO)	01	01		1			H0712	023	0	2022	Select counties in NC		2	1348	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0712	025	0	1	01	01	H0712_025_0	6	1	2	1			0	08/03/2021	2022.01	08/03/2021 12:21:28 PM Eastern Daylight Time	08/03/2021 10:38:44 PM Eastern Daylight Time	07/30/2021 10:02:12 AM Eastern Daylight Time			08/04/2021 10:12:55 PM Eastern Daylight Time	WELLCARE OF CONNECTICUT, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Access Medicare (HMO D-SNP)	01	01		1			H0712	025	0	2022	Select counties in NC		2	3244	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0712	029	0	1	01	01	H0712_029_0	5	1	2	1			0	06/02/2021	2022.01	06/02/2021 09:31:26 PM Eastern Daylight Time	08/03/2021 10:39:13 PM Eastern Daylight Time	07/30/2021 10:02:50 AM Eastern Daylight Time			08/04/2021 11:21:47 PM Eastern Daylight Time	WELLCARE OF CONNECTICUT, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Liberty (HMO D-SNP)	01	01		1			H0712	029	0	2022	All counties in CT		2	16973	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(833)444-9089		(833)444-9089		(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	4	1					0	08/04/2021	2022.01	08/04/2021 09:42:30 AM Eastern Daylight Time	08/03/2021 10:39:46 PM Eastern Daylight Time	07/30/2021 10:03:12 AM Eastern Daylight Time			08/04/2021 09:45:33 PM Eastern Daylight Time	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Wellcare by Allwell	www.wellcare.com/allwellOH	Wellcare No Premium Medicare (HMO)	01	01		1			H0724	001	0	2022	Select counties in OH		2	28798	2			2						www.wellcare.com/allwellOH	www.wellcare.com/allwellOH	www.wellcare.com/allwellOH	(855)766-1851		(855)766-1851		(866)277-6583		(866)277-6583		(855)766-1851		(855)766-1851		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0724	005	0	1	01	01	H0724_005_0	3	1				0	0	05/31/2021	2022.01	05/31/2021 08:26:16 AM Eastern Daylight Time	06/04/2021 11:43:21 AM Eastern Daylight Time				07/19/2021 05:05:07 PM Eastern Daylight Time	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Wellcare by Allwell	www.wellcare.com/allwellOH	Wellcare Patriot No Premium (HMO)	01	01		1			H0724	005	0	2022	Select counties in OH		2	560	2			2						www.wellcare.com/allwellOH	www.wellcare.com/allwellOH	www.wellcare.com/allwellOH	(855)766-1851		(855)766-1851		(866)277-6583		(866)277-6583										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H0724	006	0	1	01	01	H0724_006_0	4	1					0	06/04/2021	2022.01	06/04/2021 01:04:57 PM Eastern Daylight Time	08/03/2021 10:40:48 PM Eastern Daylight Time	07/30/2021 10:03:34 AM Eastern Daylight Time			08/04/2021 09:45:33 PM Eastern Daylight Time	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Wellcare by Allwell	www.wellcare.com/allwellOH	Wellcare Assist Complement (HMO)	01	01		1			H0724	006	0	2022	Select counties in OH		2	2269	2			2						www.wellcare.com/allwellOH	www.wellcare.com/allwellOH	www.wellcare.com/allwellOH	(855)766-1851		(855)766-1851		(866)277-6583		(866)277-6583		(855)766-1851		(855)766-1851		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0724	007	0	1	01	01	H0724_007_0	4	1					0	05/31/2021	2022.01	05/31/2021 08:28:38 AM Eastern Daylight Time	08/03/2021 10:41:17 PM Eastern Daylight Time	07/30/2021 10:04:08 AM Eastern Daylight Time			08/04/2021 09:45:33 PM Eastern Daylight Time	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Wellcare by Allwell	www.wellcare.com/allwellOH	Wellcare Giveback Boost (HMO)	01	01		1			H0724	007	0	2022	Select counties in OH		2	4744	2			2						www.wellcare.com/allwellOH	www.wellcare.com/allwellOH	www.wellcare.com/allwellOH	(855)766-1851		(855)766-1851		(866)277-6583		(866)277-6583		(855)766-1851		(855)766-1851		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0724	801	0	1	01	01	H0724_801_0	2	1						05/03/2021	2022.01	05/03/2021 01:30:34 PM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Wellcare by Allwell	allwell.buckeyehealthplan.com	Allwell Group (HMO)	01	01		1			H0724	801	0	2022	Countywide		1	100	2			2						allwell.buckeyehealthplan.com/findadoctor	allwell.buckeyehealthplan.com/formulary	allwell.buckeyehealthplan.com/findadoctor	(855)766-1851		(855)766-1851		(844)942-0039		(844)942-0039		(855)766-1851		(855)766-1851		(844)942-0039		(844)942-0039		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H0724	802	0	1	01	01	H0724_802_0	2	1				0	0	05/03/2021	2022.01	05/03/2021 01:30:45 PM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Wellcare by Allwell	allwell.buckeyehealthplan.com	Allwell Group (HMO)	01	01		1			H0724	802	0	2022	Countywide		1	100	2			2						allwell.buckeyehealthplan.com/findadoctor	allwell.buckeyehealthplan.com/formulary	allwell.buckeyehealthplan.com/findadoctor	(855)766-1851		(855)766-1851		(844)942-0039		(844)942-0039										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H0724	803	0	1	01	01	H0724_803_0	2	1						05/03/2021	2022.01	05/03/2021 01:30:56 PM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Wellcare by Allwell	allwell.buckeyehealthplan.com	Allwell Group (HMO)	01	01		1			H0724	803	0	2022	Countywide		1	100	2			2						allwell.buckeyehealthplan.com/findadoctor	allwell.buckeyehealthplan.com/formulary	allwell.buckeyehealthplan.com/findadoctor	(855)766-1851		(855)766-1851		(844)942-0039		(844)942-0039		(855)766-1851		(855)766-1851		(844)942-0039		(844)942-0039		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H0755	030	0	1	01	01	H0755_030_0	3	1					1	08/04/2021	2022.01	08/04/2021 01:25:05 PM Central Daylight Time	08/03/2021 12:14:44 PM Central Daylight Time	07/29/2021 07:25:29 PM Central Daylight Time			08/05/2021 02:39:17 PM Central Daylight Time	OXFORD HEALTH PLANS (CT), INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Plan 1 (HMO)	01	01		1			H0755	030	0	2022	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	3	1					1	08/04/2021	2022.01	08/04/2021 01:26:50 PM Central Daylight Time	08/03/2021 12:15:12 PM Central Daylight Time	07/29/2021 07:25:45 PM Central Daylight Time			08/05/2021 02:39:17 PM Central Daylight Time	OXFORD HEALTH PLANS (CT), INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Plan 2 (HMO)	01	01		1			H0755	031	0	2022	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				0	0	07/15/2021	2022.01	07/15/2021 09:15:07 AM Central Daylight Time	06/03/2021 02:46:20 PM Central Daylight Time				07/16/2021 09:25:56 AM Central Daylight Time	OXFORD HEALTH PLANS (CT), INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Patriot (HMO)	01	01		1			H0755	032	0	2022	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	3	1					1	08/04/2021	2022.01	08/04/2021 01:28:17 PM Central Daylight Time	08/03/2021 12:15:41 PM Central Daylight Time	07/29/2021 07:26:01 PM Central Daylight Time			08/05/2021 02:39:17 PM Central Daylight Time	OXFORD HEALTH PLANS (CT), INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Plan 3 (HMO)	01	01		1			H0755	033	0	2022	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	037	0	1	01	01	H0755_037_0	2	1				0	0	07/15/2021	2022.01	07/15/2021 11:26:27 AM Central Daylight Time	06/03/2021 02:47:21 PM Central Daylight Time				07/15/2021 05:04:37 PM Central Daylight Time	OXFORD HEALTH PLANS (CT), INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (HMO)	01	01		1			H0755	037	0	2022	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					1	08/04/2021	2022.01	08/04/2021 09:19:25 AM Central Daylight Time	08/03/2021 12:16:11 PM Central Daylight Time	07/29/2021 07:26:16 PM Central Daylight Time			08/05/2021 12:44:06 PM Central Daylight Time	OXFORD HEALTH PLANS (CT), INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO)	01	01		1			H0755	038	0	2022	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	043	0	1	01	01	H0755_043_0	3	1					1	08/04/2021	2022.01	08/04/2021 09:21:30 AM Central Daylight Time	08/03/2021 12:16:41 PM Central Daylight Time	07/29/2021 07:26:36 PM Central Daylight Time			08/05/2021 12:44:06 PM Central Daylight Time	OXFORD HEALTH PLANS (CT), INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO)	01	01		1			H0755	043	0	2022	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	044	0	1	01	01	H0755_044_0	3	1					1	08/04/2021	2022.01	08/04/2021 09:23:30 AM Central Daylight Time	08/03/2021 12:17:11 PM Central Daylight Time	07/29/2021 07:26:51 PM Central Daylight Time			08/05/2021 12:44:06 PM Central Daylight Time	OXFORD HEALTH PLANS (CT), INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 3 (HMO)	01	01		1			H0755	044	0	2022	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	045	0	1	01	01	H0755_045_0	3	1					1	08/04/2021	2022.01	08/04/2021 09:25:15 AM Central Daylight Time	08/03/2021 12:17:41 PM Central Daylight Time	07/29/2021 07:27:07 PM Central Daylight Time			08/05/2021 12:44:06 PM Central Daylight Time	OXFORD HEALTH PLANS (CT), INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 4 (HMO)	01	01		1			H0755	045	0	2022	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	810	0	1	01	01	H0755_810_0	1	1						06/02/2021	2022.01	06/02/2021 12:20:28 PM Central Daylight Time					06/02/2021 12:27:15 PM Central Daylight Time	OXFORD HEALTH PLANS (CT), INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0755	810	0	2022	Connecticut		1	984	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1					1				
H0755	811	0	1	01	01	H0755_811_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 12:22:23 PM Central Daylight Time					06/02/2021 12:27:15 PM Central Daylight Time	OXFORD HEALTH PLANS (CT), INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0755	811	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1					1				
H0755	812	0	1	01	01	H0755_812_0	1	1						06/02/2021	2022.01	06/02/2021 12:22:53 PM Central Daylight Time					06/02/2021 12:27:15 PM Central Daylight Time	OXFORD HEALTH PLANS (CT), INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0755	812	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1					1				
H0755	813	0	1	01	01	H0755_813_0	1	1						06/02/2021	2022.01	06/02/2021 12:25:48 PM Central Daylight Time					06/02/2021 12:27:15 PM Central Daylight Time	OXFORD HEALTH PLANS (CT), INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0755	813	0	2022	NJ		1	984	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1					1				
H0755	814	0	1	01	01	H0755_814_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 12:26:12 PM Central Daylight Time					06/02/2021 12:27:15 PM Central Daylight Time	OXFORD HEALTH PLANS (CT), INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0755	814	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1					1				
H0755	815	0	1	01	01	H0755_815_0	1	1						06/02/2021	2022.01	06/02/2021 12:26:39 PM Central Daylight Time					06/02/2021 12:27:15 PM Central Daylight Time	OXFORD HEALTH PLANS (CT), INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0755	815	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1					1				
H0783	002	0	1	01	01	H0783_002_0	4	1			2		1	08/02/2021	2022.01	08/02/2021 10:55:44 AM Eastern Daylight Time	08/03/2021 06:15:25 PM Eastern Daylight Time	07/30/2021 10:04:06 AM Eastern Daylight Time			08/04/2021 02:00:17 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF TEXAS, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H0783-002 (HMO)	01	01		1			H0783	002	0	2022	Cameron, Hidalgo and Willacy counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0798	001	0	1	01	01	H0798_001_0	7	1					1	09/27/2021	2022.01	09/27/2021 09:38:56 AM Central Daylight Time	08/05/2021 08:33:03 AM Central Daylight Time	08/05/2021 08:33:42 AM Central Daylight Time			09/27/2021 10:01:16 AM Central Daylight Time	MEDICA COMMUNITY HEALTH PLAN	Medica	medica.com	Medica Advantage Solution with CHI Health (HMO)	01	01		1			H0798	001	0	2022	Select counties in IA and NE		2		2			2						medica.com/Members	medica.com/Members	medica.com/Members	(866)398-7374		(952)992-2134		(800)906-5432		(952)992-2345		(866)398-7374		(952)992-2134		(800)906-5432		(952)992-2345		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0798	002	0	1	01	01	H0798_002_0	8	1		1			0	08/04/2021	2022.01	08/04/2021 12:37:10 PM Central Daylight Time	08/05/2021 12:29:34 PM Central Daylight Time	08/05/2021 12:28:46 PM Central Daylight Time			08/05/2021 01:20:46 PM Central Daylight Time	MEDICA COMMUNITY HEALTH PLAN	Medica	medica.com	Medica Advantage Solution H0798-002 (HMO I-SNP)	01	01		1			H0798	002	0	2022	Select counties in NE		2	637	2			1	1	1				medica.com/Members	medica.com/Members	medica.com/Members	(877)335-9181		(952)992-2580		(800)266-2157		(952)992-2030		(877)335-9181		(952)992-2580		(800)266-2157		(952)992-2030		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0809	001	0	1	20	08	H0809_001_0	1	1						06/02/2021	2022.01	06/02/2021 01:08:48 PM Eastern Daylight Time		06/01/2021 02:08:38 PM Eastern Daylight Time			06/02/2021 01:12:21 PM Eastern Daylight Time	MERCY LIFE, INC.	Mercy LIFE	www.mymercylife.com	Mercy LIFE, Inc. (PACE)	08	20		1			H0809	001	0	2022	Mercy LIFE		2		2			2						pharmastar.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						06/02/2021	2022.01	06/02/2021 01:10:18 PM Eastern Daylight Time		06/01/2021 02:08:38 PM Eastern Daylight Time			06/02/2021 01:12:21 PM Eastern Daylight Time	MERCY LIFE, INC.	Mercy LIFE	www.mymercylife.com	Mercy LIFE, Inc. (PACE)	08	20		1			H0809	002	0	2022	Mercy LIFE		2		2			2						pharmastar.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	2	1						04/28/2021	2022.01	04/28/2021 04:00:22 PM Eastern Daylight Time		07/27/2021 02:04:06 PM Eastern Daylight Time			07/27/2021 02:39:58 PM Eastern Daylight Time	SENIOR LIFE YORK, INC.	Senior LIFE York, Inc.	www.seniorlifepa.com	Senior LIFE York & Harrisburg Dual Eligibile (PACE)	08	20		1			H0819	001	0	2022	York & Harrisburg County		2		2			2						http://granerx.com/	www.seniorlifeyork.com										(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000										(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000																
H0819	002	0	1	20	08	H0819_002_0	2	1						04/28/2021	2022.01	04/28/2021 04:00:37 PM Eastern Daylight Time		07/27/2021 02:04:34 PM Eastern Daylight Time			07/27/2021 02:39:58 PM Eastern Daylight Time	SENIOR LIFE YORK, INC.	Senior LIFE York, Inc.	http://www.seniorlifeyork.com	Senior LIFE York & Harrisburg Medicare Only (PACE)	08	20		1			H0819	002	0	2022	York & Harrisburg County		2		2			2						http://granerx.com/	www.seniorlifeyork.com										(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000										(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000																
H0826	001	0	1	01	01	H0826_001_0	4	1					0	08/05/2021	2022.01	08/05/2021 04:01:20 PM Eastern Daylight Time	08/05/2021 03:24:32 PM Eastern Daylight Time	08/05/2021 03:37:59 PM Eastern Daylight Time			08/05/2021 04:51:34 PM Eastern Daylight Time	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Innovative Integrated Health Community Plans	www.iihcplans.com	IIHCP Community Choice (HMO)	01	01		1			H0826	001	0	2022	Counties: Fresno, Tulare, Kern		2		2			2						www.iihcplans.com/pharmacies	www.iihcplans.com/formulary	www.iihcplans.com/providers	(888)900-6807		(559)400-6426		(888)807-1308		(559)400-6427		(888)900-6807		(559)400-6426		(888)807-1308		(559)400-6427		(888)807-1325		(559)840-0482		(888)807-1325		(559)840-0482		(888)807-1325		(559)840-0482		(888)807-1325		(559)840-0482		2					2					2	2			
H0838	020	0	1	01	01	H0838_020_0	6	1		1			0	08/03/2021	2022.01	08/03/2021 02:15:53 PM Central Daylight Time	08/05/2021 03:37:46 PM Central Daylight Time	08/05/2021 03:37:49 PM Central Daylight Time			08/05/2021 04:22:06 PM Central Daylight Time	UNIVERSAL CARE, INC.	Brand New Day	www.bndhmo.com	Brand New Day Harmony Choice Plan (HMO C-SNP)	01	01		1			H0838	020	0	2022	All Brand New Day Approved Counties		2	28745	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0838	024	0	1	01	01	H0838_024_0	5	1	2	1			0	08/03/2021	2022.01	08/03/2021 02:16:51 PM Central Daylight Time	08/05/2021 03:37:46 PM Central Daylight Time	08/05/2021 03:37:49 PM Central Daylight Time			08/05/2021 04:22:06 PM Central Daylight Time	UNIVERSAL CARE, INC.	Brand New Day	www.bndhmo.com	Brand New Day Dual Access Plan (HMO D-SNP)	01	01		1			H0838	024	0	2022	FRE IMP KER KIN LA MAD ORG RIV SAC SBD SF SJ TUL		2	69708	2			1	3		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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0838	025	0	1	01	01	H0838_025_0	5	1					0	08/04/2021	2022.01	08/04/2021 10:22:48 AM Central Daylight Time	08/05/2021 03:37:46 PM Central Daylight Time	08/05/2021 03:37:49 PM Central Daylight Time			08/05/2021 04:22:06 PM Central 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	2022	Counties:  KER LA ORA RIV SBD SD		2	104604	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0838	028	0	1	01	01	H0838_028_0	5	1		1			0	08/04/2021	2022.01	08/04/2021 08:41:16 AM Central Daylight Time	08/05/2021 03:37:46 PM Central Daylight Time	08/05/2021 03:37:49 PM Central Daylight Time			08/05/2021 04:22:06 PM Central Daylight Time	UNIVERSAL CARE, INC.	Brand New Day	www.bndhmo.com	Brand New Day Bridges Care Plan (HMO C-SNP)	01	01		1			H0838	028	0	2022	All Brand New Day Approved Counties		2	5799	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0838	029	0	1	01	01	H0838_029_0	5	1		1			0	08/03/2021	2022.01	08/03/2021 02:31:33 PM Central Daylight Time	08/05/2021 03:37:46 PM Central Daylight Time	08/05/2021 03:37:49 PM Central Daylight Time			08/05/2021 04:22:06 PM Central Daylight Time	UNIVERSAL CARE, INC.	Brand New Day	www.bndhmo.com	Brand New Day Bridges Choice Plan (HMO C-SNP)	01	01		1			H0838	029	0	2022	All Brand New Day Approved Counties		2	2070	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0838	032	0	1	01	01	H0838_032_0	6	1		1			0	08/03/2021	2022.01	08/03/2021 02:33:16 PM Central Daylight Time	08/05/2021 03:37:46 PM Central Daylight Time	08/05/2021 03:37:49 PM Central Daylight Time			08/05/2021 04:22:06 PM Central Daylight Time	UNIVERSAL CARE, INC.	Brand New Day	www.bndhmo.com	Brand New Day Harmony Care Plan (HMO C-SNP)	01	01		1			H0838	032	0	2022	All Brand New Day Approved Counties		2	5932	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0838	033	0	1	01	01	H0838_033_0	5	1					0	08/03/2021	2022.01	08/03/2021 02:33:56 PM Central Daylight Time	08/05/2021 03:37:46 PM Central Daylight Time	08/05/2021 03:37:50 PM Central Daylight Time			08/05/2021 04:22:06 PM Central Daylight Time	UNIVERSAL CARE, INC.	Brand New Day	www.bndhmo.com	Brand New Day Classic Choice Plan (HMO)	01	01		1			H0838	033	0	2022	All Brand New Day Approved Counties		2	83340	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0838	037	0	1	01	01	H0838_037_0	5	1					0	08/03/2021	2022.01	08/03/2021 02:34:50 PM Central Daylight Time	08/05/2021 03:37:46 PM Central Daylight Time	08/05/2021 03:37:50 PM Central Daylight Time			08/05/2021 04:22:06 PM Central 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	2022	All Brand New Day Approved Counties		2	193350	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0838	039	1	1	01	01	H0838_039_1	5	1		1			1	08/03/2021	2022.01	08/03/2021 02:38:25 PM Central Daylight Time	08/05/2021 03:37:46 PM Central Daylight Time	08/05/2021 03:37:50 PM Central Daylight Time			08/05/2021 04:22:06 PM Central Daylight Time	UNIVERSAL CARE, INC.	Brand New Day	www.bndhmo.com	Brand New Day Embrace Care Plan (HMO C-SNP)	01	01		1			H0838	039	1	2022	All Brand New Day Approved Counties	KER LA ORA RIV SBD SD	2	143766	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0838	039	2	1	01	01	H0838_039_2	5	1		1			1	08/03/2021	2022.01	08/03/2021 02:39:26 PM Central Daylight Time	08/05/2021 03:37:46 PM Central Daylight Time	08/05/2021 03:37:50 PM Central Daylight Time			08/05/2021 04:22:06 PM Central Daylight Time	UNIVERSAL CARE, INC.	Brand New Day	www.bndhmo.com	Brand New Day Embrace Care Plan (HMO C-SNP)	01	01		1			H0838	039	2	2022	All Brand New Day Approved Counties	FRE IMP KIN MAD SAC SF SJ SM SCL TUL	2	193170	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0838	040	1	1	01	01	H0838_040_1	5	1		1			0	08/03/2021	2022.01	08/03/2021 02:40:52 PM Central Daylight Time	08/05/2021 03:37:46 PM Central Daylight Time	08/05/2021 03:37:50 PM Central Daylight Time			08/05/2021 04:22:06 PM Central Daylight Time	UNIVERSAL CARE, INC.	Brand New Day	www.bndhmo.com	Brand New Day Embrace Choice Plan (HMO C-SNP)	01	01		1			H0838	040	1	2022	All Brand New Day Approved Counties	KER LA ORA RIV SBD SD	2	79782	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0838	040	2	1	01	01	H0838_040_2	5	1		1			0	08/03/2021	2022.01	08/03/2021 02:41:24 PM Central Daylight Time	08/05/2021 03:37:46 PM Central Daylight Time	08/05/2021 03:37:50 PM Central Daylight Time			08/05/2021 04:22:06 PM Central Daylight Time	UNIVERSAL CARE, INC.	Brand New Day	www.bndhmo.com	Brand New Day Embrace Choice Plan (HMO C-SNP)	01	01		1			H0838	040	2	2022	All Brand New Day Approved Counties	FRE IMP KIN SAC SF SJ SM SCL TUL MAD	2	56172	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0838	042	0	1	01	01	H0838_042_0	5	1		1			0	08/03/2021	2022.01	08/03/2021 02:42:55 PM Central Daylight Time	08/05/2021 03:37:46 PM Central Daylight Time	08/05/2021 03:37:50 PM Central Daylight Time			08/05/2021 04:22:06 PM Central Daylight Time	UNIVERSAL CARE, INC.	Brand New Day	www.bndhmo.com	Brand New Day Select Care I Plan (HMO I-SNP)	01	01		1			H0838	042	0	2022	Counties: LA, ORA, RIV, SBD		2	2346	2			1	1	3				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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0838	043	0	1	01	01	H0838_043_0	6	1		1			0	08/03/2021	2022.01	08/03/2021 02:45:50 PM Central Daylight Time	08/05/2021 05:33:36 PM Central Daylight Time	08/05/2021 05:34:56 PM Central Daylight Time			08/05/2021 05:59:56 PM Central Daylight Time	UNIVERSAL CARE, INC.	Brand New Day	www.bndhmo.com	Brand New Day Select Care II Plan (HMO I-SNP)	01	01		1			H0838	043	0	2022	FRE IMP KER KIN MAD SAC SD SF SJ SM SCL TUL		2	7116	2			1	1	3				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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0838	044	0	1	01	01	H0838_044_0	6	1		1			0	08/03/2021	2022.01	08/03/2021 02:48:12 PM Central Daylight Time	08/05/2021 05:33:36 PM Central Daylight Time	08/05/2021 05:34:56 PM Central Daylight Time			08/05/2021 05:59:56 PM Central Daylight Time	UNIVERSAL CARE, INC.	Brand New Day	www.bndhmo.com	Brand New Day Select Choice I Plan (HMO I-SNP)	01	01		1			H0838	044	0	2022	LA ORA SBD RIV		2	1644	2			1	1	3				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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0838	045	0	1	01	01	H0838_045_0	6	1		1			0	08/05/2021	2022.01	08/05/2021 04:38:38 PM Central Daylight Time	08/05/2021 05:33:36 PM Central Daylight Time	08/05/2021 05:34:57 PM Central Daylight Time			08/05/2021 05:59:56 PM Central Daylight Time	UNIVERSAL CARE, INC.	Brand New Day	www.bndhmo.com	Brand New Day Select Choice II Plan (HMO I-SNP)	01	01		1			H0838	045	0	2022	KER SD FRE IMP KIN SM SCL MAD SAC SF SJ TUL		2	7164	2			1	1	3				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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0838	046	0	1	01	01	H0838_046_0	6	1					0	08/03/2021	2022.01	08/03/2021 02:51:20 PM Central Daylight Time	08/05/2021 05:33:36 PM Central Daylight Time	08/05/2021 05:34:57 PM Central Daylight Time			08/05/2021 05:59:56 PM Central Daylight Time	UNIVERSAL CARE, INC.	Brand New Day	www.bndhmo.com	Brand New Day Classic Care III Plan (HMO)	01	01		1			H0838	046	0	2022	Contra Costa, Santa Cruz, and Solano Counties		2	9660	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0838	047	0	1	01	01	H0838_047_0	6	1		1			1	08/03/2021	2022.01	08/03/2021 02:51:53 PM Central Daylight Time	08/05/2021 05:56:48 PM Central Daylight Time	08/05/2021 03:37:50 PM Central Daylight Time			08/05/2021 05:59:56 PM Central Daylight Time	UNIVERSAL CARE, INC.	Brand New Day	www.bndhmo.com	Brand New Day Embrace Care (HMO C-SNP)	01	01		1			H0838	047	0	2022	Contra Costa, Santa Cruz, and Solano Counties		2	4758	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0838	048	0	1	01	01	H0838_048_0	4	1				0	0	07/19/2021	2022.01	07/19/2021 11:55:45 AM Central Daylight Time	06/07/2021 01:05:28 PM Central Daylight Time				07/19/2021 06:09:06 PM Central Daylight Time	UNIVERSAL CARE, INC.	Brand New Day	www.bndhmo.com	Brand New Day Valor Care Plan (HMO)	01	01		1			H0838	048	0	2022	All Brand New Day Approved Counties		2	960	2			2						www.bndhmo.com	www.bndhmo.com	www.bndhmo.com	(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H0838	049	0	1	01	01	H0838_049_0	6	1					0	08/03/2021	2022.01	08/03/2021 02:52:37 PM Central Daylight Time	08/05/2021 03:37:47 PM Central Daylight Time	08/05/2021 03:37:50 PM Central Daylight Time			08/05/2021 04:22:06 PM Central Daylight Time	UNIVERSAL CARE, INC.	Brand New Day	www.bndhmo.com	Brand New Day Part B Savings Plan (HMO)	01	01		1			H0838	049	0	2022	KER LA ORA RIV SBD SD		2	1500	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0839	001	0	1	20	08	H0839_001_0	1	1						05/28/2021	2022.01	05/28/2021 11:30:13 AM Eastern Daylight Time		05/27/2021 03:30:07 PM Eastern Daylight Time			05/28/2021 11:34:38 AM 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	2022	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						05/28/2021	2022.01	05/28/2021 11:31:52 AM Eastern Daylight Time		05/27/2021 03:28:37 PM Eastern Daylight Time			05/28/2021 11:34:38 AM 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	2022	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																
H0876	001	0	1	01	01	H0876_001_0	9	1	2	1			0	08/10/2021	2022.01	08/10/2021 02:51:19 PM Eastern Daylight Time	08/05/2021 04:00:26 PM Eastern Daylight Time	08/05/2021 04:00:26 PM Eastern Daylight Time			08/10/2021 04:53:05 PM Eastern Daylight Time	CCA HMO COMPLETE RHODE ISLAND LLC	CCA HMO Complete Rhode Island	commonwealthcarealliance.org/ri/become-a-member	CCA Medicare Maximum (HMO D-SNP)	01	01		1			H0876	001	0	2022	Rhode Island		2		2			1	3		1		1	https://www.commonwealthcarealliance.org/members/pharmacy-program	https://www.commonwealthcarealliance.org/ri/members/dsnp/dsnp-formulary	provider-directory.commonwealthcarealliance.org/	(866)655-3117		(866)655-3117		(866)275-1222		(866)275-1222		(866)655-3117		(866)655-3117		(866)275-1222		(866)275-1222		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0885	001	0	1	04	01	H0885_001_0	6	1					1	07/14/2021	2022.01	07/14/2021 12:44:53 PM Central Daylight Time	08/05/2021 03:50:52 PM Central Daylight Time	08/05/2021 03:52:43 PM Central Daylight Time			08/05/2021 04:10:03 PM Central Daylight Time	HEALTHIER NEW JERSEY INSURANCE COMPANY	Braven Health	www.bravenhealth.com	Braven Medicare Choice (PPO)	01	04		1			H0885	001	0	2022	Eastern New Jersey		2		2			2						https://www.bravenhealth.com	https://www.bravenhealth.com	www.bravenhealth.com	(833)272-8360		(833)272-8360		(833)713-1313		(833)713-1313		(855)457-0222		(855)457-0222		(833)713-1313		(833)713-1313		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0885	002	0	1	04	01	H0885_002_0	6	1					1	07/14/2021	2022.01	07/14/2021 12:48:06 PM Central Daylight Time	08/05/2021 03:51:37 PM Central Daylight Time	08/05/2021 03:53:47 PM Central Daylight Time			08/05/2021 04:10:03 PM Central Daylight Time	HEALTHIER NEW JERSEY INSURANCE COMPANY	Braven Health	www.bravenhealth.com	Braven Medicare Freedom (PPO)	01	04		1			H0885	002	0	2022	Eastern New Jersey		2		2			2						https://www.bravenhealth.com	https://www.bravenhealth.com	www.bravenhealth.com	(833)272-8360		(833)272-8360		(833)713-1313		(833)713-1313		(855)457-0222		(855)457-0222		(833)713-1313		(833)713-1313		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0885	801	0	1	04	01	H0885_801_0	2	1				0	0	06/03/2021	2022.01	06/03/2021 01:10:39 PM Central Daylight Time					06/06/2021 08:05:45 PM Central Daylight Time	HEALTHIER NEW JERSEY INSURANCE COMPANY	Braven Health	www.bravenhealth.com	Braven Medicare Group (PPO)	01	04		1			H0885	801	0	2022	National		1	27191	2			2						https://www.bravenhealth.com	https://www.bravenhealth.com	www.bravenhealth.com	(833)272-8360		(833)272-8360		(833)713-1313		(833)713-1313										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7c;7d;7i;8a;8b1;8b2;9a1;9b;9c;10a;11a;11b;11c;15;	2		1									
H0885	802	0	1	04	01	H0885_802_0	2	1						06/03/2021	2022.01	06/03/2021 12:25:16 PM Central Daylight Time					06/06/2021 08:05:45 PM Central Daylight Time	HEALTHIER NEW JERSEY INSURANCE COMPANY	Braven Health	www.bravenhealth.com	Braven Medicare Group w/Rx (PPO)	01	04		1			H0885	802	0	2022	National		1	13256	2			2						https://www.bravenhealth.com	https://www.bravenhealth.com	www.bravenhealth.com	(833)272-8360		(833)272-8360		(833)713-1313		(833)713-1313		(855)457-0222		(855)457-0222		(833)713-1313		(833)713-1313		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7c;7d;7i;8a;8b1;8b2;9a1;9b;9c;10a;11a;11b;11c;15;	2		1									
H0885	803	0	1	04	01	H0885_803_0	2	1						06/03/2021	2022.01	06/03/2021 12:25:23 PM Central Daylight Time					06/06/2021 08:05:45 PM Central Daylight Time	HEALTHIER NEW JERSEY INSURANCE COMPANY	Braven Health	www.bravenhealth.com	Braven Medicare Group w/Rx Ideal (PPO)	01	04		1			H0885	803	0	2022	National		1	120	2			2						https://www.bravenhealth.com	https://www.bravenhealth.com	www.bravenhealth.com	(833)272-8360		(833)272-8360		(833)713-1313		(833)713-1313		(855)457-0222		(855)457-0222		(833)713-1313		(833)713-1313		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7c;7d;7i;8a;8b1;8b2;9a1;9b;9c;10a;11a;11b;11c;15;	2		1									
H0885	804	0	1	04	01	H0885_804_0	2	1						06/03/2021	2022.01	06/03/2021 12:25:29 PM Central Daylight Time					06/06/2021 08:05:45 PM Central Daylight Time	HEALTHIER NEW JERSEY INSURANCE COMPANY	Braven Health	www.bravenhealth.com	Braven Medicare Group w/Rx Complete (PPO)	01	04		1			H0885	804	0	2022	National		1	120	2			2						https://www.bravenhealth.com	https://www.bravenhealth.com	www.bravenhealth.com	(833)272-8360		(833)272-8360		(833)713-1313		(833)713-1313		(855)457-0222		(855)457-0222		(833)713-1313		(833)713-1313		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7c;7d;7i;8a;8b1;8b2;9a1;9b;9c;10a;11a;11b;11c;15;	2		1									
H0907	001	0	1	01	01	H0907_001_0	7	1	2	1	1		0	07/28/2021	2022.01	07/28/2021 03:11:16 PM Eastern Daylight Time	08/03/2021 06:04:00 PM Eastern Daylight Time	08/03/2021 06:04:00 PM Eastern Daylight Time			08/04/2021 02:28:17 PM Eastern Daylight Time	AMERIGROUP IOWA, INC.	Amerigroup Iowa	https://shop.amerigroup.com/medicare	Amerivantage Dual Coordination (HMO D-SNP)	01	01		1			H0907	001	0	2022	Select Counties in Iowa		2		2			1	3		1		1	https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	(833)557-0950		(833)557-0950		(855)593-0903		(855)593-0903		(833)498-1578		(833)498-1578		(855)948-5574		(855)948-5574		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0908	001	0	1	01	01	H0908_001_0	4	1	2	1			0	05/31/2021	2022.01	05/31/2021 08:33:32 AM Eastern Daylight Time	08/03/2021 10:41:47 PM Eastern Daylight Time	07/30/2021 10:04:28 AM Eastern Daylight Time			08/04/2021 09:45:33 PM Eastern Daylight Time	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellOH	Wellcare Dual Access (HMO D-SNP)	01	01		1			H0908	001	0	2022	Select counties in OH		2	25419	2			1	3		1		1	www.wellcare.com/allwellOH	www.wellcare.com/allwellOH	www.wellcare.com/allwellOH	(866)389-7690		(866)389-7690		(866)277-6583		(866)277-6583		(866)389-7690		(866)389-7690		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0908	003	0	1	01	01	H0908_003_0	4	1					0	08/03/2021	2022.01	08/03/2021 10:29:49 AM Eastern Daylight Time	08/03/2021 10:42:16 PM Eastern Daylight Time	07/30/2021 10:05:10 AM Eastern Daylight Time			08/04/2021 09:45:33 PM Eastern Daylight Time	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellOH	Wellcare No Premium (HMO)	01	01		1			H0908	003	0	2022	Select counties in OH		2	39361	2			2						www.wellcare.com/allwellOH	www.wellcare.com/allwellOH	www.wellcare.com/allwellOH	(855)766-1851		(855)766-1851		(866)277-6583		(866)277-6583		(855)766-1851		(855)766-1851		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0908	004	0	1	01	01	H0908_004_0	4	1					0	06/04/2021	2022.01	06/04/2021 01:05:43 PM Eastern Daylight Time	08/03/2021 10:42:45 PM Eastern Daylight Time	07/30/2021 10:05:44 AM Eastern Daylight Time			08/04/2021 09:45:33 PM Eastern Daylight Time	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellOH	Wellcare Assist (HMO)	01	01		1			H0908	004	0	2022	Select counties in OH		2	4704	2			2						www.wellcare.com/allwellOH	www.wellcare.com/allwellOH	www.wellcare.com/allwellOH	(855)766-1851		(855)766-1851		(866)277-6583		(866)277-6583		(855)766-1851		(855)766-1851		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0908	005	0	1	01	01	H0908_005_0	4	1					0	08/03/2021	2022.01	08/03/2021 10:24:05 AM Eastern Daylight Time	08/03/2021 10:43:20 PM Eastern Daylight Time	07/30/2021 10:06:04 AM Eastern Daylight Time			08/04/2021 09:45:33 PM Eastern Daylight Time	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellOH	Wellcare Giveback (HMO)	01	01		1			H0908	005	0	2022	Select counties in OH		2	15845	2			2						www.wellcare.com/allwellOH	www.wellcare.com/allwellOH	www.wellcare.com/allwellOH	(855)766-1851		(855)766-1851		(866)277-6583		(866)277-6583		(855)766-1851		(855)766-1851		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0908	801	0	1	01	01	H0908_801_0	2	1						05/03/2021	2022.01	05/03/2021 01:31:09 PM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Wellcare by Allwell	allwell.buckeyehealthplan.com	Allwell Group (HMO)	01	01		1			H0908	801	0	2022	Statewide		1	100	2			2						allwell.buckeyehealthplan.com/findadoctor	allwell.buckeyehealthplan.com/formulary	allwell.buckeyehealthplan.com/findadoctor	(855)766-1851		(855)766-1851		(844)942-0039		(844)942-0039		(855)766-1851		(855)766-1851		(844)942-0039		(844)942-0039		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H0908	802	0	1	01	01	H0908_802_0	2	1				0	0	05/03/2021	2022.01	05/03/2021 01:31:18 PM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Wellcare by Allwell	allwell.buckeyehealthplan.com	Allwell Group (HMO)	01	01		1			H0908	802	0	2022	Statewide		1	100	2			2						allwell.buckeyehealthplan.com/findadoctor	allwell.buckeyehealthplan.com/formulary	allwell.buckeyehealthplan.com/findadoctor	(855)766-1851		(855)766-1851		(844)942-0039		(844)942-0039										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H0908	803	0	1	01	01	H0908_803_0	2	1						05/03/2021	2022.01	05/03/2021 01:31:28 PM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Wellcare by Allwell	allwell.buckeyehealthplan.com	Allwell Group (HMO)	01	01		1			H0908	803	0	2022	Statewide		1	100	2			2						allwell.buckeyehealthplan.com/findadoctor	allwell.buckeyehealthplan.com/formulary	allwell.buckeyehealthplan.com/findadoctor	(855)766-1851		(855)766-1851		(844)942-0039		(844)942-0039		(855)766-1851		(855)766-1851		(844)942-0039		(844)942-0039		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H0913	002	0	1	02	01	H0913_002_0	5	1					0	08/03/2021	2022.01	08/03/2021 10:36:32 AM Eastern Daylight Time	08/03/2021 10:43:53 PM Eastern Daylight Time	07/30/2021 10:06:34 AM Eastern Daylight Time			08/04/2021 10:12:55 PM Eastern Daylight Time	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO-POS)	01	02		1			H0913	002	0	2022	Select counties in NJ		2	20218	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0913	013	0	1	01	01	H0913_013_0	7	1	2	1			0	07/19/2021	2022.01	07/19/2021 02:49:13 PM Eastern Daylight Time	08/03/2021 10:44:22 PM Eastern Daylight Time	07/30/2021 10:06:56 AM Eastern Daylight Time			08/04/2021 10:12:55 PM Eastern Daylight Time	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Liberty (HMO D-SNP)	01	01		1			H0913	013	0	2022	Select counties in NJ		2	78586	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0913	015	0	1	01	01	H0913_015_0	5	1					0	06/02/2021	2022.01	06/02/2021 03:56:33 PM Eastern Daylight Time	08/04/2021 03:18:57 PM Eastern Daylight Time	07/30/2021 10:07:20 AM Eastern Daylight Time			08/04/2021 10:12:55 PM Eastern Daylight Time	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Assist (HMO)	01	01		1			H0913	015	0	2022	Select counties in NJ		2	15414	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0913	017	0	1	01	01	H0913_017_0	5	1					0	08/03/2021	2022.01	08/03/2021 10:56:23 AM Eastern Daylight Time	08/03/2021 10:45:22 PM Eastern Daylight Time	07/30/2021 10:07:42 AM Eastern Daylight Time			08/04/2021 10:12:55 PM Eastern Daylight Time	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium Focus (HMO)	01	01		1			H0913	017	0	2022	Select counties in NJ		2	17049	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	7a;7g;	
H0913	020	0	1	01	01	H0913_020_0	4	1				0	0	06/02/2021	2022.01	06/02/2021 04:35:39 PM Eastern Daylight Time	06/04/2021 01:37:57 PM Eastern Daylight Time				07/19/2021 07:06:39 PM Eastern Daylight Time	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Patriot No Premium (HMO)	01	01		1			H0913	020	0	2022	Select counties in NJ		2	3100	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H0927	001	0	1	48	05	H0927_001_0	2	1						07/16/2021	2022.01	07/16/2021 01:40:41 PM Central Daylight Time					07/16/2021 01:44:37 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross Community MMAI	www.bcbsil.com/mmai	Blue Cross Community MMAI (Medicare-Medicaid Plan)	05	48		1			H0927	001	0	2022	State of IL		2	356706	2			2						www.myprime.com/v/BCBSIL/MEDICARE_D/ILBCCMAI/en/find-pharmacy.html	www.bcbsil.com/mmai/plan_details/drug_coverage.html		(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)-																
H0934	001	0	1	20	08	H0934_001_0	1	1						06/01/2021	2022.01	06/01/2021 03:46:32 PM Mountain Daylight Time		06/01/2021 10:03:18 AM Mountain Daylight Time			06/01/2021 03:49:18 PM Mountain Daylight Time	PACIFIC PACE, LLC	WelbeHealth Pacific PACE	https://welbehealth.com/pacific/	WelbeHealth Pacific PACE (PACE)	08	20		1			H0934	001	0	2022	Parts of Los Angeles County		2		2			2						www.omnicare.com	NA												(800)851-0966				(800)851-0966												(800)735-2922				(800)735-2922																
H0934	002	0	1	20	08	H0934_002_0	1	1						06/01/2021	2022.01	06/01/2021 03:46:41 PM Mountain Daylight Time		06/01/2021 10:03:23 AM Mountain Daylight Time			06/01/2021 03:49:18 PM Mountain Daylight Time	PACIFIC PACE, LLC	WelbeHealth Pacific PACE	https://welbehealth.com/pacific/	WelbeHealth Pacific PACE (PACE)	08	20		1			H0934	002	0	2022	Parts of Los Angeles County		2		2			2						www.omnicare.com	NA												(800)851-0966				(800)851-0966												(800)735-2922				(800)735-2922																
H0969	001	0	1	04	01	H0969_001_0	6	1					0	08/03/2021	2022.01	08/03/2021 01:45:52 PM Eastern Daylight Time	08/03/2021 10:46:20 PM Eastern Daylight Time	07/30/2021 10:08:26 AM Eastern Daylight Time			08/04/2021 10:12:55 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Wellcare	www.wellcare.com/medicare	Wellcare No Premium Open (PPO)	01	04		1			H0969	001	0	2022	Select counties in NH		2	16917	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0969	002	0	1	04	01	H0969_002_0	6	1					0	06/07/2021	2022.01	06/07/2021 12:16:08 PM Eastern Daylight Time	08/03/2021 10:46:50 PM Eastern Daylight Time	07/30/2021 10:08:56 AM Eastern Daylight Time			08/04/2021 10:12:55 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Wellcare	www.wellcare.com/medicare	Wellcare Assist Open (PPO)	01	04		1			H0969	002	0	2022	Select counties in NH		2	2097	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0969	003	0	1	04	01	H0969_003_0	7	1					0	08/10/2021	2022.01	08/10/2021 05:34:25 PM Eastern Daylight Time	08/03/2021 10:47:16 PM Eastern Daylight Time	07/30/2021 10:09:18 AM Eastern Daylight Time			08/11/2021 03:53:12 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Wellcare	www.wellcare.com/medicare	Wellcare Giveback Open (PPO)	01	04		1			H0969	003	0	2022	Select counties in NH		2	2361	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0969	004	0	1	04	01	H0969_004_0	5	1				0	0	06/07/2021	2022.01	06/07/2021 12:20:27 PM Eastern Daylight Time	06/07/2021 03:01:10 PM Eastern Daylight Time				07/19/2021 07:06:39 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Wellcare	www.wellcare.com/medicare	Wellcare Patriot Giveback Open (PPO)	01	04		1			H0969	004	0	2022	Select counties in NH		2	590	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175										(711)-		(711)-		(711)-		(711)-										2					2						2			
H0969	005	0	1	04	01	H0969_005_0	6	1					0	06/07/2021	2022.01	06/07/2021 11:08:46 AM Eastern Daylight Time	08/03/2021 10:48:13 PM Eastern Daylight Time	07/30/2021 10:09:38 AM Eastern Daylight Time			08/04/2021 10:12:55 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Wellcare	www.wellcare.com/medicare	Wellcare Plus Open (PPO)	01	04		1			H0969	005	0	2022	Select counties in NH		2	1661	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0978	001	0	1	01	01	H0978_001_0	5	1					1	08/05/2021	2022.01	08/05/2021 08:58:10 AM Pacific Daylight Time	08/05/2021 01:40:16 PM Pacific Daylight Time	07/29/2021 03:59:22 PM Pacific Daylight Time			08/05/2021 05:39:13 PM Pacific Daylight Time	SCAN HEALTH PLAN NEVADA, INC.	SCAN Health Plan	www.scanhealthplan.com	SCAN Classic (HMO)	01	01		1			H0978	001	0	2022	Clark County		2		2			2						www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0978	002	0	1	01	01	H0978_002_0	5	1		1			1	08/05/2021	2022.01	08/05/2021 09:00:58 AM Pacific Daylight Time	08/05/2021 01:34:55 PM Pacific Daylight Time	07/29/2021 03:59:42 PM Pacific Daylight Time			08/05/2021 05:39:13 PM Pacific Daylight Time	SCAN HEALTH PLAN NEVADA, INC.	SCAN Health Plan	www.scanhealthplan.com	SCAN Balance (HMO C-SNP)	01	01		1			H0978	002	0	2022	Clark County		2		2			1	4			00000010000000000000		www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0978	003	0	1	01	01	H0978_003_0	5	1		1			1	08/05/2021	2022.01	08/05/2021 09:01:47 AM Pacific Daylight Time	08/05/2021 01:38:35 PM Pacific Daylight Time	07/29/2021 03:59:58 PM Pacific Daylight Time			08/05/2021 05:39:13 PM Pacific Daylight Time	SCAN HEALTH PLAN NEVADA, INC.	SCAN Health Plan	www.scanhealthplan.com	SCAN Heart First (HMO C-SNP)	01	01		1			H0978	003	0	2022	Clark County		2		2			1	4			00000000000000010000		www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0978	004	0	1	01	01	H0978_004_0	5	1					1	08/05/2021	2022.01	08/05/2021 08:59:31 AM Pacific Daylight Time	08/05/2021 01:33:37 PM Pacific Daylight Time	07/29/2021 04:00:14 PM Pacific Daylight Time			08/05/2021 05:39:13 PM Pacific Daylight Time	SCAN HEALTH PLAN NEVADA, INC.	SCAN Health Plan	www.scanhealthplan.com	SCAN Venture (HMO)	01	01		1			H0978	004	0	2022	Clark County		2		2			2						www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0978	802	0	1	01	01	H0978_802_0	2	1						05/21/2021	2022.01	05/21/2021 04:34:03 PM Pacific Daylight Time					06/04/2021 11:04:52 AM Pacific Daylight Time	SCAN HEALTH PLAN NEVADA, INC.	SCAN Health Plan	www.scanhealthplan.com	SCAN Retiree Group (HMO)	01	01		1			H0978	802	0	2022	Clark County		1	500	2			2						https://www.scanhealthplan.com/	https://www.scanhealthplan.com/	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0978	803	0	1	01	01	H0978_803_0	2	1						05/25/2021	2022.01	05/25/2021 03:49:15 PM Pacific Daylight Time					06/04/2021 11:04:52 AM Pacific Daylight Time	SCAN HEALTH PLAN NEVADA, INC.	SCAN Health Plan	www.scanhealthplan.com	SCAN Retiree Group (HMO)	01	01		1			H0978	803	0	2022	Clark County		1	500	2			2						https://www.scanhealthplan.com/	https://www.scanhealthplan.com/	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0982	001	0	1	01	01	H0982_001_0	8	1					0	07/08/2021	2022.01	07/08/2021 11:37:45 AM Eastern Daylight Time	08/05/2021 01:09:31 PM Central Daylight Time	08/03/2021 12:30:38 PM Central Daylight Time			08/05/2021 05:14:57 PM Central Daylight Time	SOLIS HEALTH PLANS, INC.	Solis Health Plans	https://solishealthplans.com	SOLIS SPF 001 (HMO)	01	01		1			H0982	001	0	2022	Miami-Dade MAPD		2	11100	2			2						https://solishealthplans.com	https://solishealthplans.com	https://solishealthplans.com	(844)447-6547		(305)420-3079		(844)447-6547		(305)420-3079		(844)447-6547		(305)420-3079		(844)447-6547		(305)420-3079		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0982	002	0	1	01	01	H0982_002_0	8	1	2	1	1		0	08/03/2021	2022.01	08/03/2021 01:57:35 PM Eastern Daylight Time	08/05/2021 01:14:53 PM Central Daylight Time	08/03/2021 12:31:21 PM Central Daylight Time			08/05/2021 05:14:57 PM Central Daylight Time	SOLIS HEALTH PLANS, INC.	Solis Health Plans	https://solishealthplans.com	SOLIS SPF 002 (HMO D-SNP)	01	01		1			H0982	002	0	2022	Miami-Dade D-SNP		2	23625	2			1	3		2		1	https://solishealthplans.com	https://solishealthplans.com	https://solishealthplans.com	(844)447-6547		(305)420-3079		(844)447-6547		(305)420-3079		(844)447-6547		(305)420-3079		(844)447-6547		(305)420-3079		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0982	005	0	1	01	01	H0982_005_0	8	1					0	08/03/2021	2022.01	08/03/2021 01:55:45 PM Eastern Daylight Time	08/05/2021 01:16:15 PM Central Daylight Time	08/03/2021 12:31:46 PM Central Daylight Time			08/05/2021 05:14:57 PM Central Daylight Time	SOLIS HEALTH PLANS, INC.	Solis Health Plans	https://solishealthplans.com	SOLIS SPF 005 (HMO)	01	01		1			H0982	005	0	2022	Orange MAPD		2	4110	2			2						https://solishealthplans.com	https://solishealthplans.com	https://solishealthplans.com	(844)447-6547		(305)420-3079		(844)447-6547		(305)420-3079		(844)447-6547		(305)420-3079		(844)447-6547		(305)420-3079		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0982	006	0	1	01	01	H0982_006_0	8	1	2	1	1		0	08/03/2021	2022.01	08/03/2021 01:58:22 PM Eastern Daylight Time	08/05/2021 01:17:47 PM Central Daylight Time	08/03/2021 12:32:12 PM Central Daylight Time			08/05/2021 05:14:57 PM Central Daylight Time	SOLIS HEALTH PLANS, INC.	Solis Health Plans	https://solishealthplans.com	SOLIS SPF 006 (HMO D-SNP)	01	01		1			H0982	006	0	2022	Orange D-SNP		2	7575	2			1	3		2		1	https://solishealthplans.com	https://solishealthplans.com	https://solishealthplans.com	(844)447-6547		(305)420-3079		(844)447-6547		(305)420-3079		(844)447-6547		(305)420-3079		(844)447-6547		(305)420-3079		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0982	007	0	1	01	01	H0982_007_0	8	1					0	08/03/2021	2022.01	08/03/2021 01:55:16 PM Eastern Daylight Time	08/05/2021 01:18:48 PM Central Daylight Time	08/03/2021 12:32:35 PM Central Daylight Time			08/05/2021 05:14:57 PM Central Daylight Time	SOLIS HEALTH PLANS, INC.	Solis Health Plans	https://solishealthplans.com	SOLIS SPF 007 (HMO)	01	01		1			H0982	007	0	2022	Broward MAPD		2	3780	2			2						https://solishealthplans.com	https://solishealthplans.com	https://solishealthplans.com	(844)447-6547		(305)420-3079		(844)447-6547		(305)420-3079		(844)447-6547		(305)420-3079		(844)447-6547		(305)420-3079		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0982	008	0	1	01	01	H0982_008_0	8	1					0	08/03/2021	2022.01	08/03/2021 01:54:50 PM Eastern Daylight Time	08/05/2021 01:20:30 PM Central Daylight Time	08/03/2021 12:33:11 PM Central Daylight Time			08/05/2021 05:14:57 PM Central Daylight Time	SOLIS HEALTH PLANS, INC.	Solis Health Plans	https://solishealthplans.com	SOLIS SPF 008 (HMO)	01	01		1			H0982	008	0	2022	Palm Beach MAPD		2	1800	2			2						https://solishealthplans.com	https://solishealthplans.com	https://solishealthplans.com	(844)447-6547		(305)420-3079		(844)447-6547		(305)420-3079		(844)447-6547		(305)420-3079		(844)447-6547		(305)420-3079		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0982	009	0	1	01	01	H0982_009_0	8	1					0	07/08/2021	2022.01	07/08/2021 11:36:42 AM Eastern Daylight Time	08/05/2021 01:21:57 PM Central Daylight Time	08/03/2021 12:33:35 PM Central Daylight Time			08/05/2021 05:14:57 PM Central Daylight Time	SOLIS HEALTH PLANS, INC.	Solis Health Plans	https://solishealthplans.com	SOLIS SPF 009 (HMO)	01	01		1			H0982	009	0	2022	Hillsborough MAPD		2	2280	2			2						https://solishealthplans.com	https://solishealthplans.com	https://solishealthplans.com	(844)447-6547		(305)420-3079		(844)447-6547		(305)420-3079		(844)447-6547		(305)420-3079		(844)447-6547		(305)420-3079		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0982	010	0	1	01	01	H0982_010_0	8	1	2	1	1		0	08/03/2021	2022.01	08/03/2021 01:59:00 PM Eastern Daylight Time	08/05/2021 01:23:21 PM Central Daylight Time	08/03/2021 12:33:59 PM Central Daylight Time			08/05/2021 05:14:57 PM Central Daylight Time	SOLIS HEALTH PLANS, INC.	Solis Health Plans	https://solishealthplans.com	SOLIS SPF 010 (HMO D-SNP)	01	01		1			H0982	010	0	2022	Hillsborough D-SNP		2	5190	2			1	3		2		1	https://solishealthplans.com	https://solishealthplans.com	https://solishealthplans.com	(844)447-6547		(305)420-3079		(844)447-6547		(305)420-3079		(844)447-6547		(305)420-3079		(844)447-6547		(305)420-3079		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0982	011	0	1	01	01	H0982_011_0	9	1		1			0	08/04/2021	2022.01	08/04/2021 04:28:39 PM Eastern Daylight Time	08/09/2021 09:53:31 AM Central Daylight Time	08/03/2021 12:34:20 PM Central Daylight Time			08/09/2021 03:23:58 PM Central Daylight Time	SOLIS HEALTH PLANS, INC.	Solis Health Plans	https://solishealthplans.com	SOLIS SPF 011 (HMO C-SNP)	01	01		1			H0982	011	0	2022	Miami-Dade C-SNP		2	4530	2			1	4			00000000000010000000		https://solishealthplans.com	https://solishealthplans.com	https://solishealthplans.com	(844)447-6547		(305)420-3079		(844)447-6547		(305)420-3079		(844)447-6547		(305)420-3079		(844)447-6547		(305)420-3079		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0982	012	0	1	01	01	H0982_012_0	8	1	2	1	1		0	08/03/2021	2022.01	08/03/2021 02:00:13 PM Eastern Daylight Time	08/05/2021 01:25:25 PM Central Daylight Time	08/03/2021 12:34:44 PM Central Daylight Time			08/05/2021 05:14:57 PM Central Daylight Time	SOLIS HEALTH PLANS, INC.	Solis Health Plans	https://solishealthplans.com	SOLIS SPF 012 (HMO D-SNP)	01	01		1			H0982	012	0	2022	Broward D-SNP		2	5040	2			1	3		2		1	https://solishealthplans.com	https://solishealthplans.com	https://solishealthplans.com	(844)447-6547		(305)420-3079		(844)447-6547		(305)420-3079		(844)447-6547		(305)420-3079		(844)447-6547		(305)420-3079		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0982	013	0	1	01	01	H0982_013_0	8	1	2	1	1		0	08/03/2021	2022.01	08/03/2021 02:01:02 PM Eastern Daylight Time	08/05/2021 01:07:06 PM Central Daylight Time	08/03/2021 12:35:13 PM Central Daylight Time			08/05/2021 05:14:57 PM Central Daylight Time	SOLIS HEALTH PLANS, INC.	Solis Health Plans	https://solishealthplans.com	SOLIS SPF 013 (HMO D-SNP)	01	01		1			H0982	013	0	2022	Palm Beach D-SNP		2	3030	2			1	3		2		1	https://solishealthplans.com	https://solishealthplans.com	https://solishealthplans.com	(844)447-6547		(305)420-3079		(844)447-6547		(305)420-3079		(844)447-6547		(305)420-3079		(844)447-6547		(305)420-3079		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1016	001	0	1	01	01	H1016_001_0	6	1			1		1	08/04/2021	2022.01	08/04/2021 04:00:30 PM Eastern Daylight Time	08/04/2021 03:10:40 PM Eastern Daylight Time	08/04/2021 01:26:34 PM Eastern Daylight Time			08/05/2021 05:22:43 PM Eastern Daylight Time	AVMED, INC.	AvMed Medicare	www.avmed.org	AvMed Medicare Choice (HMO)	01	01		1			H1016	001	0	2022	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	021	0	1	01	01	H1016_021_0	6	1			1		1	08/04/2021	2022.01	08/04/2021 04:07:48 PM Eastern Daylight Time	08/04/2021 03:11:26 PM Eastern Daylight Time	08/04/2021 01:29:54 PM Eastern Daylight Time			08/05/2021 05:22:43 PM Eastern Daylight Time	AVMED, INC.	AvMed Medicare	www.avmed.org	AvMed Medicare Choice (HMO)	01	01		1			H1016	021	0	2022	Broward County		2	12	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	023	0	1	01	01	H1016_023_0	6	1			1		1	08/04/2021	2022.01	08/04/2021 04:03:47 PM Eastern Daylight Time	08/04/2021 03:11:56 PM Eastern Daylight Time	08/04/2021 01:36:24 PM Eastern Daylight Time			08/05/2021 05:22:43 PM Eastern Daylight Time	AVMED, INC.	AvMed Medicare	www.avmed.org	AvMed Medicare Circle (HMO)	01	01		1			H1016	023	0	2022	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	6	1			1		1	08/03/2021	2022.01	08/03/2021 04:10:35 PM Eastern Daylight Time	08/04/2021 03:12:24 PM Eastern Daylight Time	08/04/2021 01:37:44 PM Eastern Daylight Time			08/05/2021 05:22:43 PM Eastern Daylight Time	AVMED, INC.	AvMed Medicare	www.avmed.org	AvMed Medicare Circle (HMO)	01	01		1			H1016	024	0	2022	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	025	0	1	02	01	H1016_025_0	6	1			1		1	08/04/2021	2022.01	08/04/2021 04:04:56 PM Eastern Daylight Time	08/04/2021 03:12:58 PM Eastern Daylight Time	08/04/2021 01:39:22 PM Eastern Daylight Time			08/05/2021 05:22:43 PM Eastern Daylight Time	AVMED, INC.	AvMed Medicare	www.avmed.org	AvMed Medicare Access (HMO-POS)	01	02		1			H1016	025	0	2022	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	026	0	1	02	01	H1016_026_0	6	1			1		1	08/04/2021	2022.01	08/04/2021 04:10:12 PM Eastern Daylight Time	08/04/2021 03:13:32 PM Eastern Daylight Time	08/04/2021 01:40:44 PM Eastern Daylight Time			08/05/2021 05:22:43 PM Eastern Daylight Time	AVMED, INC.	AvMed Medicare	www.avmed.org	AvMed Medicare Access (HMO-POS)	01	02		1			H1016	026	0	2022	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	028	0	1	01	01	H1016_028_0	5	1			1		0	08/04/2021	2022.01	08/04/2021 04:11:47 PM Eastern Daylight Time	08/05/2021 10:36:56 AM Eastern Daylight Time	08/04/2021 01:46:56 PM Eastern Daylight Time			08/05/2021 05:22:43 PM Eastern Daylight Time	AVMED, INC.	AvMed Medicare	www.avmed.org	AvMed Medicare Premium Saver (HMO)	01	01		1			H1016	028	0	2022	Broward County		2	2021	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	1	1						04/15/2021	2022.01	04/15/2021 12:24:58 PM Eastern Daylight Time					06/08/2021 11:15:37 AM Eastern Daylight Time	AVMED, INC.	AvMed Medicare	www.avmed.org	AvMed Employer Group MAPD Plan (HMO)	01	01		1			H1016	801	0	2022	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	1	1				0	0	04/15/2021	2022.01	04/15/2021 12:09:00 PM Eastern Daylight Time					06/08/2021 11:15:37 AM Eastern Daylight Time	AVMED, INC.	AvMed Medicare	www.avmed.org	AvMed Employer Group MA Only Plan (HMO)	01	01		1			H1016	802	0	2022	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	1	1						04/15/2021	2022.01	04/15/2021 12:50:54 PM Eastern Daylight Time					06/08/2021 11:15:37 AM Eastern Daylight Time	AVMED, INC.	AvMed Medicare	www.avmed.org	AvMed Employer Group MAPD Non-CY Plan (HMO)	01	01		1			H1016	803	0	2022	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	1	1				0	0	04/15/2021	2022.01	04/15/2021 01:06:07 PM Eastern Daylight Time					06/08/2021 11:15:37 AM 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	2022	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	7	1			2		1	08/01/2021	2022.01	08/01/2021 10:28:02 AM Eastern Daylight Time	08/03/2021 05:24:02 PM Eastern Daylight Time	07/30/2021 10:04:22 AM Eastern Daylight Time			08/04/2021 02:24:36 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareOne (HMO)	01	01		1			H1019	001	0	2022	Broward County		2		2			2						www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2019-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	6	1			2		1	08/01/2021	2022.01	08/01/2021 11:45:14 AM Eastern Daylight Time	08/03/2021 05:22:22 PM Eastern Daylight Time	07/30/2021 10:04:36 AM Eastern Daylight Time			08/04/2021 01:45:42 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareOne PLUS (HMO)	01	01		1			H1019	006	0	2022	Miami-Dade County		2		2			2						www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2019-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	6	1	2	1	1		0	08/02/2021	2022.01	08/02/2021 12:57:08 PM Eastern Daylight Time	08/03/2021 05:35:56 PM Eastern Daylight Time	07/30/2021 10:04:52 AM Eastern Daylight Time			08/04/2021 01:45:42 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareNeeds PLUS (HMO D-SNP)	01	01		1			H1019	023	0	2022	Broward, Miami-Dade, & Palm Beach Counties		2		2			1	3		2		2	www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2019-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	6	1	2	1	1		0	08/02/2021	2022.01	08/02/2021 12:58:06 PM Eastern Daylight Time	08/03/2021 05:37:23 PM Eastern Daylight Time	07/30/2021 10:05:08 AM Eastern Daylight Time			08/04/2021 01:45:42 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareNeeds PLUS (HMO D-SNP)	01	01		1			H1019	026	0	2022	Orlando & Tampa Area		2		2			1	3		2		2	www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2019-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			2		1	08/01/2021	2022.01	08/01/2021 10:28:53 AM Eastern Daylight Time	08/03/2021 05:26:41 PM Eastern Daylight Time	07/30/2021 10:05:24 AM Eastern Daylight Time			08/04/2021 01:45:42 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareOne (HMO)	01	01		1			H1019	043	0	2022	Brevard and Indian River counties		2		2			2						www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2019-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	02	01	H1019_057_0	5	1			2		1	08/01/2021	2022.01	08/01/2021 10:31:15 AM Eastern Daylight Time	08/03/2021 05:28:26 PM Eastern Daylight Time	07/30/2021 10:05:40 AM Eastern Daylight Time			08/04/2021 01:45:42 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareOne PLUS (HMO-POS)	01	02		1			H1019	057	0	2022	Orlando Area		2		2			2						www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2019-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	3	1			2		1	08/01/2021	2022.01	08/01/2021 10:31:30 AM Eastern Daylight Time	08/03/2021 05:29:55 PM Eastern Daylight Time	07/30/2021 10:05:54 AM Eastern Daylight Time			08/04/2021 01:45:42 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareFree (HMO)	01	01		1			H1019	065	0	2022	Broward and Palm Beach counties		2		2			2						www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2019-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	5	1			2		1	08/01/2021	2022.01	08/01/2021 10:32:37 AM Eastern Daylight Time	08/03/2021 05:32:05 PM Eastern Daylight Time	07/30/2021 10:06:10 AM Eastern Daylight Time			08/04/2021 01:45:42 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareOne (HMO)	01	01		1			H1019	069	0	2022	Clay and Duval Counties		2		2			2						www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2019-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	6	1	2	1	1		0	08/02/2021	2022.01	08/02/2021 12:59:17 PM Eastern Daylight Time	08/03/2021 05:38:50 PM Eastern Daylight Time	07/30/2021 10:06:26 AM Eastern Daylight Time			08/04/2021 01:45:42 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareNeeds PLUS (HMO D-SNP)	01	01		1			H1019	073	0	2022	Brevard, Clay, Duval, Indian River, & Volusia Co.		2		2			1	3		2		2	www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2019-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	3	1			2		1	08/01/2021	2022.01	08/01/2021 10:32:59 AM Eastern Daylight Time	08/03/2021 05:34:25 PM Eastern Daylight Time	07/30/2021 10:06:42 AM Eastern Daylight Time			08/04/2021 01:45:42 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareFree PLUS (HMO)	01	01		1			H1019	076	0	2022	Miami-Dade County		2		2			2						www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2019-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			2		1	07/21/2021	2022.01	07/21/2021 03:32:45 PM Eastern Daylight Time	08/03/2021 05:40:19 PM Eastern Daylight Time	07/30/2021 10:06:58 AM Eastern Daylight Time			08/04/2021 01:50:55 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareExtra (HMO)	01	01		1			H1019	089	0	2022	Miami-Dade County		2		2			2						www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2019-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	3	1			2		1	08/01/2021	2022.01	08/01/2021 10:33:40 AM Eastern Daylight Time	08/03/2021 05:41:45 PM Eastern Daylight Time	07/30/2021 10:07:14 AM Eastern Daylight Time			08/04/2021 01:50:55 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareFree (HMO)	01	01		1			H1019	094	0	2022	Clay and Duval Counties		2		2			2						www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2019-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	098	0	1	01	01	H1019_098_0	5	1			2		1	08/01/2021	2022.01	08/01/2021 10:34:06 AM Eastern Daylight Time	08/03/2021 05:43:12 PM Eastern Daylight Time	07/30/2021 10:07:28 AM Eastern Daylight Time			08/04/2021 01:50:55 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareOne PLUS (HMO)	01	01		1			H1019	098	0	2022	Volusia County		2		2			2						www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2019-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	099	0	1	01	01	H1019_099_0	3	1			2		1	08/01/2021	2022.01	08/01/2021 10:34:37 AM Eastern Daylight Time	08/03/2021 05:44:42 PM Eastern Daylight Time	07/30/2021 10:07:44 AM Eastern Daylight Time			08/04/2021 01:50:55 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareFree (HMO)	01	01		1			H1019	099	0	2022	Volusia County		2		2			2						www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2019-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	102	0	1	01	01	H1019_102_0	5	1			2		1	08/01/2021	2022.01	08/01/2021 10:34:59 AM Eastern Daylight Time	08/03/2021 05:46:07 PM Eastern Daylight Time	07/30/2021 10:08:00 AM Eastern Daylight Time			08/04/2021 01:50:55 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareOne (HMO)	01	01		1			H1019	102	0	2022	Palm Beach County		2		2			2						www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2019-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	103	1	1	01	01	H1019_103_1	5	1			2		1	08/01/2021	2022.01	08/01/2021 11:46:09 AM Eastern Daylight Time	08/03/2021 05:38:33 PM Eastern Daylight Time	07/30/2021 10:08:16 AM Eastern Daylight Time			08/04/2021 01:50:55 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareOne PLUS (HMO)	01	01		1			H1019	103	1	2022	Polk County	Polk County	2		2			2						www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2019-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	103	2	1	01	01	H1019_103_2	5	1			2		1	08/01/2021	2022.01	08/01/2021 11:47:38 AM Eastern Daylight Time	08/03/2021 05:37:00 PM Eastern Daylight Time	07/30/2021 10:08:32 AM Eastern Daylight Time			08/04/2021 01:50:55 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareOne PLUS (HMO)	01	01		1			H1019	103	2	2022	Polk County	Hillsborough, Pasco, and Pinellas Counties	2		2			2						www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2019-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	104	1	1	01	01	H1019_104_1	3	1			2		1	08/01/2021	2022.01	08/01/2021 11:25:29 AM Eastern Daylight Time	08/03/2021 05:47:46 PM Eastern Daylight Time	07/30/2021 10:08:48 AM Eastern Daylight Time			08/04/2021 02:05:09 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareFree (HMO)	01	01		1			H1019	104	1	2022	Polk County	Polk County	2		2			2						www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2019-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	104	2	1	01	01	H1019_104_2	3	1			2		1	08/01/2021	2022.01	08/01/2021 11:25:48 AM Eastern Daylight Time	08/03/2021 05:49:14 PM Eastern Daylight Time	07/30/2021 10:09:02 AM Eastern Daylight Time			08/04/2021 02:05:09 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareFree (HMO)	01	01		1			H1019	104	2	2022	Polk County	Hillsborough, Pasco, and Pinellas Counties	2		2			2						www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2019-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	105	0	1	01	01	H1019_105_0	5	1		1	2		1	08/01/2021	2022.01	08/01/2021 11:40:36 AM Eastern Daylight Time	08/03/2021 05:35:27 PM Eastern Daylight Time	07/30/2021 10:09:18 AM Eastern Daylight Time			08/04/2021 02:05:09 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareComplete (HMO C-SNP)	01	01		1			H1019	105	0	2022	Miami-Dade County		2		2			1	4			00000000000000000010		www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2019-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	106	0	1	01	01	H1019_106_0	5	1		1	2		1	08/01/2021	2022.01	08/01/2021 11:41:43 AM Eastern Daylight Time	08/03/2021 05:34:50 PM Eastern Daylight Time	07/30/2021 10:09:34 AM Eastern Daylight Time			08/04/2021 02:05:09 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareComplete (HMO C-SNP)	01	01		1			H1019	106	0	2022	Broward and Palm Beach Counties		2		2			1	4			00000000000000000010		www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2019-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	107	0	1	01	01	H1019_107_0	5	1		1	2		1	08/01/2021	2022.01	08/01/2021 11:42:13 AM Eastern Daylight Time	08/03/2021 05:34:06 PM Eastern Daylight Time	07/30/2021 10:09:50 AM Eastern Daylight Time			08/04/2021 02:05:09 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareComplete (HMO C-SNP)	01	01		1			H1019	107	0	2022	Orlando & Tampa Area		2		2			1	4			00000000000000000010		www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2019-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	108	0	1	01	01	H1019_108_0	5	1		1	2		1	08/01/2021	2022.01	08/01/2021 11:39:03 AM Eastern Daylight Time	08/03/2021 05:33:22 PM Eastern Daylight Time	07/30/2021 10:10:02 AM Eastern Daylight Time			08/04/2021 02:05:09 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareComplete (HMO C-SNP)	01	01		1			H1019	108	0	2022	Brevard, Indian River, & Volusia Counties		2		2			1	4			00000000000000000010		www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2019-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	109	0	1	01	01	H1019_109_0	5	1		1	2		1	08/01/2021	2022.01	08/01/2021 11:42:34 AM Eastern Daylight Time	08/03/2021 05:28:34 PM Eastern Daylight Time	07/30/2021 10:10:18 AM Eastern Daylight Time			08/04/2021 02:05:09 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareComplete (HMO C-SNP)	01	01		1			H1019	109	0	2022	Clay and Duval Counties		2		2			1	4			00000000000000000010		www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2019-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	110	0	1	02	01	H1019_110_0	3	1			2		1	08/01/2021	2022.01	08/01/2021 11:03:03 AM Eastern Daylight Time	08/03/2021 05:32:46 PM Eastern Daylight Time	07/30/2021 10:10:34 AM Eastern Daylight Time			08/04/2021 02:05:09 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareOne PLATINUM (HMO-POS)	01	02		1			H1019	110	0	2022	Brevard and Indian River Counties		2		2			2						www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2019-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	111	0	1	01	01	H1019_111_0	3	1			2		1	08/01/2021	2022.01	08/01/2021 11:03:17 AM Eastern Daylight Time	08/03/2021 05:31:11 PM Eastern Daylight Time	07/30/2021 10:10:50 AM Eastern Daylight Time			08/04/2021 02:05:09 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareOne PLATINUM (HMO)	01	01		1			H1019	111	0	2022	Hillsborough, Pasco, and Pinellas Counties		2		2			2						www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2019-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	112	0	1	01	01	H1019_112_0	3	1			2		1	08/01/2021	2022.01	08/01/2021 11:03:32 AM Eastern Daylight Time	08/03/2021 05:30:23 PM Eastern Daylight Time	07/30/2021 10:11:04 AM Eastern Daylight Time			08/04/2021 02:09:36 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareOne PLATINUM (HMO)	01	01		1			H1019	112	0	2022	Orlando Area		2		2			2						www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2019-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	113	0	1	01	01	H1019_113_0	4	1			2		1	08/01/2021	2022.01	08/01/2021 11:03:45 AM Eastern Daylight Time	08/03/2021 05:29:41 PM Eastern Daylight Time	07/30/2021 10:11:20 AM Eastern Daylight Time			08/04/2021 02:09:36 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareOne PLATINUM (HMO)	01	01		1			H1019	113	0	2022	Clay and Duval Counties		2		2			2						www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2019-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	114	0	1	01	01	H1019_114_0	5	1		1	2		1	08/01/2021	2022.01	08/01/2021 11:42:59 AM Eastern Daylight Time	08/03/2021 05:27:57 PM Eastern Daylight Time	07/30/2021 10:11:36 AM Eastern Daylight Time			08/04/2021 02:09:36 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareBreeze (HMO C-SNP)	01	01		1			H1019	114	0	2022	Miami-Dade County		2		2			1	4			00000000000100000000		www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2019-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	115	0	1	01	01	H1019_115_0	5	1		1	2		1	08/01/2021	2022.01	08/01/2021 11:29:49 AM Eastern Daylight Time	08/03/2021 05:27:09 PM Eastern Daylight Time	07/30/2021 10:11:50 AM Eastern Daylight Time			08/04/2021 02:09:36 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareBreeze (HMO C-SNP)	01	01		1			H1019	115	0	2022	Broward and Palm Beach Counties		2		2			1	4			00000000000100000000		www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2019-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)794-5907		(800)794-5907		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1019	116	0	1	01	01	H1019_116_0	5	1		1	2		1	08/01/2021	2022.01	08/01/2021 11:43:22 AM Eastern Daylight Time	08/03/2021 05:26:28 PM Eastern Daylight Time	07/30/2021 10:12:06 AM Eastern Daylight Time			08/04/2021 02:09:36 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareBreeze (HMO C-SNP)	01	01		1			H1019	116	0	2022	Orlando & Tampa Area		2		2			1	4			00000000000100000000		www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2019-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	117	0	1	01	01	H1019_117_0	5	1		1	2		1	08/01/2021	2022.01	08/01/2021 11:39:53 AM Eastern Daylight Time	08/03/2021 05:25:44 PM Eastern Daylight Time	07/30/2021 10:12:22 AM Eastern Daylight Time			08/04/2021 02:09:36 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareBreeze (HMO C-SNP)	01	01		1			H1019	117	0	2022	Brevard, Indian River, & Volusia Counties		2		2			1	4			00000000000100000000		www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2019-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	118	0	1	01	01	H1019_118_0	5	1		1	2		1	08/01/2021	2022.01	08/01/2021 11:05:10 AM Eastern Daylight Time	08/03/2021 05:24:35 PM Eastern Daylight Time	07/30/2021 10:12:36 AM Eastern Daylight Time			08/04/2021 02:09:36 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareBreeze (HMO C-SNP)	01	01		1			H1019	118	0	2022	Clay and Duval Counties		2		2			1	4			00000000000100000000		www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2019-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	119	0	1	01	01	H1019_119_0	3	1			2	0	0	06/07/2021	2022.01	06/07/2021 03:42:57 PM Eastern Daylight Time	07/22/2021 09:43:06 AM Eastern Daylight Time				07/22/2021 01:48:12 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareSalute (HMO)	01	01		1			H1019	119	0	2022	Broward and Palm Beach Counties		2		2			2						www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2019-prescription-drug-guides	www.careplushealthplans.com/physician-finder	(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H1019	120	1	1	01	01	H1019_120_1	3	1			2		1	08/01/2021	2022.01	08/01/2021 10:36:02 AM Eastern Daylight Time	08/03/2021 05:23:52 PM Eastern Daylight Time	07/30/2021 10:12:52 AM Eastern Daylight Time			08/04/2021 01:50:55 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareFree (HMO)	01	01		1			H1019	120	1	2022	Orlando Area	Orlando Area	2		2			2						www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2019-prescription-drug-guides	www.careplushealthplans.com/physician-finder	(800)794-5907		(800)794-5907		(800)794-5907		(800)794-5907		(800)794-5907		(800)794-5907		(800)794-5907		(800)794-5907		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1019	120	2	1	01	01	H1019_120_2	3	1			2		1	08/01/2021	2022.01	08/01/2021 10:36:22 AM Eastern Daylight Time	08/03/2021 05:23:07 PM Eastern Daylight Time	07/30/2021 10:13:08 AM Eastern Daylight Time			08/04/2021 01:50:55 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareFree (HMO)	01	01		1			H1019	120	2	2022	Orlando Area	Orlando Area	2		2			2						www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2019-prescription-drug-guides	www.careplushealthplans.com/physician-finder	(800)794-5907		(800)794-5907		(800)794-5907		(800)794-5907		(800)794-5907		(800)794-5907		(800)794-5907		(800)794-5907		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	040	0	1	01	01	H1032_040_0	5	1					0	07/30/2021	2022.01	07/30/2021 02:23:33 PM Eastern Daylight Time	08/03/2021 10:48:41 PM Eastern Daylight Time	07/30/2021 10:09:58 AM Eastern Daylight Time			08/04/2021 10:03:14 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Giveback (HMO)	01	01		1			H1032	040	0	2022	Select counties in FL		2	84473	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(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			0	07/16/2021	2022.01	07/16/2021 10:00:47 AM Eastern Daylight Time	08/03/2021 10:49:13 PM Eastern Daylight Time	07/30/2021 10:10:20 AM Eastern Daylight Time			08/04/2021 10:03:14 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Access (HMO D-SNP)	01	01		1			H1032	124	0	2022	Select counties in FL		2	194266	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	170	0	1	01	01	H1032_170_0	5	1	2	1			0	07/30/2021	2022.01	07/30/2021 02:28:14 PM Eastern Daylight Time	08/03/2021 10:49:41 PM Eastern Daylight Time	07/30/2021 10:10:56 AM Eastern Daylight Time			08/04/2021 10:03:14 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Access (HMO D-SNP)	01	01		1			H1032	170	0	2022	Select counties in FL		2	3147	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(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			0	07/30/2021	2022.01	07/30/2021 02:31:43 PM Eastern Daylight Time	08/03/2021 10:50:15 PM Eastern Daylight Time	07/30/2021 10:11:18 AM Eastern Daylight Time			08/04/2021 10:03:14 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Liberty (HMO D-SNP)	01	01		1			H1032	175	0	2022	Select counties in FL		2	227339	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	176	0	1	01	01	H1032_176_0	5	1	2	1			0	07/30/2021	2022.01	07/30/2021 02:35:13 PM Eastern Daylight Time	08/03/2021 10:50:48 PM Eastern Daylight Time	07/30/2021 10:11:38 AM Eastern Daylight Time			08/04/2021 10:03:14 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Liberty (HMO D-SNP)	01	01		1			H1032	176	0	2022	Select counties in FL		2	9664	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	182	0	1	01	01	H1032_182_0	5	1	2	1			0	07/30/2021	2022.01	07/30/2021 02:38:18 PM Eastern Daylight Time	08/03/2021 10:51:17 PM Eastern Daylight Time	07/30/2021 10:12:36 AM Eastern Daylight Time			08/04/2021 10:03:14 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Select (HMO D-SNP)	01	01		1			H1032	182	0	2022	Select counties in FL		2	24992	2			1	3		2		2	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	184	0	1	01	01	H1032_184_0	5	1		1			1	07/30/2021	2022.01	07/30/2021 02:41:48 PM Eastern Daylight Time	08/03/2021 10:51:45 PM Eastern Daylight Time	07/30/2021 10:12:58 AM Eastern Daylight Time			08/04/2021 10:03:14 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Specialty No Premium (HMO C-SNP)	01	01		1			H1032	184	0	2022	Select counties in FL		2	1144	2			1	4			00000000000000000010		www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	186	0	1	01	01	H1032_186_0	5	1		1			1	07/30/2021	2022.01	07/30/2021 02:46:24 PM Eastern Daylight Time	08/03/2021 10:52:14 PM Eastern Daylight Time	07/30/2021 10:13:18 AM Eastern Daylight Time			08/04/2021 10:03:14 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Specialty Giveback (HMO C-SNP)	01	01		1			H1032	186	0	2022	Select counties in FL		2	586	2			1	4			00000000000000000010		www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	189	0	1	01	01	H1032_189_0	5	1					0	07/30/2021	2022.01	07/30/2021 02:49:23 PM Eastern Daylight Time	08/03/2021 10:52:43 PM Eastern Daylight Time	07/30/2021 10:13:56 AM Eastern Daylight Time			08/04/2021 10:03:14 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Giveback (HMO)	01	01		1			H1032	189	0	2022	Select counties in FL		2	10050	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	190	0	1	01	01	H1032_190_0	5	1					0	07/30/2021	2022.01	07/30/2021 02:52:42 PM Eastern Daylight Time	08/03/2021 10:53:13 PM Eastern Daylight Time	07/30/2021 10:14:24 AM Eastern Daylight Time			08/04/2021 10:03:14 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO)	01	01		1			H1032	190	0	2022	Select counties in FL		2	10194	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	191	0	1	01	01	H1032_191_0	5	1					0	07/30/2021	2022.01	07/30/2021 02:56:12 PM Eastern Daylight Time	08/03/2021 10:53:43 PM Eastern Daylight Time	07/30/2021 10:14:42 AM Eastern Daylight Time			08/04/2021 10:03:14 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Giveback (HMO)	01	01		1			H1032	191	0	2022	Select counties in FL		2	28956	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	192	0	1	01	01	H1032_192_0	5	1					0	08/02/2021	2022.01	08/02/2021 09:41:38 AM Eastern Daylight Time	08/03/2021 10:54:14 PM Eastern Daylight Time	07/30/2021 10:15:18 AM Eastern Daylight Time			08/04/2021 10:03:14 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO)	01	01		1			H1032	192	0	2022	Select counties in FL		2	34193	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	193	0	1	01	01	H1032_193_0	5	1					0	07/30/2021	2022.01	07/30/2021 03:01:40 PM Eastern Daylight Time	08/03/2021 10:54:43 PM Eastern Daylight Time	07/30/2021 10:15:38 AM Eastern Daylight Time			08/04/2021 10:03:14 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Giveback (HMO)	01	01		1			H1032	193	0	2022	Select counties in FL		2	84702	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	194	0	1	01	01	H1032_194_0	6	1					0	07/30/2021	2022.01	07/30/2021 03:04:53 PM Eastern Daylight Time	08/03/2021 10:55:12 PM Eastern Daylight Time	07/30/2021 10:16:06 AM Eastern Daylight Time			08/04/2021 10:03:14 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO)	01	01		1			H1032	194	0	2022	Select counties in FL		2	36734	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	195	0	1	01	01	H1032_195_0	7	1					0	08/02/2021	2022.01	08/02/2021 11:10:58 AM Eastern Daylight Time	08/03/2021 10:55:44 PM Eastern Daylight Time	07/30/2021 10:16:26 AM Eastern Daylight Time			08/04/2021 10:03:14 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Giveback (HMO)	01	01		1			H1032	195	0	2022	Select counties in FL		2	32983	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	196	0	1	01	01	H1032_196_0	5	1					0	07/30/2021	2022.01	07/30/2021 03:11:42 PM Eastern Daylight Time	08/03/2021 10:56:12 PM Eastern Daylight Time	07/30/2021 10:16:48 AM Eastern Daylight Time			08/04/2021 10:03:14 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO)	01	01		1			H1032	196	0	2022	Select counties in FL		2	12664	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	198	0	1	01	01	H1032_198_0	5	1					0	07/30/2021	2022.01	07/30/2021 03:15:04 PM Eastern Daylight Time	08/03/2021 10:56:41 PM Eastern Daylight Time	07/30/2021 10:17:10 AM Eastern Daylight Time			08/04/2021 10:03:14 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Giveback (HMO)	01	01		1			H1032	198	0	2022	Select counties in FL		2	47602	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	199	0	1	01	01	H1032_199_0	5	1					0	07/30/2021	2022.01	07/30/2021 03:18:08 PM Eastern Daylight Time	08/03/2021 10:57:10 PM Eastern Daylight Time	07/30/2021 10:17:30 AM Eastern Daylight Time			08/04/2021 10:03:14 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO)	01	01		1			H1032	199	0	2022	Select counties in FL		2	21681	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	200	0	1	01	01	H1032_200_0	5	1					0	07/30/2021	2022.01	07/30/2021 03:21:29 PM Eastern Daylight Time	08/03/2021 10:57:40 PM Eastern Daylight Time	07/30/2021 10:18:10 AM Eastern Daylight Time			08/04/2021 10:03:14 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Giveback (HMO)	01	01		1			H1032	200	0	2022	Select counties in FL		2	184680	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	201	0	1	01	01	H1032_201_0	5	1					0	07/30/2021	2022.01	07/30/2021 03:24:47 PM Eastern Daylight Time	08/03/2021 10:58:10 PM Eastern Daylight Time	07/30/2021 10:18:44 AM Eastern Daylight Time			08/04/2021 10:03:14 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO)	01	01		1			H1032	201	0	2022	Select counties in FL		2	79688	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(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			0	05/31/2021	2022.01	05/31/2021 08:32:36 AM Eastern Daylight Time	08/04/2021 03:19:23 PM Eastern Daylight Time	07/30/2021 10:19:04 AM Eastern Daylight Time			08/04/2021 10:03:14 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Reserve (HMO D-SNP)	01	01		1			H1032	202	0	2022	Select counties in FL		2	18351	2			1	3		2		2	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	203	0	1	01	01	H1032_203_0	5	1		1			1	07/30/2021	2022.01	07/30/2021 03:28:11 PM Eastern Daylight Time	08/03/2021 10:59:08 PM Eastern Daylight Time	07/30/2021 10:19:26 AM Eastern Daylight Time			08/04/2021 10:03:14 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Specialty Giveback (HMO C-SNP)	01	01		1			H1032	203	0	2022	Select counties in FL		2	8565	2			1	4			00000000000000000010		www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	204	0	1	01	01	H1032_204_0	5	1					0	07/30/2021	2022.01	07/30/2021 03:31:33 PM Eastern Daylight Time	08/03/2021 10:59:36 PM Eastern Daylight Time	07/30/2021 10:19:46 AM Eastern Daylight Time			08/04/2021 10:03:14 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Giveback (HMO)	01	01		1			H1032	204	0	2022	Select counties in FL		2	29156	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	205	0	1	01	01	H1032_205_0	5	1					0	07/30/2021	2022.01	07/30/2021 03:34:47 PM Eastern Daylight Time	08/03/2021 11:00:05 PM Eastern Daylight Time	07/30/2021 10:20:04 AM Eastern Daylight Time			08/04/2021 10:03:14 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO)	01	01		1			H1032	205	0	2022	Select counties in FL		2	63583	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(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			0	06/04/2021	2022.01	06/04/2021 12:57:46 PM Eastern Daylight Time	08/04/2021 03:19:50 PM Eastern Daylight Time	07/30/2021 10:20:36 AM Eastern Daylight Time			08/04/2021 10:03:14 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Reserve (HMO D-SNP)	01	01		1			H1032	206	0	2022	Select counties in FL		2	727	2			1	3		2		2	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	209	0	1	01	01	H1032_209_0	5	1					0	07/30/2021	2022.01	07/30/2021 03:37:56 PM Eastern Daylight Time	08/03/2021 11:01:03 PM Eastern Daylight Time	07/30/2021 10:20:56 AM Eastern Daylight Time			08/04/2021 10:03:14 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Giveback (HMO)	01	01		1			H1032	209	0	2022	Select counties in FL		2	10735	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	210	0	1	01	01	H1032_210_0	5	1					0	07/30/2021	2022.01	07/30/2021 03:41:13 PM Eastern Daylight Time	08/03/2021 11:01:32 PM Eastern Daylight Time	07/30/2021 10:21:16 AM Eastern Daylight Time			08/04/2021 10:03:14 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Giveback (HMO)	01	01		1			H1032	210	0	2022	Select counties in FL		2	30676	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	211	0	1	01	01	H1032_211_0	5	1					0	07/30/2021	2022.01	07/30/2021 03:44:23 PM Eastern Daylight Time	08/03/2021 11:02:00 PM Eastern Daylight Time	07/30/2021 10:21:40 AM Eastern Daylight Time			08/04/2021 10:03:14 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO)	01	01		1			H1032	211	0	2022	Select counties in FL		2	21166	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	212	0	1	01	01	H1032_212_0	5	1					0	07/30/2021	2022.01	07/30/2021 03:47:37 PM Eastern Daylight Time	08/03/2021 11:02:30 PM Eastern Daylight Time	07/30/2021 10:22:18 AM Eastern Daylight Time			08/04/2021 10:03:14 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Giveback (HMO)	01	01		1			H1032	212	0	2022	Select counties in FL		2	121591	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	213	0	1	01	01	H1032_213_0	5	1					0	07/30/2021	2022.01	07/30/2021 03:50:23 PM Eastern Daylight Time	08/03/2021 11:03:01 PM Eastern Daylight Time	07/30/2021 10:23:26 AM Eastern Daylight Time			08/04/2021 10:03:14 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO)	01	01		1			H1032	213	0	2022	Select counties in FL		2	119017	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(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			0	07/30/2021	2022.01	07/30/2021 03:53:20 PM Eastern Daylight Time	08/03/2021 11:03:31 PM Eastern Daylight Time	07/30/2021 10:23:52 AM Eastern Daylight Time			08/04/2021 10:03:14 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Reserve (HMO D-SNP)	01	01		1			H1032	214	0	2022	Select counties in FL		2	25313	2			1	3		2		2	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(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			0	05/31/2021	2022.01	05/31/2021 08:13:16 AM Eastern Daylight Time	08/03/2021 11:04:02 PM Eastern Daylight Time	07/30/2021 10:24:12 AM Eastern Daylight Time			08/04/2021 10:03:14 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Reserve (HMO D-SNP)	01	01		1			H1032	217	0	2022	Select counties in FL		2	3190	2			1	3		2		2	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	218	0	1	01	01	H1032_218_0	5	1					0	07/30/2021	2022.01	07/30/2021 03:57:03 PM Eastern Daylight Time	08/03/2021 11:04:31 PM Eastern Daylight Time	07/30/2021 10:24:30 AM Eastern Daylight Time			08/04/2021 10:03:14 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO)	01	01		1			H1032	218	0	2022	Select counties in FL		2	8005	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	224	0	1	01	01	H1032_224_0	5	1		1			1	07/30/2021	2022.01	07/30/2021 04:01:09 PM Eastern Daylight Time	08/03/2021 11:05:03 PM Eastern Daylight Time	07/30/2021 10:24:50 AM Eastern Daylight Time			08/04/2021 10:03:14 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Specialty No Premium (HMO C-SNP)	01	01		1			H1032	224	0	2022	Select counties in FL		2	5065	2			1	4			00000000000000000010		www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	227	0	1	01	01	H1032_227_0	5	1		1			1	07/30/2021	2022.01	07/30/2021 04:05:01 PM Eastern Daylight Time	08/03/2021 11:05:30 PM Eastern Daylight Time	07/30/2021 10:25:12 AM Eastern Daylight Time			08/04/2021 10:03:14 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Specialty Giveback (HMO C-SNP)	01	01		1			H1032	227	0	2022	Select counties in FL		2	3413	2			1	4			00000000000000000010		www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	236	0	1	01	01	H1032_236_0	5	1	2	1			0	05/31/2021	2022.01	05/31/2021 08:05:03 AM Eastern Daylight Time	08/04/2021 03:20:17 PM Eastern Daylight Time	07/30/2021 10:25:46 AM Eastern Daylight Time			08/04/2021 10:03:14 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Reserve (HMO D-SNP)	01	01		1			H1032	236	0	2022	Select counties in FL		2	2740	2			1	3		2		2	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1035	002	0	1	02	01	H1035_002_0	6	1					0	07/30/2021	2022.01	07/30/2021 05:03:35 PM Eastern Daylight Time	08/02/2021 01:20:50 AM Eastern Daylight Time	08/02/2021 01:27:26 AM Eastern Daylight Time			08/02/2021 10:05:38 AM Eastern Daylight Time	FLORIDA BLUE MEDICARE, INC.	Florida Blue HMO	www.fhcpmedicare.com	FHCP Medicare Rx Plus (HMO-POS)	01	02		1			H1035	002	0	2022	Flagler and Volusia counties		2		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	6	1					0	06/07/2021	2022.01	06/07/2021 02:54:49 PM Eastern Daylight Time	08/02/2021 01:21:57 AM Eastern Daylight Time	08/02/2021 01:28:02 AM Eastern Daylight Time			08/02/2021 10:05:38 AM Eastern Daylight Time	FLORIDA BLUE MEDICARE, INC.	Florida Blue HMO	www.fhcpmedicare.com	FHCP Medicare Rx (HMO)	01	01		1			H1035	006	0	2022	Flagler and Volusia counties		2		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					0	06/22/2021	2022.01	06/22/2021 09:14:50 PM Eastern Daylight Time	08/02/2021 01:22:35 AM Eastern Daylight Time	08/02/2021 01:28:34 AM Eastern Daylight Time			08/02/2021 10:05:38 AM Eastern Daylight Time	FLORIDA BLUE MEDICARE, INC.	Florida Blue HMO	www.fhcpmedicare.com	FHCP Medicare Premier Plus (HMO)	01	01		1			H1035	011	0	2022	Brevard and Seminole counties		2		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					0	06/07/2021	2022.01	06/07/2021 02:54:29 PM Eastern Daylight Time	08/02/2021 01:23:24 AM Eastern Daylight Time	08/02/2021 01:29:04 AM Eastern Daylight Time			08/02/2021 10:05:38 AM Eastern Daylight Time	FLORIDA BLUE MEDICARE, INC.	Florida Blue HMO	www.fhcpmedicare.com	FHCP Medicare Rx Savings (HMO)	01	01		1			H1035	014	0	2022	Counties: BRE, FLG, SEM, & VOL		2		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					0	07/14/2021	2022.01	07/14/2021 09:41:23 AM Eastern Daylight Time	08/02/2021 01:24:13 AM Eastern Daylight Time	08/02/2021 01:29:33 AM Eastern Daylight Time			08/02/2021 10:05:38 AM Eastern Daylight Time	FLORIDA BLUE MEDICARE, INC.	Florida Blue HMO	www.fhcpmedicare.com	FHCP Medicare Flagler Advantage (HMO)	01	01		1			H1035	016	0	2022	St. Johns County		2		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	5	1					1	08/04/2021	2022.01	08/04/2021 11:42:46 AM Eastern Daylight Time	08/05/2021 11:31:12 AM Eastern Daylight Time	08/02/2021 10:19:50 AM Eastern Daylight Time			08/05/2021 01:25:49 PM Eastern Daylight Time	FLORIDA BLUE MEDICARE, INC.	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Classic (HMO)	01	01		1			H1035	017	0	2022	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	5	1					1	08/04/2021	2022.01	08/04/2021 11:53:28 AM Eastern Daylight Time	08/05/2021 11:32:48 AM Eastern Daylight Time	07/30/2021 01:24:13 PM Eastern Daylight Time			08/05/2021 01:25:49 PM Eastern Daylight Time	FLORIDA BLUE MEDICARE, INC.	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Classic (HMO)	01	01		1			H1035	018	0	2022	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	7	1					1	08/04/2021	2022.01	08/04/2021 12:01:59 PM Eastern Daylight Time	08/05/2021 11:34:32 AM Eastern Daylight Time	07/30/2021 01:24:48 PM Eastern Daylight Time			08/05/2021 01:25:49 PM Eastern Daylight Time	FLORIDA BLUE MEDICARE, INC.	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Classic (HMO)	01	01		1			H1035	019	0	2022	South, Central and North East Florida 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	5	1					1	08/04/2021	2022.01	08/04/2021 12:04:40 PM Eastern Daylight Time	08/05/2021 11:36:15 AM Eastern Daylight Time	07/30/2021 01:25:23 PM Eastern Daylight Time			08/05/2021 01:25:49 PM Eastern Daylight Time	FLORIDA BLUE MEDICARE, INC.	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Classic (HMO)	01	01		1			H1035	020	0	2022	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	5	1					1	08/04/2021	2022.01	08/04/2021 12:08:38 PM Eastern Daylight Time	08/05/2021 11:37:53 AM Eastern Daylight Time	07/30/2021 01:26:01 PM Eastern Daylight Time			08/05/2021 01:25:49 PM Eastern Daylight Time	FLORIDA BLUE MEDICARE, INC.	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Classic (HMO)	01	01		1			H1035	021	0	2022	Hillsborough, Hernando, Pasco, & 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	5	1					1	08/04/2021	2022.01	08/04/2021 01:02:56 PM Eastern Daylight Time	08/04/2021 01:57:05 PM Eastern Daylight Time	07/30/2021 01:26:36 PM Eastern Daylight Time			08/05/2021 09:08:50 AM Eastern Daylight Time	FLORIDA BLUE MEDICARE, INC.	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Premier (HMO)	01	01		1			H1035	022	0	2022	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	5	1					1	08/04/2021	2022.01	08/04/2021 01:01:20 PM Eastern Daylight Time	08/04/2021 01:57:43 PM Eastern Daylight Time	07/30/2021 01:27:14 PM Eastern Daylight Time			08/05/2021 09:08:50 AM Eastern Daylight Time	FLORIDA BLUE MEDICARE, INC.	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Premier (HMO)	01	01		1			H1035	023	0	2022	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	5	1					1	08/04/2021	2022.01	08/04/2021 01:13:56 PM Eastern Daylight Time	08/04/2021 01:58:20 PM Eastern Daylight Time	07/30/2021 01:27:48 PM Eastern Daylight Time			08/05/2021 09:08:50 AM Eastern Daylight Time	FLORIDA BLUE MEDICARE, INC.	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Premier (HMO)	01	01		1			H1035	024	0	2022	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	5	1					1	08/04/2021	2022.01	08/04/2021 01:20:24 PM Eastern Daylight Time	08/04/2021 01:58:57 PM Eastern Daylight Time	07/30/2021 01:28:24 PM Eastern Daylight Time			08/05/2021 09:08:50 AM Eastern Daylight Time	FLORIDA BLUE MEDICARE, INC.	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Premier (HMO)	01	01		1			H1035	025	0	2022	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	6	1					1	08/04/2021	2022.01	08/04/2021 01:25:32 PM Eastern Daylight Time	08/05/2021 02:48:55 PM Eastern Daylight Time	07/30/2021 01:28:59 PM Eastern Daylight Time			08/05/2021 03:43:08 PM Eastern Daylight Time	FLORIDA BLUE MEDICARE, INC.	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Premier (HMO)	01	01		1			H1035	026	0	2022	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	027	0	1	01	01	H1035_027_0	6	1	2	1			0	08/05/2021	2022.01	08/05/2021 09:56:31 AM Eastern Daylight Time	08/05/2021 02:50:18 PM Eastern Daylight Time	07/30/2021 01:29:32 PM Eastern Daylight Time			08/05/2021 03:43:08 PM Eastern Daylight Time	FLORIDA BLUE MEDICARE, INC.	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Complete (HMO D-SNP)	01	01		1			H1035	027	0	2022	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			0	08/05/2021	2022.01	08/05/2021 10:01:36 AM Eastern Daylight Time	08/05/2021 02:51:47 PM Eastern Daylight Time	07/30/2021 01:30:06 PM Eastern Daylight Time			08/05/2021 03:43:08 PM Eastern Daylight Time	FLORIDA BLUE MEDICARE, INC.	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Complete (HMO D-SNP)	01	01		1			H1035	028	0	2022	Counties: Broward, Palm Beach, St. Lucie		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	6	1	2	1			0	08/05/2021	2022.01	08/05/2021 10:04:54 AM Eastern Daylight Time	08/05/2021 02:53:24 PM Eastern Daylight Time	07/30/2021 01:30:39 PM Eastern Daylight Time			08/05/2021 03:43:08 PM Eastern Daylight Time	FLORIDA BLUE MEDICARE, INC.	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Complete (HMO D-SNP)	01	01		1			H1035	029	0	2022	Central Florida		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	6	1	2	1			0	08/05/2021	2022.01	08/05/2021 10:07:19 AM Eastern Daylight Time	08/05/2021 02:54:52 PM Eastern Daylight Time	07/30/2021 01:31:14 PM Eastern Daylight Time			08/05/2021 03:43:08 PM Eastern Daylight Time	FLORIDA BLUE MEDICARE, INC.	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Complete (HMO D-SNP)	01	01		1			H1035	030	0	2022	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	031	0	1	01	01	H1035_031_0	6	1	2	1			0	08/05/2021	2022.01	08/05/2021 10:13:16 AM Eastern Daylight Time	08/05/2021 02:56:24 PM Eastern Daylight Time	07/30/2021 01:31:50 PM Eastern Daylight Time			08/05/2021 03:43:08 PM Eastern Daylight Time	FLORIDA BLUE MEDICARE, INC.	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Complete (HMO D-SNP)	01	01		1			H1035	031	0	2022	Clay, Duval & Marion 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	032	0	1	01	01	H1035_032_0	6	1	2	1			0	08/05/2021	2022.01	08/05/2021 10:15:03 AM Eastern Daylight Time	08/05/2021 02:57:58 PM Eastern Daylight Time	07/30/2021 01:32:25 PM Eastern Daylight Time			08/05/2021 03:43:08 PM Eastern Daylight Time	FLORIDA BLUE MEDICARE, INC.	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Complete (HMO D-SNP)	01	01		1			H1035	032	0	2022	Westcoast Florida		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	033	0	1	01	01	H1035_033_0	5	1					1	08/04/2021	2022.01	08/04/2021 01:32:30 PM Eastern Daylight Time	08/04/2021 02:04:03 PM Eastern Daylight Time	07/30/2021 01:33:01 PM Eastern Daylight Time			08/05/2021 12:36:18 PM Eastern Daylight Time	FLORIDA BLUE MEDICARE, INC.	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Premier (HMO)	01	01		1			H1035	033	0	2022	Clay & Duval 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	034	0	1	01	01	H1035_034_0	5	1					1	08/04/2021	2022.01	08/04/2021 01:53:19 PM Eastern Daylight Time	08/04/2021 02:04:41 PM Eastern Daylight Time	07/30/2021 01:33:34 PM Eastern Daylight Time			08/05/2021 12:36:18 PM Eastern Daylight Time	FLORIDA BLUE MEDICARE, INC.	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Premier (HMO)	01	01		1			H1035	034	0	2022	Hernando, Pasco & Pinellas 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	035	0	1	01	01	H1035_035_0	5	1					1	08/04/2021	2022.01	08/04/2021 03:56:28 PM Eastern Daylight Time	08/04/2021 02:05:23 PM Eastern Daylight Time	07/30/2021 01:34:08 PM Eastern Daylight Time			08/05/2021 12:36:18 PM Eastern Daylight Time	FLORIDA BLUE MEDICARE, INC.	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Saver (HMO)	01	01		1			H1035	035	0	2022	Broward & Palm Beach 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	037	0	1	01	01	H1035_037_0	5	1					1	08/04/2021	2022.01	08/04/2021 04:53:29 PM Eastern Daylight Time	08/04/2021 02:06:01 PM Eastern Daylight Time	07/30/2021 01:34:42 PM Eastern Daylight Time			08/05/2021 12:36:18 PM Eastern Daylight Time	FLORIDA BLUE MEDICARE, INC.	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Saver (HMO)	01	01		1			H1035	037	0	2022	Hillsborough, Pinellas & 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	038	0	1	01	01	H1035_038_0	5	1					1	08/04/2021	2022.01	08/04/2021 04:55:38 PM Eastern Daylight Time	08/05/2021 12:00:55 PM Eastern Daylight Time	07/30/2021 01:35:16 PM Eastern Daylight Time			08/05/2021 01:25:49 PM Eastern Daylight Time	FLORIDA BLUE MEDICARE, INC.	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Saver (HMO)	01	01		1			H1035	038	0	2022	Orange & Osceola 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	039	0	1	01	01	H1035_039_0	5	1					1	08/04/2021	2022.01	08/04/2021 04:59:53 PM Eastern Daylight Time	08/05/2021 12:02:19 PM Eastern Daylight Time	07/30/2021 01:35:51 PM Eastern Daylight Time			08/05/2021 01:25:49 PM Eastern Daylight Time	FLORIDA BLUE MEDICARE, INC.	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Saver (HMO)	01	01		1			H1035	039	0	2022	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	1	01	7a;7d;	
H1035	040	0	1	01	01	H1035_040_0	7	1					0	07/06/2021	2022.01	07/06/2021 02:11:01 PM Eastern Daylight Time	08/02/2021 01:24:57 AM Eastern Daylight Time	08/02/2021 01:30:33 AM Eastern Daylight Time			08/02/2021 10:05:38 AM Eastern Daylight Time	FLORIDA BLUE MEDICARE, INC.	Florida Blue HMO	www.fhcpmedicare.com	FHCP Medicare Premier Advantage (HMO)	01	01		1			H1035	040	0	2022	Counties: BRE, FLG, SEM, & VOL		2		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	043	0	1	01	01	H1035_043_0	5	1					1	08/04/2021	2022.01	08/04/2021 05:13:49 PM Eastern Daylight Time	08/05/2021 12:03:46 PM Eastern Daylight Time	07/30/2021 01:36:24 PM Eastern Daylight Time			08/05/2021 01:25:49 PM Eastern Daylight Time	FLORIDA BLUE MEDICARE, INC.	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Premier (HMO)	01	01		1			H1035	043	0	2022	Lake, Marion, & Sumter 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	045	0	1	01	01	H1035_045_0	5	1					1	08/04/2021	2022.01	08/04/2021 05:21:13 PM Eastern Daylight Time	08/05/2021 12:05:16 PM Eastern Daylight Time	07/30/2021 01:37:01 PM Eastern Daylight Time			08/05/2021 01:25:49 PM Eastern Daylight Time	FLORIDA BLUE MEDICARE, INC.	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Premier (HMO)	01	01		1			H1035	045	0	2022	Counties: Char., Collier, Lee, 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	2			
H1035	046	0	1	01	01	H1035_046_0	5	1					1	08/04/2021	2022.01	08/04/2021 12:13:58 PM Eastern Daylight Time	08/05/2021 12:06:42 PM Eastern Daylight Time	07/30/2021 01:37:34 PM Eastern Daylight Time			08/05/2021 01:25:49 PM Eastern Daylight Time	FLORIDA BLUE MEDICARE, INC.	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Classic Plus (HMO)	01	01		1			H1035	046	0	2022	Citrus 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	047	0	1	01	01	H1035_047_0	5	1					1	08/04/2021	2022.01	08/04/2021 12:17:26 PM Eastern Daylight Time	08/05/2021 12:08:17 PM Eastern Daylight Time	07/30/2021 01:38:10 PM Eastern Daylight Time			08/05/2021 01:25:49 PM Eastern Daylight Time	FLORIDA BLUE MEDICARE, INC.	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Classic Plus (HMO)	01	01		1			H1035	047	0	2022	Bay, Escambia, Okaloosa & Santa Rosa 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	048	0	1	01	01	H1035_048_0	6	1					1	08/05/2021	2022.01	08/05/2021 06:43:24 AM Eastern Daylight Time	08/05/2021 12:09:50 PM Eastern Daylight Time	07/30/2021 01:38:46 PM Eastern Daylight Time			08/05/2021 02:37:03 PM Eastern Daylight Time	FLORIDA BLUE MEDICARE, INC.	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Premier (HMO)	01	01		1			H1035	048	0	2022	Brevard, & St. Lucie 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	049	0	1	01	01	H1035_049_0	4	1				0	0	06/07/2021	2022.01	06/07/2021 02:51:38 PM Eastern Daylight Time	06/25/2021 03:48:45 PM Eastern Daylight Time				06/28/2021 09:54:09 AM Eastern Daylight Time	FLORIDA BLUE MEDICARE, INC.	Florida Blue HMO	www.fhcpmedicare.com	FHCP Medicare Valor (HMO)	01	01		1			H1035	049	0	2022	Counties: BRE, FLG, SEM, & VOL		2		2			2						www.fhcpmedicare.com	www.fhcpmedicare.com	www.fhcpmedicare.com	(833)866-6559		(386)615-5051		(855)462-3427		(386)676-7110										(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	3	1						06/07/2021	2022.01	06/07/2021 10:59:19 AM Eastern Daylight Time					06/07/2021 03:42:04 PM Eastern Daylight Time	FLORIDA BLUE MEDICARE, INC.	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Group HMO (HMO)	01	01		1			H1035	801	0	2022	Florida		1	0	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		1	1	1a;1b;2;5;6;7c;7e;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;15;16b;	1	3-1;3-2;3-3;3-4;7d;7i;8a;8b1;8b2;18a;	1					1				
H1035	802	0	1	01	01	H1035_802_0	3	1						06/04/2021	2022.01	06/04/2021 06:37:45 PM Eastern Daylight Time					06/07/2021 03:42:04 PM Eastern Daylight Time	FLORIDA BLUE MEDICARE, INC.	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Group HMO (HMO)	01	01		1			H1035	802	0	2022	Florida		1	0	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		1	1	1a;1b;5;6;7c;7e;7i;7k;8a;8b1;8b2;8b3;9a1;9c;10a;11a;11b;11c;15;16b;	1	3-1;3-2;3-3;3-4;7d;7i;8a;8b1;8b2;18a;	1					1				
H1036	025	0	1	01	01	H1036_025_0	6	1			1		1	08/02/2021	2022.01	08/02/2021 12:34:48 PM Eastern Daylight Time	08/03/2021 06:38:05 PM Eastern Daylight Time	07/30/2021 10:13:24 AM Eastern Daylight Time			08/04/2021 01:32:26 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1036-025 (HMO)	01	01		1			H1036	025	0	2022	Tampa Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	6	1			1		1	08/02/2021	2022.01	08/02/2021 10:37:51 AM Eastern Daylight Time	08/03/2021 05:48:49 PM Eastern Daylight Time	07/30/2021 10:13:40 AM Eastern Daylight Time			08/04/2021 01:19:52 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	2022	Flagler and Volusia counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	9	1			1		1	07/31/2021	2022.01	07/31/2021 11:59:13 AM Eastern Daylight Time	08/03/2021 05:45:14 PM Eastern Daylight Time	07/30/2021 10:13:56 AM Eastern Daylight Time			08/04/2021 01:34:40 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1036-054C (HMO)	01	01		1			H1036	054	0	2022	Miami-Dade County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			2	0	0	06/03/2021	2022.01	06/03/2021 03:02:01 PM Eastern Daylight Time	07/22/2021 08:51:34 AM Eastern Daylight Time				07/22/2021 01:14:52 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Honor (HMO)	01	01		1			H1036	056	0	2022	Flagler and Volusia counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_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	6	1			1		1	08/02/2021	2022.01	08/02/2021 10:34:21 AM Eastern Daylight Time	08/03/2021 05:49:38 PM Eastern Daylight Time	07/30/2021 10:14:12 AM Eastern Daylight Time			08/04/2021 01:34:40 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1036-062C (HMO)	01	01		1			H1036	062	0	2022	Palm Beach County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	6	1			1		1	07/31/2021	2022.01	07/31/2021 12:07:00 PM Eastern Daylight Time	08/03/2021 05:47:24 PM Eastern Daylight Time	07/30/2021 10:14:28 AM Eastern Daylight Time			08/04/2021 01:34:40 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1036-065C (HMO)	01	01		1			H1036	065	0	2022	Broward County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	6	1			1		1	08/02/2021	2022.01	08/02/2021 10:38:15 AM Eastern Daylight Time	08/03/2021 05:47:13 PM Eastern Daylight Time	07/30/2021 10:14:44 AM Eastern Daylight Time			08/04/2021 01:19:52 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	2022	Jacksonville Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		1	08/02/2021	2022.01	08/02/2021 10:38:34 AM Eastern Daylight Time	08/03/2021 05:50:11 PM Eastern Daylight Time	07/30/2021 10:15:00 AM Eastern Daylight Time			08/04/2021 01:32:26 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1036-074 (HMO)	01	01		1			H1036	074	0	2022	Manatee and Sarasota Counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	6	1	2	1	1		0	07/22/2021	2022.01	07/22/2021 09:35:43 AM Eastern Daylight Time	08/03/2021 06:27:44 PM Eastern Daylight Time	07/30/2021 10:15:16 AM Eastern Daylight Time			08/04/2021 01:34:40 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1036-077A (HMO D-SNP)	01	01		1			H1036	077	0	2022	Miami-Dade County		2		2			1	3		2		2	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	7	1	2	1	1		0	08/02/2021	2022.01	08/02/2021 10:43:26 AM Eastern Daylight Time	08/03/2021 06:10:20 PM Eastern Daylight Time	07/30/2021 10:15:32 AM Eastern Daylight Time			08/04/2021 01:48:20 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1036-102 (HMO D-SNP)	01	01		1			H1036	102	0	2022	Tampa Metro Area		2		2			1	3		2		2	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	6	1	2	1	1		0	07/22/2021	2022.01	07/22/2021 09:39:49 AM Eastern Daylight Time	08/03/2021 06:24:33 PM Eastern Daylight Time	07/30/2021 10:15:48 AM Eastern Daylight Time			08/04/2021 01:34:40 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1036-103A (HMO D-SNP)	01	01		1			H1036	103	0	2022	Broward County		2		2			1	3		2		2	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	6	1	2	1	1		0	07/19/2021	2022.01	07/19/2021 07:31:28 PM Eastern Daylight Time	08/03/2021 06:35:15 PM Eastern Daylight Time	07/30/2021 10:16:02 AM Eastern Daylight Time			08/04/2021 01:34:40 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1036-104A (HMO D-SNP)	01	01		1			H1036	104	0	2022	Palm Beach County		2		2			1	3		2		2	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			2	0	0	06/03/2021	2022.01	06/03/2021 02:07:46 PM Eastern Daylight Time	07/22/2021 08:51:08 AM Eastern Daylight Time				07/22/2021 01:52:12 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Honor (HMO)	01	01		1			H1036	119	0	2022	Tampa Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_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	6	1		1	1		1	07/31/2021	2022.01	07/31/2021 10:57:23 AM Eastern Daylight Time	08/03/2021 05:51:12 PM Eastern Daylight Time	07/30/2021 10:16:18 AM Eastern Daylight Time			08/04/2021 01:23:56 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus - Diabetes and Heart (HMO C-SNP)	01	01		1			H1036	121	0	2022	Broward, Miami-Dade, and Palm Beach counties		2		2			1	4			00000000000000000010		https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		1	08/02/2021	2022.01	08/02/2021 03:00:44 PM Eastern Daylight Time	08/03/2021 10:02:40 PM Eastern Daylight Time	07/30/2021 10:16:34 AM Eastern Daylight Time			08/04/2021 02:08:22 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1036-137 (HMO)	01	01		1			H1036	137	0	2022	Charlotte Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		1	08/01/2021	2022.01	08/01/2021 10:38:56 AM Eastern Daylight Time	08/03/2021 05:51:51 PM Eastern Daylight Time	07/30/2021 10:16:50 AM Eastern Daylight Time			08/04/2021 01:48:20 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1036-140 (HMO)	01	01		1			H1036	140	0	2022	Citrus County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	6	1			1		1	08/01/2021	2022.01	08/01/2021 10:39:18 AM Eastern Daylight Time	08/03/2021 05:54:54 PM Eastern Daylight Time	07/30/2021 10:17:06 AM Eastern Daylight Time			08/04/2021 01:48:20 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	2022	Select counties of Panhandle East		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		1	08/01/2021	2022.01	08/01/2021 10:39:35 AM Eastern Daylight Time	08/03/2021 06:02:05 PM Eastern Daylight Time	07/30/2021 10:17:22 AM Eastern Daylight Time			08/04/2021 01:48:20 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	2022	Orange, Osceola and Seminole counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		1	08/02/2021	2022.01	08/02/2021 06:53:31 PM Eastern Daylight Time	08/03/2021 06:11:07 PM Eastern Daylight Time	07/30/2021 10:17:38 AM Eastern Daylight Time			08/04/2021 02:59:21 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1036-151 (HMO)	01	01		1			H1036	151	0	2022	Jackson Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		1	08/01/2021	2022.01	08/01/2021 09:39:24 AM Eastern Daylight Time	08/03/2021 06:17:32 PM Eastern Daylight Time	07/30/2021 10:17:54 AM Eastern Daylight Time			08/04/2021 02:48:19 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1036-153 (HMO)	01	01		1			H1036	153	0	2022	Portland Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	8	1		1	1		1	08/01/2021	2022.01	08/01/2021 10:39:57 AM Eastern Daylight Time	08/03/2021 06:03:25 PM Eastern Daylight Time	07/30/2021 10:18:08 AM Eastern Daylight Time			08/04/2021 01:48:20 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus - Diabetes and Heart (HMO C-SNP)	01	01		1			H1036	156	0	2022	Flagler and Volusia counties		2		2			1	4			00000000000000000010		https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	08/01/2021	2022.01	08/01/2021 10:40:46 AM Eastern Daylight Time	08/03/2021 06:06:02 PM Eastern Daylight Time	07/30/2021 10:18:26 AM Eastern Daylight Time			08/04/2021 01:48:20 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	2022	Flagler and Volusia counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	1		1	08/01/2021	2022.01	08/01/2021 10:41:41 AM Eastern Daylight Time	08/03/2021 06:04:46 PM Eastern Daylight Time	07/30/2021 10:18:42 AM Eastern Daylight Time			08/04/2021 01:48:20 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus - Diabetes and Heart (HMO C-SNP)	01	01		1			H1036	160	0	2022	Tampa Metro Area		2		2			1	4			00000000000000000010		https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1	2	1	1		0	08/02/2021	2022.01	08/02/2021 03:02:01 PM Eastern Daylight Time	08/03/2021 09:42:15 PM Eastern Daylight Time	07/30/2021 10:18:56 AM Eastern Daylight Time			08/04/2021 02:08:22 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)	01	01		1			H1036	167	0	2022	Charlotte Metro Area		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1	2	1	1		0	08/02/2021	2022.01	08/02/2021 03:02:40 PM Eastern Daylight Time	08/03/2021 09:42:36 PM Eastern Daylight Time	07/30/2021 10:19:12 AM Eastern Daylight Time			08/04/2021 02:08:22 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1036-168 (HMO D-SNP)	01	01		1			H1036	168	0	2022	Greensboro / Winston-Salem Metro Area		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		1	08/02/2021	2022.01	08/02/2021 06:54:23 PM Eastern Daylight Time	08/03/2021 06:14:04 PM Eastern Daylight Time	07/30/2021 10:19:28 AM Eastern Daylight Time			08/04/2021 02:59:21 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1036-171 (HMO)	01	01		1			H1036	171	0	2022	Gulf Coast Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	8	1		1	1		1	08/01/2021	2022.01	08/01/2021 10:42:03 AM Eastern Daylight Time	08/03/2021 06:07:22 PM Eastern Daylight Time	07/30/2021 10:19:44 AM Eastern Daylight Time			08/04/2021 01:48:20 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus - Diabetes (HMO C-SNP)	01	01		1			H1036	175	0	2022	Jacksonville Area		2		2			1	4			00000010000000000000		https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	6	1			1		1	07/31/2021	2022.01	07/31/2021 11:29:38 AM Eastern Daylight Time	08/03/2021 05:54:24 PM Eastern Daylight Time	07/30/2021 10:20:00 AM Eastern Daylight Time			08/04/2021 01:23:56 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1036-199 (HMO)	01	01		1			H1036	199	0	2022	Palm Beach County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	6	1	2	1	1		0	08/02/2021	2022.01	08/02/2021 10:43:59 AM Eastern Daylight Time	08/03/2021 06:19:26 PM Eastern Daylight Time	07/30/2021 10:20:16 AM Eastern Daylight Time			08/04/2021 01:48:20 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1036-209 (HMO D-SNP)	01	01		1			H1036	209	0	2022	Flagler and Volusia counties		2		2			1	3		2		2	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	6	1	2	1	1		0	08/02/2021	2022.01	08/02/2021 10:44:23 AM Eastern Daylight Time	08/03/2021 06:22:49 PM Eastern Daylight Time	07/30/2021 10:20:32 AM Eastern Daylight Time			08/04/2021 01:48:20 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1036-210 (HMO D-SNP)	01	01		1			H1036	210	0	2022	Jacksonville Area		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	6	1	2	1	1		0	08/02/2021	2022.01	08/02/2021 10:44:49 AM Eastern Daylight Time	08/03/2021 06:14:42 PM Eastern Daylight Time	07/30/2021 10:20:48 AM Eastern Daylight Time			08/04/2021 01:57:06 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1036-213 (HMO D-SNP)	01	01		1			H1036	213	0	2022	Greater Orlando		2		2			1	3		2		2	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	6	1	2	1	1		0	08/02/2021	2022.01	08/02/2021 10:45:14 AM Eastern Daylight Time	08/03/2021 06:26:05 PM Eastern Daylight Time	07/30/2021 10:21:04 AM Eastern Daylight Time			08/04/2021 01:57:06 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1036-214 (HMO D-SNP)	01	01		1			H1036	214	0	2022	Certain Panhandle Counties		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		1	08/01/2021	2022.01	08/01/2021 10:42:45 AM Eastern Daylight Time	08/03/2021 06:40:49 PM Eastern Daylight Time	07/30/2021 10:21:20 AM Eastern Daylight Time			08/04/2021 01:57:06 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1036-217 (HMO)	01	01		1			H1036	217	0	2022	Charlotte, Collier and Lee counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		1	08/04/2021	2022.01	08/04/2021 02:39:19 PM Eastern Daylight Time	08/03/2021 06:23:45 PM Eastern Daylight Time	07/30/2021 10:21:36 AM Eastern Daylight Time			08/04/2021 02:48:19 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1036-219 (HMO)	01	01		1			H1036	219	0	2022	Deschutes and Jefferson counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1	2	1	1		0	08/02/2021	2022.01	08/02/2021 06:55:08 PM Eastern Daylight Time	08/03/2021 06:16:10 PM Eastern Daylight Time	07/30/2021 10:21:52 AM Eastern Daylight Time			08/04/2021 02:59:21 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1036-222 (HMO D-SNP)	01	01		1			H1036	222	0	2022	Select Counties in Mississippi		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		1	08/02/2021	2022.01	08/02/2021 06:56:29 PM Eastern Daylight Time	08/03/2021 05:59:44 PM Eastern Daylight Time	07/30/2021 10:22:08 AM Eastern Daylight Time			08/04/2021 02:59:21 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1036-223 (HMO)	01	01		1			H1036	223	0	2022	DeSoto County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1	2	1	1		0	07/08/2021	2022.01	07/08/2021 03:53:41 PM Eastern Daylight Time	08/03/2021 06:32:13 PM Eastern Daylight Time	07/30/2021 10:22:26 AM Eastern Daylight Time			08/04/2021 01:23:56 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1036-226 (HMO D-SNP)	01	01		1			H1036	226	0	2022	Glades, Martin, Okeechobee and St. Lucie counties		2		2			1	3		2		2	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		1	07/31/2021	2022.01	07/31/2021 11:30:56 AM Eastern Daylight Time	08/03/2021 05:56:17 PM Eastern Daylight Time	07/30/2021 10:22:42 AM Eastern Daylight Time			08/04/2021 01:23:56 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1036-229 (HMO)	01	01		1			H1036	229	0	2022	Treasure Coast		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	7	1			1		1	08/02/2021	2022.01	08/02/2021 10:45:40 AM Eastern Daylight Time	08/03/2021 06:08:51 PM Eastern Daylight Time	07/30/2021 10:22:58 AM Eastern Daylight Time			08/04/2021 01:57:06 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1036-230 (HMO)	01	01		1			H1036	230	0	2022	Hardee, Highlands and Polk counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	6	1	2	1	1		0	08/02/2021	2022.01	08/02/2021 10:46:06 AM Eastern Daylight Time	08/03/2021 06:11:46 PM Eastern Daylight Time	07/30/2021 10:23:14 AM Eastern Daylight Time			08/04/2021 01:57:06 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1036-231 (HMO D-SNP)	01	01		1			H1036	231	0	2022	Hardee, Highlands and Polk counties		2		2			1	3		2		2	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		1	08/02/2021	2022.01	08/02/2021 03:03:14 PM Eastern Daylight Time	08/03/2021 09:45:14 PM Eastern Daylight Time	07/30/2021 10:23:30 AM Eastern Daylight Time			08/04/2021 02:08:22 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1036-233 (HMO)	01	01		1			H1036	233	0	2022	Raleigh Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	7	1		1	1		1	07/31/2021	2022.01	07/31/2021 06:38:35 PM Eastern Daylight Time	08/03/2021 05:36:19 PM Eastern Daylight Time	07/30/2021 10:23:46 AM Eastern Daylight Time			08/04/2021 01:36:45 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Community HMO Diabetes and Heart (HMO C-SNP)	01	01		1			H1036	234	0	2022	Jefferson County		2		2			1	4			00000000000000000010		https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	8	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 10:34:46 AM Eastern Daylight Time	08/03/2021 05:36:39 PM Eastern Daylight Time	07/30/2021 10:24:04 AM Eastern Daylight Time			08/04/2021 01:36:45 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Community HMO SNP-DE (HMO D-SNP)	01	01		1			H1036	235	0	2022	Jefferson County		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	7	1			1		1	08/02/2021	2022.01	08/02/2021 10:31:08 AM Eastern Daylight Time	08/03/2021 05:35:58 PM Eastern Daylight Time	07/30/2021 10:24:22 AM Eastern Daylight Time			08/04/2021 01:36:45 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Community (HMO)	01	01		1			H1036	236	0	2022	Jefferson County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	6	1			1		1	07/31/2021	2022.01	07/31/2021 11:32:35 AM Eastern Daylight Time	08/03/2021 05:58:15 PM Eastern Daylight Time	07/30/2021 10:24:36 AM Eastern Daylight Time			08/04/2021 01:23:56 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1036-237 (HMO)	01	01		1			H1036	237	1	2022	South Florida: Broward or Miami-Dade	South Florida- Broward	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		1	07/31/2021	2022.01	07/31/2021 11:52:31 AM Eastern Daylight Time	08/03/2021 05:52:57 PM Eastern Daylight Time	07/30/2021 10:24:52 AM Eastern Daylight Time			08/04/2021 01:23:56 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1036-237 (HMO)	01	01		1			H1036	237	2	2022	South Florida: Broward or Miami-Dade	South Florida- Miami-Dade	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	6	1	2	1	1		0	07/19/2021	2022.01	07/19/2021 07:44:22 PM Eastern Daylight Time	08/03/2021 06:20:40 PM Eastern Daylight Time	07/30/2021 10:25:04 AM Eastern Daylight Time			08/04/2021 01:57:06 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1036-243 (HMO D-SNP)	01	01		1			H1036	243	0	2022	Jacksonville Area		2		2			1	3		2		2	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	6	1	2	1	1		0	07/19/2021	2022.01	07/19/2021 07:48:31 PM Eastern Daylight Time	08/03/2021 06:24:11 PM Eastern Daylight Time	07/30/2021 10:25:16 AM Eastern Daylight Time			08/04/2021 01:57:06 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1036-245 (HMO D-SNP)	01	01		1			H1036	245	0	2022	Certain Panhandle Counties		2		2			1	3		2		2	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	6	1	2	1	1		0	07/19/2021	2022.01	07/19/2021 07:51:02 PM Eastern Daylight Time	08/03/2021 06:27:18 PM Eastern Daylight Time	07/30/2021 10:25:28 AM Eastern Daylight Time			08/04/2021 01:57:06 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1036-261 (HMO D-SNP)	01	01		1			H1036	261	0	2022	Sarasota County		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1	2	1	1		0	07/08/2021	2022.01	07/08/2021 05:34:05 PM Eastern Daylight Time	08/03/2021 06:28:35 PM Eastern Daylight Time	07/30/2021 10:25:40 AM Eastern Daylight Time			08/04/2021 01:57:06 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1036-262 (HMO D-SNP)	01	01		1			H1036	262	0	2022	Sarasota County		2		2			1	3		2		2	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		1	08/01/2021	2022.01	08/01/2021 10:43:32 AM Eastern Daylight Time	08/03/2021 06:35:29 PM Eastern Daylight Time	07/30/2021 10:25:52 AM Eastern Daylight Time			08/04/2021 01:57:06 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1036-265 (HMO)	01	01		1			H1036	265	1	2022	Tampa Metro Area	Tampa Metro Area	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		1	08/01/2021	2022.01	08/01/2021 10:43:58 AM Eastern Daylight Time	08/03/2021 06:31:25 PM Eastern Daylight Time	07/30/2021 10:26:04 AM Eastern Daylight Time			08/04/2021 05:06:26 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1036-265 (HMO)	01	01		1			H1036	265	2	2022	Tampa Metro Area	Manatee and Sarasota Counties	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		1	08/01/2021	2022.01	08/01/2021 10:44:18 AM Eastern Daylight Time	08/03/2021 06:30:14 PM Eastern Daylight Time	07/30/2021 10:26:16 AM Eastern Daylight Time			08/04/2021 02:07:37 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1036-266 (HMO)	01	01		1			H1036	266	0	2022	Citrus County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		1	08/01/2021	2022.01	08/01/2021 10:44:40 AM Eastern Daylight Time	08/03/2021 06:32:36 PM Eastern Daylight Time	07/30/2021 10:26:26 AM Eastern Daylight Time			08/04/2021 02:07:37 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1036-268 (HMO)	01	01		1			H1036	268	0	2022	Hardee, Highlands and Polk counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	08/01/2021	2022.01	08/01/2021 10:45:03 AM Eastern Daylight Time	08/03/2021 06:34:08 PM Eastern Daylight Time	07/30/2021 10:26:38 AM Eastern Daylight Time			08/04/2021 02:07:37 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	2022	Greater Orlando		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		1	08/01/2021	2022.01	08/01/2021 10:45:22 AM Eastern Daylight Time	08/03/2021 06:39:29 PM Eastern Daylight Time	07/30/2021 10:26:50 AM Eastern Daylight Time			08/04/2021 02:07:37 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	2022	Jacksonville Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		1	08/01/2021	2022.01	08/01/2021 10:45:39 AM Eastern Daylight Time	08/03/2021 06:36:44 PM Eastern Daylight Time	07/30/2021 10:27:02 AM Eastern Daylight Time			08/04/2021 02:07:37 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	2022	Select counties of Panhandle East		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1	2	1	1		0	08/02/2021	2022.01	08/02/2021 03:03:39 PM Eastern Daylight Time	08/03/2021 09:48:04 PM Eastern Daylight Time	07/30/2021 10:27:14 AM Eastern Daylight Time			08/04/2021 02:08:22 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1036-276 (HMO D-SNP)	01	01		1			H1036	276	0	2022	Raleigh Metro Area		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	08/01/2021	2022.01	08/01/2021 10:46:01 AM Eastern Daylight Time	08/03/2021 06:42:09 PM Eastern Daylight Time	07/30/2021 10:27:26 AM Eastern Daylight Time			08/04/2021 02:07:37 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	2022	Charlotte, Collier and Lee counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	279	0	1	01	01	H1036_279_0	4	1			2	0	0	07/19/2021	2022.01	07/19/2021 02:07:57 PM Eastern Daylight Time	07/25/2021 05:59:47 PM Eastern Daylight Time				07/26/2021 03:40:35 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Honor (HMO)	01	01		1			H1036	279	0	2022	Broward, Miami-Dade, and Palm Beach counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_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	280	0	1	01	01	H1036_280_0	5	1	2	1	1		0	07/08/2021	2022.01	07/08/2021 04:02:11 PM Eastern Daylight Time	08/03/2021 06:31:15 PM Eastern Daylight Time	07/30/2021 10:27:38 AM Eastern Daylight Time			08/04/2021 01:23:56 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Fully Integrated H1036-280 (HMO D-SNP)	01	01		1			H1036	280	0	2022	Broward, Miami-Dade, and Palm Beach counties		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	283	0	1	01	01	H1036_283_0	7	1	2	1	1		0	08/02/2021	2022.01	08/02/2021 10:46:52 AM Eastern Daylight Time	08/03/2021 06:46:25 PM Eastern Daylight Time	07/30/2021 10:27:50 AM Eastern Daylight Time			08/04/2021 02:07:37 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Fully Integrated H1036-283 (HMO D-SNP)	01	01		1			H1036	283	0	2022	Select Counties in Central Florida		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	284	0	1	01	01	H1036_284_0	6	1	2	1	1		0	07/19/2021	2022.01	07/19/2021 05:33:42 PM Eastern Daylight Time	08/03/2021 06:43:28 PM Eastern Daylight Time	07/30/2021 10:28:02 AM Eastern Daylight Time			08/04/2021 01:32:26 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1036-284 (HMO D-SNP)	01	01		1			H1036	284	0	2022	Charlotte, Collier and Lee counties		2		2			1	3		2		2	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	285	0	1	01	01	H1036_285_0	6	1	2	1	1		0	08/02/2021	2022.01	08/02/2021 10:39:03 AM Eastern Daylight Time	08/03/2021 06:44:59 PM Eastern Daylight Time	07/30/2021 10:28:14 AM Eastern Daylight Time			08/04/2021 01:32:26 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1036-285 (HMO D-SNP)	01	01		1			H1036	285	0	2022	Charlotte, Collier and Lee counties		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	286	0	1	01	01	H1036_286_0	4	1			1		1	07/31/2021	2022.01	07/31/2021 11:54:32 AM Eastern Daylight Time	08/03/2021 06:22:09 PM Eastern Daylight Time	07/30/2021 10:28:26 AM Eastern Daylight Time			08/04/2021 01:23:56 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1036-286 (HMO)	01	01		1			H1036	286	0	2022	Indian River, Martin, St. Lucie counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	287	0	1	01	01	H1036_287_0	2	1			2	0	0	06/03/2021	2022.01	06/03/2021 02:53:08 PM Eastern Daylight Time	07/22/2021 09:07:53 AM Eastern Daylight Time				07/22/2021 02:13:10 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Honor (HMO)	01	01		1			H1036	287	0	2022	Escambia, Santa Rosa, Bay, Walton, Okaloosa		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_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	288	0	1	01	01	H1036_288_0	3	1			2	0	0	07/19/2021	2022.01	07/19/2021 02:06:17 PM Eastern Daylight Time	07/22/2021 09:08:25 AM Eastern Daylight Time				07/22/2021 01:33:50 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Honor (HMO)	01	01		1			H1036	288	0	2022	Charlotte, Collier, Lee		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_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	289	0	1	01	01	H1036_289_0	3	1			2	0	0	07/19/2021	2022.01	07/19/2021 02:06:44 PM Eastern Daylight Time	07/22/2021 09:08:56 AM Eastern Daylight Time				07/22/2021 01:33:50 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Honor (HMO)	01	01		1			H1036	289	0	2022	Hardee, Highlands and Polk counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_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	290	0	1	01	01	H1036_290_0	2	1			2	0	0	06/03/2021	2022.01	06/03/2021 01:56:40 PM Eastern Daylight Time	07/22/2021 09:07:20 AM Eastern Daylight Time				07/22/2021 01:33:50 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Honor (HMO)	01	01		1			H1036	290	0	2022	Greater Orlando		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_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	291	0	1	01	01	H1036_291_0	5	1			1		1	08/02/2021	2022.01	08/02/2021 03:05:03 PM Eastern Daylight Time	08/03/2021 10:18:22 PM Eastern Daylight Time	07/30/2021 10:28:38 AM Eastern Daylight Time			08/04/2021 02:08:22 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1036-291 (HMO)	01	01		1			H1036	291	0	2022	Greensboro - Winston Salem Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	292	0	1	01	01	H1036_292_0	4	1		1	1		1	07/31/2021	2022.01	07/31/2021 12:09:36 PM Eastern Daylight Time	08/03/2021 06:20:31 PM Eastern Daylight Time	07/30/2021 10:28:52 AM Eastern Daylight Time			08/04/2021 01:34:40 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus - Diabetes and Heart (HMO C-SNP)	01	01		1			H1036	292	0	2022	Indian River, Martin, St. Lucie counties		2		2			1	4			00000000000000000010		https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	293	0	1	01	01	H1036_293_0	5	1			2	0	0	07/19/2021	2022.01	07/19/2021 04:46:53 PM Eastern Daylight Time	07/22/2021 09:09:29 AM Eastern Daylight Time				07/22/2021 01:14:52 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Honor (HMO)	01	01		1			H1036	293	0	2022	Jacksonville area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)457-4708		(800)457-4708										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H1036	294	0	1	01	01	H1036_294_0	5	1		1	1		1	08/01/2021	2022.01	08/01/2021 09:36:53 AM Eastern Daylight Time	08/03/2021 06:50:20 PM Eastern Daylight Time	07/30/2021 10:29:04 AM Eastern Daylight Time			08/04/2021 01:32:26 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus - Diabetes and Heart (HMO C-SNP)	01	01		1			H1036	294	0	2022	Greater Orlando		2		2			1	4			00000000000000000010		https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	295	0	1	01	01	H1036_295_0	4	1			1		1	08/01/2021	2022.01	08/01/2021 09:37:29 AM Eastern Daylight Time	08/03/2021 06:47:39 PM Eastern Daylight Time	07/30/2021 10:29:16 AM Eastern Daylight Time			08/04/2021 01:39:20 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Community (HMO)	01	01		1			H1036	295	0	2022	Sumter County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	296	0	1	01	01	H1036_296_0	6	1		1	1		1	08/01/2021	2022.01	08/01/2021 09:37:59 AM Eastern Daylight Time	08/03/2021 06:49:03 PM Eastern Daylight Time	07/30/2021 10:29:28 AM Eastern Daylight Time			08/04/2021 01:32:26 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus - Diabetes and Heart (HMO C-SNP)	01	01		1			H1036	296	0	2022	Hardee, Highlands and Polk counties		2		2			1	4			00000000000000000010		https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	2	1						05/24/2021	2022.01	05/24/2021 02:53:59 PM Eastern Daylight Time					06/04/2021 08:33:40 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H1036	801	0	2022	Select counties in Florida		1	36407	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242		(866)396-8810		(866)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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H1036	806	0	1	01	01	H1036_806_0	1	1				0	0	05/24/2021	2022.01	05/24/2021 03:24:11 PM Eastern Daylight Time					06/04/2021 08:33:40 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H1036	806	0	2022	Select counties in Florida		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H1036	810	0	1	01	01	H1036_810_0	1	1						05/24/2021	2022.01	05/24/2021 04:29:32 PM Eastern Daylight Time					06/04/2021 08:33:40 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H1036	810	0	2022	Select Counties in MS, OR and NC		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242		(866)396-8810		(866)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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H1036	811	0	1	01	01	H1036_811_0	1	1				0	0	05/24/2021	2022.01	05/24/2021 04:30:39 PM Eastern Daylight Time					06/04/2021 08:33:40 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H1036	811	0	2022	Select Counties in MS, OR and NC		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H1036	814	0	1	01	01	H1036_814_0	1	1						05/27/2021	2022.01	05/27/2021 02:30:39 PM Eastern Daylight Time					06/04/2021 08:33:40 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H1036	814	0	2022	Select counties in Florida		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242		(866)396-8810		(866)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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					2				
H1036	815	0	1	01	01	H1036_815_0	1	1				0	0	05/27/2021	2022.01	05/27/2021 02:34:14 PM Eastern Daylight Time					06/04/2021 08:33:40 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H1036	815	0	2022	Select counties in Florida		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					2				
H1036	816	0	1	01	01	H1036_816_0	1	1						05/27/2021	2022.01	05/27/2021 02:36:53 PM Eastern Daylight Time					06/04/2021 08:33:40 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H1036	816	0	2022	Select counties in MS, OR and NC		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242		(866)396-8810		(866)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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					2				
H1036	817	0	1	01	01	H1036_817_0	1	1				0	0	05/27/2021	2022.01	05/27/2021 02:39:26 PM Eastern Daylight Time					06/04/2021 08:33:40 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H1036	817	0	2022	Select counties in MS, OR and NC		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					2				
H1036	818	0	1	01	01	H1036_818_0	1	1						05/27/2021	2022.01	05/27/2021 02:43:11 PM Eastern Daylight Time					06/04/2021 08:33:40 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H1036	818	0	2022	Select counties in Florida		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242		(866)396-8810		(866)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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					2				
H1036	819	0	1	01	01	H1036_819_0	1	1				0	0	05/27/2021	2022.01	05/27/2021 02:45:29 PM Eastern Daylight Time					06/04/2021 08:33:40 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H1036	819	0	2022	Select counties in Florida		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					2				
H1036	820	0	1	01	01	H1036_820_0	1	1						05/27/2021	2022.01	05/27/2021 02:55:10 PM Eastern Daylight Time					06/04/2021 08:33:40 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H1036	820	0	2022	Select counties in Florida		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242		(866)396-8810		(866)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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					2				
H1036	821	0	1	01	01	H1036_821_0	1	1				0	0	05/27/2021	2022.01	05/27/2021 03:02:52 PM Eastern Daylight Time					06/04/2021 08:33:40 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H1036	821	0	2022	Select counties in Florida		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					2				
H1036	822	0	1	01	01	H1036_822_0	1	1						05/27/2021	2022.01	05/27/2021 03:05:13 PM Eastern Daylight Time					06/04/2021 08:33:40 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H1036	822	0	2022	Select counties in Florida		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242		(866)396-8810		(866)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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					2				
H1036	823	0	1	01	01	H1036_823_0	1	1				0	0	05/27/2021	2022.01	05/27/2021 03:08:06 PM Eastern Daylight Time					06/04/2021 08:33:40 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H1036	823	0	2022	Select counties in Florida		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					2				
H1036	824	0	1	01	01	H1036_824_0	1	1						06/01/2021	2022.01	06/01/2021 05:04:07 PM Eastern Daylight Time					06/04/2021 08:33:40 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H1036	824	0	2022	Select counties in Florida		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242		(866)396-8810		(866)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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					2				
H1036	825	0	1	01	01	H1036_825_0	1	1				0	0	06/01/2021	2022.01	06/01/2021 04:59:55 PM Eastern Daylight Time					06/04/2021 08:33:40 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H1036	825	0	2022	Select counties in Florida		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					2				
H1036	826	0	1	01	01	H1036_826_0	1	1						06/01/2021	2022.01	06/01/2021 05:04:48 PM Eastern Daylight Time					06/04/2021 08:33:40 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H1036	826	0	2022	Select counties in Florida		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242		(866)396-8810		(866)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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					2				
H1036	827	0	1	01	01	H1036_827_0	1	1				0	0	05/27/2021	2022.01	05/27/2021 03:16:50 PM Eastern Daylight Time					06/04/2021 08:33:40 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H1036	827	0	2022	Select counties in Florida		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					2				
H1043	001	0	1	20	08	H1043_001_0	1	1						06/01/2021	2022.01	06/01/2021 01:41:01 PM Eastern Daylight Time		05/30/2021 11:57:48 AM Eastern Daylight Time			06/01/2021 01:44:44 PM Eastern Daylight Time	FLORIDA PACE CENTERS, INC.	Florida Pace Centers, Inc.	miamijewishhealthsystems.org	Florida PACE Centers, Inc. (PACE)	08	20		1			H1043	001	0	2022	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									(800)955-8771		(800)955-8771		(855)737-7223		(305)751-8626	66725															
H1043	002	0	1	20	08	H1043_002_0	1	1						06/01/2021	2022.01	06/01/2021 01:41:53 PM Eastern Daylight Time		05/30/2021 11:59:21 AM Eastern Daylight Time			06/01/2021 01:44:44 PM Eastern Daylight Time	FLORIDA PACE CENTERS, INC.	Florida Pace Centers, Inc.	miamijewishhealthsystems.org	Florida PACE Centers, Inc (PACE)	08	20		1			H1043	002	0	2022	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									(800)955-8771		(800)955-8771		(855)737-7223		(305)751-8626	8465															
H1045	001	0	1	01	01	H1045_001_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 12:26:57 PM Central Daylight Time	08/03/2021 12:07:54 PM Central Daylight Time	07/29/2021 07:27:22 PM Central Daylight Time			08/04/2021 06:58:37 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.myPreferredCare.com	Preferred Choice Dade (HMO)	01	01		1			H1045	001	0	2022	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	3	1			2		1	08/04/2021	2022.01	08/04/2021 12:27:10 PM Central Daylight Time	08/03/2021 12:08:23 PM Central Daylight Time	07/29/2021 07:27:38 PM Central Daylight Time			08/04/2021 06:58:37 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.myPreferredCare.com	Preferred Choice Broward (HMO)	01	01		1			H1045	005	0	2022	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	3	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 01:59:38 PM Central Daylight Time	08/03/2021 12:08:53 PM Central Daylight Time	07/29/2021 07:27:53 PM Central Daylight Time			08/04/2021 06:58:37 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.myPreferredCare.com	Preferred Medicare Assist Plan 1 (HMO D-SNP)	01	01		1			H1045	012	0	2022	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	3	1		1	2		1	08/04/2021	2022.01	08/04/2021 12:27:43 PM Central Daylight Time	08/03/2021 12:09:22 PM Central Daylight Time	07/29/2021 07:28:09 PM Central Daylight Time			08/04/2021 06:58:37 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.myPreferredCare.com	Preferred Special Care Miami-Dade (HMO C-SNP)	01	01		1			H1045	018	0	2022	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			2		1	08/04/2021	2022.01	08/04/2021 12:27:55 PM Central Daylight Time	08/03/2021 12:09:51 PM Central Daylight Time	07/29/2021 07:28:24 PM Central Daylight Time			08/04/2021 06:58:37 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare The Villages Medicare Advantage (HMO)	01	01		1			H1045	025	0	2022	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	02	01	H1045_026_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 12:28:06 PM Central Daylight Time	08/03/2021 12:10:20 PM Central Daylight Time	07/29/2021 07:28:39 PM Central Daylight Time			08/04/2021 06:58:37 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	01	02		1			H1045	026	0	2022	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	028	0	1	02	01	H1045_028_0	4	1			2		1	08/04/2021	2022.01	08/04/2021 12:28:23 PM Central Daylight Time	08/03/2021 12:10:50 PM Central Daylight Time	07/29/2021 07:28:54 PM Central Daylight Time			08/04/2021 06:58:37 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	01	02		1			H1045	028	0	2022	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	02	01	H1045_030_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 12:28:34 PM Central Daylight Time	08/03/2021 12:11:20 PM Central Daylight Time	07/29/2021 07:29:09 PM Central Daylight Time			08/04/2021 06:58:37 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	01	02		1			H1045	030	0	2022	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	02	01	H1045_031_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 12:28:46 PM Central Daylight Time	08/03/2021 12:11:49 PM Central Daylight Time	07/29/2021 07:29:25 PM Central Daylight Time			08/04/2021 06:58:37 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	01	02		1			H1045	031	0	2022	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	02	01	H1045_032_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 12:28:58 PM Central Daylight Time	08/03/2021 12:12:19 PM Central Daylight Time	07/29/2021 07:29:40 PM Central Daylight Time			08/04/2021 06:58:37 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	01	02		1			H1045	032	0	2022	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	3	1			2		1	08/04/2021	2022.01	08/04/2021 12:29:11 PM Central Daylight Time	08/03/2021 12:12:48 PM Central Daylight Time	07/29/2021 07:29:55 PM Central Daylight Time			08/04/2021 06:58:37 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO)	01	01		1			H1045	033	0	2022	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	3	1			2		1	08/04/2021	2022.01	08/04/2021 12:29:23 PM Central Daylight Time	08/03/2021 12:13:17 PM Central Daylight Time	07/29/2021 07:30:14 PM Central Daylight Time			08/04/2021 06:58:37 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO)	01	01		1			H1045	034	0	2022	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	02	01	H1045_036_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 12:29:34 PM Central Daylight Time	08/03/2021 12:13:48 PM Central Daylight Time	07/29/2021 07:30:29 PM Central Daylight Time			08/04/2021 06:58:37 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Focus (HMO-POS)	01	02		1			H1045	036	0	2022	Select counties in 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	037	0	1	01	01	H1045_037_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 12:29:45 PM Central Daylight Time	08/03/2021 12:14:17 PM Central Daylight Time	07/29/2021 07:30:45 PM Central Daylight Time			08/04/2021 06:58:37 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.myPreferredCare.com	Preferred Choice Palm Beach (HMO)	01	01		1			H1045	037	0	2022	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	4	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 12:29:56 PM Central Daylight Time	08/03/2021 12:14:45 PM Central Daylight Time	07/29/2021 07:31:01 PM Central Daylight Time			08/04/2021 06:58:37 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.myPreferredCare.com	Preferred Medicare Assist Palm Beach (HMO D-SNP)	01	01		1			H1045	038	0	2022	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	4	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 12:30:29 PM Central Daylight Time	08/03/2021 12:15:14 PM Central Daylight Time	07/29/2021 07:31:17 PM Central Daylight Time			08/04/2021 06:58:37 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete LP (HMO D-SNP)	01	01		1			H1045	039	0	2022	Select counties in 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	02	01	H1045_041_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 12:30:19 PM Central Daylight Time	08/03/2021 12:15:44 PM Central Daylight Time	07/29/2021 07:31:32 PM Central Daylight Time			08/04/2021 06:58:37 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	01	02		1			H1045	041	0	2022	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	02	01	H1045_042_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 12:30:47 PM Central Daylight Time	08/03/2021 12:16:12 PM Central Daylight Time	07/29/2021 07:31:48 PM Central Daylight Time			08/04/2021 06:58:37 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	01	02		1			H1045	042	0	2022	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	02	01	H1045_043_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 12:31:37 PM Central Daylight Time	08/03/2021 12:16:41 PM Central Daylight Time	07/29/2021 07:32:03 PM Central Daylight Time			08/04/2021 06:58:37 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	01	02		1			H1045	043	0	2022	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	02	01	H1045_045_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 12:31:49 PM Central Daylight Time	08/03/2021 12:17:10 PM Central Daylight Time	07/29/2021 07:32:18 PM Central Daylight Time			08/04/2021 06:58:37 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Focus (HMO-POS)	01	02		1			H1045	045	0	2022	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	048	1	1	01	01	H1045_048_1	3	1		1	2		1	08/04/2021	2022.01	08/04/2021 12:32:02 PM Central Daylight Time	08/03/2021 12:17:38 PM Central Daylight Time	07/29/2021 07:32:34 PM Central Daylight Time			08/04/2021 06:58:37 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Walgreens (HMO C-SNP)	01	01		1			H1045	048	1	2022	State of Florida	Orlando Metro	2		2			1	4			00000000000000000010		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			
H1045	048	2	1	01	01	H1045_048_2	3	1		1	2		1	08/04/2021	2022.01	08/04/2021 12:32:13 PM Central Daylight Time	08/03/2021 12:18:07 PM Central Daylight Time	07/29/2021 07:32:50 PM Central Daylight Time			08/04/2021 06:58:37 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Walgreens (HMO C-SNP)	01	01		1			H1045	048	2	2022	State of Florida	Southwest Florida	2		2			1	4			00000000000000000010		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			
H1045	048	3	1	01	01	H1045_048_3	3	1		1	2		1	08/04/2021	2022.01	08/04/2021 12:32:23 PM Central Daylight Time	08/03/2021 12:18:36 PM Central Daylight Time	07/29/2021 07:33:05 PM Central Daylight Time			08/04/2021 06:58:37 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Walgreens (HMO C-SNP)	01	01		1			H1045	048	3	2022	State of Florida	Tampa Metro	2		2			1	4			00000000000000000010		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			
H1045	048	4	1	01	01	H1045_048_4	3	1		1	2		1	08/04/2021	2022.01	08/04/2021 12:32:34 PM Central Daylight Time	08/03/2021 12:19:04 PM Central Daylight Time	07/29/2021 07:33:21 PM Central Daylight Time			08/04/2021 06:58:37 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Walgreens (HMO C-SNP)	01	01		1			H1045	048	4	2022	State of Florida	Lake, Marion & Sumter Counties	2		2			1	4			00000000000000000010		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			
H1045	053	0	1	01	01	H1045_053_0	4	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 12:32:46 PM Central Daylight Time	08/03/2021 12:19:33 PM Central Daylight Time	07/29/2021 07:33:36 PM Central Daylight Time			08/04/2021 06:58:37 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.myPreferredCare.com	Preferred Medicare Assist Plan 2 (HMO D-SNP)	01	01		1			H1045	053	0	2022	Broward and Dade counties		2		2			1	3		1		1	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	055	0	1	01	01	H1045_055_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 12:32:59 PM Central Daylight Time	08/03/2021 12:20:01 PM Central Daylight Time	07/29/2021 07:33:52 PM Central Daylight Time			08/04/2021 06:58:37 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP Medicare Advantage (HMO)	01	01		1			H1045	055	0	2022	Palm Beach county		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	801	0	1	01	01	H1045_801_0	1	1						06/02/2021	2022.01	06/02/2021 03:49:40 PM Central Daylight Time					06/02/2021 04:04:51 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H1045	801	0	2022	Select counties in Florida		1	204	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;17a;18a;	2		1					1				
H1045	802	0	1	01	01	H1045_802_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 03:52:06 PM Central Daylight Time					06/02/2021 04:04:51 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H1045	802	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;17a;18a;	2		1					1				
H1045	803	0	1	01	01	H1045_803_0	1	1						06/02/2021	2022.01	06/02/2021 03:52:57 PM Central Daylight Time					06/02/2021 04:04:51 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H1045	803	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;17a;18a;	2		1					1				
H1045	804	0	2	01	01	H1045_804_0	1	1						06/02/2021	2022.01	06/02/2021 03:53:16 PM Central Daylight Time					06/02/2021 04:04:51 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		2	2		H1045	804	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;17a;18a;	2		1					1				
H1099	001	0	1	02	01	H1099_001_0	8	1					1	08/02/2021	2022.01	08/02/2021 06:24:53 PM Eastern Daylight Time	08/03/2021 02:07:06 PM Eastern Daylight Time	07/30/2021 11:25:28 AM Eastern Daylight Time			08/04/2021 04:10:50 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	2022	Counties: BR, IR		2	112156	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	8	1					0	08/02/2021	2022.01	08/02/2021 06:27:03 PM Eastern Daylight Time	08/03/2021 02:07:54 PM Eastern Daylight Time	07/30/2021 11:26:22 AM Eastern Daylight Time			08/04/2021 04:10:50 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	2022	Counties: BR, IR		2	102657	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	6	1				0	0	07/08/2021	2022.01	07/08/2021 08:56:17 AM Eastern Daylight Time	06/29/2021 02:09:08 PM Eastern Daylight Time				07/15/2021 02:19:41 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	2022	Counties: BR, IR		2	7722	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	8	1					0	08/02/2021	2022.01	08/02/2021 06:29:16 PM Eastern Daylight Time	08/03/2021 02:08:32 PM Eastern Daylight Time	07/30/2021 11:28:54 AM Eastern Daylight Time			08/04/2021 04:10:50 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	2022	Counties: BR, IR		2	118792	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	8	1					0	08/02/2021	2022.01	08/02/2021 06:32:22 PM Eastern Daylight Time	08/03/2021 02:09:32 PM Eastern Daylight Time	07/30/2021 11:24:14 AM Eastern Daylight Time			08/04/2021 04:10:50 PM Eastern Daylight Time	HEALTH FIRST HEALTH PLANS	Health First Health Plans, Inc.	myAHplan.com	AdventHealth SunSaver Plan (HMO)	01	01		1			H1099	016	0	2022	Counties: VO, FL, HA, HI, SE		2	96227	2			2						myAHplan.com	myAHplan.com	myAHplan.com	(877)535-8278		(877)535-8278		(877)535-8278		(877)535-8278		(877)535-8278		(877)535-8278		(877)535-8278		(877)535-8278		(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			
H1109	005	0	1	01	01	H1109_005_0	4	1					0	08/02/2021	2022.01	08/02/2021 12:28:15 PM Central Daylight Time	08/03/2021 10:33:04 AM Eastern Daylight Time	08/02/2021 09:22:57 AM Eastern Daylight Time			08/04/2021 04:19:54 PM Eastern Daylight Time	AETNA HEALTH INC.(GA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	01	01		1			H1109	005	0	2022	Select Counties in Atlanta and Macon area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1109	006	0	1	01	01	H1109_006_0	5	1					0	08/02/2021	2022.01	08/02/2021 12:29:52 PM Central Daylight Time	08/03/2021 10:34:02 AM Eastern Daylight Time	08/02/2021 09:23:01 AM Eastern Daylight Time			08/04/2021 04:19:54 PM Eastern Daylight Time	AETNA HEALTH INC.(GA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	01	01		1			H1109	006	0	2022	Hall County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1109	801	0	1	01	01	H1109_801_0	1	1				0	0	05/27/2021	2022.01	05/27/2021 01:57:08 PM Eastern Daylight Time					06/03/2021 12:38:53 PM Eastern Daylight Time	AETNA HEALTH INC.(GA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (HMO)	01	01		1			H1109	801	0	2022	Georgia		1	1390	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H1109	802	0	1	01	01	H1109_802_0	1	1						05/27/2021	2022.01	05/27/2021 01:57:27 PM Eastern Daylight Time					06/03/2021 12:38:53 PM Eastern Daylight Time	AETNA HEALTH INC.(GA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan w/Rx (HMO)	01	01		1			H1109	802	0	2022	Georgia		1	4640	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H1111	011	0	1	01	01	H1111_011_0	3	1					1	08/04/2021	2022.01	08/04/2021 10:43:45 AM Central Daylight Time	08/03/2021 01:40:27 PM Central Daylight Time	07/29/2021 07:34:07 PM Central Daylight Time			08/04/2021 01:23:58 PM Central Daylight Time	UNITEDHEALTHCARE OF GEORGIA, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Walgreens (HMO)	01	01		1			H1111	011	0	2022	Select Counties in GA		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						06/02/2021	2022.01	06/02/2021 03:54:17 PM Central Daylight Time					06/02/2021 04:17:37 PM Central Daylight Time	UNITEDHEALTHCARE OF GEORGIA, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H1111	801	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;17a;18a;	2		1					1				
H1111	804	0	1	01	01	H1111_804_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 03:55:43 PM Central Daylight Time					06/02/2021 04:17:37 PM Central Daylight Time	UNITEDHEALTHCARE OF GEORGIA, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H1111	804	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;17a;18a;	2		1					1				
H1111	805	0	1	01	01	H1111_805_0	1	1						06/02/2021	2022.01	06/02/2021 03:56:18 PM Central Daylight Time					06/02/2021 04:17:37 PM Central Daylight Time	UNITEDHEALTHCARE OF GEORGIA, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H1111	805	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;17a;18a;	2		1					1				
H1111	807	0	2	01	01	H1111_807_0	1	1						06/02/2021	2022.01	06/02/2021 03:56:47 PM Central Daylight Time					06/02/2021 04:17:37 PM Central Daylight Time	UNITEDHEALTHCARE OF GEORGIA, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		2	2		H1111	807	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;17a;18a;	2		1					1				
H1112	006	0	1	01	01	H1112_006_0	4	1	2	1			0	07/18/2021	2022.01	07/18/2021 06:21:56 PM Eastern Daylight Time	08/03/2021 11:06:32 PM Eastern Daylight Time	07/30/2021 10:26:06 AM Eastern Daylight Time			08/04/2021 09:57:30 PM Eastern Daylight Time	WELLCARE OF GEORGIA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Access (HMO D-SNP)	01	01		1			H1112	006	0	2022	Select counties in GA		2	139812	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1112	033	0	1	01	01	H1112_033_0	4	1	2	1			0	07/18/2021	2022.01	07/18/2021 06:22:46 PM Eastern Daylight Time	08/03/2021 11:07:01 PM Eastern Daylight Time	07/30/2021 10:26:28 AM Eastern Daylight Time			08/04/2021 09:57:30 PM Eastern Daylight Time	WELLCARE OF GEORGIA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Liberty (HMO D-SNP)	01	01		1			H1112	033	0	2022	Select counties in GA		2	83512	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1112	034	0	1	02	01	H1112_034_0	5	1				0	0	05/29/2021	2022.01	05/29/2021 07:33:40 PM Eastern Daylight Time	06/06/2021 12:29:53 PM Eastern Daylight Time				07/19/2021 06:42:26 PM Eastern Daylight Time	WELLCARE OF GEORGIA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Patriot No Premium (HMO-POS)	01	02		1			H1112	034	0	2022	Select counties in GA		2	16066	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H1112	035	0	1	01	01	H1112_035_0	4	1					0	08/02/2021	2022.01	08/02/2021 11:52:05 AM Eastern Daylight Time	08/03/2021 11:07:57 PM Eastern Daylight Time	07/30/2021 10:26:48 AM Eastern Daylight Time			08/04/2021 09:57:30 PM Eastern Daylight Time	WELLCARE OF GEORGIA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium Choice (HMO)	01	01		1			H1112	035	0	2022	Select counties in GA		2	7529	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1112	037	0	1	01	01	H1112_037_0	4	1		1			1	08/02/2021	2022.01	08/02/2021 11:53:37 AM Eastern Daylight Time	08/03/2021 11:08:25 PM Eastern Daylight Time	07/30/2021 10:27:08 AM Eastern Daylight Time			08/04/2021 09:57:30 PM Eastern Daylight Time	WELLCARE OF GEORGIA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Specialty No Premium (HMO C-SNP)	01	01		1			H1112	037	0	2022	Select counties in GA		2	6437	2			1	4			00000000000000000010		www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1112	038	0	1	01	01	H1112_038_0	4	1					0	08/02/2021	2022.01	08/02/2021 11:55:34 AM Eastern Daylight Time	08/03/2021 11:08:53 PM Eastern Daylight Time	07/30/2021 10:27:30 AM Eastern Daylight Time			08/04/2021 09:57:30 PM Eastern Daylight Time	WELLCARE OF GEORGIA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO)	01	01		1			H1112	038	0	2022	Select counties in GA		2	151520	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1112	039	0	1	01	01	H1112_039_0	4	1					0	08/02/2021	2022.01	08/02/2021 11:56:51 AM Eastern Daylight Time	08/03/2021 11:09:21 PM Eastern Daylight Time	07/30/2021 10:27:52 AM Eastern Daylight Time			08/04/2021 09:57:30 PM Eastern Daylight Time	WELLCARE OF GEORGIA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO)	01	01		1			H1112	039	0	2022	Select counties in GA		2	94538	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1112	040	0	1	01	01	H1112_040_0	4	1					0	08/02/2021	2022.01	08/02/2021 11:57:53 AM Eastern Daylight Time	08/03/2021 11:09:49 PM Eastern Daylight Time	07/30/2021 10:28:30 AM Eastern Daylight Time			08/04/2021 09:57:30 PM Eastern Daylight Time	WELLCARE OF GEORGIA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium Focus (HMO)	01	01		1			H1112	040	0	2022	Select counties in GA		2	45940	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1112	042	0	1	01	01	H1112_042_0	4	1					0	08/03/2021	2022.01	08/03/2021 12:17:00 PM Eastern Daylight Time	08/03/2021 11:10:19 PM Eastern Daylight Time	07/30/2021 10:28:50 AM Eastern Daylight Time			08/04/2021 09:57:30 PM Eastern Daylight Time	WELLCARE OF GEORGIA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Giveback (HMO)	01	01		1			H1112	042	0	2022	Select counties in GA		2	136108	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1112	043	0	1	01	01	H1112_043_0	4	1					0	06/02/2021	2022.01	06/02/2021 09:46:01 PM Eastern Daylight Time	08/03/2021 11:10:48 PM Eastern Daylight Time	07/30/2021 10:29:08 AM Eastern Daylight Time			08/04/2021 09:57:30 PM Eastern Daylight Time	WELLCARE OF GEORGIA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Assist (HMO)	01	01		1			H1112	043	0	2022	Select counties in GA		2	129370	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1112	044	0	1	01	01	H1112_044_0	4	1					0	08/02/2021	2022.01	08/02/2021 12:00:30 PM Eastern Daylight Time	08/03/2021 11:11:17 PM Eastern Daylight Time	07/30/2021 10:29:28 AM Eastern Daylight Time			08/04/2021 09:57:30 PM Eastern Daylight Time	WELLCARE OF GEORGIA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO)	01	01		1			H1112	044	0	2022	Select counties in GA		2	8656	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1119	001	0	1	01	01	H1119_001_0	4	1		1			0	08/02/2021	2022.01	08/02/2021 10:59:03 AM Eastern Daylight Time	08/03/2021 10:32:28 AM Eastern Daylight Time	08/03/2021 10:32:28 AM Eastern Daylight Time			08/03/2021 10:36:59 AM Eastern Daylight Time	TSG GUARD, INC.	Valor Health Plan	www.valorhealthplan.com	Valor Health Plan (HMO I-SNP)	01	01		1			H1119	001	0	2022	Northeast, Central and Northwest Ohio		2	14320	2			1	1	1				www.valorhealthplan.com	www.valorhealthplan.com	www.valorhealthplan.com	(800)485-3793		(501)255-0109		(800)485-3793		(501)255-0109		(800)485-3793		(501)255-0109		(800)485-3793		(501)255-0109		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1170	002	0	1	01	01	H1170_002_0	7	1					0	07/30/2021	2022.01	07/30/2021 05:25:54 PM Eastern Daylight Time	07/30/2021 08:23:51 PM Eastern Daylight Time	07/30/2021 08:30:52 PM Eastern Daylight Time			08/04/2021 12:49:43 PM Eastern Daylight Time	KAISER FOUNDATION HP OF GA, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Enhanced 1 (HMO)	01	01		1			H1170	002	0	2022	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	9	1	2	1			0	07/19/2021	2022.01	07/19/2021 12:57:43 PM Eastern Daylight Time	07/30/2021 08:25:35 PM Eastern Daylight Time	07/30/2021 08:32:42 PM Eastern Daylight Time			08/04/2021 12:49:43 PM Eastern Daylight Time	KAISER FOUNDATION HP OF GA, INC.	Kaiser Permanente	kp.org/medicare	Senior Advantage Medicare Medicaid Plan 1 (HMO D-SNP)	01	01		1			H1170	008	0	2022	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	7	1					0	07/30/2021	2022.01	07/30/2021 05:16:55 PM Eastern Daylight Time	07/30/2021 08:24:58 PM Eastern Daylight Time	07/30/2021 08:31:48 PM Eastern Daylight Time			08/04/2021 12:49:43 PM Eastern Daylight Time	KAISER FOUNDATION HP OF GA, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Basic 1 (HMO)	01	01		1			H1170	009	0	2022	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	010	0	1	01	01	H1170_010_0	7	1					0	07/30/2021	2022.01	07/30/2021 05:28:25 PM Eastern Daylight Time	07/30/2021 08:26:27 PM Eastern Daylight Time	07/30/2021 08:33:36 PM Eastern Daylight Time			08/04/2021 12:49:43 PM Eastern Daylight Time	KAISER FOUNDATION HP OF GA, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Enhanced 2 (HMO)	01	01		1			H1170	010	0	2022	Barrow, Butts, Newton, Rockdale, Spalding, Walton		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	011	0	1	01	01	H1170_011_0	9	1	2	1			0	07/19/2021	2022.01	07/19/2021 01:02:30 PM Eastern Daylight Time	07/30/2021 08:29:26 PM Eastern Daylight Time	07/30/2021 09:07:20 PM Eastern Daylight Time			08/04/2021 12:49:43 PM Eastern Daylight Time	KAISER FOUNDATION HP OF GA, INC.	Kaiser Permanente	kp.org/medicare	Senior Advantage Medicare Medicaid Plan 2 (HMO D-SNP)	01	01		1			H1170	011	0	2022	Barrow, Butts, Newton, Rockdale, Spalding, Walton		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	012	0	1	01	01	H1170_012_0	7	1					0	07/30/2021	2022.01	07/30/2021 05:17:29 PM Eastern Daylight Time	07/30/2021 08:28:40 PM Eastern Daylight Time	07/30/2021 09:06:16 PM Eastern Daylight Time			08/04/2021 12:49:43 PM Eastern Daylight Time	KAISER FOUNDATION HP OF GA, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Basic 2 (HMO)	01	01		1			H1170	012	0	2022	Barrow, Butts, Newton, Rockdale, Spalding, Walton		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				0	0	05/12/2021	2022.01	05/12/2021 03:31:08 PM Eastern Daylight Time					06/04/2021 04:35:07 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	2022	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;3-4;5;6;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;16b;	1	1a;1b;2;3-1;3-2;3-3;3-4;7c;7d;7f;7g;7i;7k;8a;8b1;8b2;8b3;16b;	1					2				
H1170	802	0	1	01	01	H1170_802_0	3	1						05/12/2021	2022.01	05/12/2021 03:38:52 PM Eastern Daylight Time					06/04/2021 04:35:07 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	2022	Atlanta Metro Area		1	58348	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;3-4;5;6;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;16b;	1	1a;1b;2;3-1;3-2;3-3;3-4;7c;7d;7f;7g;7i;7k;8a;8b1;8b2;8b3;16b;	1					2				
H1170	805	0	1	01	01	H1170_805_0	4	1						05/12/2021	2022.01	05/12/2021 03:39:26 PM Eastern Daylight Time					06/04/2021 04:35:07 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	2022	Atlanta Metro Area		1	23840	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;3-4;5;6;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;16b;	1	1a;1b;2;3-1;3-2;3-3;3-4;7c;7d;7f;7g;7i;7k;8a;8b1;8b2;8b3;16b;	1					2				
H1181	001	0		07	02	H1181_001_0	3	2				0	0	05/21/2021	2022.01	05/21/2021 04:36:23 PM Eastern Daylight Time			06/02/2021 10:04:32 AM Central Daylight Time		06/04/2021 12:20:24 PM Central Daylight Time	NETWORK HEALTH INSURANCE CORPORATION	Network Health Medicare Advantage Plans	https://networkhealth.com/	NetworkPrime (MSA)	02	07	2				H1181	001	0	2022	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	5	1					0	07/16/2021	2022.01	07/16/2021 12:08:43 PM Pacific Daylight Time	07/30/2021 04:05:26 PM Pacific Daylight Time	07/29/2021 03:02:38 PM Pacific Daylight Time			08/04/2021 02:45:47 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	2022	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	5	1					0	07/16/2021	2022.01	07/16/2021 12:08:53 PM Pacific Daylight Time	07/30/2021 04:05:52 PM Pacific Daylight Time	07/29/2021 03:03:28 PM Pacific Daylight Time			08/04/2021 02:45:47 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	2022	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	5	1					0	07/16/2021	2022.01	07/16/2021 12:09:02 PM Pacific Daylight Time	07/30/2021 04:06:19 PM Pacific Daylight Time	07/29/2021 03:04:06 PM Pacific Daylight Time			08/04/2021 02:45:47 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	2022	Northeast Texas		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	5	1					0	07/16/2021	2022.01	07/16/2021 12:09:11 PM Pacific Daylight Time	07/30/2021 04:06:45 PM Pacific Daylight Time	07/29/2021 03:05:15 PM Pacific Daylight Time			08/04/2021 02:45:47 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	2022	Northeast Texas		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	005	0	1	01	01	H1189_005_0	5	1					0	07/16/2021	2022.01	07/16/2021 12:09:21 PM Pacific Daylight Time	07/30/2021 04:07:12 PM Pacific Daylight Time	07/29/2021 03:05:49 PM Pacific Daylight Time			08/04/2021 02:45:47 PM Pacific Daylight Time	CHRISTUS HEALTH PLAN	CHRISTUS Health Plan Generations	www.christushealthplan.org	CHRISTUS Health Plan Generations Plus (HMO)	01	01		1			H1189	005	0	2022	Southeast Texas		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	006	0	1	01	01	H1189_006_0	4	1				0	0	07/16/2021	2022.01	07/16/2021 12:09:34 PM Pacific Daylight Time	07/02/2021 12:29:13 PM Pacific Daylight Time				07/16/2021 01:26:59 PM Pacific Daylight Time	CHRISTUS HEALTH PLAN	CHRISTUS Health Plan Generations	www.christushealthplan.org	CHRISTUS Health Plan Guardian (HMO)	01	01		1			H1189	006	0	2022	Southeast Texas		2		2			2						www.christushealthplan.org	www.christushealthplan.org		(844)282-3026		(844)282-3026		(844)282-3026		(844)282-3026										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H1189	007	0	1	01	01	H1189_007_0	4	1				0	0	07/16/2021	2022.01	07/16/2021 12:09:45 PM Pacific Daylight Time	07/02/2021 12:29:38 PM Pacific Daylight Time				07/16/2021 01:26:59 PM Pacific Daylight Time	CHRISTUS HEALTH PLAN	CHRISTUS Health Plan Generations	www.christushealthplan.org	CHRISTUS Health Plan Guardian (HMO)	01	01		1			H1189	007	0	2022	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										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H1189	008	0	1	01	01	H1189_008_0	4	1				0	0	07/16/2021	2022.01	07/16/2021 12:10:01 PM Pacific Daylight Time	07/02/2021 12:30:04 PM Pacific Daylight Time				07/16/2021 01:26:59 PM Pacific Daylight Time	CHRISTUS HEALTH PLAN	CHRISTUS Health Plan Generations	www.christushealthplan.org	CHRISTUS Health Plan Guardian (HMO)	01	01		1			H1189	008	0	2022	Northeast Texas		2		2			2						www.christushealthplan.org	www.christushealthplan.org		(844)282-3026		(844)282-3026		(844)282-3026		(844)282-3026										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H1205	001	0	1	01	01	H1205_001_0	8	1	2	1			0	08/04/2021	2022.01	08/04/2021 01:15:06 PM Eastern Daylight Time	08/04/2021 10:01:00 AM Eastern Daylight Time	08/04/2021 10:00:42 AM Eastern Daylight Time			08/04/2021 01:18:20 PM Eastern Daylight Time	INTEGRA MLTC, INC	Integra Managed Care	www.integramanagedcare.com	Integra Harmony (HMO D-SNP)	01	01		1			H1205	001	0	2022	Bronx, Kings, Queens and New York counties		2	2206	2			1	3		2		1	www.integramanagedcare.com/provider-search	client.formularynavigator.com/Search.aspx?siteCode=3037733490	www.integramanagedcare.com/provider-search	(877)388-5195		(877)388-5195		(877)388-5190		(877)388-5190		(877)388-5195		(877)388-5195		(877)388-5190		(877)388-5190		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1205	002	0	1	01	01	H1205_002_0	8	1	2	1			0	08/04/2021	2022.01	08/04/2021 01:15:28 PM Eastern Daylight Time	08/04/2021 10:01:00 AM Eastern Daylight Time	08/04/2021 10:00:42 AM Eastern Daylight Time			08/04/2021 01:18:20 PM Eastern Daylight Time	INTEGRA MLTC, INC	Integra Managed Care	www.integramanagedcare.com	Integra Synergy Medicaid Advantage Plus (MAP) (HMO D-SNP)	01	01		1			H1205	002	0	2022	Bronx, Kings, Queens and New York counties		2	2206	2			1	3		1		1	www.integramanagedcare.com/provider-search	client.formularynavigator.com/Search.aspx?siteCode=3037733490	www.integramanagedcare.com/provider-search	(877)388-5195		(877)388-5195		(877)388-5190		(877)388-5190		(877)388-5195		(877)388-5195		(877)388-5190		(877)388-5190		(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			0	08/04/2021	2022.01	08/04/2021 01:15:50 PM Eastern Daylight Time	08/04/2021 10:00:59 AM Eastern Daylight Time	08/04/2021 10:00:41 AM Eastern Daylight Time			08/04/2021 01:18:20 PM Eastern Daylight Time	INTEGRA MLTC, INC	Integra Managed Care	www.integramanagedcare.com	Integra Harmony (HMO D-SNP)	01	01		1			H1205	005	0	2022	Nassau County		2	154	2			1	3		2		1	www.integramanagedcare.com/provider-search	client.formularynavigator.com/Search.aspx?siteCode=3037733490	www.integramanagedcare.com/provider-search	(877)388-5195		(877)388-5195		(877)388-5190		(877)388-5190		(877)388-5195		(877)388-5195		(877)388-5190		(877)388-5190		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1205	006	0	1	01	01	H1205_006_0	8	1	2	1			0	08/04/2021	2022.01	08/04/2021 01:16:24 PM Eastern Daylight Time	08/04/2021 10:00:59 AM Eastern Daylight Time	08/04/2021 10:00:42 AM Eastern Daylight Time			08/04/2021 01:18:20 PM Eastern Daylight Time	INTEGRA MLTC, INC	Integra Managed Care	www.integramanagedcare.com	Integra Synergy Medicaid Advantage Plus (MAP) (HMO D-SNP)	01	01		1			H1205	006	0	2022	Nassau County		2	154	2			1	3		1		1	www.integramanagedcare.com/provider-search	client.formularynavigator.com/Search.aspx?siteCode=3037733490	www.integramanagedcare.com/provider-search	(877)388-5195		(877)388-5195		(877)388-5190		(877)388-5190		(877)388-5195		(877)388-5195		(877)388-5190		(877)388-5190		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1215	001	0	1	01	01	H1215_001_0	4	1	2	1			0	06/04/2021	2022.01	06/04/2021 01:44:41 PM Eastern Daylight Time	08/03/2021 11:11:45 PM Eastern Daylight Time	07/30/2021 10:29:56 AM Eastern Daylight Time			08/04/2021 10:34:28 PM Eastern Daylight Time	NEBRASKA TOTAL CARE, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Liberty (HMO D-SNP)	01	01		1			H1215	001	0	2022	Select counties in NE		2	934	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)853-0864		(833)853-0864		(844)917-0175		(844)917-0175		(833)853-0864		(833)853-0864		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1215	002	0	1	01	01	H1215_002_0	5	1					0	08/02/2021	2022.01	08/02/2021 10:31:19 AM Eastern Daylight Time	08/03/2021 11:12:13 PM Eastern Daylight Time	07/30/2021 10:30:16 AM Eastern Daylight Time			08/04/2021 10:34:28 PM Eastern Daylight Time	NEBRASKA TOTAL CARE, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO)	01	01		1			H1215	002	0	2022	Select counties in NE		2	625	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)542-0693		(833)542-0693		(844)917-0175		(844)917-0175		(833)542-0693		(833)542-0693		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1215	003	0	1	01	01	H1215_003_0	5	1					0	08/02/2021	2022.01	08/02/2021 11:04:46 AM Eastern Daylight Time	08/03/2021 11:12:42 PM Eastern Daylight Time	07/30/2021 10:30:34 AM Eastern Daylight Time			08/04/2021 10:34:28 PM Eastern Daylight Time	NEBRASKA TOTAL CARE, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Giveback (HMO)	01	01		1			H1215	003	0	2022	Select counties in NE		2	1874	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)542-0693		(833)542-0693		(844)917-0175		(844)917-0175		(833)542-0693		(833)542-0693		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1225	001	0	1	01	01	H1225_001_0	5	1					1	08/04/2021	2022.01	08/04/2021 11:46:44 PM US Eastern Daylight Time	08/04/2021 04:29:29 PM US Eastern Daylight Time	08/04/2021 04:30:04 PM US Eastern Daylight Time			08/04/2021 11:48:28 PM US Eastern Daylight Time	HOPKINS HEALTH ADVANTAGE, INC.	Johns Hopkins HealthCare	www.hopkinsmedicare.com/	Johns Hopkins Advantage MD (HMO)	01	01		1			H1225	001	0	2022	Counties: AA BL CR FR HW MG SS WH WC WR		2	68502	2			2						www.hopkinsmedicare.com/	www.hopkinsmedicare.com/	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	003	0	1	01	01	H1225_003_0	5	1	2	1			0	08/04/2021	2022.01	08/04/2021 11:45:12 PM US Eastern Daylight Time	08/04/2021 11:42:50 PM US Eastern Daylight Time	08/04/2021 11:43:16 PM US Eastern Daylight Time			08/04/2021 11:48:28 PM US Eastern Daylight Time	HOPKINS HEALTH ADVANTAGE, INC.	Johns Hopkins HealthCare	www.hopkinsmedicare.com	Johns Hopkins Advantage MD D-SNP (HMO D-SNP)	01	01		1			H1225	003	0	2022	Anne Arundel, Howard and Montgomery Counties		2	5400	2			1	3		1		1	www.hopkinsmedicare.com	www.hopkinsmedicare.com	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			
H1228	001	0	1	20	08	H1228_001_0	1	1						05/27/2021	2022.01	05/27/2021 04:21:51 PM Pacific Daylight Time		05/27/2021 04:00:23 PM Pacific Daylight Time			05/27/2021 04:22:41 PM Pacific Daylight Time	GOLDEN VALLEY HEALTH CENTERS	Central Valley PACE	www.cvpace.org	Central Valley PACE - Dual Eligible (PACE)	08	20		1			H1228	001	0	2022	Stanislaus and San Joaquin Counties California		2		2			2						N/A	N/A										(855)461-7223		(209)724-6000		(855)461-7223		(209)724-6000										(844)461-7223		(209)726-7380		(844)461-7223		(209)726-7380																
H1228	002	0	1	20	08	H1228_002_0	1	1						05/27/2021	2022.01	05/27/2021 04:22:00 PM Pacific Daylight Time		05/27/2021 04:00:23 PM Pacific Daylight Time			05/27/2021 04:22:41 PM Pacific Daylight Time	GOLDEN VALLEY HEALTH CENTERS	Central Valley PACE	www.cvpace.org	Central Valley PACE - Medicare Only (PACE)	08	20		1			H1228	002	0	2022	Stanislaus and San Joaquin Counties California		2		2			2						N/A	N/A										(855)461-7223		(209)724-6000		(855)461-7223		(209)724-6000										(844)461-7223		(209)726-7380		(844)461-7223		(209)726-7380																
H1230	001	0	1	01	01	H1230_001_0	14	1					0	07/12/2021	2022.01	07/12/2021 05:43:42 PM Hawaiian Standard Time	07/29/2021 12:05:18 PM Hawaiian Standard Time	07/29/2021 11:52:17 AM Hawaiian Standard Time			08/04/2021 10:42:50 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	2022	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	11	1					0	07/12/2021	2022.01	07/12/2021 05:44:04 PM Hawaiian Standard Time	07/29/2021 12:06:02 PM Hawaiian Standard Time	07/29/2021 11:53:45 AM Hawaiian Standard Time			08/04/2021 10:42:50 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	2022	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	11	1	2	1			0	06/21/2021	2022.01	06/21/2021 10:50:43 AM Hawaiian Standard Time	07/29/2021 12:08:14 PM Hawaiian Standard Time	07/29/2021 11:58:13 AM Hawaiian Standard Time			08/04/2021 10:42:50 AM Hawaiian Standard Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Senior Advantage Medicare Medicaid (HMO D-SNP)	01	01		1			H1230	008	0	2022	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	11	1					0	07/12/2021	2022.01	07/12/2021 05:44:25 PM Hawaiian Standard Time	07/29/2021 12:06:44 PM Hawaiian Standard Time	07/29/2021 11:55:16 AM Hawaiian Standard Time			08/04/2021 10:42:50 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	2022	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	11	1					0	07/12/2021	2022.01	07/12/2021 05:44:52 PM Hawaiian Standard Time	07/29/2021 12:07:29 PM Hawaiian Standard Time	07/29/2021 11:56:44 AM Hawaiian Standard Time			08/04/2021 10:42:50 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	2022	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	8	1				0	0	05/11/2021	2022.01	05/11/2021 04:33:04 PM Hawaiian Standard Time					06/07/2021 12:15:39 PM 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	2022	Islands of Oahu, Maui and Hawaii except for 3 ZIPs		1	1090	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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;9d;10a;11a;11b;11c;12;15;16b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;9d;12;14a;14d;14e3;16b;17a;18a;	1					2				
H1230	803	0	1	01	01	H1230_803_0	8	1						05/11/2021	2022.01	05/11/2021 04:39:40 PM Hawaiian Standard Time					06/07/2021 12:15:39 PM 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	2022	Islands of Oahu, Maui and Hawaii except for 3 ZIPs		1	165724	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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;9d;10a;11a;11b;11c;12;15;16b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;9d;12;14a;14d;14e3;16b;17a;18a;	1					2				
H1230	804	0	2	01	01	H1230_804_0	8	1						05/19/2021	2022.01	05/19/2021 04:46:10 PM Hawaiian Standard Time					06/07/2021 12:15:39 PM 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	2022	Islands of Oahu, Maui and Hawaii except for 3 ZIPs		1	325	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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;9d;10a;11a;11b;11c;12;15;16b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;9d;12;14a;14d;14e3;16b;17a;18a;	1					2				
H1230	805	0	1	01	01	H1230_805_0	8	1						05/11/2021	2022.01	05/11/2021 04:49:05 PM Hawaiian Standard Time					06/07/2021 12:15:39 PM Hawaiian Standard Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	FEHB AB with D (HMO)	01	01		1			H1230	805	0	2022	Islands of Oahu, Maui and Hawaii except for 3 ZIPs		1	23444	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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;9d;10a;11a;11b;11c;12;15;16b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;9d;12;14a;14d;14e3;16b;17a;18a;	1					2				
H1230	806	0	2	01	01	H1230_806_0	8	1						05/19/2021	2022.01	05/19/2021 04:46:37 PM Hawaiian Standard Time					06/07/2021 12:15:39 PM 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	2022	Islands of Oahu, Maui and Hawaii except for 3 ZIPs		1	72	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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;9d;10a;11a;11b;11c;12;15;16b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;9d;12;14a;14d;14e3;16b;17a;18a;	1					2				
H1234	001	0	1	20	08	H1234_001_0	1	1						05/27/2021	2022.01	05/27/2021 12:38:07 PM Eastern Daylight Time		05/27/2021 08:06:06 AM Eastern Daylight Time			05/27/2021 12:41:55 PM Eastern Daylight Time	LIFE ST. FRANCIS	LIFE St. Francis	www.stfrancismedical.org/LIFE	SFMC-Dual (PACE)	08	20		1			H1234	001	0	2022	Mercer County and portions of Burlington County		2		2			2						www.pharmastar.com	www.stfrancismedical.org										(609)599-5433		(609)599-5433		(609)599-5433		(609)599-5433										(609)599-5433		(609)599-5433		(609)599-5433		(609)599-5433																
H1234	002	0	1	20	08	H1234_002_0	1	1						05/27/2021	2022.01	05/27/2021 12:38:45 PM Eastern Daylight Time		05/27/2021 08:06:06 AM Eastern Daylight Time			05/27/2021 12:41:55 PM Eastern Daylight Time	LIFE ST. FRANCIS	LIFE St. Francis	www.stfrancismedical.org/LIFE	SFMC-Medicare only (PACE)	08	20		1			H1234	002	0	2022	Mercer County and portions of Burlington County		2		2			2						www.pharmastar.com	www.stfrancismedical.org										(609)599-5433		(609)599-5433		(609)599-5433		(609)599-5433										(609)599-5433		(609)599-5433		(609)599-5433		(609)599-5433																
H1239	001	0	1	20	08	H1239_001_0	1	1						05/27/2021	2022.01	05/27/2021 09:12:21 AM Mountain Daylight Time		05/27/2021 08:41:42 AM Mountain Daylight Time			05/27/2021 09:22:18 AM 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	2022	Roanoke Valley Area		2		2			2						https://www.granerx.com/	N/A										(844)704-9613	711	(844)704-9613		(844)704-9613		(844)704-9613										(844)704-9613	711	(844)704-9613	711	(844)704-9613		(844)704-9613																
H1239	002	0	1	20	08	H1239_002_0	1	1						05/27/2021	2022.01	05/27/2021 09:12:33 AM Mountain Daylight Time		05/27/2021 08:41:42 AM Mountain Daylight Time			05/27/2021 09:22:18 AM 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	2022	Roanoke Valley Area		2		2			2						https://www.granerx.com/	N/A										(844)704-9613	711	(844)704-9613		(844)704-9613		(844)704-9613										(844)704-9613	711	(844)704-9613	711	(844)704-9613		(844)704-9613																
H1248	001	0	1	04	01	H1248_001_0	8	1					0	08/03/2021	2022.01	08/03/2021 11:30:33 AM Central Daylight Time	08/03/2021 07:17:34 AM Central Daylight Time	07/30/2021 09:37:30 AM Central Daylight Time			08/05/2021 10:14:58 AM Central Daylight Time	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Blue Cross and Blue Shield of Louisiana	www.bcbsla.com/blueadvantage	Blue Advantage (PPO)	01	04		1			H1248	001	0	2022	Baton Rouge, Surrounding Parishes		2	2480	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	8	1					0	08/03/2021	2022.01	08/03/2021 11:32:50 AM Central Daylight Time	08/03/2021 07:19:46 AM Central Daylight Time	07/30/2021 09:37:50 AM Central Daylight Time			08/05/2021 10:14:58 AM Central Daylight Time	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Blue Cross and Blue Shield of Louisiana	www.bcbsla.com/blueadvantage	Blue Advantage (PPO)	01	04		1			H1248	002	0	2022	New Orleans, Surrounding Parishes		2	3921	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	9	1					0	08/03/2021	2022.01	08/03/2021 11:46:44 AM Central Daylight Time	08/03/2021 07:21:12 AM Central Daylight Time	07/30/2021 09:38:10 AM Central Daylight Time			08/05/2021 10:14:58 AM Central Daylight Time	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Blue Cross and Blue Shield of Louisiana	www.bcbsla.com/blueadvantage	Blue Advantage (PPO)	01	04		1			H1248	003	0	2022	Tangipahoa, St. Tammany, Washington Parishes		2	2707	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	8	1					0	08/03/2021	2022.01	08/03/2021 11:49:22 AM Central Daylight Time	08/03/2021 07:21:44 AM Central Daylight Time	07/30/2021 09:38:28 AM Central Daylight Time			08/05/2021 10:14:58 AM Central Daylight Time	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Blue Cross and Blue Shield of Louisiana	www.bcbsla.com/blueadvantage	Blue Advantage (PPO)	01	04		1			H1248	004	0	2022	Alexandria, LC, Lafayette, Surrounding Parishes		2	6729	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	8	1					0	07/20/2021	2022.01	07/20/2021 08:36:19 PM Central Daylight Time	08/03/2021 07:22:52 AM Central Daylight Time	07/30/2021 09:38:48 AM Central Daylight Time			08/05/2021 10:14:58 AM Central Daylight Time	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Blue Cross and Blue Shield of Louisiana	www.bcbsla.com/blueadvantage	Blue Advantage (PPO)	01	04		1			H1248	005	0	2022	Northwest Parishes		2	1795	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	9	1					0	08/03/2021	2022.01	08/03/2021 11:51:44 AM Central Daylight Time	08/03/2021 07:23:56 AM Central Daylight Time	08/05/2021 01:18:08 PM Central Daylight Time			08/05/2021 02:05:25 PM Central Daylight Time	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Blue Cross and Blue Shield of Louisiana	www.bcbsla.com/blueadvantage	Blue Advantage (PPO)	01	04		1			H1248	006	0	2022	Northeast Parishes		2	3460	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	007	0	1	04	01	H1248_007_0	9	1					0	08/03/2021	2022.01	08/03/2021 02:22:35 PM Central Daylight Time	08/03/2021 07:24:32 AM Central Daylight Time	07/30/2021 09:39:28 AM Central Daylight Time			08/05/2021 10:14:58 AM Central Daylight Time	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Blue Cross and Blue Shield of Louisiana	www.bcbsla.com/blueadvantage	Blue Advantage (PPO)	01	04		1			H1248	007	0	2022	Baton Rouge, Surrounding Areas		2	5903	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	1	1						06/06/2021	2022.01	06/06/2021 02:11:29 PM Central Daylight Time					06/06/2021 03:31:01 PM Central Daylight Time	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Blue Cross and Blue Shield of Louisiana	www.bcbsla.com/blueadvantage	Blue Advantage (PPO)	01	04		1			H1248	801	0	2022	State of Louisiana		1	1	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;3-4;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;15;	2		1									
H1248	802	0	1	04	01	H1248_802_0	1	1						06/06/2021	2022.01	06/06/2021 02:17:55 PM Central Daylight Time					06/06/2021 03:31:01 PM Central Daylight Time	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Blue Cross and Blue Shield of Louisiana	www.bcbsla.com/blueadvantage	Blue Advantage (PPO)	01	04		1			H1248	802	0	2022	State of Louisiana		1	1	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;3-4;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;15;	2		1									
H1248	803	0	1	04	01	H1248_803_0	1	1				0	0	06/06/2021	2022.01	06/06/2021 02:29:23 PM Central Daylight Time					06/06/2021 03:31:01 PM Central Daylight Time	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Blue Cross and Blue Shield of Louisiana	www.bcbsla.com/blueadvantage	Blue Advantage (PPO)	01	04		1			H1248	803	0	2022	State of Louisiana		1	1	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;3-4;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;15;	2		1									
H1277	001	0	1	01	01	H1277_001_0	6	1		1			0	07/07/2021	2022.01	07/07/2021 12:28:47 PM Eastern Daylight Time	08/05/2021 01:03:28 PM Eastern Daylight Time	08/02/2021 03:13:40 PM Eastern Daylight Time			08/05/2021 04:38:50 PM Eastern Daylight Time	ALIGN SENIOR CARE, INC.	Align Senior Care	www.alignseniorcare.com	Align Thrive (HMO I-SNP)	01	01		1			H1277	001	0	2022	Virginia (partial)		2	2997	2			1	1	3				www.PLACEHOLDER.com	www.PLACEHOLDER.com	www.alignseniorcare.com	(844)205-7244		(844)205-7244		(844)205-7244		(844)205-7244		(844)205-7244		(844)205-7244		(844)205-7244		(844)205-7244		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1277	002	0	1	01	01	H1277_002_0	6	1		1			0	07/07/2021	2022.01	07/07/2021 12:32:55 PM Eastern Daylight Time	08/05/2021 01:04:02 PM Eastern Daylight Time	08/02/2021 03:14:05 PM Eastern Daylight Time			08/05/2021 04:38:50 PM Eastern Daylight Time	ALIGN SENIOR CARE, INC.	Align Senior Care	www.alignseniorcare.com	Align Connect (HMO C-SNP)	01	01		1			H1277	002	0	2022	Virginia (partial)		2	1213	2			1	4			00000100000000000000		www.PLACEHOLDER.com	www.PLACEHOLDER.com	www.alignseniorcare.com	(844)205-7244		(844)205-7244		(844)205-7244		(844)205-7244		(844)205-7244		(844)205-7244		(844)205-7244		(844)205-7244		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1278	001	0	1	04	01	H1278_001_0	3	1					1	08/04/2021	2022.01	08/04/2021 02:57:59 PM Central Daylight Time	08/03/2021 11:56:16 AM Central Daylight Time	07/29/2021 07:34:23 PM Central Daylight Time			08/05/2021 10:25:56 AM Central Daylight Time	HARKEN HEALTH INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 1 (PPO)	01	04		1			H1278	001	0	2022	Select Counties in IA and NE		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	3	1					1	08/04/2021	2022.01	08/04/2021 08:38:02 AM Central Daylight Time	08/03/2021 11:56:47 AM Central Daylight Time	07/29/2021 07:34:38 PM Central Daylight Time			08/04/2021 03:01:15 PM Central Daylight Time	HARKEN HEALTH INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H1278	003	0	2022	West Texas		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	3	1					1	08/04/2021	2022.01	08/04/2021 08:40:57 AM Central Daylight Time	08/03/2021 11:57:20 AM Central Daylight Time	07/29/2021 07:34:53 PM Central Daylight Time			08/04/2021 03:01:15 PM Central Daylight Time	HARKEN HEALTH INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Walgreens (PPO)	01	04		1			H1278	004	0	2022	Austin 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			
H1278	005	0	1	04	01	H1278_005_0	3	1					1	08/04/2021	2022.01	08/04/2021 08:42:15 AM Central Daylight Time	08/03/2021 11:57:52 AM Central Daylight Time	07/29/2021 07:35:11 PM Central Daylight Time			08/04/2021 03:01:15 PM Central Daylight Time	HARKEN HEALTH INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H1278	005	0	2022	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			
H1278	007	0	1	04	01	H1278_007_0	3	1					1	08/04/2021	2022.01	08/04/2021 02:56:47 PM Central Daylight Time	08/03/2021 11:58:25 AM Central Daylight Time	07/29/2021 07:35:26 PM Central Daylight Time			08/05/2021 10:25:56 AM Central Daylight Time	HARKEN HEALTH INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H1278	007	0	2022	Sioux Falls 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			
H1278	009	0	1	04	01	H1278_009_0	3	1					1	08/04/2021	2022.01	08/04/2021 02:54:58 PM Central Daylight Time	08/03/2021 11:58:57 AM Central Daylight Time	07/29/2021 07:35:41 PM Central Daylight Time			08/05/2021 10:25:56 AM Central Daylight Time	HARKEN HEALTH INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H1278	009	0	2022	Rapid City 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			
H1278	010	0	1	04	01	H1278_010_0	3	1					1	08/04/2021	2022.01	08/04/2021 08:44:27 AM Central Daylight Time	08/03/2021 11:59:30 AM Central Daylight Time	07/29/2021 07:35:56 PM Central Daylight Time			08/04/2021 03:01:15 PM Central Daylight Time	HARKEN HEALTH INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H1278	010	0	2022	Brownsville 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			
H1278	013	0	1	04	01	H1278_013_0	3	1					1	08/04/2021	2022.01	08/04/2021 08:47:35 AM Central Daylight Time	08/03/2021 12:00:02 PM Central Daylight Time	07/29/2021 07:36:17 PM Central Daylight Time			08/04/2021 03:01:15 PM Central Daylight Time	HARKEN HEALTH INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H1278	013	0	2022	Dallas 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			
H1278	014	0	1	04	01	H1278_014_0	3	1					1	08/04/2021	2022.01	08/04/2021 08:48:56 AM Central Daylight Time	08/03/2021 12:00:35 PM Central Daylight Time	07/29/2021 07:36:32 PM Central Daylight Time			08/04/2021 03:01:15 PM Central Daylight Time	HARKEN HEALTH INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H1278	014	0	2022	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			
H1278	015	0	1	04	01	H1278_015_0	3	1					1	08/04/2021	2022.01	08/04/2021 08:50:19 AM Central Daylight Time	08/03/2021 12:01:05 PM Central Daylight Time	07/29/2021 07:36:47 PM Central Daylight Time			08/04/2021 03:01:15 PM Central Daylight Time	HARKEN HEALTH INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H1278	015	0	2022	East Texas		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	016	0	1	04	01	H1278_016_0	3	1					1	08/04/2021	2022.01	08/04/2021 08:51:42 AM Central Daylight Time	08/03/2021 12:01:36 PM Central Daylight Time	07/29/2021 07:37:02 PM Central Daylight Time			08/04/2021 03:01:15 PM Central Daylight Time	HARKEN HEALTH INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H1278	016	0	2022	Corpus Christi 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			
H1278	018	0	1	04	01	H1278_018_0	2	1				0	0	07/15/2021	2022.01	07/15/2021 01:48:08 PM Central Daylight Time	06/03/2021 03:39:36 PM Central Daylight Time				07/16/2021 10:11:58 AM Central Daylight Time	HARKEN HEALTH INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (PPO)	01	04		1			H1278	018	0	2022	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										(711)-		(711)-		(711)-		(711)-										2					2						2			
H1278	019	0	1	04	01	H1278_019_0	2	1				0	0	07/15/2021	2022.01	07/15/2021 01:49:34 PM Central Daylight Time	06/03/2021 03:40:00 PM Central Daylight Time				07/16/2021 10:11:58 AM Central Daylight Time	HARKEN HEALTH INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP Medicare Advantage Patriot (PPO)	01	04		1			H1278	019	0	2022	Select Counties in IA, NE, and SD		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757										(711)-		(711)-		(711)-		(711)-										2					2						2			
H1278	020	0	1	04	01	H1278_020_0	3	1					1	08/04/2021	2022.01	08/04/2021 02:51:10 PM Central Daylight Time	08/03/2021 12:02:06 PM Central Daylight Time	07/29/2021 07:37:17 PM Central Daylight Time			08/05/2021 10:25:56 AM Central Daylight Time	HARKEN HEALTH INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 2 (PPO)	01	04		1			H1278	020	0	2022	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			
H1280	001	0	1	01	01	H1280_001_0	19	1					0	08/05/2021	2022.01	08/05/2021 06:40:32 PM Central Daylight Time						ETERNALHEALTH,INC.	eternalHealth	www.eternalHealth.com	eternalHealth HMO 1 (HMO)	01	01		1			H1280	001	0	2022	Middlesex, Suffolk and Worcester Counties		2	15600	2			2						www.eternalHealth.com	www.eternalHealth.com	www.eternalHealth.com	(800)680-4568		(617)684-2348		(800)464-7198		(617)546-5733		(866)443-1095		(520)918-1254		(866)443-1095		(520)918-1254		(711)-		(711)-		(711)-		(711)-		(800)498-5428		(711)-		(800)498-5428		(711)-		2					2					2	2			
H1280	002	0	1	01	01	H1280_002_0	17	1					0	08/05/2021	2022.01	08/05/2021 06:41:10 PM Central Daylight Time						ETERNALHEALTH,INC.	eternalHealth	www.eternalHealth.com	eternalHealth HMO 2 (HMO)	01	01		1			H1280	002	0	2022	Middlesex, Suffolk and Worcester Counties		2	10800	2			2						www.eternalHealth.com	www.eternalHealth.com	www.eternalHealth.com	(800)680-4568		(617)684-2348		(800)464-7198		(617)546-5733		(866)443-1095		(520)918-1254		(866)443-1095		(520)918-1254		(711)-		(711)-		(711)-		(711)-		(800)498-5428		(711)-		(800)498-5428		(711)-		2					2					2	2			
H1290	001	0	1	01	01	H1290_001_0	11	1			1		1	08/02/2021	2022.01	08/02/2021 05:06:49 PM US Eastern Daylight Time	08/04/2021 03:18:54 PM Eastern Daylight Time	07/30/2021 10:10:28 AM Eastern Daylight Time			08/05/2021 09:29:00 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	www.Devoted.com	Devoted Health Core Miami-Dade (HMO)	01	01		1			H1290	001	0	2022	Miami-Dade County		2		2			2						www.Devoted.com	www.Devoted.com	www.Devoted.com	(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1290	002	0	1	01	01	H1290_002_0	10	1			1		1	07/15/2021	2022.01	07/15/2021 09:32:19 PM US Eastern Daylight Time	08/04/2021 03:19:20 PM Eastern Daylight Time	07/30/2021 10:10:49 AM Eastern Daylight Time			08/05/2021 09:29:00 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	www.Devoted.com	Devoted Health Core Broward (HMO)	01	01		1			H1290	002	0	2022	Broward County		2		2			2						www.Devoted.com	www.Devoted.com	www.Devoted.com	(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1290	003	0	1	01	01	H1290_003_0	10	1			1		1	07/15/2021	2022.01	07/15/2021 09:33:02 PM US Eastern Daylight Time	08/04/2021 03:19:47 PM Eastern Daylight Time	07/30/2021 10:11:10 AM Eastern Daylight Time			08/05/2021 09:29:00 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	www.Devoted.com	Devoted Health Core Palm Beach (HMO)	01	01		1			H1290	003	0	2022	Palm Beach County		2		2			2						www.Devoted.com	www.Devoted.com	www.Devoted.com	(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1290	005	0	1	01	01	H1290_005_0	10	1			1		1	07/15/2021	2022.01	07/15/2021 09:33:51 PM US Eastern Daylight Time	08/04/2021 03:20:15 PM Eastern Daylight Time	07/30/2021 10:11:32 AM Eastern Daylight Time			08/05/2021 09:29:00 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	www.Devoted.com	Devoted Health Core Greater Orlando (HMO)	01	01		1			H1290	005	0	2022	Osceola, Seminole, and Orange Counties		2		2			2						www.Devoted.com	www.Devoted.com	www.Devoted.com	(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1290	013	0	1	01	01	H1290_013_0	10	1			1		1	07/15/2021	2022.01	07/15/2021 08:21:11 PM US Eastern Daylight Time	08/04/2021 03:20:43 PM Eastern Daylight Time	07/30/2021 10:11:52 AM Eastern Daylight Time			08/05/2021 09:29:00 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	www.Devoted.com	Devoted Health Essentials Miami-Dade (HMO)	01	01		1			H1290	013	0	2022	Miami-Dade County		2		2			2						www.Devoted.com	www.Devoted.com	www.Devoted.com	(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1290	014	0	1	01	01	H1290_014_0	10	1			1		1	07/15/2021	2022.01	07/15/2021 08:21:44 PM US Eastern Daylight Time	08/04/2021 03:21:10 PM Eastern Daylight Time	07/30/2021 10:12:12 AM Eastern Daylight Time			08/05/2021 09:29:00 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	www.Devoted.com	Devoted Health Essentials Broward (HMO)	01	01		1			H1290	014	0	2022	Broward County		2		2			2						www.Devoted.com	www.Devoted.com	www.Devoted.com	(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1290	015	0	1	01	01	H1290_015_0	10	1			1		1	07/15/2021	2022.01	07/15/2021 08:23:21 PM US Eastern Daylight Time	08/04/2021 03:21:38 PM Eastern Daylight Time	07/30/2021 10:12:32 AM Eastern Daylight Time			08/05/2021 09:29:00 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	www.Devoted.com	Devoted Health Essentials Palm Beach (HMO)	01	01		1			H1290	015	0	2022	Palm Beach County		2		2			2						www.Devoted.com	www.Devoted.com	www.Devoted.com	(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1290	016	0	1	01	01	H1290_016_0	10	1			1		1	07/15/2021	2022.01	07/15/2021 08:25:01 PM US Eastern Daylight Time	08/04/2021 03:22:06 PM Eastern Daylight Time	07/30/2021 10:12:52 AM Eastern Daylight Time			08/05/2021 09:29:00 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	www.Devoted.com	Devoted Health Essentials Greater Tampa Bay (HMO)	01	01		1			H1290	016	0	2022	Hillsborough,Pinellas, Hernando, Pasco		2		2			2						www.Devoted.com	www.Devoted.com	www.Devoted.com	(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1290	017	0	1	01	01	H1290_017_0	10	1			1		1	07/15/2021	2022.01	07/15/2021 08:25:27 PM US Eastern Daylight Time	08/04/2021 05:15:33 PM Eastern Daylight Time	07/30/2021 10:13:12 AM Eastern Daylight Time			08/05/2021 09:29:00 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	www.Devoted.com	Devoted Health Essentials Polk (HMO)	01	01		1			H1290	017	0	2022	Polk County		2		2			2						www.Devoted.com	www.Devoted.com	www.Devoted.com	(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1290	018	0	1	01	01	H1290_018_0	10	1			1		1	07/15/2021	2022.01	07/15/2021 08:25:58 PM US Eastern Daylight Time	08/04/2021 03:22:42 PM Eastern Daylight Time	07/30/2021 10:13:32 AM Eastern Daylight Time			08/05/2021 09:29:00 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	www.Devoted.com	Devoted Health Essentials Greater Orlando (HMO)	01	01		1			H1290	018	0	2022	Osceola, Seminole, and Orange Counties		2		2			2						www.Devoted.com	www.Devoted.com	www.Devoted.com	(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1290	019	0	1	01	01	H1290_019_0	13	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 11:41:40 AM US Eastern Daylight Time	08/04/2021 03:23:11 PM Eastern Daylight Time	07/30/2021 10:13:52 AM Eastern Daylight Time			08/05/2021 09:29:00 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	www.Devoted.com	Devoted Health Dual Miami-Dade (HMO D-SNP)	01	01		1			H1290	019	0	2022	Miami-Dade		2		2			1	3		2		2	www.Devoted.com	www.Devoted.com	www.Devoted.com	(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1290	020	0	1	01	01	H1290_020_0	13	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 11:42:01 AM US Eastern Daylight Time	08/04/2021 03:23:38 PM Eastern Daylight Time	07/30/2021 10:14:12 AM Eastern Daylight Time			08/05/2021 09:29:00 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	www.Devoted.com	Devoted Health Dual Broward (HMO D-SNP)	01	01		1			H1290	020	0	2022	Broward		2		2			1	3		2		2	www.Devoted.com	www.Devoted.com	www.Devoted.com	(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1290	021	0	1	01	01	H1290_021_0	13	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 11:42:25 AM US Eastern Daylight Time	08/04/2021 03:24:06 PM Eastern Daylight Time	07/30/2021 10:14:32 AM Eastern Daylight Time			08/05/2021 09:29:00 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	www.Devoted.com	Devoted Health Dual Palm Beach (HMO D-SNP)	01	01		1			H1290	021	0	2022	Palm Beach		2		2			1	3		2		2	www.Devoted.com	www.Devoted.com	www.Devoted.com	(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1290	022	0	1	01	01	H1290_022_0	13	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 11:43:14 AM US Eastern Daylight Time	08/04/2021 03:24:33 PM Eastern Daylight Time	07/30/2021 10:14:52 AM Eastern Daylight Time			08/05/2021 09:29:00 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	www.Devoted.com	Devoted Health Dual Greater Orlando (HMO D-SNP)	01	01		1			H1290	022	0	2022	Osceola, Seminole, and Orange Counties		2		2			1	3		2		2	www.Devoted.com	www.Devoted.com	www.Devoted.com	(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1290	023	0	1	01	01	H1290_023_0	13	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 11:43:43 AM US Eastern Daylight Time	08/04/2021 03:25:01 PM Eastern Daylight Time	07/30/2021 10:15:11 AM Eastern Daylight Time			08/05/2021 09:29:00 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	www.Devoted.com	Devoted Health Dual Greater Jacksonville (HMO D-SNP)	01	01		1			H1290	023	0	2022	Clay, Duval, and Nassau Counties		2		2			1	3		2		2	www.Devoted.com	www.Devoted.com	www.Devoted.com	(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1290	024	0	1	01	01	H1290_024_0	13	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 11:44:11 AM US Eastern Daylight Time	08/04/2021 03:25:30 PM Eastern Daylight Time	07/30/2021 10:15:31 AM Eastern Daylight Time			08/05/2021 09:29:00 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	www.Devoted.com	Devoted Health Dual Greater Tampa Bay (HMO D-SNP)	01	01		1			H1290	024	0	2022	Greater Tampa Bay		2		2			1	3		2		2	www.Devoted.com	www.Devoted.com	www.Devoted.com	(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1290	025	0	1	01	01	H1290_025_0	10	1			1		1	07/15/2021	2022.01	07/15/2021 09:59:25 PM US Eastern Daylight Time	08/04/2021 03:25:57 PM Eastern Daylight Time	07/30/2021 10:15:51 AM Eastern Daylight Time			08/05/2021 09:29:00 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	www.Devoted.com	Devoted Health Core Manatee (HMO)	01	01		1			H1290	025	0	2022	Manatee		2		2			2						www.Devoted.com	www.Devoted.com	www.Devoted.com	(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1290	026	0	1	01	01	H1290_026_0	10	1			1		1	08/04/2021	2022.01	08/04/2021 11:44:43 AM US Eastern Daylight Time	08/04/2021 03:26:25 PM Eastern Daylight Time	07/30/2021 10:16:11 AM Eastern Daylight Time			08/05/2021 09:29:00 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	www.Devoted.com	Devoted Health Prime Manatee (HMO)	01	01		1			H1290	026	0	2022	Manatee		2		2			2						www.Devoted.com	www.Devoted.com	www.Devoted.com	(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1290	027	0	1	01	01	H1290_027_0	10	1			1		1	07/15/2021	2022.01	07/15/2021 10:00:21 PM US Eastern Daylight Time	08/04/2021 03:26:54 PM Eastern Daylight Time	07/30/2021 10:16:31 AM Eastern Daylight Time			08/05/2021 09:29:00 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	www.Devoted.com	Devoted Health Core (HMO)	01	01		1			H1290	027	0	2022	Lake, Marion, and Sumter Counties		2		2			2						www.Devoted.com	www.Devoted.com	www.Devoted.com	(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1290	028	0	1	01	01	H1290_028_0	11	1			1		1	08/04/2021	2022.01	08/04/2021 11:45:19 AM US Eastern Daylight Time	08/04/2021 03:27:21 PM Eastern Daylight Time	07/30/2021 10:16:51 AM Eastern Daylight Time			08/05/2021 09:29:00 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	www.Devoted.com	Devoted Health Prime (HMO)	01	01		1			H1290	028	0	2022	Lake, Marion, and Sumter Counties		2		2			2						www.Devoted.com	www.Devoted.com	www.Devoted.com	(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1290	029	0	1	01	01	H1290_029_0	10	1			1		1	07/15/2021	2022.01	07/15/2021 10:01:24 PM US Eastern Daylight Time	08/04/2021 03:27:50 PM Eastern Daylight Time	07/30/2021 10:17:11 AM Eastern Daylight Time			08/05/2021 09:29:00 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	www.Devoted.com	Devoted Health Core Greater Jacksonville (HMO)	01	01		1			H1290	029	0	2022	Clay, Duval, and Nassau Counties		2		2			2						www.Devoted.com	www.Devoted.com	www.Devoted.com	(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1290	030	0	1	01	01	H1290_030_0	10	1			1		1	08/04/2021	2022.01	08/04/2021 11:45:37 AM US Eastern Daylight Time	08/04/2021 03:28:19 PM Eastern Daylight Time	07/30/2021 10:17:31 AM Eastern Daylight Time			08/05/2021 09:29:00 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	www.Devoted.com	Devoted Health Prime Greater Jacksonville (HMO)	01	01		1			H1290	030	0	2022	Clay, Duval, and Nassau Counties		2		2			2						www.Devoted.com	www.Devoted.com	www.Devoted.com	(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1290	031	0	1	01	01	H1290_031_0	11	1			1		1	07/15/2021	2022.01	07/15/2021 08:53:41 PM US Eastern Daylight Time	08/04/2021 03:28:46 PM Eastern Daylight Time	07/30/2021 10:17:51 AM Eastern Daylight Time			08/05/2021 09:29:00 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	www.Devoted.com	Devoted Health Essentials Greater Jacksonville (HMO)	01	01		1			H1290	031	0	2022	Clay, Duval, and Nassau Counties		2		2			2						www.Devoted.com	www.Devoted.com	www.Devoted.com	(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1290	032	0	1	01	01	H1290_032_0	10	1			1		1	07/20/2021	2022.01	07/20/2021 12:42:00 PM US Eastern Daylight Time	08/04/2021 03:29:13 PM Eastern Daylight Time	07/30/2021 10:18:12 AM Eastern Daylight Time			08/05/2021 09:29:00 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	www.Devoted.com	Devoted Health Essentials Manatee (HMO)	01	01		1			H1290	032	0	2022	Manatee		2		2			2						www.Devoted.com	www.Devoted.com	www.Devoted.com	(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1290	033	0	1	01	01	H1290_033_0	13	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 11:45:59 AM US Eastern Daylight Time	08/04/2021 03:29:41 PM Eastern Daylight Time	07/30/2021 10:18:32 AM Eastern Daylight Time			08/05/2021 09:29:00 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	www.Devoted.com	Devoted Health Dual (HMO D-SNP)	01	01		1			H1290	033	0	2022	Lake, Marion, and Sumter Counties		2		2			1	3		2		2	www.Devoted.com	www.Devoted.com	www.Devoted.com	(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1290	034	0	1	01	01	H1290_034_0	13	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 11:46:34 AM US Eastern Daylight Time	08/04/2021 03:30:08 PM Eastern Daylight Time	07/30/2021 10:18:51 AM Eastern Daylight Time			08/05/2021 09:29:00 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	www.Devoted.com	Devoted Health Dual Manatee (HMO D-SNP)	01	01		1			H1290	034	0	2022	Manatee		2		2			1	3		2		2	www.Devoted.com	www.Devoted.com	www.Devoted.com	(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1290	035	0	1	01	01	H1290_035_0	10	1			1		1	07/15/2021	2022.01	07/15/2021 08:57:15 PM US Eastern Daylight Time	08/04/2021 03:30:38 PM Eastern Daylight Time	07/30/2021 10:19:11 AM Eastern Daylight Time			08/05/2021 09:29:00 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	www.Devoted.com	Devoted Health Essentials (HMO)	01	01		1			H1290	035	0	2022	Lake, Marion, and Sumter Counties		2		2			2						www.Devoted.com	www.Devoted.com	www.Devoted.com	(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1290	036	1	1	01	01	H1290_036_1	11	1			1		1	07/26/2021	2022.01	07/26/2021 10:31:05 AM US Eastern Daylight Time	08/04/2021 03:31:07 PM Eastern Daylight Time	07/30/2021 10:19:30 AM Eastern Daylight Time			08/05/2021 09:29:00 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	www.Devoted.com	Devoted Health Core Greater Tampa Bay (HMO)	01	01		1			H1290	036	1	2022	Greater Tampa Bay	Hillsborough, Pinellas, Hernando, Pasco	2		2			2						www.Devoted.com	www.Devoted.com	www.Devoted.com	(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1290	036	2	1	01	01	H1290_036_2	11	1			1		1	07/15/2021	2022.01	07/15/2021 10:10:37 PM US Eastern Daylight Time	08/04/2021 03:31:35 PM Eastern Daylight Time	07/30/2021 10:19:50 AM Eastern Daylight Time			08/05/2021 09:29:00 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	www.Devoted.com	Devoted Health Core Greater Tampa Bay (HMO)	01	01		1			H1290	036	2	2022	Greater Tampa Bay	Polk	2		2			2						www.Devoted.com	www.Devoted.com	www.Devoted.com	(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1290	037	1	1	01	01	H1290_037_1	10	1			1		1	08/04/2021	2022.01	08/04/2021 11:40:07 AM US Eastern Daylight Time	08/04/2021 03:32:02 PM Eastern Daylight Time	07/30/2021 10:20:10 AM Eastern Daylight Time			08/05/2021 09:29:00 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	www.Devoted.com	Devoted Health Prime South Florida (HMO)	01	01		1			H1290	037	1	2022	Miami-Dade, Broward, and Palm Beach counties	Miami-Dade county	2		2			2						www.Devoted.com	www.Devoted.com	www.Devoted.com	(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1290	037	2	1	01	01	H1290_037_2	11	1			1		1	08/04/2021	2022.01	08/04/2021 11:39:56 AM US Eastern Daylight Time	08/04/2021 03:32:30 PM Eastern Daylight Time	07/30/2021 10:20:29 AM Eastern Daylight Time			08/05/2021 09:29:00 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	www.Devoted.com	Devoted Health Prime South Florida (HMO)	01	01		1			H1290	037	2	2022	Miami-Dade, Broward, and Palm Beach counties	Broward county	2		2			2						www.Devoted.com	www.Devoted.com	www.Devoted.com	(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1290	037	3	1	01	01	H1290_037_3	11	1			1		1	08/04/2021	2022.01	08/04/2021 11:40:30 AM US Eastern Daylight Time	08/04/2021 03:32:58 PM Eastern Daylight Time	07/30/2021 10:20:48 AM Eastern Daylight Time			08/05/2021 09:29:00 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	www.Devoted.com	Devoted Health Prime South Florida (HMO)	01	01		1			H1290	037	3	2022	Miami-Dade, Broward, and Palm Beach counties	Palm Beach county	2		2			2						www.Devoted.com	www.Devoted.com	www.Devoted.com	(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1290	038	1	1	01	01	H1290_038_1	9	1			1		1	08/04/2021	2022.01	08/04/2021 12:28:34 PM US Eastern Daylight Time	08/04/2021 03:33:26 PM Eastern Daylight Time	07/30/2021 10:21:08 AM Eastern Daylight Time			08/05/2021 09:29:00 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	www.Devoted.com	Devoted Health Prime (HMO)	01	01		1			H1290	038	1	2022	Greater Orlando and Greater Tampa Bay	Greater Orlando	2		2			2						www.Devoted.com	www.Devoted.com	www.Devoted.com	(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1290	038	2	1	01	01	H1290_038_2	9	1			1		1	08/04/2021	2022.01	08/04/2021 12:29:06 PM US Eastern Daylight Time	08/04/2021 03:33:54 PM Eastern Daylight Time	07/30/2021 10:21:28 AM Eastern Daylight Time			08/05/2021 09:29:00 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Devoted Health	www.Devoted.com	Devoted Health Prime (HMO)	01	01		1			H1290	038	2	2022	Greater Orlando and Greater Tampa Bay	Greater Tampa Bay	2		2			2						www.Devoted.com	www.Devoted.com	www.Devoted.com	(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1302	004	0	1	04	01	H1302_004_0	2	1				0	0	07/07/2021	2022.01	07/07/2021 03:55:57 PM Mountain Daylight Time	06/04/2021 10:16:44 AM Mountain Daylight Time				07/14/2021 09:58:18 AM Mountain Daylight Time	BLUE CROSS OF IDAHO CARE PLUS, INC.	Blue Cross of Idaho	medicare.bcidaho.com	Secure Blue Courage (PPO)	01	04		1			H1302	004	0	2022	Select Counties in Idaho		2		2			2						bcidaho.com/FindAPharmacy	bcidaho.com/DrugList	bcidaho.com/FindSecureBlueDoctors	(888)494-2583		(208)395-8200		(888)492-2583		(208)286-3673										(711)-		(711)-		(711)-		(711)-										2					2						2			
H1302	802	0	1	04	01	H1302_802_0	1	1				0	0	06/03/2021	2022.01	06/03/2021 11:35:05 AM Mountain Daylight Time					06/04/2021 10:35:45 AM Mountain Daylight Time	BLUE CROSS OF IDAHO CARE PLUS, INC.	Blue Cross of Idaho	www.bcidaho.com/medicare	Secure Blue Employer (PPO)	01	04		1			H1302	802	0	2022	Idaho		1	3000	2			2						bcidaho.com/ma_formulary	bcidaho.com/ma_formulary	www.bcidaho.com/medicare	(888)494-2583		(208)395-8200		(888)492-2583		(208)286-3673										(711)-		(711)-		(711)-		(711)-										2					2						2			
H1302	803	0	1	04	01	H1302_803_0	1	1						06/03/2021	2022.01	06/03/2021 11:35:10 AM Mountain Daylight Time					06/04/2021 10:35:45 AM Mountain Daylight Time	BLUE CROSS OF IDAHO CARE PLUS, INC.	Blue Cross of Idaho	www.bcidaho.com/medicare	Secure Blue Employer (PPO)	01	04		1			H1302	803	0	2022	Idaho		1	3000	2			2						bcidaho.com/ma_formulary	bcidaho.com/ma_formulary	www.bcidaho.com/medicare	(888)494-2583		(208)395-8200		(888)492-2583		(208)286-3673		(855)479-3661		(855)479-3661		(888)492-2583		(208)286-3673		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1302	804	0	1	04	01	H1302_804_0	1	1						06/03/2021	2022.01	06/03/2021 11:35:15 AM Mountain Daylight Time					06/04/2021 10:35:45 AM Mountain Daylight Time	BLUE CROSS OF IDAHO CARE PLUS, INC.	Blue Cross of Idaho	www.bcidaho.com/medicare	Secure Blue Employer (PPO)	01	04		1			H1302	804	0	2022	Idaho		1	3000	2			2						bcidaho.com/ma_formulary	bcidaho.com/ma_formulary	www.bcidaho.com/medicare	(888)494-2583		(208)395-8200		(888)492-2583		(208)286-3673		(855)479-3661		(855)479-3661		(888)492-2583		(208)286-3673		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1304	001	0	1	04	01	H1304_001_0	4	1				0	0	07/07/2021	2022.01	07/07/2021 01:34:22 PM Pacific Daylight Time	07/01/2021 01:57:56 PM Pacific Daylight Time				07/07/2021 03:24:11 PM Pacific Daylight Time	REGENCE BLUESHIELD OF IDAHO	Regence BlueShield Of Idaho	www.regence.com/medicare	Regence Valiance (PPO)	01	04		1			H1304	001	0	2022	Select Counties in Idaho/Asotin Co, WA		2	5518	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	004	0	1	04	01	H1304_004_0	7	1					1	07/07/2021	2022.01	07/07/2021 11:29:22 AM Pacific Daylight Time	08/04/2021 12:34:15 PM Pacific Daylight Time	08/06/2021 09:33:44 AM Pacific Daylight Time			08/09/2021 09:46:09 AM Pacific 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	2022	Select Counties in Idaho/Asotin Co, WA		2	12453	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	011	1	1	04	01	H1304_011_1	8	1					1	08/03/2021	2022.01	08/03/2021 11:31:11 AM Pacific Daylight Time	08/05/2021 06:56:23 AM Pacific Daylight Time	08/06/2021 09:35:26 AM Pacific Daylight Time			08/09/2021 09:46:09 AM Pacific Daylight Time	REGENCE BLUESHIELD OF IDAHO	Regence BlueShield Of Idaho	www.regence.com/medicare	Regence MedAdvantage + Rx Primary (PPO)	01	04		1			H1304	011	1	2022	Select Counties in Idaho/Asotin Co, WA	South	2	6873	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	011	2	1	04	01	H1304_011_2	8	1					1	08/03/2021	2022.01	08/03/2021 11:31:34 AM Pacific Daylight Time	08/05/2021 06:57:07 AM Pacific Daylight Time	08/06/2021 09:37:03 AM Pacific Daylight Time			08/09/2021 09:46:09 AM Pacific Daylight Time	REGENCE BLUESHIELD OF IDAHO	Regence BlueShield Of Idaho	www.regence.com/medicare	Regence MedAdvantage + Rx Primary (PPO)	01	04		1			H1304	011	2	2022	Select Counties in Idaho/Asotin Co, WA	North	2	14857	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	012	1	1	04	01	H1304_012_1	7	1					1	08/03/2021	2022.01	08/03/2021 11:32:01 AM Pacific Daylight Time	08/04/2021 12:36:41 PM Pacific Daylight Time	08/06/2021 09:38:38 AM Pacific Daylight Time			08/09/2021 09:46:09 AM Pacific Daylight Time	REGENCE BLUESHIELD OF IDAHO	Regence BlueShield Of Idaho	www.regence.com/medicare	Regence MedAdvantage + Rx Classic (PPO)	01	04		1			H1304	012	1	2022	Select Counties in Idaho/Asotin Co, WA	South	2	6745	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	012	2	1	04	01	H1304_012_2	7	1					1	08/03/2021	2022.01	08/03/2021 11:32:25 AM Pacific Daylight Time	08/04/2021 12:37:22 PM Pacific Daylight Time	08/06/2021 09:40:14 AM Pacific Daylight Time			08/09/2021 09:46:09 AM Pacific Daylight Time	REGENCE BLUESHIELD OF IDAHO	Regence BlueShield Of Idaho	www.regence.com/medicare	Regence MedAdvantage + Rx Classic (PPO)	01	04		1			H1304	012	2	2022	Select Counties in Idaho/Asotin Co, WA	North	2	26370	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	4	1				0	0	06/03/2021	2022.01	06/03/2021 09:17:44 AM Pacific Daylight Time					06/03/2021 11:12:52 AM Pacific Daylight Time	REGENCE BLUESHIELD OF IDAHO	Regence BlueShield Of Idaho	www.regence.com/medicare	Regence MedAdvantage (PPO)	01	04		1			H1304	803	0	2022	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										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7c;7e;7h;7i;7k;8a;8b1;8b2;9a1;9a2;9b;9c;10a;11a;11b;11c;15;	2		1									
H1304	804	0	1	04	01	H1304_804_0	4	1						06/02/2021	2022.01	06/02/2021 10:28:00 AM Pacific Daylight Time					06/03/2021 11:12:52 AM Pacific Daylight Time	REGENCE BLUESHIELD OF IDAHO	Regence BlueShield Of Idaho	www.regence.com/medicare	Regence MedAdvantage + Rx (PPO)	01	04		1			H1304	804	0	2022	Nationwide except territories		1	7428	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;7k;8a;8b1;8b2;9a1;9a2;9b;9c;10a;11a;11b;11c;15;	2		1									
H1304	805	0	1	04	01	H1304_805_0	4	1						06/02/2021	2022.01	06/02/2021 10:28:23 AM Pacific Daylight Time					06/03/2021 11:12:52 AM Pacific 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	2022	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;7e;7h;7i;7k;8a;8b1;8b2;9a1;9a2;9b;9c;10a;11a;11b;11c;15;	2		1									
H1304	806	0	1	04	01	H1304_806_0	4	1						06/02/2021	2022.01	06/02/2021 10:28:44 AM Pacific Daylight Time					06/03/2021 11:12:52 AM Pacific 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	2022	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;7e;7h;7i;7k;8a;8b1;8b2;9a1;9a2;9b;9c;10a;11a;11b;11c;15;	2		1									
H1310	001	0	1	20	08	H1310_001_0	1	1						06/02/2021	2022.01	06/02/2021 01:21:10 PM Eastern Daylight Time		06/02/2021 01:14:13 PM Eastern Daylight Time			06/02/2021 01:22:54 PM Eastern Daylight Time	COMPREHENSIVE SENIOR CARE CORPORATION	Senior Care Partners P.A.C.E.	www.SeniorCarePartnersMI.org	Senior Care Partners PACE Dual (PACE)	08	20		1			H1310	001	0	2022	Greater Kalamazoo and Calhoun County Areas		2		2			2						seniorcarepartnersmi.org	seniorcarepartnersmi.org										(877)284-4071		(269)441-9300		(877)284-4071		(269)441-9300										(800)649-3777		(269)280-9584		(800)649-3777		(269)280-9584																
H1310	003	0	1	20	08	H1310_003_0	1	1						06/02/2021	2022.01	06/02/2021 01:21:40 PM Eastern Daylight Time		06/02/2021 01:14:21 PM Eastern Daylight Time			06/02/2021 01:22:54 PM Eastern Daylight Time	COMPREHENSIVE SENIOR CARE CORPORATION	Senior Care Partners P.A.C.E.	www.SeniorCarePartnersMI.org	Senior Care Partners PACE Medicare-only (PACE)	08	20		1			H1310	003	0	2022	Greater Kalamazoo and Calhoun County Areas		2		2			2						seniorcarepartnersmi.org	seniorcarepartnersmi.org										(877)284-4071		(269)441-9300		(877)284-4071		(269)441-9300										(800)649-3777		(269)280-9584		(800)649-3777		(269)280-9584																
H1350	006	0	1	01	01	H1350_006_0	2	1				0	0	07/07/2021	2022.01	07/07/2021 03:58:51 PM Mountain Daylight Time	06/04/2021 10:16:44 AM Mountain Daylight Time				07/14/2021 09:58:18 AM Mountain Daylight Time	BLUE CROSS OF IDAHO CARE PLUS, INC.	Blue Cross of Idaho	medicare.bcidaho.com	True Blue Valor (HMO)	01	01		1			H1350	006	0	2022	Select Counties in Idaho		2		2			2						bcidaho.com/FindAPharmacy	bcidaho.com/DrugList	bcidaho.com/FindTrueBlueDoctors	(888)494-2583		(208)395-8200		(888)492-2583		(208)286-3673										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H1350	009	0	1	01	01	H1350_009_0	3	1	2	1			0	08/03/2021	2022.01	08/03/2021 03:24:14 PM Mountain Daylight Time	08/04/2021 01:01:20 PM Mountain Daylight Time	08/04/2021 01:01:20 PM Mountain Daylight Time			08/04/2021 02:15:08 PM Mountain Daylight Time	BLUE CROSS OF IDAHO CARE PLUS, INC.	Blue Cross of Idaho	idahotruebluesnp.com	True Blue Special Needs Plan (HMO D-SNP)	01	01		1			H1350	009	0	2022	Select Counties in Idaho		2		2			1	3		1		1	bcidaho.com/FindASNPpharmacy	bcidaho.com/SNPDrugList	bcidaho.com/FindSNPDoctors	(888)495-2583		(208)286-3675		(888)495-2583		(208)286-3675		(855)479-3661		(855)479-3661		(888)495-2583		(208)286-3675		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1350	015	1	1	01	01	H1350_015_1	3	1					0	08/03/2021	2022.01	08/03/2021 03:29:02 PM Mountain Daylight Time	08/04/2021 01:01:20 PM Mountain Daylight Time	08/04/2021 01:01:21 PM Mountain Daylight Time			08/04/2021 02:15:08 PM 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	2022	Select Counties Idaho	Select Counties 1 Idaho	2		2			2						bcidaho.com/FindAPharmacy	bcidaho.com/DrugList	bcidaho.com/FindTrueBlueDoctors	(888)494-2583		(208)395-8200		(888)492-2583		(208)286-3673		(855)479-3661		(855)479-3661		(888)492-2583		(208)286-3673		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1350	015	2	1	01	01	H1350_015_2	3	1					0	08/03/2021	2022.01	08/03/2021 03:32:12 PM Mountain Daylight Time	08/04/2021 01:01:21 PM Mountain Daylight Time	08/04/2021 01:01:21 PM Mountain Daylight Time			08/04/2021 02:15:08 PM 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	2022	Select Counties Idaho	Select Counties 2 Idaho	2		2			2						bcidaho.com/FindAPharmacy	bcidaho.com/DrugList	bcidaho.com/FindTrueBlueDoctors	(888)494-2583		(208)395-8200		(888)492-2583		(208)286-3673		(855)479-3661		(855)479-3661		(888)492-2583		(208)286-3673		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1350	016	1	1	01	01	H1350_016_1	3	1					0	06/01/2021	2022.01	06/01/2021 05:49:48 PM Mountain Daylight Time	08/04/2021 01:01:22 PM Mountain Daylight Time	08/04/2021 01:01:22 PM Mountain Daylight Time			08/04/2021 02:15:08 PM 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	2022	Select Counties Idaho	Select Counties 1 Idaho	2		2			2						bcidaho.com/FindAPharmacy	bcidaho.com/DrugList	bcidaho.com/FindTrueBlueDoctors	(888)494-2583		(208)395-8200		(888)492-2583		(208)286-3673		(855)479-3661		(855)479-3661		(888)492-2583		(208)286-3673		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1350	016	2	1	01	01	H1350_016_2	3	1					0	06/01/2021	2022.01	06/01/2021 05:51:36 PM Mountain Daylight Time	08/04/2021 01:01:22 PM Mountain Daylight Time	08/04/2021 01:01:22 PM Mountain Daylight Time			08/04/2021 02:15:08 PM 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	2022	Select Counties Idaho	Select Counties 2 Idaho	2		2			2						bcidaho.com/FindAPharmacy	bcidaho.com/DrugList	bcidaho.com/FindTrueBlueDoctors	(888)494-2583		(208)395-8200		(888)492-2583		(208)286-3673		(855)479-3661		(855)479-3661		(888)492-2583		(208)286-3673		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1350	019	1	1	01	01	H1350_019_1	3	1					0	07/01/2021	2022.01	07/01/2021 02:11:45 PM Mountain Daylight Time	08/04/2021 01:01:23 PM Mountain Daylight Time	08/04/2021 01:01:23 PM Mountain Daylight Time			08/04/2021 02:15:08 PM 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	2022	Select Counties Idaho	Select Counties 1 Idaho	2		2			2						bcidaho.com/FindAPharmacy	bcidaho.com/DrugList	bcidaho.com/FindTrueBlueDoctors	(888)494-2583		(208)395-8200		(888)492-2583		(208)286-3673		(855)479-3661		(855)479-3661		(888)492-2583		(208)286-3673		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1350	019	2	1	01	01	H1350_019_2	3	1					0	08/03/2021	2022.01	08/03/2021 03:37:56 PM Mountain Daylight Time	08/04/2021 01:01:23 PM Mountain Daylight Time	08/04/2021 01:01:24 PM Mountain Daylight Time			08/04/2021 02:15:08 PM 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	2022	Select Counties Idaho	Select Counties 2 Idaho	2		2			2						bcidaho.com/FindAPharmacy	bcidaho.com/DrugList	bcidaho.com/FindTrueBlueDoctors	(888)494-2583		(208)395-8200		(888)492-2583		(208)286-3673		(855)479-3661		(855)479-3661		(888)492-2583		(208)286-3673		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1350	023	1	1	01	01	H1350_023_1	4	1					0	08/03/2021	2022.01	08/03/2021 03:39:03 PM Mountain Daylight Time	08/04/2021 01:01:24 PM Mountain Daylight Time	08/04/2021 01:01:24 PM Mountain Daylight Time			08/04/2021 02:15:08 PM Mountain Daylight Time	BLUE CROSS OF IDAHO CARE PLUS, INC.	Blue Cross of Idaho	medicare.bcidaho.com	True Blue Rx | St. Luke's Health Partners (HMO)	01	01		1			H1350	023	1	2022	Select Counties in Idaho	Select Counties 1 Idaho	2		2			2						bcidaho.com/FindAPharmacy	bcidaho.com/DrugList	bcidaho.com/SLHP-doctors	(888)494-2583		(208)395-8200		(888)492-2583		(208)286-3673		(855)479-3661		(855)479-3661		(888)492-2583		(208)286-3673		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1350	023	2	1	01	01	H1350_023_2	4	1					0	08/03/2021	2022.01	08/03/2021 03:39:55 PM Mountain Daylight Time	08/04/2021 01:01:25 PM Mountain Daylight Time	08/04/2021 01:01:25 PM Mountain Daylight Time			08/04/2021 02:15:08 PM Mountain Daylight Time	BLUE CROSS OF IDAHO CARE PLUS, INC.	Blue Cross of Idaho	medicare.bcidaho.com	True Blue Rx | St. Luke's Health Partners (HMO)	01	01		1			H1350	023	2	2022	Select Counties in Idaho	Select Counties 2 Idaho	2		2			2						bcidaho.com/FindAPharmacy	bcidaho.com/DrugList	bcidaho.com/SLHP-doctors	(888)494-2583		(208)395-8200		(888)492-2583		(208)286-3673		(855)479-3661		(855)479-3661		(888)492-2583		(208)286-3673		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1350	024	1	1	01	01	H1350_024_1	5	1					0	07/07/2021	2022.01	07/07/2021 04:10:20 PM Mountain Daylight Time	08/04/2021 01:01:25 PM Mountain Daylight Time	08/04/2021 01:01:26 PM Mountain Daylight Time			08/04/2021 02:15:08 PM 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	024	1	2022	Select Counties in Idaho	Select Counties 1 Idaho	2		2			2						bcidaho.com/FindAPharmacy	bcidaho.com/DrugList	bcidaho.com/FindTrueBlueDoctors	(888)494-2583		(208)395-8200		(888)492-2583		(208)286-3673		(855)479-3661		(855)479-3661		(888)492-2583		(208)286-3673		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1350	024	2	1	01	01	H1350_024_2	4	1					0	08/03/2021	2022.01	08/03/2021 03:43:02 PM Mountain Daylight Time	08/04/2021 01:01:26 PM Mountain Daylight Time	08/04/2021 01:01:26 PM Mountain Daylight Time			08/04/2021 02:15:08 PM 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	024	2	2022	Select Counties in Idaho	Select Counties 2 Idaho	2		2			2						bcidaho.com/FindAPharmacy	bcidaho.com/DrugList	bcidaho.com/FindTrueBlueDoctors	(888)494-2583		(208)395-8200		(888)492-2583		(208)286-3673		(855)479-3661		(855)479-3661		(888)492-2583		(208)286-3673		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1350	024	3	1	01	01	H1350_024_3	5	1					0	08/03/2021	2022.01	08/03/2021 03:44:34 PM Mountain Daylight Time	08/04/2021 01:01:27 PM Mountain Daylight Time	08/04/2021 01:01:27 PM Mountain Daylight Time			08/04/2021 02:15:08 PM 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	024	3	2022	Select Counties in Idaho	Select Counties 3 Idaho	2		2			2						bcidaho.com/FindAPharmacy	bcidaho.com/DrugList	bcidaho.com/FindTrueBlueDoctors	(888)494-2583		(208)395-8200		(888)492-2583		(208)286-3673		(855)479-3661		(855)479-3661		(888)492-2583		(208)286-3673		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1350	025	0	1	01	01	H1350_025_0	3	1	2	1			0	08/03/2021	2022.01	08/03/2021 03:45:23 PM Mountain Daylight Time	08/04/2021 01:01:17 PM Mountain Daylight Time	08/04/2021 01:01:17 PM Mountain Daylight Time			08/04/2021 02:15:08 PM Mountain Daylight Time	BLUE CROSS OF IDAHO CARE PLUS, INC.	Blue Cross of Idaho	idahotruebluesnp.com	True Blue Special Needs Plan (HMO D-SNP)	01	01		1			H1350	025	0	2022	Select Counties in Idaho		2		2			1	3		1		1	bcidaho.com/FindASNPpharmacy	bcidaho.com/SNPDrugList	bcidaho.com/FindSNPDoctors	(888)495-2583		(208)286-3675		(888)495-2583		(208)286-3675		(855)479-3661		(855)479-3661		(888)495-2583		(208)286-3675		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1350	026	0	1	01	01	H1350_026_0	4	1					0	08/03/2021	2022.01	08/03/2021 03:48:03 PM Mountain Daylight Time	08/04/2021 01:01:18 PM Mountain Daylight Time	08/04/2021 01:01:18 PM Mountain Daylight Time			08/04/2021 02:15:08 PM Mountain Daylight Time	BLUE CROSS OF IDAHO CARE PLUS, INC.	Blue Cross of Idaho	medicare.bcidaho.com	True Blue Rx Essentials (HMO)	01	01		1			H1350	026	0	2022	Select Counties in Idaho		2		2			2						bcidaho.com/FindAPharmacy	bcidaho.com/DrugList	bcidaho.com/FindTrueBlueDoctors	(888)494-2583		(208)395-8200		(888)492-2583		(208)286-3673		(855)479-3661		(855)479-3661		(888)492-2583		(208)286-3673		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1350	027	1	1	01	01	H1350_027_1	4	1					0	08/03/2021	2022.01	08/03/2021 03:50:20 PM Mountain Daylight Time	08/04/2021 01:01:18 PM Mountain Daylight Time	08/04/2021 01:01:19 PM Mountain Daylight Time			08/04/2021 02:15:08 PM 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	027	1	2022	Select Counties in Idaho	Select Counties 1 Idaho	2		2			2						bcidaho.com/FindAPharmacy	bcidaho.com/DrugList	bcidaho.com/Preferred-doctors	(888)494-2583		(208)395-8200		(888)492-2583		(208)286-3673		(855)479-3661		(855)479-3661		(888)492-2583		(208)286-3673		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	4b;7a;8a2;8b3;	
H1350	027	2	1	01	01	H1350_027_2	4	1					0	08/04/2021	2022.01	08/04/2021 10:27:58 AM Mountain Daylight Time	08/04/2021 01:01:19 PM Mountain Daylight Time	08/04/2021 01:01:19 PM Mountain Daylight Time			08/04/2021 02:15:08 PM 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	027	2	2022	Select Counties in Idaho	Select Counties 2 Idaho	2		2			2						bcidaho.com/FindAPharmacy	bcidaho.com/DrugList	bcidaho.com/Preferred-doctors	(888)494-2583		(208)395-8200		(888)492-2583		(208)286-3673		(855)479-3661		(855)479-3661		(888)492-2583		(208)286-3673		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	4b;7a;8a2;8b3;	
H1350	803	0	1	01	01	H1350_803_0	1	1				0	0	06/03/2021	2022.01	06/03/2021 11:39:10 AM Mountain Daylight Time					06/04/2021 10:35:45 AM Mountain Daylight Time	BLUE CROSS OF IDAHO CARE PLUS, INC.	Blue Cross of Idaho	medicare.bcidaho.com	True Blue Employer (HMO)	01	01		1			H1350	803	0	2022	Idaho		1	3000	2			2						https://medicare.bcidaho.com/formulary-information/medicare-advantage-drug-lists.page	https://medicare.bcidaho.com/formulary-information/medicare-advantage-drug-lists.page	medicare.bcidaho.com	(888)494-2583		(208)395-8200		(888)492-2583		(208)286-3673										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H1350	804	0	1	01	01	H1350_804_0	1	1						06/03/2021	2022.01	06/03/2021 11:39:19 AM Mountain Daylight Time					06/04/2021 10:35:45 AM Mountain Daylight Time	BLUE CROSS OF IDAHO CARE PLUS, INC.	Blue Cross of Idaho	medicare.bcidaho.com	True Blue Employer (HMO)	01	01		1			H1350	804	0	2022	Idaho		1	3000	2			2						https://medicare.bcidaho.com/formulary-information/medicare-advantage-drug-lists.page	https://medicare.bcidaho.com/formulary-information/medicare-advantage-drug-lists.page	medicare.bcidaho.com	(888)494-2583		(208)395-8200		(888)492-2583		(208)286-3673		(855)479-3661		(855)479-3661		(888)492-2583		(208)286-3673		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1350	805	0	1	01	01	H1350_805_0	1	1						06/03/2021	2022.01	06/03/2021 11:39:29 AM Mountain Daylight Time					06/04/2021 10:35:45 AM Mountain Daylight Time	BLUE CROSS OF IDAHO CARE PLUS, INC.	Blue Cross of Idaho	medicare.bcidaho.com	True Blue Employer (HMO)	01	01		1			H1350	805	0	2022	Idaho		1	3000	2			2						https://medicare.bcidaho.com/formulary-information/medicare-advantage-drug-lists.page	https://medicare.bcidaho.com/formulary-information/medicare-advantage-drug-lists.page	medicare.bcidaho.com	(888)494-2583		(208)395-8200		(888)492-2583		(208)286-3673		(855)479-3661		(855)479-3661		(888)492-2583		(208)286-3673		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1350	806	0	1	02	01	H1350_806_0	1	1						06/03/2021	2022.01	06/03/2021 11:39:51 AM Mountain Daylight Time					06/04/2021 10:35:45 AM Mountain Daylight Time	BLUE CROSS OF IDAHO CARE PLUS, INC.	Blue Cross of Idaho	medicare.bcidaho.com	True Blue Employer (HMO-POS)	01	02		1			H1350	806	0	2022	Idaho		1	3000	2			2						https://medicare.bcidaho.com/formulary-information/medicare-advantage-drug-lists.page	https://medicare.bcidaho.com/formulary-information/medicare-advantage-drug-lists.page	medicare.bcidaho.com	(888)494-2583		(208)395-8200		(888)492-2583		(208)286-3673		(855)479-3661		(855)479-3661		(888)492-2583		(208)286-3673		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1350	807	0	1	02	01	H1350_807_0	1	1						06/03/2021	2022.01	06/03/2021 11:40:06 AM Mountain Daylight Time					06/04/2021 10:35:45 AM Mountain Daylight Time	BLUE CROSS OF IDAHO CARE PLUS, INC.	Blue Cross of Idaho	medicare.bcidaho.com	True Blue Employer (HMO-POS)	01	02		1			H1350	807	0	2022	Idaho		1	3000	2			2						https://medicare.bcidaho.com/formulary-information/medicare-advantage-drug-lists.page	https://medicare.bcidaho.com/formulary-information/medicare-advantage-drug-lists.page	medicare.bcidaho.com	(888)494-2583		(208)395-8200		(888)492-2583		(208)286-3673		(855)479-3661		(855)479-3661		(888)492-2583		(208)286-3673		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1350	808	0	1	01	01	H1350_808_0	1	1						06/03/2021	2022.01	06/03/2021 11:39:59 AM Mountain Daylight Time					06/04/2021 10:35:45 AM Mountain Daylight Time	BLUE CROSS OF IDAHO CARE PLUS, INC.	Blue Cross of Idaho	medicare.bcidaho.com	True Blue Employer (HMO)	01	01		1			H1350	808	0	2022	Idaho		1	3000	2			2						https://medicare.bcidaho.com/formulary-information/medicare-advantage-drug-lists.page	https://medicare.bcidaho.com/formulary-information/medicare-advantage-drug-lists.page	medicare.bcidaho.com	(888)494-2583		(208)395-8200		(888)492-2583		(208)286-3673		(855)479-3661		(855)479-3661		(888)492-2583		(208)286-3673		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1350	809	0	1	01	01	H1350_809_0	1	1						06/03/2021	2022.01	06/03/2021 11:40:14 AM Mountain Daylight Time					06/04/2021 10:35:45 AM Mountain Daylight Time	BLUE CROSS OF IDAHO CARE PLUS, INC.	Blue Cross of Idaho	medicare.bcidaho.com	True Blue Employer (HMO)	01	01		1			H1350	809	0	2022	Idaho		1	3000	2			2						https://medicare.bcidaho.com/formulary-information/medicare-advantage-drug-lists.page	https://medicare.bcidaho.com/formulary-information/medicare-advantage-drug-lists.page	medicare.bcidaho.com	(888)494-2583		(208)395-8200		(888)492-2583		(208)286-3673		(855)479-3661		(855)479-3661		(888)492-2583		(208)286-3673		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1350	810	0	1	02	01	H1350_810_0	1	1						06/03/2021	2022.01	06/03/2021 11:40:23 AM Mountain Daylight Time					06/04/2021 10:35:45 AM Mountain Daylight Time	BLUE CROSS OF IDAHO CARE PLUS, INC.	Blue Cross of Idaho	medicare.bcidaho.com	True Blue Employer (HMO-POS)	01	02		1			H1350	810	0	2022	Idaho		1	3000	2			2						https://medicare.bcidaho.com/formulary-information/medicare-advantage-drug-lists.page	https://medicare.bcidaho.com/formulary-information/medicare-advantage-drug-lists.page	medicare.bcidaho.com	(888)494-2583		(208)395-8200		(888)492-2583		(208)286-3673		(855)479-3661		(855)479-3661		(888)492-2583		(208)286-3673		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1350	811	0	1	02	01	H1350_811_0	1	1						06/03/2021	2022.01	06/03/2021 11:40:35 AM Mountain Daylight Time					06/04/2021 10:35:45 AM Mountain Daylight Time	BLUE CROSS OF IDAHO CARE PLUS, INC.	Blue Cross of Idaho	medicare.bcidaho.com	True Blue Employer (HMO-POS)	01	02		1			H1350	811	0	2022	Idaho		1	3000	2			2						https://medicare.bcidaho.com/formulary-information/medicare-advantage-drug-lists.page	https://medicare.bcidaho.com/formulary-information/medicare-advantage-drug-lists.page	medicare.bcidaho.com	(888)494-2583		(208)395-8200		(888)492-2583		(208)286-3673		(855)479-3661		(855)479-3661		(888)492-2583		(208)286-3673		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1352	003	0	1	01	01	H1352_003_0	10	1					1	07/30/2021	2022.01	07/30/2021 11:38:04 AM Central Daylight Time	08/04/2021 07:48:01 AM Central Daylight Time	08/04/2021 07:48:01 AM Central Daylight Time			08/04/2021 08:02:24 AM Central Daylight Time	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Blue Medicare Advantage	www.MedicareBlueKC.com	Blue Medicare Advantage Spira Care (HMO)	01	01		1			H1352	003	0	2022	Kansas City Area		2		2			2						www.MedicareBlueKC.com	www.MedicareBlueKC.com	www.MedicareBlueKC.com	(877)774-7265		(877)774-7265		(855)208-8246		(816)395-3152		(877)774-7265		(877)774-7265		(855)208-8246		(816)395-3152		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1352	004	0	1	01	01	H1352_004_0	9	1					1	07/30/2021	2022.01	07/30/2021 11:38:38 AM Central Daylight Time	08/04/2021 07:48:00 AM Central Daylight Time	08/04/2021 07:48:00 AM Central Daylight Time			08/04/2021 08:02:24 AM Central Daylight Time	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Blue Medicare Advantage	www.MedicareBlueKC.com	Blue Secure (HMO)	01	01		1			H1352	004	0	2022	Kansas City Metro Area		2		2			2						www.MedicareBlueKC.com	www.MedicareBlueKC.com	www.MedicareBlueKC.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				0	0	06/05/2021	2022.01	06/05/2021 07:32:35 AM Central Daylight Time					06/05/2021 08:07:03 AM Central Daylight Time	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Blue Medicare Advantage	www.MedicareBlueKC.com	Blue Medicare Advantage Employer Group Plan MA-CY (HMO)	01	01		1			H1352	801	0	2022	Kansas City Area		1	0	2			2						https://www.medicarebluekc.com/	https://www.medicarebluekc.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;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	2		1					1				
H1352	803	0	1	01	01	H1352_803_0	1	1						06/05/2021	2022.01	06/05/2021 07:49:16 AM Central Daylight Time					06/05/2021 08:07:03 AM Central Daylight Time	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Blue Medicare Advantage	www.MedicareBlueKC.com	Blue Medicare Advantage Employer Group Plan MAPDCY (HMO)	01	01		1			H1352	803	0	2022	Kansas City Area		1	6820	2			2						https://www.medicarebluekc.com/	https://www.medicarebluekc.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;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	2		1					1				
H1352	804	0	1	01	01	H1352_804_0	1	1						06/05/2021	2022.01	06/05/2021 07:33:31 AM Central Daylight Time					06/05/2021 08:07:03 AM Central Daylight Time	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Blue Medicare Advantage	www.MedicareBlueKC.com	Blue Medicare Advantage Employer Group Plan MAPDBY (HMO)	01	01		1			H1352	804	0	2022	Kansas City Area		1	0	2			2						https://www.medicarebluekc.com/	https://www.medicarebluekc.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;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	2		1					1				
H1352	805	0	1	02	01	H1352_805_0	1	1						06/05/2021	2022.01	06/05/2021 07:49:38 AM Central Daylight Time					06/05/2021 08:07:03 AM Central Daylight Time	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Blue Medicare Advantage	www.MedicareBlueKC.com	Blue Medicare Advantage Employer Group CYMAPD POS (HMO-POS)	01	02		1			H1352	805	0	2022	Kansas City Metro Area		1	3300	2			2						https://www.medicarebluekc.com/	https://www.medicarebluekc.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;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	2		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	2		1				
H1353	002	0	1	01	01	H1353_002_0	4	1	2	1			0	08/02/2021	2022.01	08/02/2021 02:11:08 PM Eastern Daylight Time	08/03/2021 11:13:12 PM Eastern Daylight Time	07/30/2021 10:30:58 AM Eastern Daylight Time			08/04/2021 11:54:32 PM Eastern Daylight Time	WELLCARE OF WASHINGTON, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Access (HMO D-SNP)	01	01		1			H1353	002	0	2022	Select counties in WA		2	808	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1353	004	0	1	01	01	H1353_004_0	4	1	2	1			0	07/18/2021	2022.01	07/18/2021 06:09:12 PM Eastern Daylight Time	08/03/2021 11:13:42 PM Eastern Daylight Time	07/30/2021 10:31:34 AM Eastern Daylight Time			08/04/2021 11:54:32 PM Eastern Daylight Time	WELLCARE OF WASHINGTON, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Liberty (HMO D-SNP)	01	01		1			H1353	004	0	2022	Select counties in WA		2	2601	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1353	005	0	1	01	01	H1353_005_0	4	1					0	08/02/2021	2022.01	08/02/2021 02:12:47 PM Eastern Daylight Time	08/03/2021 11:14:11 PM Eastern Daylight Time	07/30/2021 10:32:14 AM Eastern Daylight Time			08/04/2021 11:54:32 PM Eastern Daylight Time	WELLCARE OF WASHINGTON, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO)	01	01		1			H1353	005	0	2022	Select counties in WA		2	23529	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1353	006	0	1	01	01	H1353_006_0	4	1					0	08/02/2021	2022.01	08/02/2021 01:08:56 PM Eastern Daylight Time	08/03/2021 11:14:41 PM Eastern Daylight Time	07/30/2021 10:33:18 AM Eastern Daylight Time			08/04/2021 11:54:32 PM Eastern Daylight Time	WELLCARE OF WASHINGTON, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Giveback (HMO)	01	01		1			H1353	006	0	2022	Select counties in WA		2	11876	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1353	007	0	1	01	01	H1353_007_0	4	1					0	07/18/2021	2022.01	07/18/2021 06:13:21 PM Eastern Daylight Time	08/03/2021 11:15:12 PM Eastern Daylight Time	07/30/2021 10:34:02 AM Eastern Daylight Time			08/04/2021 11:54:32 PM Eastern Daylight Time	WELLCARE OF WASHINGTON, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Assist (HMO)	01	01		1			H1353	007	0	2022	Select counties in WA		2	555	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1357	001	0	1	20	08	H1357_001_0	3	1						06/03/2021	2022.01	06/03/2021 09:41:08 AM Eastern Daylight Time		05/25/2021 11:27:56 PM Eastern Daylight Time			06/03/2021 09:43:58 AM Eastern Daylight Time	CAROLINA SENIORCARE	Carolina SeniorCare	http://www.carolinaseniorcare.org/	Carolina SeniorCare (PACE)	08	20		1			H1357	001	0	2022	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										(800)735-2962		(800)735-2962		(800)735-2962		(800)735-2962																
H1357	002	0	1	20	08	H1357_002_0	2	1						06/03/2021	2022.01	06/03/2021 09:28:18 AM Eastern Daylight Time		05/25/2021 11:29:02 PM Eastern Daylight Time			06/03/2021 09:29:03 AM Eastern Daylight Time	CAROLINA SENIORCARE	Carolina SeniorCare	http://www.carolinaseniorcare.org/	Carolina SeniorCare (PACE)	08	20		1			H1357	002	0	2022	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										(800)735-2962		(800)735-2962		(800)735-2962		(800)735-2962																
H1360	001	0	1	01	01	H1360_001_0	4	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 10:56:55 AM Central Daylight Time	08/03/2021 12:56:40 PM Central Daylight Time	07/29/2021 07:37:33 PM Central Daylight Time			08/04/2021 09:10:19 PM Central Daylight Time	HEALTH PLAN OF NEVADA, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Dual Complete (HMO D-SNP)	01	01		1			H1360	001	0	2022	Clark and Washoe counties		2		2			1	3		1		1	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			
H1365	001	0	1	04	01	H1365_001_0	6	1					1	08/03/2021	2022.01	08/03/2021 10:28:51 AM Eastern Daylight Time	08/05/2021 12:35:19 PM Eastern Daylight Time	08/05/2021 12:35:32 PM Eastern Daylight Time			08/05/2021 03:08:14 PM Eastern Daylight Time	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Martin's Point Generations Advantage	MartinsPoint.org/Advantage	Martin's Point Generations Advantage Select (PPO)	01	04		1			H1365	001	0	2022	Southern Maine & Southern New Hampshire		2		2			2						MartinsPoint.org/Advantage	MartinsPoint.org/Advantage	MartinsPoint.org/Advantage	(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	004	1	1	04	01	H1365_004_1	5	1					1	08/03/2021	2022.01	08/03/2021 09:57:24 AM Eastern Daylight Time	08/05/2021 12:35:47 PM Eastern Daylight Time	08/05/2021 12:36:00 PM Eastern Daylight Time			08/05/2021 03:08:14 PM Eastern Daylight Time	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Martin's Point Generations Advantage	Martinspoint.org/Advantage	Martin's Point Generations Advantage Select (PPO)	01	04		1			H1365	004	1	2022	Northern Maine & Northern New Hampshire	Aroo, Hanc, Kenn, Penob, Pisc, Some, Wash, Coos	2		2			2						Martinspoint.org/Advantage	Martinspoint.org/Advantage	Martinspoint.org/Advantage	(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	004	2	1	04	01	H1365_004_2	5	1					1	08/03/2021	2022.01	08/03/2021 10:03:35 AM Eastern Daylight Time	08/05/2021 12:36:14 PM Eastern Daylight Time	08/05/2021 12:36:26 PM Eastern Daylight Time			08/05/2021 03:08:14 PM Eastern Daylight Time	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Martin's Point Generations Advantage	Martinspoint.org/Advantage	Martin's Point Generations Advantage Select (PPO)	01	04		1			H1365	004	2	2022	Northern Maine & Northern New Hampshire	Belknap, Carroll, Grafton Counties	2		2			2						Martinspoint.org/Advantage	Martinspoint.org/Advantage	Martinspoint.org/Advantage	(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	3	1						05/11/2021	2022.01	05/11/2021 12:16:44 PM Eastern Daylight Time					07/16/2021 03:12:26 PM Eastern Daylight Time	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Martin's Point Generations Advantage	MartinsPoint.org/Advantage	Martin's Point Generations Advantage Premier Group (PPO)	01	04		1			H1365	802	0	2022	National		1	0	2			2						MartinsPoint.org/Advantage	MartinsPoint.org/Advantage	MartinsPoint.org/Advantage	(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	3	1						05/11/2021	2022.01	05/11/2021 12:18:09 PM Eastern Daylight Time					07/16/2021 03:12:26 PM Eastern Daylight Time	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Martin's Point Generations Advantage	MartinsPoint.org/Advantage	Martin's Point Generations Advantage Premier Group (PPO)	01	04		1			H1365	803	0	2022	National		1	0	2			2						MartinsPoint.org/Advantage	MartinsPoint.org/Advantage	MartinsPoint.org/Advantage	(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	7	1		1			0	08/05/2021	2022.01	08/05/2021 11:06:34 AM Central Daylight Time	08/04/2021 11:04:36 AM Central Daylight Time	08/02/2021 12:23:19 PM Central Daylight Time			08/05/2021 11:18:13 AM Central Daylight Time	MARQUIS ADVANTAGE, INC.	AgeRight Advantage	www.agerightadvantage.com	AgeRight Advantage Health Plan (HMO I-SNP)	01	01		1			H1372	001	0	2022	OR Counties: CLK, KLA, LAN, MUL, WSH & YAM		2		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			
H1372	002	0	1	01	01	H1372_002_0	7	1		1			0	07/06/2021	2022.01	07/06/2021 07:45:01 PM Central Daylight Time	08/04/2021 11:16:58 AM Central Daylight Time	08/02/2021 12:07:33 PM Central Daylight Time			08/05/2021 11:18:13 AM Central Daylight Time	MARQUIS ADVANTAGE, INC.	AgeRight Advantage	www.agerightadvantage.com	AgeRight Advantage Plus (HMO I-SNP)	01	01		1			H1372	002	0	2022	OR Counties: CLK, KLA, LAN, MUL, WSH & YAM		2		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			
H1372	003	0	1	01	01	H1372_003_0	7	1		1			0	07/06/2021	2022.01	07/06/2021 07:46:11 PM Central Daylight Time	08/04/2021 11:19:07 AM Central Daylight Time	08/02/2021 12:06:16 PM Central Daylight Time			08/05/2021 11:18:13 AM Central Daylight Time	MARQUIS ADVANTAGE, INC.	AgeRight Advantage	www.agerightadvantage.com	AgeRight Advantage Premier (HMO C-SNP)	01	01		1			H1372	003	0	2022	OR Counties: CLK, KLA, LAN, MUL, WSH & YAM		2		2			1	4			00000000000000000010		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			
H1375	001	0	1	01	01	H1375_001_0	4	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 08:54:31 AM Central Daylight Time	08/03/2021 01:06:22 PM Central Daylight Time	07/29/2021 07:37:48 PM Central Daylight Time			08/04/2021 07:05:02 PM Central Daylight Time	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO D-SNP)	01	01		1			H1375	001	0	2022	Alameda county		2		2			1	3		1		1	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(800)933-4017		(800)933-4017		(888)834-3721		(888)834-3721		(800)933-4017		(800)933-4017		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1375	002	0	1	01	01	H1375_002_0	4	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 08:39:25 AM Central Daylight Time	08/03/2021 01:07:00 PM Central Daylight Time	07/29/2021 07:38:04 PM Central Daylight Time			08/04/2021 07:05:02 PM Central Daylight Time	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO D-SNP)	01	01		1			H1375	002	0	2022	Fresno, Kings, and Madera counties		2		2			1	3		1		1	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(800)933-4017		(800)933-4017		(888)834-3721		(888)834-3721		(800)933-4017		(800)933-4017		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1395	001	0	1	04	01	H1395_001_0	5	1	2	1			0	06/04/2021	2022.01	06/04/2021 10:58:42 AM Eastern Daylight Time	08/03/2021 11:15:42 PM Eastern Daylight Time	07/30/2021 10:34:22 AM Eastern Daylight Time			08/04/2021 10:34:28 PM Eastern Daylight Time	NEBRASKA TOTAL CARE, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Access Open (PPO D-SNP)	01	04		1			H1395	001	0	2022	Select counties in NE		2	91	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)853-0864		(833)853-0864		(844)917-0175		(844)917-0175		(833)853-0864		(833)853-0864		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1395	002	0	1	04	01	H1395_002_0	5	1					0	08/02/2021	2022.01	08/02/2021 11:16:12 AM Eastern Daylight Time	08/03/2021 11:16:10 PM Eastern Daylight Time	07/30/2021 10:34:54 AM Eastern Daylight Time			08/04/2021 10:34:28 PM Eastern Daylight Time	NEBRASKA TOTAL CARE, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium Open (PPO)	01	04		1			H1395	002	0	2022	Select counties in NE		2	628	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)542-0693		(833)542-0693		(844)917-0175		(844)917-0175		(833)542-0693		(833)542-0693		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1395	003	0	1	04	01	H1395_003_0	5	1					0	07/18/2021	2022.01	07/18/2021 11:27:02 AM Eastern Daylight Time	08/03/2021 11:16:38 PM Eastern Daylight Time	07/30/2021 10:35:32 AM Eastern Daylight Time			08/04/2021 10:34:28 PM Eastern Daylight Time	NEBRASKA TOTAL CARE, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Assist Open (PPO)	01	04		1			H1395	003	0	2022	Select counties in NE		2	419	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)542-0693		(833)542-0693		(844)917-0175		(844)917-0175		(833)542-0693		(833)542-0693		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1415	013	0	1	01	01	H1415_013_0	2	1				0	0	05/28/2021	2022.01	05/28/2021 04:12:48 PM Central Daylight Time	05/31/2021 01:01:49 PM Central Daylight Time				06/02/2021 02:12:43 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Fundamental Medicare (HMO)	01	01		1			H1415	013	0	2022	Chicago Area		2		2			2						www.cigna.com/medicare	www.cignamedicare.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	3	1					0	08/02/2021	2022.01	08/02/2021 07:52:52 PM Central Daylight Time	08/03/2021 09:41:57 AM Central Daylight Time	07/30/2021 11:28:18 AM Central Daylight Time			08/04/2021 10:01:31 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Premier Medicare (HMO-POS)	01	02		1			H1415	021	0	2022	Chicago Area		2		2			2						www.cigna.com/medicare	www.cignamedicare.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	3	1					0	08/02/2021	2022.01	08/02/2021 07:53:50 PM Central Daylight Time	08/03/2021 09:43:09 AM Central Daylight Time	07/30/2021 11:28:42 AM Central Daylight Time			08/04/2021 10:01:31 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H1415	024	0	2022	Chicago Area		2		2			2						www.cigna.com/medicare	www.cignamedicare.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	4	1					0	08/01/2021	2022.01	08/01/2021 10:58:37 AM Eastern Daylight Time	08/03/2021 11:17:07 PM Eastern Daylight Time	07/30/2021 10:35:50 AM Eastern Daylight Time			08/04/2021 11:43:06 PM Eastern Daylight Time	HARMONY HEALTH PLAN,  INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO-POS)	01	02		1			H1416	009	0	2022	Select counties in IL		2	130429	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1416	023	0	1	01	01	H1416_023_0	4	1					0	05/31/2021	2022.01	05/31/2021 06:36:10 AM Pacific Daylight Time	08/04/2021 03:20:43 PM Eastern Daylight Time	07/30/2021 10:36:24 AM Eastern Daylight Time			08/04/2021 11:43:06 PM Eastern Daylight Time	HARMONY HEALTH PLAN,  INC.	Wellcare	www.wellcare.com/medicare	Wellcare Assist Compass (HMO)	01	01		1			H1416	023	0	2022	Select counties in IL		2	41046	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1416	026	0	1	02	01	H1416_026_0	5	1					0	08/01/2021	2022.01	08/01/2021 03:19:08 PM Eastern Daylight Time	08/03/2021 11:18:04 PM Eastern Daylight Time	07/30/2021 10:36:44 AM Eastern Daylight Time			08/04/2021 08:53:46 PM Eastern Daylight Time	HARMONY HEALTH PLAN,  INC.	Wellcare	www.wellcare.com/medicare	Wellcare Low Premium (HMO-POS)	01	02		1			H1416	026	0	2022	Select counties in MS		2	28673	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1416	033	0	1	02	01	H1416_033_0	5	1	2	1			0	08/01/2021	2022.01	08/01/2021 03:06:21 PM Eastern Daylight Time	08/03/2021 11:18:33 PM Eastern Daylight Time	07/30/2021 10:37:06 AM Eastern Daylight Time			08/04/2021 08:53:46 PM Eastern Daylight Time	HARMONY HEALTH PLAN,  INC.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Access (HMO-POS D-SNP)	01	02		1			H1416	033	0	2022	Select counties in AR		2	19551	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1416	034	0	1	01	01	H1416_034_0	5	1	2	1			0	06/02/2021	2022.01	06/02/2021 04:24:13 PM Eastern Daylight Time	08/03/2021 11:19:02 PM Eastern Daylight Time	07/30/2021 10:37:26 AM Eastern Daylight Time			08/04/2021 08:53:46 PM Eastern Daylight Time	HARMONY HEALTH PLAN,  INC.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Access (HMO D-SNP)	01	01		1			H1416	034	0	2022	Select counties in MS		2	99370	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1416	035	0	1	01	01	H1416_035_0	5	1	2	1			0	06/02/2021	2022.01	06/02/2021 03:01:17 PM Central Daylight Time	08/03/2021 11:19:32 PM Eastern Daylight Time	07/30/2021 10:37:56 AM Eastern Daylight Time			08/04/2021 09:45:33 PM Eastern Daylight Time	HARMONY HEALTH PLAN,  INC.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Access (HMO D-SNP)	01	01		1			H1416	035	0	2022	All counties in TN		2	56684	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(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			0	07/18/2021	2022.01	07/18/2021 06:24:00 PM Eastern Daylight Time	08/03/2021 11:19:59 PM Eastern Daylight Time	07/30/2021 10:38:16 AM Eastern Daylight Time			08/04/2021 09:57:30 PM Eastern Daylight Time	HARMONY HEALTH PLAN,  INC.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Liberty (HMO D-SNP)	01	01		1			H1416	036	0	2022	Select counties in SC		2	45831	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1416	041	0	1	01	01	H1416_041_0	5	1					0	05/30/2021	2022.01	05/30/2021 10:04:18 AM Eastern Daylight Time	08/03/2021 11:20:29 PM Eastern Daylight Time	07/30/2021 10:38:42 AM Eastern Daylight Time			08/04/2021 08:53:46 PM Eastern Daylight Time	HARMONY HEALTH PLAN,  INC.	Wellcare	www.wellcare.com/medicare	Wellcare Assist Compass (HMO)	01	01		1			H1416	041	0	2022	Select counties in AR		2	32510	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1416	042	0	1	01	01	H1416_042_0	5	1					0	06/04/2021	2022.01	06/04/2021 01:37:30 PM Eastern Daylight Time	08/04/2021 03:21:08 PM Eastern Daylight Time	07/30/2021 10:39:36 AM Eastern Daylight Time			08/04/2021 09:45:33 PM Eastern Daylight Time	HARMONY HEALTH PLAN,  INC.	Wellcare	www.wellcare.com/medicare	Wellcare Assist (HMO)	01	01		1			H1416	042	0	2022	All counties in TN		2	26504	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1416	043	0	1	02	01	H1416_043_0	5	1	2	1			0	08/01/2021	2022.01	08/01/2021 03:07:49 PM Eastern Daylight Time	08/03/2021 11:21:24 PM Eastern Daylight Time	07/30/2021 10:39:56 AM Eastern Daylight Time			08/04/2021 08:53:46 PM Eastern Daylight Time	HARMONY HEALTH PLAN,  INC.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Liberty (HMO-POS D-SNP)	01	02		1			H1416	043	0	2022	Select counties in AR		2	16974	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1416	044	0	1	01	01	H1416_044_0	5	1	2	1			0	06/02/2021	2022.01	06/02/2021 04:28:08 PM Eastern Daylight Time	08/03/2021 11:21:53 PM Eastern Daylight Time	07/30/2021 10:40:32 AM Eastern Daylight Time			08/04/2021 08:53:46 PM Eastern Daylight Time	HARMONY HEALTH PLAN,  INC.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Liberty (HMO D-SNP)	01	01		1			H1416	044	0	2022	Select counties in MS		2	66350	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1416	048	0	1	01	01	H1416_048_0	5	1					0	07/06/2021	2022.01	07/06/2021 01:34:00 PM Eastern Daylight Time	08/04/2021 03:21:34 PM Eastern Daylight Time	07/30/2021 10:40:54 AM Eastern Daylight Time			08/04/2021 11:43:06 PM Eastern Daylight Time	HARMONY HEALTH PLAN,  INC.	Wellcare	www.wellcare.com/medicare	Wellcare Plus (HMO)	01	01		1			H1416	048	0	2022	Select counties in IL		2	34240	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1416	053	0	1	02	01	H1416_053_0	4	1				0	0	05/31/2021	2022.01	05/31/2021 06:40:09 AM Pacific Daylight Time	06/06/2021 12:31:54 PM Eastern Daylight Time				07/19/2021 05:24:36 PM Eastern Daylight Time	HARMONY HEALTH PLAN,  INC.	Wellcare	www.wellcare.com/medicare	Wellcare Patriot No Premium (HMO-POS)	01	02		1			H1416	053	0	2022	Select counties in IL		2	2030	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H1416	055	0	1	01	01	H1416_055_0	5	1					0	08/01/2021	2022.01	08/01/2021 02:41:55 PM Eastern Daylight Time	08/03/2021 11:23:20 PM Eastern Daylight Time	07/30/2021 10:41:22 AM Eastern Daylight Time			08/04/2021 08:53:46 PM Eastern Daylight Time	HARMONY HEALTH PLAN,  INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium Preferred (HMO)	01	01		1			H1416	055	0	2022	Select counties in AR		2	56479	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1416	056	0	1	01	01	H1416_056_0	4	1					0	08/03/2021	2022.01	08/03/2021 11:24:09 AM Eastern Daylight Time	08/03/2021 11:23:49 PM Eastern Daylight Time	07/30/2021 10:41:44 AM Eastern Daylight Time			08/04/2021 09:57:30 PM Eastern Daylight Time	HARMONY HEALTH PLAN,  INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium Value (HMO)	01	01		1			H1416	056	0	2022	Select counties in SC		2	13183	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1416	057	0	1	01	01	H1416_057_0	4	1					0	08/03/2021	2022.01	08/03/2021 11:25:16 AM Eastern Daylight Time	08/03/2021 11:24:19 PM Eastern Daylight Time	07/30/2021 10:42:04 AM Eastern Daylight Time			08/04/2021 09:57:30 PM Eastern Daylight Time	HARMONY HEALTH PLAN,  INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium Value (HMO)	01	01		1			H1416	057	0	2022	Select counties in SC		2	1987	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1416	058	0	1	02	01	H1416_058_0	5	1				0	0	05/30/2021	2022.01	05/30/2021 10:10:18 AM Eastern Daylight Time	06/06/2021 12:34:42 PM Eastern Daylight Time				07/19/2021 04:34:39 PM Eastern Daylight Time	HARMONY HEALTH PLAN,  INC.	Wellcare	www.wellcare.com/medicare	Wellcare Patriot Giveback (HMO-POS)	01	02		1			H1416	058	0	2022	Select counties in AR		2	5511	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H1416	059	0	1	02	01	H1416_059_0	4	1				0	0	06/02/2021	2022.01	06/02/2021 07:30:00 AM Eastern Daylight Time	06/06/2021 12:36:14 PM Eastern Daylight Time				07/19/2021 06:42:26 PM Eastern Daylight Time	HARMONY HEALTH PLAN,  INC.	Wellcare	www.wellcare.com/medicare	Wellcare Patriot No Premium (HMO-POS)	01	02		1			H1416	059	0	2022	Select counties in SC		2	2028	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H1416	060	0	1	02	01	H1416_060_0	5	1				0	0	05/30/2021	2022.01	05/30/2021 10:11:49 AM Eastern Daylight Time	06/06/2021 12:38:13 PM Eastern Daylight Time				07/19/2021 04:34:39 PM Eastern Daylight Time	HARMONY HEALTH PLAN,  INC.	Wellcare	www.wellcare.com/medicare	Wellcare Patriot Giveback (HMO-POS)	01	02		1			H1416	060	0	2022	Select counties in MS		2	9654	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H1416	061	0	1	02	01	H1416_061_0	5	1				0	0	05/31/2021	2022.01	05/31/2021 07:24:09 AM Eastern Daylight Time	06/06/2021 12:40:19 PM Eastern Daylight Time				07/19/2021 05:11:22 PM Eastern Daylight Time	HARMONY HEALTH PLAN,  INC.	Wellcare	www.wellcare.com/medicare	Wellcare Patriot Giveback (HMO-POS)	01	02		1			H1416	061	0	2022	All counties in TN		2	5654	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H1416	064	0	1	01	01	H1416_064_0	5	1					0	08/01/2021	2022.01	08/01/2021 02:43:12 PM Eastern Daylight Time	08/03/2021 11:26:49 PM Eastern Daylight Time	07/30/2021 10:42:24 AM Eastern Daylight Time			08/04/2021 08:53:46 PM Eastern Daylight Time	HARMONY HEALTH PLAN,  INC.	Wellcare	www.wellcare.com/medicare	Wellcare Giveback Dividend (HMO)	01	01		1			H1416	064	0	2022	Select counties in AR		2	33272	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1416	065	0	1	01	01	H1416_065_0	5	1					0	08/01/2021	2022.01	08/01/2021 03:25:04 PM Eastern Daylight Time	08/03/2021 11:27:18 PM Eastern Daylight Time	07/30/2021 10:42:44 AM Eastern Daylight Time			08/04/2021 08:53:46 PM Eastern Daylight Time	HARMONY HEALTH PLAN,  INC.	Wellcare	www.wellcare.com/medicare	Wellcare Giveback (HMO)	01	01		1			H1416	065	0	2022	Select counties in MS		2	121615	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1416	066	0	1	01	01	H1416_066_0	4	1		1			1	08/01/2021	2022.01	08/01/2021 10:29:34 AM Eastern Daylight Time	08/03/2021 11:27:47 PM Eastern Daylight Time	07/30/2021 10:43:22 AM Eastern Daylight Time			08/04/2021 11:43:06 PM Eastern Daylight Time	HARMONY HEALTH PLAN,  INC.	Wellcare	www.wellcare.com/medicare	Wellcare Specialty No Premium (HMO C-SNP)	01	01		1			H1416	066	0	2022	Select counties in IL		2	652	2			1	4			00000010000000000000		www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1416	068	0	1	01	01	H1416_068_0	5	1					0	05/30/2021	2022.01	05/30/2021 10:15:08 AM Eastern Daylight Time	08/03/2021 11:28:15 PM Eastern Daylight Time	07/30/2021 10:43:44 AM Eastern Daylight Time			08/04/2021 08:53:46 PM Eastern Daylight Time	HARMONY HEALTH PLAN,  INC.	Wellcare	www.wellcare.com/medicare	Wellcare Assist (HMO)	01	01		1			H1416	068	0	2022	Select counties in MS		2	47950	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1416	070	0	1	01	01	H1416_070_0	5	1					0	08/01/2021	2022.01	08/01/2021 03:23:45 PM Eastern Daylight Time	08/03/2021 11:28:44 PM Eastern Daylight Time	07/30/2021 10:44:08 AM Eastern Daylight Time			08/04/2021 08:53:46 PM Eastern Daylight Time	HARMONY HEALTH PLAN,  INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO)	01	01		1			H1416	070	0	2022	Select Counties in MS		2	4589	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1416	071	0	1	01	01	H1416_071_0	5	1					0	08/01/2021	2022.01	08/01/2021 03:27:35 PM Eastern Daylight Time	08/03/2021 11:29:12 PM Eastern Daylight Time	07/30/2021 10:44:36 AM Eastern Daylight Time			08/04/2021 08:53:46 PM Eastern Daylight Time	HARMONY HEALTH PLAN,  INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO)	01	01		1			H1416	071	0	2022	Select Counties in MS		2	96058	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1416	072	0	1	01	01	H1416_072_0	5	1					0	08/01/2021	2022.01	08/01/2021 03:28:59 PM Eastern Daylight Time	08/03/2021 11:29:40 PM Eastern Daylight Time	07/30/2021 10:44:56 AM Eastern Daylight Time			08/04/2021 08:53:46 PM Eastern Daylight Time	HARMONY HEALTH PLAN,  INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO)	01	01		1			H1416	072	0	2022	Select Counties in MS		2	3493	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1416	073	1	1	01	01	H1416_073_1	5	1					0	07/30/2021	2022.01	07/30/2021 01:53:50 PM Eastern Daylight Time	08/03/2021 11:30:09 PM Eastern Daylight Time	07/30/2021 10:45:16 AM Eastern Daylight Time			08/04/2021 09:45:33 PM Eastern Daylight Time	HARMONY HEALTH PLAN,  INC.	Wellcare	www.wellcare.com/medicare	Wellcare Giveback (HMO)	01	01		1			H1416	073	1	2022	Select counties in TN	Nashville Region	2	8088	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1416	073	2	1	01	01	H1416_073_2	5	1					0	07/30/2021	2022.01	07/30/2021 01:56:02 PM Eastern Daylight Time	08/03/2021 11:30:38 PM Eastern Daylight Time	07/30/2021 10:45:46 AM Eastern Daylight Time			08/04/2021 09:45:33 PM Eastern Daylight Time	HARMONY HEALTH PLAN,  INC.	Wellcare	www.wellcare.com/medicare	Wellcare Giveback (HMO)	01	01		1			H1416	073	2	2022	Select counties in TN		2	19979	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1416	073	3	1	01	01	H1416_073_3	5	1					0	07/30/2021	2022.01	07/30/2021 01:58:11 PM Eastern Daylight Time	08/03/2021 11:31:08 PM Eastern Daylight Time	07/30/2021 10:46:06 AM Eastern Daylight Time			08/04/2021 09:45:33 PM Eastern Daylight Time	HARMONY HEALTH PLAN,  INC.	Wellcare	www.wellcare.com/medicare	Wellcare Giveback (HMO)	01	01		1			H1416	073	3	2022	Select counties in TN	Outlying counties	2	48327	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1416	075	0	1	02	01	H1416_075_0	5	1					0	07/30/2021	2022.01	07/30/2021 02:00:19 PM Eastern Daylight Time	08/03/2021 11:31:38 PM Eastern Daylight Time	07/30/2021 10:46:42 AM Eastern Daylight Time			08/04/2021 09:45:33 PM Eastern Daylight Time	HARMONY HEALTH PLAN,  INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO-POS)	01	02		1			H1416	075	0	2022	Select counties in TN		2	2950	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1416	076	0	1	02	01	H1416_076_0	5	1					0	07/30/2021	2022.01	07/30/2021 02:02:54 PM Eastern Daylight Time	08/04/2021 03:22:00 PM Eastern Daylight Time	07/30/2021 10:47:00 AM Eastern Daylight Time			08/04/2021 09:45:33 PM Eastern Daylight Time	HARMONY HEALTH PLAN,  INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO-POS)	01	02		1			H1416	076	0	2022	Select counties in TN		2	6842	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1416	077	0	1	02	01	H1416_077_0	5	1					0	07/30/2021	2022.01	07/30/2021 02:05:01 PM Eastern Daylight Time	08/03/2021 11:32:36 PM Eastern Daylight Time	07/30/2021 10:47:24 AM Eastern Daylight Time			08/04/2021 09:45:33 PM Eastern Daylight Time	HARMONY HEALTH PLAN,  INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO-POS)	01	02		1			H1416	077	0	2022	Select counties in TN		2	24092	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1423	001	0	1	01	01	H1423_001_0	7	1		1			0	07/16/2021	2022.01	07/16/2021 04:52:28 PM Pacific Daylight Time	08/03/2021 06:04:07 PM Eastern Daylight Time	08/03/2021 06:04:07 PM Eastern Daylight Time			08/04/2021 01:51:40 PM Eastern Daylight Time	AMERIGROUP OHIO, INC.	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Lung Care Plus (HMO C-SNP)	01	01		1			H1423	001	0	2022	Pima County		2		2			1	4			00000000000100000000		https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	(888)816-2790		(888)816-2790		(855)593-0904		(855)593-0904		(833)498-1582		(833)498-1582		(855)948-5575		(855)948-5575		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1423	002	0	1	01	01	H1423_002_0	6	1		1			1	07/16/2021	2022.01	07/16/2021 04:53:00 PM Pacific Daylight Time	08/03/2021 06:04:07 PM Eastern Daylight Time	08/03/2021 06:04:07 PM Eastern Daylight Time			08/04/2021 01:51:40 PM Eastern Daylight Time	AMERIGROUP OHIO, INC.	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Diabetes Care Plus (HMO C-SNP)	01	01		1			H1423	002	0	2022	Pima County		2		2			1	4			00000010000000000000		https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	(888)816-2790		(888)816-2790		(855)593-0904		(855)593-0904		(833)498-1582		(833)498-1582		(855)948-5575		(855)948-5575		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1423	003	0	1	01	01	H1423_003_0	6	1		1			0	07/16/2021	2022.01	07/16/2021 05:32:19 PM Pacific Daylight Time	08/03/2021 06:04:07 PM Eastern Daylight Time	08/03/2021 06:04:07 PM Eastern Daylight Time			08/04/2021 01:51:40 PM Eastern Daylight Time	AMERIGROUP OHIO, INC.	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Heart Care Plus (HMO C-SNP)	01	01		1			H1423	003	0	2022	Pima County		2		2			1	4			00000000000000010000		https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	(888)816-2790		(888)816-2790		(855)593-0904		(855)593-0904		(833)498-1582		(833)498-1582		(855)948-5575		(855)948-5575		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1423	004	0	1	01	01	H1423_004_0	6	1					0	07/16/2021	2022.01	07/16/2021 04:54:02 PM Pacific Daylight Time	08/03/2021 06:04:07 PM Eastern Daylight Time	08/03/2021 06:04:07 PM Eastern Daylight Time			08/04/2021 01:51:40 PM Eastern Daylight Time	AMERIGROUP OHIO, INC.	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Classic Plus (HMO)	01	01		1			H1423	004	0	2022	Pima County		2		2			2						https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	(888)816-2790		(888)816-2790		(855)593-0905		(855)593-0905		(833)498-1582		(833)498-1582		(855)948-5576		(855)948-5576		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1423	005	0	1	01	01	H1423_005_0	6	1					0	07/16/2021	2022.01	07/16/2021 04:54:31 PM Pacific Daylight Time	08/03/2021 06:04:08 PM Eastern Daylight Time	08/03/2021 06:04:08 PM Eastern Daylight Time			08/04/2021 01:51:40 PM Eastern Daylight Time	AMERIGROUP OHIO, INC.	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Smart Value Plus (HMO)	01	01		1			H1423	005	0	2022	Pima County		2		2			2						https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	(888)816-2790		(888)816-2790		(855)593-0905		(855)593-0905		(833)498-1582		(833)498-1582		(855)948-5576		(855)948-5576		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1423	007	0	1	01	01	H1423_007_0	7	1		1			0	06/04/2021	2022.01	06/04/2021 03:27:03 PM Eastern Daylight Time	08/03/2021 06:04:08 PM Eastern Daylight Time	08/03/2021 06:04:08 PM Eastern Daylight Time			08/04/2021 01:51:40 PM Eastern Daylight Time	AMERIGROUP OHIO, INC.	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Comfort Plus (HMO I-SNP)	01	01		1			H1423	007	0	2022	Pima County		2		2			1	1	3				https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	(888)816-2790		(888)816-2790		(855)593-0906		(855)593-0906		(833)498-1582		(833)498-1582		(855)948-5577		(855)948-5577		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1423	008	0	1	01	01	H1423_008_0	7	1		1			0	06/16/2021	2022.01	06/16/2021 09:00:48 AM Eastern Daylight Time	08/03/2021 06:04:08 PM Eastern Daylight Time	08/03/2021 06:04:08 PM Eastern Daylight Time			08/04/2021 01:51:40 PM Eastern Daylight Time	AMERIGROUP OHIO, INC.	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Comfort Plus (HMO I-SNP)	01	01		1			H1423	008	0	2022	Maricopa County		2		2			1	1	3				https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	(888)816-2790		(888)816-2790		(855)593-0906		(855)593-0906		(833)498-1582		(833)498-1582		(855)948-5577		(855)948-5577		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1423	009	0	1	01	01	H1423_009_0	8	1					0	07/16/2021	2022.01	07/16/2021 04:55:19 PM Pacific Daylight Time	08/04/2021 01:00:04 PM Eastern Daylight Time	08/04/2021 01:01:10 PM Eastern Daylight Time			08/04/2021 01:51:40 PM Eastern Daylight Time	AMERIGROUP OHIO, INC.	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Plus (HMO)	01	01		1			H1423	009	0	2022	Maricopa County		2		2			2						https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	(888)816-2790		(888)816-2790		(855)593-0905		(855)593-0905		(833)498-1582		(833)498-1582		(855)948-5576		(855)948-5576		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1426	001	0	1	01	01	H1426_001_0	3	1					0	08/01/2021	2022.01	08/01/2021 05:01:11 PM Pacific Daylight Time	08/02/2021 09:28:23 AM Pacific Daylight Time	07/29/2021 01:44:45 PM Pacific Daylight Time			08/04/2021 04:46:13 PM Pacific Daylight Time	VITALITY HEALTH PLAN OF CALIFORNIA, INC.	Vitality Health Plan of California	www.vitalityhp.net	Choice (HMO)	01	01		1			H1426	001	0	2022	San Joaquin County		2	14060	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		(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	3	1					0	08/01/2021	2022.01	08/01/2021 05:01:56 PM Pacific Daylight Time	08/02/2021 09:11:37 AM Pacific Daylight Time	07/29/2021 01:45:22 PM Pacific Daylight Time			08/04/2021 04:46:13 PM Pacific Daylight Time	VITALITY HEALTH PLAN OF CALIFORNIA, INC.	Vitality Health Plan of California	www.vitalityhp.net	Choice (HMO)	01	01		1			H1426	002	0	2022	Santa Clara County		2	12925	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		(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	3	1					0	08/01/2021	2022.01	08/01/2021 05:02:59 PM Pacific Daylight Time	08/02/2021 09:13:13 AM Pacific Daylight Time	07/29/2021 01:45:58 PM Pacific Daylight Time			08/04/2021 04:46:13 PM Pacific Daylight Time	VITALITY HEALTH PLAN OF CALIFORNIA, INC.	Vitality Health Plan of California	www.vitalityhp.net	Plus (HMO)	01	01		1			H1426	003	0	2022	San Joaquin and Santa Clara counties		2	6235	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		(866)333-3530		(866)333-3530		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1436	002	0	1	01	01	H1436_002_0	4	1					0	08/03/2021	2022.01	08/03/2021 11:26:30 AM Eastern Daylight Time	08/03/2021 11:33:07 PM Eastern Daylight Time	07/30/2021 10:47:54 AM Eastern Daylight Time			08/04/2021 09:57:30 PM Eastern Daylight Time	ABSOLUTE TOTAL CARE, INC.	Wellcare by Allwell	www.wellcare.com/allwellSC	Wellcare No Premium Medicare (HMO)	01	01		1			H1436	002	0	2022	Select counties in SC		2	24899	2			2						www.wellcare.com/allwellSC	www.wellcare.com/allwellSC	www.wellcare.com/allwellSC	(855)766-1497		(855)766-1497		(866)277-6583		(866)277-6583		(855)766-1497		(855)766-1497		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1436	004	0	1	01	01	H1436_004_0	4	1					0	08/03/2021	2022.01	08/03/2021 11:27:27 AM Eastern Daylight Time	08/03/2021 11:33:37 PM Eastern Daylight Time	07/30/2021 10:48:22 AM Eastern Daylight Time			08/04/2021 09:57:30 PM Eastern Daylight Time	ABSOLUTE TOTAL CARE, INC.	Wellcare by Allwell	www.wellcare.com/allwellSC	Wellcare No Premium Medicare (HMO)	01	01		1			H1436	004	0	2022	Select counties in SC		2	7760	2			2						www.wellcare.com/allwellSC	www.wellcare.com/allwellSC	www.wellcare.com/allwellSC	(855)766-1497		(855)766-1497		(866)277-6583		(866)277-6583		(855)766-1497		(855)766-1497		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1436	005	0	1	01	01	H1436_005_0	4	1	2	1			0	07/19/2021	2022.01	07/19/2021 12:31:42 PM Eastern Daylight Time	08/03/2021 11:34:07 PM Eastern Daylight Time	07/30/2021 10:48:40 AM Eastern Daylight Time			08/04/2021 09:57:30 PM Eastern Daylight Time	ABSOLUTE TOTAL CARE, INC.	Wellcare by Allwell	www.wellcare.com/allwellSC	Wellcare Dual Access (HMO D-SNP)	01	01		1			H1436	005	0	2022	All counties in SC		2	9950	2			1	3		1		1	www.wellcare.com/allwellSC	www.wellcare.com/allwellSC	www.wellcare.com/allwellSC	(855)766-1497		(855)766-1497		(866)277-6583		(866)277-6583		(855)766-1497		(855)766-1497		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1436	007	0	1	01	01	H1436_007_0	4	1	2	1			0	07/19/2021	2022.01	07/19/2021 12:33:40 PM Eastern Daylight Time	08/03/2021 11:34:37 PM Eastern Daylight Time	07/30/2021 10:49:10 AM Eastern Daylight Time			08/04/2021 09:57:30 PM Eastern Daylight Time	ABSOLUTE TOTAL CARE, INC.	Wellcare by Allwell	www.wellcare.com/allwellSC	Wellcare Dual Liberty (HMO D-SNP)	01	01		1			H1436	007	0	2022	Select counties in SC		2	3243	2			1	3		1		1	www.wellcare.com/allwellSC	www.wellcare.com/allwellSC	www.wellcare.com/allwellSC	(855)766-1497		(855)766-1497		(866)277-6583		(866)277-6583		(855)766-1497		(855)766-1497		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1436	801	0	1	01	01	H1436_801_0	2	1						05/03/2021	2022.01	05/03/2021 01:31:40 PM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	ABSOLUTE TOTAL CARE, INC.	Wellcare by Allwell	allwell.absolutetotalcare.com	Allwell Group (HMO)	01	01		1			H1436	801	0	2022	South Carolina		1	100	2			2						allwell.absolutetotalcare.com/findadoctor	allwell.absolutetotalcare.com/formulary	allwell.absolutetotalcare.com/findadoctor	(855)766-1497		(855)766-1497		(844)942-0039		(844)942-0039		(855)766-1497		(855)766-1497		(844)942-0039		(844)942-0039		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H1436	802	0	1	01	01	H1436_802_0	2	1				0	0	05/03/2021	2022.01	05/03/2021 01:31:52 PM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	ABSOLUTE TOTAL CARE, INC.	Wellcare by Allwell	allwell.absolutetotalcare.com	Allwell Group (HMO)	01	01		1			H1436	802	0	2022	South Carolina		1	100	2			2						allwell.absolutetotalcare.com/findadoctor	allwell.absolutetotalcare.com/formulary	allwell.absolutetotalcare.com/findadoctor	(855)766-1497		(855)766-1497		(844)942-0039		(844)942-0039										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H1436	803	0	1	01	01	H1436_803_0	2	1						05/03/2021	2022.01	05/03/2021 01:32:00 PM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	ABSOLUTE TOTAL CARE, INC.	Wellcare by Allwell	allwell.absolutetotalcare.com	Allwell Group (HMO)	01	01		1			H1436	803	0	2022	South Carolina		1	100	2			2						allwell.absolutetotalcare.com/findadoctor	allwell.absolutetotalcare.com/formulary	allwell.absolutetotalcare.com/findadoctor	(855)766-1497		(855)766-1497		(844)942-0039		(844)942-0039		(855)766-1497		(855)766-1497		(844)942-0039		(844)942-0039		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H1463	003	0	1	01	01	H1463_003_0	10	1					1	09/27/2021	2022.01	09/27/2021 08:41:09 AM Central Daylight Time	08/02/2021 10:58:43 PM Central Daylight Time	07/30/2021 01:59:21 PM Central Daylight Time			09/27/2021 12:09:43 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	2022	North Central, Central, Southern, & Quad Cities IL		2	27043	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	9	1				0	0	09/27/2021	2022.01	09/27/2021 08:55:24 AM Central Daylight Time	08/02/2021 11:01:28 PM Central Daylight Time				09/27/2021 12:09:43 PM 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	2022	North Central, Central, Southern, & Quad Cities IL		2	6461	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	10	1					1	09/27/2021	2022.01	09/27/2021 08:43:42 AM Central Daylight Time	08/02/2021 11:04:10 PM Central Daylight Time	07/30/2021 01:59:50 PM Central Daylight Time			09/27/2021 12:09:43 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	2022	North Central, Central, Southern, & Quad Cities IL		2	34127	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	9	1					1	09/27/2021	2022.01	09/27/2021 08:43:43 AM Central Daylight Time	08/02/2021 11:06:55 PM Central Daylight Time	07/30/2021 02:00:20 PM Central Daylight Time			09/27/2021 12:09:43 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	2022	North Central, Central, Southern, & Quad Cities IL		2	29812	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	013	0	1	01	01	H1463_013_0	11	1					1	09/29/2021	2022.01	09/29/2021 11:48:31 AM Central Daylight Time	08/02/2021 11:08:43 PM Central Daylight Time	07/30/2021 02:00:49 PM Central Daylight Time			09/29/2021 12:45:36 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	2022	East Central IN and Western OH		2	4533	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	8	1				0	0	09/29/2021	2022.01	09/29/2021 11:49:06 AM Central Daylight Time	08/02/2021 11:11:22 PM Central Daylight Time				09/29/2021 12:45:36 PM 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	2022	North Central, Central, Southern, & Quad Cities IL		2	1143	2			2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(800)965-4022		(800)965-4022		(888)382-9771		(217)902-8744										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H1463	015	0	1	02	01	H1463_015_0	11	1					1	09/29/2021	2022.01	09/29/2021 11:50:20 AM Central Daylight Time	08/02/2021 11:14:05 PM Central Daylight Time	07/30/2021 02:01:19 PM Central Daylight Time			09/29/2021 12:45:36 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	2022	North Central, Central, Southern, & Quad Cities IL		2	8616	2			2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(800)965-4022		(800)965-4022		(888)382-9771		(217)902-8744		(800)965-4022		(800)965-4022		(888)382-9771		(217)902-8744		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1463	017	0	1	02	01	H1463_017_0	11	1					1	09/29/2021	2022.01	09/29/2021 11:51:19 AM Central Daylight Time	08/02/2021 11:16:48 PM Central Daylight Time	07/30/2021 02:01:49 PM Central Daylight Time			09/29/2021 12:45:36 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	2022	North Central, Central, Southern, & Quad Cities IL		2	11116	2			2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(800)965-4022		(800)965-4022		(888)382-9771		(217)902-8744		(800)965-4022		(800)965-4022		(888)382-9771		(217)902-8744		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1463	019	0	1	02	01	H1463_019_0	11	1					1	09/29/2021	2022.01	09/29/2021 11:51:47 AM Central Daylight Time	08/02/2021 11:19:33 PM Central Daylight Time	07/30/2021 02:02:19 PM Central Daylight Time			09/29/2021 12:45:36 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	2022	North Central, Central, Southern, & Quad Cities IL		2	18948	2			2						healthalliancemedicare.org	healthalliancemedicare.org	healthalliancemedicare.org	(800)965-4022		(800)965-4022		(888)382-9771		(217)902-8744		(800)965-4022		(800)965-4022		(888)382-9771		(217)902-8744		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1463	020	0	1	01	01	H1463_020_0	8	1				0	0	09/29/2021	2022.01	09/29/2021 11:52:24 AM Central Daylight Time	08/02/2021 11:21:24 PM Central Daylight Time				09/29/2021 12:45:36 PM 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	2022	East Central IN and Western OH		2	555	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	11	1					1	09/29/2021	2022.01	09/29/2021 11:53:36 AM Central Daylight Time	08/02/2021 11:23:11 PM Central Daylight Time	07/30/2021 02:02:48 PM Central Daylight Time			09/29/2021 12:45:36 PM Central Daylight Time	HEALTH ALLIANCE CONNECT, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Health Alliance Medicare Guide HMO Rx 2 (HMO)	01	01		1			H1463	021	0	2022	Whiteside,Henry, Mercer,Rock Island IL & Scott IA		2	12681	2			2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.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	11	1					1	09/29/2021	2022.01	09/29/2021 12:00:02 PM Central Daylight Time	08/02/2021 11:24:58 PM Central Daylight Time	07/30/2021 02:03:17 PM Central Daylight Time			09/29/2021 12:45:36 PM Central Daylight Time	HEALTH ALLIANCE CONNECT, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Reid Health Alliance Medicare POS Rx (HMO-POS)	01	02		1			H1463	022	0	2022	East Central IN		2	5271	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	023	0	1	01	01	H1463_023_0	10	1					1	09/27/2021	2022.01	09/27/2021 08:44:01 AM Central Daylight Time	08/02/2021 11:26:48 PM Central Daylight Time	07/30/2021 02:03:47 PM Central Daylight Time			09/27/2021 12:09:43 PM Central Daylight Time	HEALTH ALLIANCE CONNECT, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Simplete 1 (HMO)	01	01		1			H1463	023	0	2022	Eastern and Central IL; Western IN in contracted		2	53419	2			2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)933-8475		(877)933-8475		(877)634-3390		(877)634-3390		(877)933-8475		(877)933-8475		(877)634-3390		(877)634-3390		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1463	024	0	1	01	01	H1463_024_0	10	1					1	09/27/2021	2022.01	09/27/2021 08:44:02 AM Central Daylight Time	08/02/2021 11:28:36 PM Central Daylight Time	07/30/2021 02:04:15 PM Central Daylight Time			09/27/2021 12:09:43 PM Central Daylight Time	HEALTH ALLIANCE CONNECT, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Simplete 2 (HMO)	01	01		1			H1463	024	0	2022	Eastern and Central IL; Western IN in contracted		2	24550	2			2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)933-8475		(877)933-8475		(877)634-3390		(877)634-3390		(877)933-8475		(877)933-8475		(877)634-3390		(877)634-3390		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	7a;7b;7d;7g;7j;7k;8a1;8a2;8b1;8b2;8b3;9a1;9b;17a;	
H1463	025	0	1	02	01	H1463_025_0	10	1					1	09/27/2021	2022.01	09/27/2021 10:31:02 AM Central Daylight Time	08/02/2021 11:30:27 PM Central Daylight Time	07/30/2021 02:04:44 PM Central Daylight Time			09/27/2021 12:09:43 PM Central Daylight Time	HEALTH ALLIANCE CONNECT, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Simplete 3 (HMO-POS)	01	02		1			H1463	025	0	2022	Eastern and Central IL; Western IN in contracted		2	26267	2			2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)933-8475		(877)933-8475		(877)634-3390		(877)634-3390		(877)933-8475		(877)933-8475		(877)634-3390		(877)634-3390		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	11	7a;7b;7d;7g;7j;7k;8a1;8a2;8b1;8b2;8b3;9a1;9b;17a;	17a1;
H1463	032	0	1	01	01	H1463_032_0	13	1					1	09/27/2021	2022.01	09/27/2021 08:44:05 AM Central Daylight Time	08/02/2021 11:32:13 PM Central Daylight Time	07/30/2021 02:05:12 PM Central Daylight Time			09/27/2021 12:09:43 PM Central Daylight Time	HEALTH ALLIANCE CONNECT, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Simplete Riverside 1 (HMO)	01	01		1			H1463	032	0	2022	Kankakee and Iroquois Counties		2	4673	2			2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)933-8481		(877)933-8481		(877)642-4753		(877)642-4753		(877)933-8481		(877)933-8481		(877)642-4753		(877)642-4753		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1463	033	0	1	01	01	H1463_033_0	10	1					1	09/27/2021	2022.01	09/27/2021 08:44:06 AM Central Daylight Time	08/02/2021 11:34:01 PM Central Daylight Time	07/30/2021 02:05:41 PM Central Daylight Time			09/27/2021 12:09:43 PM Central Daylight Time	HEALTH ALLIANCE CONNECT, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Simplete Riverside 2 (HMO)	01	01		1			H1463	033	0	2022	Greater Kankakee Area of NE IL/NW IN		2	1398	2			2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)933-8481		(877)933-8481		(877)642-4753		(877)642-4753		(877)933-8481		(877)933-8481		(877)642-4753		(877)642-4753		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	7a;7b;7d;7i;7j;7k;8a1;8a2;8b1;8b2;8b3;9a1;9a2;9b;17a;	
H1463	034	0	1	02	01	H1463_034_0	10	1					1	09/27/2021	2022.01	09/27/2021 10:33:33 AM Central Daylight Time	08/02/2021 11:35:50 PM Central Daylight Time	07/30/2021 02:06:09 PM Central Daylight Time			09/27/2021 12:09:43 PM Central Daylight Time	HEALTH ALLIANCE CONNECT, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Simplete Riverside 3 (HMO-POS)	01	02		1			H1463	034	0	2022	Greater Kankakee Area of NE IL/NW IN		2	1392	2			2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)933-8481		(877)933-8481		(877)642-4753		(877)642-4753		(877)933-8481		(877)933-8481		(877)642-4753		(877)642-4753		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	7a;7b;7c;7d;7g;7i;7j;7k;8a1;8a2;8b1;8b2;8b3;9a1;9a2;9b;9c;17a;	
H1463	035	0	1	01	01	H1463_035_0	10	1					1	09/27/2021	2022.01	09/27/2021 08:44:09 AM Central Daylight Time	08/02/2021 11:37:47 PM Central Daylight Time	07/30/2021 02:06:38 PM Central Daylight Time			09/27/2021 12:09:43 PM Central Daylight Time	HEALTH ALLIANCE CONNECT, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	OSF MedAdvantage Core (HMO)	01	01		1			H1463	035	0	2022	West Central; Northern IL in contracted counties		2	17719	2			2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)933-8480		(877)933-8480		(877)633-2531		(877)633-2531		(877)933-8480		(877)933-8480		(877)633-2531		(877)633-2531		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	3-1;3-2;3-3;3-4;5;7a;7c;7d;7f;7g;7h1;7h2;7i;7j;7k;8a1;8a2;8b1;8b2;8b3;9a1;9a2;9b;9c;17a;17b;	
H1463	036	0	1	02	01	H1463_036_0	11	1					1	09/29/2021	2022.01	09/29/2021 12:00:20 PM Central Daylight Time	08/02/2021 11:39:44 PM Central Daylight Time	07/30/2021 02:07:06 PM Central Daylight Time			09/29/2021 12:45:36 PM Central Daylight Time	HEALTH ALLIANCE CONNECT, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	OSF MedAdvantage Open (HMO-POS)	01	02		1			H1463	036	0	2022	West Central; Northern IL in contracted counties		2	9239	2			2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)933-8480		(877)933-8480		(877)633-2531		(877)633-2531		(877)933-8480		(877)933-8480		(877)633-2531		(877)633-2531		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	3-1;3-2;3-3;3-4;5;7a;7c;7d;7f;7g;7h1;7h2;7i;7j;7k;8a1;8a2;8b1;8b2;8b3;9a1;9a2;9b;9c;11c1;17a;17b;18a;	
H1463	039	0	1	01	01	H1463_039_0	10	1					1	09/27/2021	2022.01	09/27/2021 08:44:13 AM Central Daylight Time	08/02/2021 11:41:36 PM Central Daylight Time	07/30/2021 02:07:35 PM Central Daylight Time			09/27/2021 12:09:43 PM Central Daylight Time	HEALTH ALLIANCE CONNECT, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Simplete Richland 1 (HMO)	01	01		1			H1463	039	0	2022	Southeastern IL and Southwestern IN in contracted		2	3555	2			2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)795-6118		(877)795-6118		(877)561-8307		(877)561-8307		(877)795-6118		(877)795-6118		(877)561-8307		(877)561-8307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1463	040	0	1	02	01	H1463_040_0	11	1					1	09/29/2021	2022.01	09/29/2021 12:01:04 PM Central Daylight Time	08/02/2021 11:43:24 PM Central Daylight Time	07/30/2021 02:08:03 PM Central Daylight Time			09/29/2021 12:45:36 PM Central Daylight Time	HEALTH ALLIANCE CONNECT, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Reid Health Alliance Medicare POS Basic Rx (HMO-POS)	01	02		1			H1463	040	0	2022	East Central Indiana		2	4981	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	041	0	1	01	01	H1463_041_0	11	1					1	09/29/2021	2022.01	09/29/2021 12:03:18 PM Central Daylight Time	08/02/2021 11:45:09 PM Central Daylight Time	07/30/2021 02:08:36 PM Central Daylight Time			09/29/2021 12:45:36 PM Central Daylight Time	HEALTH ALLIANCE CONNECT, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Reid Health Alliance Medicare HMO Basic Rx 2 (HMO)	01	01		1			H1463	041	0	2022	Western OH		2	386	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	042	0	1	02	01	H1463_042_0	12	1					1	09/27/2021	2022.01	09/27/2021 08:45:48 AM Central Daylight Time	08/02/2021 11:47:05 PM Central Daylight Time	07/30/2021 02:09:04 PM Central Daylight Time			09/27/2021 12:09:43 PM Central Daylight Time	HEALTH ALLIANCE CONNECT, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	OSF MedAdvantage Enrich (HMO-POS)	01	02		1			H1463	042	0	2022	West Central; Northern IL contracted counties		2	600	2			2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)933-8480		(877)933-8480		(877)633-2531		(877)633-2531		(877)933-8480		(877)933-8480		(877)633-2531		(877)633-2531		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1463	801	0	1	01	01	H1463_801_0	4	1				0	0	04/20/2021	2022.01	04/20/2021 02:57:57 PM US Eastern Daylight Time					06/06/2021 01:28:52 PM Eastern Daylight Time	HEALTH ALLIANCE CONNECT, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Medicare Employer HMO (HMO)	01	01		1			H1463	801	0	2022	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										(711)-		(711)-		(711)-		(711)-										1	1	1b;2;5;7b;7c;7i;8a;8b1;8b2;9a1;9b;10a;11a;11b;15;	1	2;	1					1				
H1463	802	0	1	01	01	H1463_802_0	4	1						04/20/2021	2022.01	04/20/2021 07:46:48 PM US Eastern Daylight Time					06/06/2021 01:28:52 PM Eastern Daylight Time	HEALTH ALLIANCE CONNECT, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Medicare Employer HMO Rx (HMO)	01	01		1			H1463	802	0	2022	Illinois		1	42554	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	1	1a;1b;2;5;7b;7i;8a;8b1;8b2;9a1;9a2;9b;11a;11b;15;	2		1					1				
H1463	810	0	1	01	01	H1463_810_0	4	1						04/20/2021	2022.01	04/20/2021 03:10:26 PM US Eastern Daylight Time					06/06/2021 01:28:52 PM Eastern Daylight Time	HEALTH ALLIANCE CONNECT, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Medicare Employer HMO Rx  - non calendar year (HMO)	01	01		1			H1463	810	0	2022	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	1	1a;1b;2;7b;7c;7i;8a;8b1;8b2;9a1;9a2;9b;10a;11a;11b;15;	2		1					1				
H1463	811	0	1	02	01	H1463_811_0	4	1				0	0	04/20/2021	2022.01	04/20/2021 03:15:02 PM US Eastern Daylight Time					06/06/2021 01:28:52 PM Eastern Daylight Time	HEALTH ALLIANCE CONNECT, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Medicare Employer HMO-POS (HMO-POS)	01	02		1			H1463	811	0	2022	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										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;7b;7c;7i;8a;8b1;8b2;9a1;9a2;9b;10a;11a;11b;15;	2		1	1	1a;1b;2;5;7b;7c;7i;8a;8b1;8b2;9a1;9a2;10a;11a;11b;15;	2		1				
H1463	812	0	1	02	01	H1463_812_0	4	1						04/20/2021	2022.01	04/20/2021 03:19:57 PM US Eastern Daylight Time					06/06/2021 01:28:52 PM Eastern 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	2022	Illinois		1	5829	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	1	1a;1b;2;5;7b;7c;7i;8a;8b1;8b2;9a1;9a2;9b;10a;11a;11b;15;	2		1	1	1a;1b;2;5;7b;7c;7i;8a;8b1;8b2;9a1;9a2;9b;10a;11a;11b;15;	2		1				
H1463	813	0	1	02	01	H1463_813_0	4	1						04/20/2021	2022.01	04/20/2021 03:24:54 PM US Eastern Daylight Time					06/06/2021 01:28:52 PM Eastern 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	2022	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	1	1a;1b;2;5;7b;7c;7i;8a;8b1;8b2;9a1;9a2;9b;10a;11a;11b;15;	2		1	1	1a;1b;2;5;7b;7c;7i;8a;8b1;8b2;9a1;9a2;9b;10a;11a;11b;15;	2		1				
H1468	007	0	1	01	01	H1468_007_0	5	1			1		1	08/01/2021	2022.01	08/01/2021 12:59:42 PM Eastern Daylight Time	08/03/2021 07:44:23 PM Eastern Daylight Time	07/30/2021 10:29:40 AM Eastern Daylight Time			08/04/2021 06:29:06 PM 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	2022	Peoria and Rockford Illinois Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		1	08/01/2021	2022.01	08/01/2021 01:00:05 PM Eastern Daylight Time	08/03/2021 07:45:25 PM Eastern Daylight Time	07/30/2021 10:29:52 AM Eastern Daylight Time			08/04/2021 06:29:06 PM 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	2022	Cook, DuPage, Lake, and Will counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		1	08/03/2021	2022.01	08/03/2021 10:27:47 AM Eastern Daylight Time	08/03/2021 07:47:11 PM Eastern Daylight Time	07/30/2021 10:30:06 AM Eastern Daylight Time			08/04/2021 06:29:06 PM 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	2022	Kane, Kendall and McHenry counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	1		1	08/01/2021	2022.01	08/01/2021 01:00:19 PM Eastern Daylight Time	08/03/2021 07:50:52 PM Eastern Daylight Time	07/30/2021 10:30:18 AM Eastern Daylight Time			08/04/2021 06:29:06 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	Humana Community HMO Diabetes and Heart (HMO C-SNP)	01	01		1			H1468	017	0	2022	Cook, DuPage and Will counties		2		2			1	4			00000000000000000010		https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	018	0	1	01	01	H1468_018_0	4	1			1		1	08/01/2021	2022.01	08/01/2021 01:00:31 PM Eastern Daylight Time	08/03/2021 08:09:06 PM Eastern Daylight Time	07/30/2021 10:30:30 AM Eastern Daylight Time			08/04/2021 06:29:06 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	Humana Community Select HMO H1468-018 (HMO)	01	01		1			H1468	018	0	2022	Chicago area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	019	0	1	01	01	H1468_019_0	8	1		1	1		0	08/03/2021	2022.01	08/03/2021 10:29:50 AM Eastern Daylight Time	08/03/2021 08:14:55 PM Eastern Daylight Time	07/30/2021 10:30:42 AM Eastern Daylight Time			08/04/2021 06:29:06 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	Humana Together in Health I-SNP (HMO I-SNP)	01	01		1			H1468	019	0	2022	Chicago Area		2		2			1	1	1				https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	020	0	1	01	01	H1468_020_0	5	1		1	2		0	08/03/2021	2022.01	08/03/2021 10:31:20 AM Eastern Daylight Time	08/03/2021 08:16:45 PM Eastern Daylight Time	07/30/2021 10:30:54 AM Eastern Daylight Time			08/04/2021 06:29:06 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	Humana Together in Health IE-SNP (HMO I-SNP)	01	01		1			H1468	020	0	2022	Chicago Area		2		2			1	1	2				https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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						05/25/2021	2022.01	05/25/2021 01:40:54 PM Eastern Daylight Time					06/04/2021 08:33:40 AM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H1468	802	0	2022	Select counties in Peoria Metro area		1	89318	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242		(866)396-8810		(866)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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H1468	803	0	1	01	01	H1468_803_0	1	1				0	0	05/25/2021	2022.01	05/25/2021 01:48:13 PM Eastern Daylight Time					06/04/2021 08:33:40 AM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H1468	803	0	2022	Select counties in Peoria Metro area		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H1468	805	0	1	01	01	H1468_805_0	1	1						05/27/2021	2022.01	05/27/2021 03:19:17 PM Eastern Daylight Time					06/04/2021 08:33:40 AM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H1468	805	0	2022	Select counties in Peoria Metro area		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242		(866)396-8810		(866)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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					2				
H1468	806	0	1	01	01	H1468_806_0	1	1				0	0	05/27/2021	2022.01	05/27/2021 03:21:26 PM Eastern Daylight Time					06/04/2021 08:33:40 AM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H1468	806	0	2022	Select counties in Peoria Metro area		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					2				
H1500	001	0	1	20	08	H1500_001_0	1	1						06/02/2021	2022.01	06/02/2021 01:41:22 PM Eastern Daylight Time		06/02/2021 11:48:51 AM Eastern Daylight Time			06/02/2021 01:44:36 PM Eastern Daylight Time	LIFE ST. JOSEPH OF THE PINES, INC.	LIFE St. Joseph of the Pines	trinityhealthpace.org	LIFE St. Joseph of the Pines (PACE)	08	20		1			H1500	001	0	2022	LIFE St. Joseph of the Pines		2		2			2						Pharmastar.com	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						06/02/2021	2022.01	06/02/2021 01:41:47 PM Eastern Daylight Time		06/02/2021 11:49:14 AM Eastern Daylight Time			06/02/2021 01:44:36 PM Eastern Daylight Time	LIFE ST. JOSEPH OF THE PINES, INC.	LIFE St. Joseph of the Pines	trinityhealthpace.org	LIFE St. Joseph of the Pines (PACE)	08	20		1			H1500	002	0	2022	LIFE St. Joseph of the Pines		2		2			2						Pharmastar.com	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						06/02/2021	2022.01	06/02/2021 01:04:25 PM Eastern Daylight Time		06/02/2021 12:03:06 PM Eastern Daylight Time			06/02/2021 01:06:52 PM Eastern Daylight Time	CATHOLIC HEALTH SYSTEM BUFFALO PACE	Catholic Health LIFE	https://www.chsbuffalo.org/services/pace	CHS Buffalo - Dual (PACE)	08	20		1			H1518	001	0	2022	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						06/02/2021	2022.01	06/02/2021 01:04:57 PM Eastern Daylight Time		06/02/2021 12:03:22 PM Eastern Daylight Time			06/02/2021 01:06:52 PM Eastern Daylight Time	CATHOLIC HEALTH SYSTEM BUFFALO PACE	Catholic Health LIFE	https://www.chsbuffalo.org/services/pace	CHS Buffalo - Medicare only (PACE)	08	20		1			H1518	002	0	2022	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						06/02/2021	2022.01	06/02/2021 08:41:20 AM Eastern Daylight Time		06/01/2021 11:30:43 AM Eastern Daylight Time			06/02/2021 08:44:47 AM Eastern Daylight Time	STAYWELL SENIOR CARE, INC.	StayWell Senior Care	https://www.randolphhealth.org/services/staywell	StayWell Senior Care - Dual Eligible (PACE)	08	20		1			H1533	001	0	2022	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						06/02/2021	2022.01	06/02/2021 08:41:54 AM Eastern Daylight Time		06/01/2021 11:31:12 AM Eastern Daylight Time			06/02/2021 08:44:47 AM Eastern Daylight Time	STAYWELL SENIOR CARE, INC.	StayWell Senior Care	https://www.randolphhealth.org/services/staywell	StayWell Senior Care - Medicare Only (PACE)	08	20		1			H1533	002	0	2022	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	801	0	1	04	01	H1537_801_0	1	1						05/24/2021	2022.01	05/24/2021 10:32:33 AM Central Daylight Time					06/02/2021 12:08:05 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1537	801	0	2022	Nationwide		1	24972	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H1537	802	0	1	04	01	H1537_802_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 09:01:21 AM Central Daylight Time					06/02/2021 12:08:05 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1537	802	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H1537	803	0	1	04	01	H1537_803_0	1	1						05/24/2021	2022.01	05/24/2021 10:35:00 AM Central Daylight Time					06/02/2021 12:08:05 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1537	803	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H1537	804	0	2	04	01	H1537_804_0	1	1						05/24/2021	2022.01	05/24/2021 10:35:29 AM Central Daylight Time					06/02/2021 12:08:05 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H1537	804	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H1537	805	0	2	04	01	H1537_805_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 09:02:57 AM Central Daylight Time					06/02/2021 12:08:05 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H1537	805	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H1537	806	0	2	04	01	H1537_806_0	1	1						05/24/2021	2022.01	05/24/2021 10:36:31 AM Central Daylight Time					06/02/2021 12:08:05 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H1537	806	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H1537	807	0	1	04	01	H1537_807_0	1	1						05/24/2021	2022.01	05/24/2021 10:38:12 AM Central Daylight Time					06/02/2021 12:08:05 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1537	807	0	2022	NY and 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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H1537	808	0	1	04	01	H1537_808_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 09:02:29 AM Central Daylight Time					06/02/2021 12:08:05 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1537	808	0	2022	NY and 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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H1537	809	0	1	04	01	H1537_809_0	1	1						05/24/2021	2022.01	05/24/2021 10:38:55 AM Central Daylight Time					06/02/2021 12:08:05 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1537	809	0	2022	NY and 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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H1537	816	0	1	04	01	H1537_816_0	1	1						05/24/2021	2022.01	05/24/2021 10:39:19 AM Central Daylight Time					06/02/2021 12:08:05 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1537	816	0	2022	NY and 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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H1537	817	0	1	04	01	H1537_817_0	1	1						05/24/2021	2022.01	05/24/2021 10:39:40 AM Central Daylight Time					06/02/2021 12:08:05 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1537	817	0	2022	NY and 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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H1537	823	0	1	04	01	H1537_823_0	1	1						05/24/2021	2022.01	05/24/2021 10:40:01 AM Central Daylight Time					06/02/2021 12:08:05 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1537	823	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H1537	824	0	1	04	01	H1537_824_0	1	1						05/24/2021	2022.01	05/24/2021 11:53:12 AM Central Daylight Time					06/02/2021 12:08:05 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1537	824	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H1537	825	0	1	04	01	H1537_825_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 09:03:28 AM Central Daylight Time					06/02/2021 12:08:05 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1537	825	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H1537	826	0	1	04	01	H1537_826_0	1	1						05/24/2021	2022.01	05/24/2021 11:54:49 AM Central Daylight Time					06/02/2021 12:08:05 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1537	826	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H1537	827	0	2	04	01	H1537_827_0	1	1						05/24/2021	2022.01	05/24/2021 11:55:32 AM Central Daylight Time					06/02/2021 12:08:05 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H1537	827	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H1537	828	0	2	04	01	H1537_828_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 09:03:51 AM Central Daylight Time					06/02/2021 12:08:05 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H1537	828	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H1537	829	0	2	04	01	H1537_829_0	1	1						05/24/2021	2022.01	05/24/2021 11:56:39 AM Central Daylight Time					06/02/2021 12:08:05 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H1537	829	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H1537	830	0	1	04	01	H1537_830_0	1	1						05/24/2021	2022.01	05/24/2021 12:05:41 PM Central Daylight Time					06/02/2021 12:08:05 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1537	830	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H1537	831	0	1	04	01	H1537_831_0	1	1						05/24/2021	2022.01	05/24/2021 12:06:00 PM Central Daylight Time					06/02/2021 12:08:05 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1537	831	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H1537	832	0	1	04	01	H1537_832_0	1	1						05/24/2021	2022.01	05/24/2021 12:06:23 PM Central Daylight Time					06/02/2021 12:08:05 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1537	832	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H1537	833	0	1	04	01	H1537_833_0	1	1						05/24/2021	2022.01	05/24/2021 12:06:54 PM Central Daylight Time					06/02/2021 12:08:05 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1537	833	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H1537	834	0	1	04	01	H1537_834_0	1	1						05/24/2021	2022.01	05/24/2021 12:07:13 PM Central Daylight Time					06/02/2021 12:08:05 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1537	834	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H1537	835	0	2	04	01	H1537_835_0	1	1						05/24/2021	2022.01	05/24/2021 12:07:35 PM Central Daylight Time					06/02/2021 12:08:05 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H1537	835	0	2022	Nationwide		1	288	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H1537	836	0	1	04	01	H1537_836_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 09:04:13 AM Central Daylight Time					06/02/2021 12:08:05 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1537	836	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H1537	837	0	1	04	01	H1537_837_0	1	1						05/24/2021	2022.01	05/24/2021 12:08:58 PM Central Daylight Time					06/02/2021 12:08:05 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1537	837	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H1537	838	0	1	04	01	H1537_838_0	1	1						05/24/2021	2022.01	05/24/2021 12:09:21 PM Central Daylight Time					06/02/2021 12:08:05 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1537	838	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H1537	839	0	1	04	01	H1537_839_0	1	1						05/24/2021	2022.01	05/24/2021 12:09:43 PM Central Daylight Time					06/02/2021 12:08:05 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1537	839	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H1537	840	0	1	04	01	H1537_840_0	1	1						05/24/2021	2022.01	05/24/2021 12:10:05 PM Central Daylight Time					06/02/2021 12:08:05 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1537	840	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H1537	841	0	1	04	01	H1537_841_0	1	1						05/24/2021	2022.01	05/24/2021 12:10:36 PM Central Daylight Time					06/02/2021 12:08:05 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1537	841	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H1537	842	0	1	04	01	H1537_842_0	1	1						05/24/2021	2022.01	05/24/2021 12:11:01 PM Central Daylight Time					06/02/2021 12:08:05 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1537	842	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H1544	001	0	1	20	08	H1544_001_0	1	1						06/01/2021	2022.01	06/01/2021 03:51:46 PM Mountain Daylight Time		06/01/2021 10:04:37 AM Mountain Daylight Time			06/01/2021 03:52:35 PM Mountain Daylight Time	LA COAST PACE, LLC	WelbeHealth Coastline PACE	https://welbehealth.com/coastline/	WelbeHealth Coastline PACE (PACE)	08	20		1			H1544	001	0	2022	Parts of Los Angeles County		2		2			2						TBD	NA												(800)734-8041				(800)734-8041												(800)735-2922				(800)735-2922																
H1544	002	0	1	20	08	H1544_002_0	1	1						06/01/2021	2022.01	06/01/2021 03:51:55 PM Mountain Daylight Time		06/01/2021 10:04:38 AM Mountain Daylight Time			06/01/2021 03:52:35 PM Mountain Daylight Time	LA COAST PACE, LLC	WelbeHealth Coastline PACE	https://welbehealth.com/coastline/	WelbeHealth Coastline PACE (PACE)	08	20		1			H1544	002	0	2022	Parts of Los Angeles County		2		2			2						TBD	NA												(800)734-8041				(800)734-8041												(800)735-2922				(800)735-2922																
H1587	001	0	1	02	01	H1587_001_0	10	1	2	1			0	07/21/2021	2022.01	07/21/2021 09:31:59 AM Central Daylight Time	08/02/2021 08:50:30 AM Central Daylight Time	08/02/2021 08:50:31 AM Central Daylight Time			08/02/2021 08:55:20 AM Central Daylight Time	ARKANSAS SUPERIOR SELECT, INC.	Tribute Health Plans	www.tributebenefits.com	Tribute Advantage (HMO-POS D-SNP)	01	02		1			H1587	001	0	2022	Arkansas		2	3114	2			1	3		1		1	www.tributebenefits.com	www.tributebenefits.com	www.tributebenefits.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	10	1		1			0	07/21/2021	2022.01	07/21/2021 09:33:52 AM Central Daylight Time	08/02/2021 08:50:31 AM Central Daylight Time	08/02/2021 08:50:32 AM Central Daylight Time			08/02/2021 08:55:20 AM Central Daylight Time	ARKANSAS SUPERIOR SELECT, INC.	Tribute Health Plans	www.tributebenefits.com	Tribute Select (HMO-POS I-SNP)	01	02		1			H1587	003	0	2022	Arkansas		2	16050	2			1	1	3				www.tributebenefits.com	www.tributebenefits.com	www.tributebenefits.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					0	08/02/2021	2022.01	08/02/2021 01:35:27 PM Eastern Daylight Time	08/03/2021 06:04:00 PM Eastern Daylight Time	08/03/2021 06:04:00 PM Eastern Daylight Time			08/04/2021 02:28:17 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	2022	Select Counties in Indiana		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(855)558-1438		(855)558-1438		(855)593-0907		(855)593-0907		(833)293-5471		(833)293-5471		(855)948-5578		(855)948-5578		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1607	015	0	1	04	01	H1607_015_0	8	1					0	08/03/2021	2022.01	08/03/2021 02:40:54 PM Eastern Daylight Time	08/03/2021 06:04:00 PM Eastern Daylight Time	08/03/2021 06:04:00 PM Eastern Daylight Time			08/04/2021 02:28:17 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Access Preferred (PPO)	01	04		1			H1607	015	0	2022	Indiana		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(855)558-1438		(855)558-1438		(855)593-0907		(855)593-0907		(833)293-5471		(833)293-5471		(855)948-5578		(855)948-5578		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1607	809	0	1	04	01	H1607_809_0	2	1						06/04/2021	2022.01	06/04/2021 09:03:55 AM Pacific Daylight Time					06/04/2021 09:30:16 AM Pacific Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H1607	809	0	2022	National		1	600	2			2						www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)370-7469		(833)370-7469		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1									
H1607	811	0	1	04	01	H1607_811_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 04:08:32 PM Pacific Daylight Time					06/04/2021 08:16:42 AM Pacific Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H1607	811	0	2022	National		1	600	2			2						www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1									
H1607	812	0	1	04	01	H1607_812_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 04:08:41 PM Pacific Daylight Time					06/04/2021 08:16:42 AM Pacific Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H1607	812	0	2022	National		1	600	2			2						www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1									
H1607	813	0	1	04	01	H1607_813_0	1	1						06/02/2021	2022.01	06/02/2021 04:08:47 PM Pacific Daylight Time					06/04/2021 08:16:42 AM Pacific Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H1607	813	0	2022	National		1	600	2			2						www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)370-7469		(833)370-7469		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1									
H1607	815	0	1	04	01	H1607_815_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 04:08:55 PM Pacific Daylight Time					06/04/2021 08:16:42 AM Pacific Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H1607	815	0	2022	National		1	600	2			2						www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1									
H1607	816	0	1	04	01	H1607_816_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 04:09:02 PM Pacific Daylight Time					06/04/2021 08:16:42 AM Pacific Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H1607	816	0	2022	National		1	600	2			2						www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1									
H1607	817	0	2	04	01	H1607_817_0	1	1						06/02/2021	2022.01	06/02/2021 04:09:10 PM Pacific Daylight Time					06/04/2021 08:16:42 AM Pacific Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		2	1		H1607	817	0	2022	National		1	600	2			2						www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)370-7469		(833)370-7469		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1									
H1607	819	0	2	04	01	H1607_819_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 04:09:16 PM Pacific Daylight Time					06/04/2021 08:16:42 AM Pacific Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		2	1		H1607	819	0	2022	National		1	600	2			2						www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1									
H1607	820	0	2	04	01	H1607_820_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 04:09:23 PM Pacific Daylight Time					06/04/2021 08:16:42 AM Pacific Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		2	1		H1607	820	0	2022	National		1	600	2			2						www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1									
H1608	001	0	1	04	01	H1608_001_0	2	1					0	08/03/2021	2022.01	08/03/2021 08:37:16 AM Central Daylight Time	08/03/2021 01:00:51 PM Central Daylight Time	08/02/2021 08:23:05 AM Central Daylight Time			08/04/2021 01:00:17 PM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (PPO)	01	04		1			H1608	001	0	2022	Partial State of Iowa and South Dakota		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	004	0	1	04	01	H1608_004_0	2	1					0	08/02/2021	2022.01	08/02/2021 03:09:03 PM Central Daylight Time	08/03/2021 01:01:50 PM Central Daylight Time	08/02/2021 08:23:09 AM Central Daylight Time			08/04/2021 01:00:17 PM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime (PPO)	01	04		1			H1608	004	0	2022	Lincoln, McCook, Minnehaha Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	008	0	1	04	01	H1608_008_0	2	1					0	08/02/2021	2022.01	08/02/2021 03:09:26 PM Central Daylight Time	08/03/2021 01:02:48 PM Central Daylight Time	08/02/2021 08:23:13 AM Central Daylight Time			08/04/2021 01:00:17 PM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime (PPO)	01	04		1			H1608	008	0	2022	Ida, Monona, Plymouth, Woodbury Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	012	0	1	04	01	H1608_012_0	2	1					0	06/02/2021	2022.01	06/02/2021 08:15:20 AM Central Daylight Time	08/03/2021 01:03:47 PM Central Daylight Time	08/02/2021 08:23:17 AM Central Daylight Time			08/04/2021 01:00:17 PM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (PPO)	01	04		1			H1608	012	0	2022	Partial State of Nebraska		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	013	0	1	04	01	H1608_013_0	2	1					0	06/02/2021	2022.01	06/02/2021 08:16:43 AM Central Daylight Time	08/03/2021 10:24:37 AM Central Daylight Time	08/02/2021 08:23:21 AM Central Daylight Time			08/04/2021 12:29:03 PM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (PPO)	01	04		1			H1608	013	0	2022	St Louis Metro		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	016	0	1	04	01	H1608_016_0	4	1			2		0	08/02/2021	2022.01	08/02/2021 03:33:51 PM Central Daylight Time	08/04/2021 09:43:44 AM Central Daylight Time	08/02/2021 08:23:26 AM Central Daylight Time			08/04/2021 03:51:37 PM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plus (PPO)	01	04		1			H1608	016	0	2022	KC Metro Kansas & Missouri Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	017	0	1	04	01	H1608_017_0	4	1					0	08/02/2021	2022.01	08/02/2021 03:34:09 PM Central Daylight Time	08/04/2021 09:44:50 AM Central Daylight Time	08/02/2021 08:23:30 AM Central Daylight Time			08/04/2021 03:51:37 PM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plus (PPO)	01	04		1			H1608	017	0	2022	Wichita Metro Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	018	0	1	04	01	H1608_018_0	2	1					0	08/02/2021	2022.01	08/02/2021 03:34:26 PM Central Daylight Time	08/04/2021 09:46:16 AM Central Daylight Time	08/02/2021 08:23:34 AM Central Daylight Time			08/04/2021 03:51:37 PM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plus (PPO)	01	04		1			H1608	018	0	2022	Southwest Missouri, Southeast Kansas		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	021	0	1	04	01	H1608_021_0	2	1					0	08/02/2021	2022.01	08/02/2021 03:34:50 PM Central Daylight Time	08/04/2021 09:47:35 AM Central Daylight Time	08/02/2021 08:23:38 AM Central Daylight Time			08/04/2021 03:51:37 PM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plus (PPO)	01	04		1			H1608	021	0	2022	Northwest Arkansas Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	024	0	1	04	01	H1608_024_0	2	1					0	08/02/2021	2022.01	08/02/2021 03:35:07 PM Central Daylight Time	08/04/2021 09:48:43 AM Central Daylight Time	08/02/2021 08:23:42 AM Central Daylight Time			08/04/2021 03:51:37 PM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plus 2 (PPO)	01	04		1			H1608	024	0	2022	Northeast Topeka Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	026	0	1	04	01	H1608_026_0	3	1			2		1	07/14/2021	2022.01	07/14/2021 11:06:13 AM Eastern Daylight Time	08/02/2021 06:08:35 PM Eastern Daylight Time	08/02/2021 09:23:46 AM Eastern Daylight Time			08/04/2021 12:08:11 PM Eastern Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Gold (PPO)	01	04		1			H1608	026	0	2022	Northern West Virginia		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	027	0	1	04	01	H1608_027_0	3	1			1		1	07/14/2021	2022.01	07/14/2021 11:06:48 AM Eastern Daylight Time	08/02/2021 05:17:27 PM Eastern Daylight Time	08/02/2021 09:23:50 AM Eastern Daylight Time			08/04/2021 12:08:11 PM Eastern Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Gold (PPO)	01	04		1			H1608	027	0	2022	Southern West Virginia		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	028	0	1	04	01	H1608_028_0	5	1					0	08/02/2021	2022.01	08/02/2021 12:32:05 PM Central Daylight Time	08/03/2021 10:34:53 AM Eastern Daylight Time	08/02/2021 09:23:55 AM Eastern Daylight Time			08/04/2021 04:19:54 PM Eastern Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Preferred Plan (PPO)	01	04		1			H1608	028	0	2022	Select Counties in Atlanta and Savannah Markets		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	029	0	1	04	01	H1608_029_0	3	1			2		0	08/02/2021	2022.01	08/02/2021 03:39:59 PM Eastern Daylight Time	08/03/2021 12:39:43 PM Eastern Daylight Time	08/02/2021 09:23:59 AM Eastern Daylight Time			08/04/2021 12:08:11 PM Eastern Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Silver (PPO)	01	04		1			H1608	029	0	2022	Northeastern and Youngstown Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	031	0	1	04	01	H1608_031_0	2	1			2		0	05/28/2021	2022.01	05/28/2021 10:02:54 AM Eastern Daylight Time	08/02/2021 05:18:18 PM Eastern Daylight Time	08/02/2021 09:24:03 AM Eastern Daylight Time			08/04/2021 12:08:11 PM Eastern Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Credit Value (PPO)	01	04		1			H1608	031	0	2022	West Virginia		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	035	0	1	04	01	H1608_035_0	3	1					0	06/01/2021	2022.01	06/01/2021 03:29:40 PM Central Daylight Time	08/03/2021 10:25:59 AM Central Daylight Time	08/02/2021 08:24:07 AM Central Daylight Time			08/04/2021 02:23:44 PM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (PPO)	01	04		1			H1608	035	0	2022	Hannibal Missouri		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	037	0	1	04	01	H1608_037_0	2	1					0	08/02/2021	2022.01	08/02/2021 03:11:20 PM Central Daylight Time	08/03/2021 01:04:47 PM Central Daylight Time	08/02/2021 08:24:11 AM Central Daylight Time			08/04/2021 01:00:17 PM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite (PPO)	01	04		1			H1608	037	0	2022	Partial State of Iowa		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	038	0	1	04	01	H1608_038_0	2	1					0	08/02/2021	2022.01	08/02/2021 03:11:38 PM Central Daylight Time	08/03/2021 01:05:49 PM Central Daylight Time	08/02/2021 08:24:15 AM Central Daylight Time			08/04/2021 01:00:17 PM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite (PPO)	01	04		1			H1608	038	0	2022	Partial State of Nebraska		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	039	0	1	04	01	H1608_039_0	2	1					0	08/02/2021	2022.01	08/02/2021 03:35:34 PM Central Daylight Time	08/04/2021 09:49:56 AM Central Daylight Time	08/02/2021 08:24:20 AM Central Daylight Time			08/04/2021 03:51:37 PM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite (PPO)	01	04		1			H1608	039	0	2022	Western Missouri and Eastern Kansas		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	040	0	1	04	01	H1608_040_0	2	1			2		0	08/02/2021	2022.01	08/02/2021 12:39:00 PM Eastern Daylight Time	08/02/2021 05:19:08 PM Eastern Daylight Time	08/02/2021 09:24:24 AM Eastern Daylight Time			08/04/2021 12:08:11 PM Eastern Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Value (PPO)	01	04		1			H1608	040	0	2022	Southern West Virginia		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	041	0	1	04	01	H1608_041_0	2	1			2		0	08/02/2021	2022.01	08/02/2021 12:39:46 PM Eastern Daylight Time	08/02/2021 05:19:55 PM Eastern Daylight Time	08/02/2021 09:24:28 AM Eastern Daylight Time			08/04/2021 12:08:11 PM Eastern Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Value (PPO)	01	04		1			H1608	041	0	2022	Northern West Virginia		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	043	0	1	04	01	H1608_043_0	2	1					0	08/02/2021	2022.01	08/02/2021 03:11:59 PM Central Daylight Time	08/03/2021 01:06:49 PM Central Daylight Time	08/02/2021 08:24:32 AM Central Daylight Time			08/04/2021 01:00:17 PM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite (PPO)	01	04		1			H1608	043	0	2022	Partial State of South Dakota		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	047	0	1	04	01	H1608_047_0	2	1					0	08/02/2021	2022.01	08/02/2021 03:35:53 PM Central Daylight Time	08/04/2021 09:51:58 AM Central Daylight Time	08/02/2021 08:24:36 AM Central Daylight Time			08/04/2021 03:51:37 PM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite (PPO)	01	04		1			H1608	047	0	2022	Southwest Missouri, Southeast Kansas		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	048	0	1	04	01	H1608_048_0	3	1					0	08/04/2021	2022.01	08/04/2021 01:44:52 PM Central Daylight Time	08/03/2021 01:07:59 PM Central Daylight Time	08/02/2021 08:24:40 AM Central Daylight Time			08/04/2021 03:10:46 PM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plus (PPO)	01	04		1			H1608	048	0	2022	Central Iowa		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	050	0	1	04	01	H1608_050_0	2	1			2		0	08/02/2021	2022.01	08/02/2021 02:37:10 PM Central Daylight Time	08/03/2021 10:40:07 AM Central Daylight Time	08/02/2021 08:24:44 AM Central Daylight Time			08/04/2021 12:29:03 PM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite (PPO)	01	04		1			H1608	050	0	2022	St Louis Metro		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	051	0	1	04	01	H1608_051_0	2	1					0	08/02/2021	2022.01	08/02/2021 02:41:34 PM Central Daylight Time	08/03/2021 10:41:28 AM Central Daylight Time	08/02/2021 08:24:48 AM Central Daylight Time			08/04/2021 12:29:03 PM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plus (PPO)	01	04		1			H1608	051	0	2022	Cape Girardeau MO		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	052	0	1	04	01	H1608_052_0	2	1					0	08/02/2021	2022.01	08/02/2021 03:36:19 PM Central Daylight Time	08/04/2021 09:53:22 AM Central Daylight Time	08/02/2021 08:24:52 AM Central Daylight Time			08/04/2021 03:51:37 PM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite (PPO)	01	04		1			H1608	052	0	2022	Northwest Missouri		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	053	0	1	04	01	H1608_053_0	2	1					0	08/02/2021	2022.01	08/02/2021 03:36:42 PM Central Daylight Time	08/04/2021 09:57:16 AM Central Daylight Time	08/02/2021 08:24:57 AM Central Daylight Time			08/04/2021 03:51:37 PM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite (PPO)	01	04		1			H1608	053	0	2022	Wichita Metro		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	054	0	1	04	01	H1608_054_0	2	1					0	08/02/2021	2022.01	08/02/2021 03:37:06 PM Central Daylight Time	08/04/2021 09:58:40 AM Central Daylight Time	08/02/2021 08:25:01 AM Central Daylight Time			08/04/2021 03:51:37 PM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite (PPO)	01	04		1			H1608	054	0	2022	Northwest Arkansas		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	056	0	1	04	01	H1608_056_0	4	1					0	08/02/2021	2022.01	08/02/2021 02:42:07 PM Central Daylight Time	08/03/2021 10:42:56 AM Central Daylight Time	08/02/2021 08:25:05 AM Central Daylight Time			08/04/2021 12:29:03 PM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plus (PPO)	01	04		1			H1608	056	0	2022	Southwest Illinois		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	059	0	1	04	01	H1608_059_0	2	1					0	08/02/2021	2022.01	08/02/2021 03:37:30 PM Central Daylight Time	08/04/2021 10:00:29 AM Central Daylight Time	08/02/2021 08:25:09 AM Central Daylight Time			08/04/2021 03:51:37 PM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite (PPO)	01	04		1			H1608	059	0	2022	Topeka and Surrounding Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	060	0	1	04	01	H1608_060_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 08:33:18 AM Central Daylight Time	06/01/2021 04:29:55 PM Central Daylight Time				06/03/2021 12:08:41 PM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Eagle (PPO)	01	04		1			H1608	060	0	2022	St Louis Metro Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										2					2						2			
H1608	061	0	1	04	01	H1608_061_0	4	1			2	0	0	07/14/2021	2022.01	07/14/2021 03:01:22 PM Central Daylight Time	06/01/2021 03:51:10 PM Central Daylight Time				07/14/2021 03:40:05 PM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Eagle (PPO)	01	04		1			H1608	061	0	2022	Partial State of South Dakota		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031										(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031										2					2						2			
H1608	801	0	1	04	01	H1608_801_0	2	1				0	0	05/27/2021	2022.01	05/27/2021 05:04:49 PM Eastern Daylight Time					06/03/2021 12:38:53 PM Eastern Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (PPO)	01	04		1			H1608	801	0	2022	Multi-State		1	15570	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H1608	802	0	1	04	01	H1608_802_0	1	1						05/27/2021	2022.01	05/27/2021 05:06:12 PM Eastern Daylight Time					06/03/2021 12:38:53 PM Eastern Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan w/Rx (PPO)	01	04		1			H1608	802	0	2022	Multi-Plan		1	1910	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H1609	001	0	1	02	01	H1609_001_0	2	1			2		0	08/02/2021	2022.01	08/02/2021 03:12:45 PM Central Daylight Time	08/03/2021 01:10:13 PM Central Daylight Time	08/02/2021 08:25:13 AM Central Daylight Time			08/04/2021 01:00:17 PM Central Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (HMO-POS)	01	02		1			H1609	001	0	2022	Partial State of Iowa		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	009	0	1	02	01	H1609_009_0	2	1			2		0	08/02/2021	2022.01	08/02/2021 03:13:04 PM Central Daylight Time	08/03/2021 01:11:12 PM Central Daylight Time	08/02/2021 08:25:17 AM Central Daylight Time			08/04/2021 01:00:17 PM Central Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime (HMO-POS)	01	02		1			H1609	009	0	2022	Dallas, Polk, Warren Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	016	0	1	01	01	H1609_016_0	4	1			2		1	06/02/2021	2022.01	06/02/2021 04:41:26 PM Eastern Daylight Time	08/03/2021 08:44:55 AM Eastern Daylight Time	08/02/2021 09:25:21 AM Eastern Daylight Time			08/05/2021 09:47:25 AM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select (HMO)	01	01		1			H1609	016	0	2022	South FL		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	017	0	1	01	01	H1609_017_0	5	1	2	1	1		0	08/02/2021	2022.01	08/02/2021 01:45:55 PM Eastern Daylight Time	08/03/2021 08:46:28 AM Eastern Daylight Time	08/02/2021 09:25:26 AM Eastern Daylight Time			08/04/2021 01:18:39 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Assure (HMO D-SNP)	01	01		1			H1609	017	0	2022	South FL		2		2			1	3		2		2	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	018	0	1	01	01	H1609_018_0	3	1			2		1	08/02/2021	2022.01	08/02/2021 01:47:52 PM Eastern Daylight Time	08/03/2021 08:47:45 AM Eastern Daylight Time	08/02/2021 09:25:30 AM Eastern Daylight Time			08/04/2021 01:18:39 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select (HMO)	01	01		1			H1609	018	0	2022	South FL		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	019	0	1	01	01	H1609_019_0	4	1	2	1	1		0	07/08/2021	2022.01	07/08/2021 10:19:52 AM Eastern Daylight Time	08/03/2021 08:48:59 AM Eastern Daylight Time	08/02/2021 09:25:34 AM Eastern Daylight Time			08/04/2021 01:18:39 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Assure (HMO D-SNP)	01	01		1			H1609	019	0	2022	South FL, Treasure Coast FL, West FL		2		2			1	3		2		2	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	020	0	1	01	01	H1609_020_0	3	1			2		1	08/02/2021	2022.01	08/02/2021 01:54:48 PM Eastern Daylight Time	08/03/2021 08:52:01 AM Eastern Daylight Time	08/02/2021 09:25:38 AM Eastern Daylight Time			08/04/2021 01:18:39 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select (HMO)	01	01		1			H1609	020	0	2022	South FL		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	021	0	1	01	01	H1609_021_0	3	1			2		1	08/02/2021	2022.01	08/02/2021 01:55:40 PM Eastern Daylight Time	08/03/2021 08:55:58 AM Eastern Daylight Time	08/02/2021 09:25:42 AM Eastern Daylight Time			08/04/2021 01:18:39 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select (HMO)	01	01		1			H1609	021	0	2022	North FL, Treasure Coast FL		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	022	0	1	01	01	H1609_022_0	3	1			2		1	08/02/2021	2022.01	08/02/2021 01:57:37 PM Eastern Daylight Time	08/03/2021 08:59:16 AM Eastern Daylight Time	08/02/2021 09:25:46 AM Eastern Daylight Time			08/04/2021 01:18:39 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select (HMO)	01	01		1			H1609	022	0	2022	West FL		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	023	0	1	01	01	H1609_023_0	4	1	2	1	1		0	07/08/2021	2022.01	07/08/2021 10:20:09 AM Eastern Daylight Time	08/03/2021 10:13:57 AM Eastern Daylight Time	08/02/2021 09:25:51 AM Eastern Daylight Time			08/04/2021 01:18:39 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Assure (HMO D-SNP)	01	01		1			H1609	023	0	2022	Central FL		2		2			1	3		2		2	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	025	0	1	01	01	H1609_025_0	3	1			2		1	08/02/2021	2022.01	08/02/2021 01:59:09 PM Eastern Daylight Time	08/03/2021 10:16:21 AM Eastern Daylight Time	08/02/2021 09:25:55 AM Eastern Daylight Time			08/04/2021 01:18:39 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select (HMO)	01	01		1			H1609	025	0	2022	Southwest FL		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	026	0	1	01	01	H1609_026_0	3	1			2		0	08/02/2021	2022.01	08/02/2021 02:00:12 PM Eastern Daylight Time	08/03/2021 10:17:44 AM Eastern Daylight Time	08/02/2021 09:25:59 AM Eastern Daylight Time			08/04/2021 01:18:39 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value (HMO)	01	01		1			H1609	026	0	2022	Southwest FL		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	027	0	1	01	01	H1609_027_0	3	1			2		1	08/02/2021	2022.01	08/02/2021 02:01:45 PM Eastern Daylight Time	08/03/2021 10:20:33 AM Eastern Daylight Time	08/02/2021 09:26:03 AM Eastern Daylight Time			08/04/2021 01:18:39 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select (HMO)	01	01		1			H1609	027	0	2022	Southwest FL		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	028	0	1	02	01	H1609_028_0	3	1			2		0	08/02/2021	2022.01	08/02/2021 02:02:50 PM Eastern Daylight Time	08/03/2021 10:25:47 AM Eastern Daylight Time	08/02/2021 09:26:07 AM Eastern Daylight Time			08/04/2021 01:18:39 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice (HMO-POS)	01	02		1			H1609	028	0	2022	North, Central, West, SW, Treasure Coast, South FL		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	034	0	1	01	01	H1609_034_0	4	1			2		1	06/01/2021	2022.01	06/01/2021 07:31:15 PM Eastern Daylight Time	08/03/2021 10:29:21 AM Eastern Daylight Time	08/02/2021 09:26:11 AM Eastern Daylight Time			08/05/2021 09:47:25 AM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select (HMO)	01	01		1			H1609	034	0	2022	West FL, Treasure Coast FL		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	035	0	1	01	01	H1609_035_0	3	1			2		0	08/02/2021	2022.01	08/02/2021 02:04:19 PM Eastern Daylight Time	08/03/2021 10:37:31 AM Eastern Daylight Time	08/02/2021 09:26:16 AM Eastern Daylight Time			08/04/2021 01:18:39 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select (HMO)	01	01		1			H1609	035	0	2022	Southwest FL		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	037	0	1	01	01	H1609_037_0	3	1			2		0	08/02/2021	2022.01	08/02/2021 02:05:25 PM Eastern Daylight Time	08/03/2021 10:40:04 AM Eastern Daylight Time	08/02/2021 09:26:20 AM Eastern Daylight Time			08/04/2021 01:18:39 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select (HMO)	01	01		1			H1609	037	0	2022	Central FL		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	038	0	1	01	01	H1609_038_0	3	1			2		0	08/02/2021	2022.01	08/02/2021 02:08:56 PM Eastern Daylight Time	08/03/2021 10:41:11 AM Eastern Daylight Time	08/02/2021 09:26:24 AM Eastern Daylight Time			08/04/2021 01:18:39 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select (HMO)	01	01		1			H1609	038	0	2022	West FL		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	039	0	1	01	01	H1609_039_0	4	1	2	1	1		0	07/08/2021	2022.01	07/08/2021 10:20:25 AM Eastern Daylight Time	08/03/2021 10:42:31 AM Eastern Daylight Time	08/02/2021 09:26:28 AM Eastern Daylight Time			08/04/2021 01:18:39 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Assure (HMO D-SNP)	01	01		1			H1609	039	0	2022	North FL		2		2			1	3		2		2	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	040	0	1	01	01	H1609_040_0	4	1	2	1	1		0	07/08/2021	2022.01	07/08/2021 10:20:40 AM Eastern Daylight Time	08/03/2021 11:02:55 AM Eastern Daylight Time	08/02/2021 09:26:32 AM Eastern Daylight Time			08/04/2021 01:18:39 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Assure (HMO D-SNP)	01	01		1			H1609	040	0	2022	Southwest FL		2		2			1	3		2		2	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	041	0	1	01	01	H1609_041_0	3	1			2		0	08/02/2021	2022.01	08/02/2021 02:10:07 PM Eastern Daylight Time	08/03/2021 11:05:13 AM Eastern Daylight Time	08/02/2021 09:26:36 AM Eastern Daylight Time			08/04/2021 01:18:39 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select (HMO)	01	01		1			H1609	041	0	2022	Panhandle/Northwest FL		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	042	0	1	01	01	H1609_042_0	3	1			2		1	08/02/2021	2022.01	08/02/2021 02:55:16 PM Eastern Daylight Time	08/03/2021 11:12:27 AM Eastern Daylight Time	08/02/2021 09:26:41 AM Eastern Daylight Time			08/04/2021 01:18:39 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select (HMO)	01	01		1			H1609	042	0	2022	Central FL		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	043	0	1	01	01	H1609_043_0	4	1	2	1	1		0	07/08/2021	2022.01	07/08/2021 10:20:57 AM Eastern Daylight Time	08/03/2021 11:15:28 AM Eastern Daylight Time	08/02/2021 09:26:45 AM Eastern Daylight Time			08/04/2021 01:18:39 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Assure Plus (HMO D-SNP)	01	01		1			H1609	043	0	2022	South FL		2		2			1	3		1		1	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	044	0	1	01	01	H1609_044_0	4	1	2	1	1		0	07/08/2021	2022.01	07/08/2021 10:21:14 AM Eastern Daylight Time	08/03/2021 11:22:35 AM Eastern Daylight Time	08/02/2021 09:26:49 AM Eastern Daylight Time			08/04/2021 01:18:39 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Assure Plus (HMO D-SNP)	01	01		1			H1609	044	0	2022	West FL		2		2			1	3		1		1	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	045	0	1	01	01	H1609_045_0	4	1	2	1	1		0	07/08/2021	2022.01	07/08/2021 10:21:29 AM Eastern Daylight Time	08/03/2021 01:40:33 PM Eastern Daylight Time	08/02/2021 09:26:53 AM Eastern Daylight Time			08/04/2021 01:18:39 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Assure Plus (HMO D-SNP)	01	01		1			H1609	045	0	2022	North FL, Treasure Coast FL		2		2			1	3		1		1	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	046	0	1	01	01	H1609_046_0	4	1	2	1	1		0	07/08/2021	2022.01	07/08/2021 10:21:45 AM Eastern Daylight Time	08/03/2021 11:24:19 AM Eastern Daylight Time	08/02/2021 09:26:57 AM Eastern Daylight Time			08/04/2021 01:18:39 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Assure Plus (HMO D-SNP)	01	01		1			H1609	046	0	2022	Central FL		2		2			1	3		1		1	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	047	0	1	01	01	H1609_047_0	4	1	2	1	1		0	07/08/2021	2022.01	07/08/2021 10:22:01 AM Eastern Daylight Time	08/03/2021 11:26:22 AM Eastern Daylight Time	08/02/2021 09:27:02 AM Eastern Daylight Time			08/04/2021 01:18:39 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Assure Plus (HMO D-SNP)	01	01		1			H1609	047	0	2022	Southwest FL		2		2			1	3		1		1	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	048	0	1	01	01	H1609_048_0	6	1	2	1	1		0	07/19/2021	2022.01	07/19/2021 05:55:27 PM Eastern Daylight Time	08/03/2021 11:29:40 AM Eastern Daylight Time	08/02/2021 09:27:06 AM Eastern Daylight Time			08/04/2021 01:18:39 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Assure Plus (HMO D-SNP)	01	01		1			H1609	048	0	2022	Palm Beach		2		2			1	3		1		1	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	049	0	1	01	01	H1609_049_0	4	1	2	1	1		0	07/08/2021	2022.01	07/08/2021 10:22:33 AM Eastern Daylight Time	08/03/2021 01:36:23 PM Eastern Daylight Time	08/02/2021 09:27:10 AM Eastern Daylight Time			08/04/2021 01:18:39 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Assure Plus (HMO D-SNP)	01	01		1			H1609	049	0	2022	West FL		2		2			1	3		1		1	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	052	0	1	01	01	H1609_052_0	3	1			2	0	0	06/01/2021	2022.01	06/01/2021 07:37:14 PM Eastern Daylight Time	07/27/2021 12:54:48 PM Eastern Daylight Time				07/27/2021 04:13:46 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Eagle (HMO)	01	01		1			H1609	052	0	2022	Panhandle/Northwest FL		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H1609	053	0	1	01	01	H1609_053_0	3	1					0	08/02/2021	2022.01	08/02/2021 02:58:41 PM Eastern Daylight Time	08/03/2021 11:32:39 AM Eastern Daylight Time	08/02/2021 09:27:14 AM Eastern Daylight Time			08/04/2021 01:18:39 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Credit (HMO)	01	01		1			H1609	053	0	2022	South FL		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	054	0	1	01	01	H1609_054_0	4	1	2	1	1		0	07/08/2021	2022.01	07/08/2021 10:22:48 AM Eastern Daylight Time	08/03/2021 11:33:51 AM Eastern Daylight Time	08/02/2021 09:27:19 AM Eastern Daylight Time			08/04/2021 01:18:39 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Assure (HMO D-SNP)	01	01		1			H1609	054	0	2022	North FL, Central FL		2		2			1	3		2		2	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	055	0	1	01	01	H1609_055_0	4	1	2	1	1		0	07/08/2021	2022.01	07/08/2021 10:23:04 AM Eastern Daylight Time	08/03/2021 11:44:29 AM Eastern Daylight Time	08/02/2021 09:27:23 AM Eastern Daylight Time			08/04/2021 01:18:39 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Assure Plus (HMO D-SNP)	01	01		1			H1609	055	0	2022	North FL, Central FL		2		2			1	3		1		1	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	056	0	1	01	01	H1609_056_0	4	1	2	1	1		0	07/08/2021	2022.01	07/08/2021 10:23:19 AM Eastern Daylight Time	08/03/2021 11:48:59 AM Eastern Daylight Time	08/02/2021 09:27:27 AM Eastern Daylight Time			08/04/2021 01:18:39 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Assure Plus (HMO D-SNP)	01	01		1			H1609	056	0	2022	Southwest FL		2		2			1	3		1		1	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	057	0	1	01	01	H1609_057_0	4	1	2	1	1		0	07/08/2021	2022.01	07/08/2021 10:23:41 AM Eastern Daylight Time	08/03/2021 11:52:05 AM Eastern Daylight Time	08/02/2021 09:27:31 AM Eastern Daylight Time			08/04/2021 01:18:39 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Assure (HMO D-SNP)	01	01		1			H1609	057	0	2022	Southwest FL		2		2			1	3		2		2	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	058	0	1	02	01	H1609_058_0	1	1			2	0	0	06/02/2021	2022.01	06/02/2021 08:33:18 AM Central Daylight Time	06/01/2021 03:54:08 PM Central Daylight Time				06/03/2021 11:27:39 AM Central Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Eagle (HMO-POS)	01	02		1			H1609	058	0	2022	Partial State of Iowa		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031										(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031										2					2					2	2			
H1609	059	0	1	01	01	H1609_059_0	3	1			2		0	08/02/2021	2022.01	08/02/2021 03:02:29 PM Eastern Daylight Time	08/03/2021 11:54:58 AM Eastern Daylight Time	08/02/2021 09:27:35 AM Eastern Daylight Time			08/04/2021 01:18:39 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select (HMO)	01	01		1			H1609	059	0	2022	North FL, Central FL		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	060	0	1	01	01	H1609_060_0	3	1			2		0	08/02/2021	2022.01	08/02/2021 03:03:40 PM Eastern Daylight Time	08/03/2021 11:56:20 AM Eastern Daylight Time	08/02/2021 09:27:39 AM Eastern Daylight Time			08/04/2021 01:18:39 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Credit (HMO)	01	01		1			H1609	060	0	2022	West FL		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	801	0	1	01	01	H1609_801_0	1	1				0	0	05/27/2021	2022.01	05/27/2021 03:00:04 PM Eastern Daylight Time					06/03/2021 12:42:10 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (HMO)	01	01		1			H1609	801	0	2022	Florida		1	120	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H1609	807	0	1	01	01	H1609_807_0	1	1						05/27/2021	2022.01	05/27/2021 02:53:47 PM Eastern Daylight Time					06/03/2021 12:42:10 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare w/Rx Plan (HMO)	01	01		1			H1609	807	0	2022	Florida		1	1180	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H1610	001	0	1	01	01	H1610_001_0	2	1	2	1			0	06/02/2021	2022.01	06/02/2021 11:22:27 AM Eastern Daylight Time	08/03/2021 11:50:57 AM Central Daylight Time	08/02/2021 08:27:43 AM Central Daylight Time			08/04/2021 02:07:30 PM Central Daylight Time	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Aetna Better Health of Virginia	www.aetnabetterhealth.com/virginia-hmosnp	Aetna Better Health of Virginia (HMO D-SNP)	01	01		1			H1610	001	0	2022	Virginia		2		2			1	3		1		1	www.aetnabetterhealth.com/virginia-hmosnp/find-provider	www.aetnabetterhealth.com/Virginia-hmosnp/formulary	www.aetnabetterhealth.com/virginia-hmosnp/find-provider	(855)463-0933		(855)463-0933		(833)859-6031		(833)859-6031		(855)463-0933		(855)463-0933		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1610	002	0	1	01	01	H1610_002_0	2	1	2	1			0	06/02/2021	2022.01	06/02/2021 11:22:41 AM Eastern Daylight Time	08/03/2021 11:56:06 AM Central Daylight Time	08/02/2021 08:27:47 AM Central Daylight Time			08/04/2021 02:07:30 PM Central Daylight Time	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Aetna Better Health of Virginia	www.aetnabetterhealth.com/virginia-hmosnp	Aetna Medicare Assure Premier (HMO D-SNP)	01	01		1			H1610	002	0	2022	Virginia		2		2			1	3		1		1	https://www.aetnabetterhealth.com/virginia-hmosnp/find-provider	www.aetnabetterhealth.com/virginia-hmosnp/formulary	https://www.aetnabetterhealth.com/virginia-hmosnp/find-provider	(855)463-0933		(855)463-0933		(833)859-6031		(833)859-6031		(855)463-0933		(855)463-0933		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1610	003	0	1	01	01	H1610_003_0	3	1	2	1			0	06/02/2021	2022.01	06/02/2021 11:22:56 AM Eastern Daylight Time	08/03/2021 12:12:32 PM Central Daylight Time	08/02/2021 08:27:52 AM Central Daylight Time			08/04/2021 02:07:30 PM Central Daylight Time	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Aetna Better Health of Virginia	www.aetnabetterhealth.com/virginia-hmosnp	Aetna Medicare Assure Value (HMO D-SNP)	01	01		1			H1610	003	0	2022	Virginia		2		2			1	3		1		1	https://www.aetnabetterhealth.com/virginia-hmosnp/find-provider	www.aetnabetterhealth.com/virginia-hmosnp/formulary	https://www.aetnabetterhealth.com/virginia-hmosnp/find-provider	(855)463-0933		(855)463-0933		(833)859-6031		(833)859-6031		(855)463-0933		(855)463-0933		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1622	001	0	1	20	08	H1622_001_0	1	1						05/28/2021	2022.01	05/28/2021 06:00:44 PM Pacific Daylight Time		05/28/2021 05:49:43 PM Pacific Daylight Time			05/28/2021 06:08:25 PM Pacific Daylight Time	NORTH EAST MEDICAL SERVICES	North East Medical Services	https://www.nems.org/index.html	NEMS PACE (PACE)	08	20		1			H1622	001	0	2022	San Francisco County		2		2			2						N/A	N/A										(800)508-4578		(415)352-5050		(800)508-4578		(415)352-5050												(415)213-1973				(415)213-1973																
H1622	003	0	1	20	08	H1622_003_0	1	1						05/28/2021	2022.01	05/28/2021 06:01:35 PM Pacific Daylight Time		05/28/2021 05:51:06 PM Pacific Daylight Time			05/28/2021 06:08:25 PM Pacific Daylight Time	NORTH EAST MEDICAL SERVICES	North East Medical Services	https://www.nems.org/index.html	NEMS PACE  Medicare Only (PACE)	08	20		1			H1622	003	0	2022	San Francisco County		2		2			2						N/A	N/A												(415)352-5050				(415)352-5050												(415)213-1973				(415)213-1973																
H1644	001	0	1	01	01	H1644_001_0	4	1		1			0	08/04/2021	2022.01	08/04/2021 09:42:32 AM Central Daylight Time	08/03/2021 06:44:35 PM Central Daylight Time	08/04/2021 12:05:38 AM Central Daylight Time			08/05/2021 10:08:57 AM Central Daylight Time	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Longevity Health Plan	www.longevityhealthplan.com	Longevity Health Plan (HMO I-SNP)	01	01		1			H1644	001	0	2022	Florida (partial)		2		2			1	1	1				www.longevityhealthplan.com	www.longevityhealthplan.com	www.longevityhealthplan.com	(866)224-9499		(866)224-9499		(866)224-9499		(866)224-9499		(866)224-9499		(866)224-9499		(866)224-9499		(866)224-9499		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1651	001	0	1	18	06	H1651_001_0	1	2				0	0	06/03/2021	2022.01	06/03/2021 02:02:25 PM Central Daylight Time					06/04/2021 09:25:35 AM Central Daylight Time	MEDICAL ASSOCIATES HEALTH PLAN, INC.	Medical Associates Health Plan, Inc.	www.mahealthplans.com	Medical Associates SmartPlan (Cost)	06	18		1			H1651	001	0	2022	Dubuque, Clayton, Delaware, Jackson,Jones Counties		2	77184	2			2								www.mahealthplans.com	(866)821-1365		(563)556-8070		(866)821-1365		(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				0	0	06/04/2021	2022.01	06/04/2021 08:48:22 AM Central Daylight Time					06/04/2021 09:25:35 AM Central Daylight Time	MEDICAL ASSOCIATES HEALTH PLAN, INC.	Medical Associates Health Plan, Inc.	www.mahealthplans.com	Medical Associates Basic Plan (Cost)	06	18		1			H1651	002	0	2022	Dubuque, Clayton, Delaware, Jackson,Jones Counties		2	24	2			2								www.mahealthplans.com	(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				0	0	06/03/2021	2022.01	06/03/2021 02:18:10 PM Central Daylight Time					06/04/2021 09:25:35 AM Central Daylight Time	MEDICAL ASSOCIATES HEALTH PLAN, INC.	Medical Associates Health Plan, Inc.	www.mahealthplans.com	Medical Associates SmartPlan (Cost)	06	18		1			H1651	003	0	2022	JoDaviess County		2	15000	2			2								www.mahealthplans.com	(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				0	0	06/03/2021	2022.01	06/03/2021 02:25:48 PM Central Daylight Time					06/04/2021 09:25:35 AM Central Daylight Time	MEDICAL ASSOCIATES HEALTH PLAN, INC.	Medical Associates Health Plan, Inc.	www.mahealthplans.com	Medical Associates Community Plan (Cost)	06	18		1			H1651	004	0	2022	Dubuque, Clayton, Delaware, Jackson,Jones Counties		2	44400	2			2								www.mahealthplans.com	(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				0	0	06/03/2021	2022.01	06/03/2021 02:25:12 PM Central Daylight Time					06/04/2021 09:25:35 AM Central Daylight Time	MEDICAL ASSOCIATES HEALTH PLAN, INC.	Medical Associates Health Plan, Inc.	www.mahealthplans.com	Medical Associates Community Plan (Cost)	06	18		1			H1651	005	0	2022	JoDaviess County		2	6600	2			2								www.mahealthplans.com	(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				0	0	06/03/2021	2022.01	06/03/2021 02:34:11 PM Central Daylight Time					06/04/2021 09:25:35 AM Central Daylight Time	MEDICAL ASSOCIATES HEALTH PLAN, INC.	Medical Associates Health Plan, Inc.	www.mahealthplans.com	Medical Associates Freedom Plan (Cost)	06	18		1			H1651	008	0	2022	Dubuque, Clayton, Delaware, Jackson,Jones Counties		2	9600	2			2								www.mahealthplans.com	(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				0	0	06/03/2021	2022.01	06/03/2021 02:39:08 PM Central Daylight Time					06/04/2021 09:25:35 AM Central Daylight Time	MEDICAL ASSOCIATES HEALTH PLAN, INC.	Medical Associates Health Plan, Inc.	www.mahealthplans.com	Medical Associates Freedom Plan (Cost)	06	18		1			H1651	009	0	2022	JoDaviess County		2	2700	2			2								www.mahealthplans.com	(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				0	0	06/03/2021	2022.01	06/03/2021 02:42:02 PM Central Daylight Time					06/04/2021 09:25:35 AM Central Daylight Time	MEDICAL ASSOCIATES HEALTH PLAN, INC.	Medical Associates Health Plan, Inc.	www.mahealthplans.com	MercyOne Cedar Valley Senior Plan (Cost)	06	18		1			H1651	010	0	2022	Benton and Tama Counties		2	348	2			2								www.mahealthplans.com	(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				0	0	06/03/2021	2022.01	06/03/2021 02:46:02 PM Central Daylight Time					06/04/2021 09:25:35 AM Central Daylight Time	MEDICAL ASSOCIATES HEALTH PLAN, INC.	Medical Associates Health Plan, Inc.	www.mahealthplans.com	Central Iowa Health Senior Plan (Cost)	06	18		1			H1651	011	0	2022	Central Iowa		2	804	2			2								www.mahealthplans.com	(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				0	0	06/03/2021	2022.01	06/03/2021 02:47:11 PM Central Daylight Time					06/04/2021 09:25:35 AM Central Daylight Time	MEDICAL ASSOCIATES HEALTH PLAN, INC.	Medical Associates Health Plan, Inc.	www.mahealthplans.com	MercyOne Clinton Community Senior Plan (Cost)	06	18		1			H1651	012	0	2022	Cedar, Clinton, Jackson and Scott Counties		2	540	2			2								www.mahealthplans.com	(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				0	0	06/03/2021	2022.01	06/03/2021 02:49:02 PM Central Daylight Time					06/04/2021 09:25:35 AM Central Daylight Time	MEDICAL ASSOCIATES HEALTH PLAN, INC.	Medical Associates Health Plan, Inc.	www.mahealthplans.com	Quad Cities Community Health Senior Plan (Cost)	06	18		1			H1651	013	0	2022	Cedar, Clinton, Jackson, Muscatine, Scott Counties		2	1200	2			2								www.mahealthplans.com	(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				0	0	06/03/2021	2022.01	06/03/2021 02:50:53 PM Central Daylight Time					06/04/2021 09:25:35 AM Central Daylight Time	MEDICAL ASSOCIATES HEALTH PLAN, INC.	Medical Associates Health Plan, Inc.	www.mahealthplans.com	Mercy Cedar Rapids Senior Plan (Cost)	06	18		1			H1651	014	0	2022	Cedar Rapids and Surrounding Counties		2	6000	2			2								www.mahealthplans.com	(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				0	0	06/03/2021	2022.01	06/03/2021 02:52:49 PM Central Daylight Time					06/04/2021 09:25:35 AM Central Daylight Time	MEDICAL ASSOCIATES HEALTH PLAN, INC.	Medical Associates Health Plan, Inc.	www.mahealthplans.com	MercyOne North Iowa Senior Plan (Cost)	06	18		1			H1651	015	0	2022	North Iowa		2	3600	2			2								www.mahealthplans.com	(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				0	0	06/03/2021	2022.01	06/03/2021 02:55:30 PM Central Daylight Time					06/04/2021 09:25:35 AM Central Daylight Time	MEDICAL ASSOCIATES HEALTH PLAN, INC.	Medical Associates Health Plan, Inc.	www.mahealthplans.com	Mercy Iowa City Senior Plan (Cost)	06	18		1			H1651	016	0	2022	Cedar and Muscatine Counties		2	780	2			2								www.mahealthplans.com	(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	017	0	1	18	06	H1651_017_0	1	2				0	0	06/03/2021	2022.01	06/03/2021 02:58:11 PM Central Daylight Time					06/04/2021 09:25:35 AM Central Daylight Time	MEDICAL ASSOCIATES HEALTH PLAN, INC.	Medical Associates Health Plan, Inc.	www.mahealthplans.com	Quad Cities Community Health Senior Plan (Cost)	06	18		1			H1651	017	0	2022	Mercer County		2	60	2			2								www.mahealthplans.com	(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	025	0	1	18	06	H1651_025_0	1	2				0	0	06/03/2021	2022.01	06/03/2021 03:00:22 PM Central Daylight Time					06/04/2021 09:25:35 AM Central Daylight Time	MEDICAL ASSOCIATES HEALTH PLAN, INC.	Medical Associates Health Plan, Inc.	www.live360healthplan.com	Live360 Health Plan (Cost)	06	18		1			H1651	025	0	2022	South Central Illinois		2	1500	2			2								www.mahealthplans.com	(833)728-0538		(217)206-5050		(833)728-0538		(217)206-5050										(800)735-2942		(800)735-2942		(800)735-2942		(800)735-2942										2					2					2	2			
H1659	002	0	1	04	01	H1659_002_0	3	1					1	08/04/2021	2022.01	08/04/2021 08:34:33 AM Central Daylight Time	08/03/2021 01:45:53 PM Central Daylight Time	07/29/2021 07:38:19 PM Central Daylight Time			08/04/2021 04:03:00 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE CO. OF THE RIVER VALLEY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Choice Plan 1 (PPO)	01	04		1			H1659	002	0	2022	Select counties in Virginia		2	19379	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)272-1967		(866)272-1967		(800)555-5757		(800)555-5757		(866)272-1967		(866)272-1967		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1659	003	0	1	04	01	H1659_003_0	3	1					1	08/04/2021	2022.01	08/04/2021 08:36:51 AM Central Daylight Time	08/03/2021 01:46:27 PM Central Daylight Time	07/29/2021 07:38:34 PM Central Daylight Time			08/04/2021 04:03:00 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE CO. OF THE RIVER VALLEY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Choice Plan 2 (PPO)	01	04		1			H1659	003	0	2022	Select counties in Virginia		2	29995	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)272-1967		(866)272-1967		(800)555-5757		(800)555-5757		(866)272-1967		(866)272-1967		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1664	001	0	1	01	01	H1664_001_0	4	1					0	08/02/2021	2022.01	08/02/2021 03:31:16 PM Eastern Daylight Time	08/04/2021 08:24:57 AM Eastern Daylight Time	07/30/2021 10:49:30 AM Eastern Daylight Time			08/04/2021 11:43:06 PM Eastern Daylight Time	HOME STATE HEALTH PLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellMO	Wellcare No Premium (HMO)	01	01		1			H1664	001	0	2022	Select counties in MO		2	15803	2			2						www.wellcare.com/allwellMO	www.wellcare.com/allwellMO	www.wellcare.com/allwellMO	(855)766-1452		(855)766-1452		(844)917-0175		(844)917-0175		(855)766-1452		(855)766-1452		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1664	004	0	1	01	01	H1664_004_0	4	1					0	08/02/2021	2022.01	08/02/2021 03:41:59 PM Eastern Daylight Time	08/04/2021 08:25:45 AM Eastern Daylight Time	07/30/2021 10:49:48 AM Eastern Daylight Time			08/04/2021 11:43:06 PM Eastern Daylight Time	HOME STATE HEALTH PLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellMO	Wellcare No Premium (HMO)	01	01		1			H1664	004	0	2022	Section counties in MO		2	8927	2			2						www.wellcare.com/allwellMO	www.wellcare.com/allwellMO	www.wellcare.com/allwellMO	(855)766-1452		(855)766-1452		(844)917-0175		(844)917-0175		(855)766-1452		(855)766-1452		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1664	005	0	1	01	01	H1664_005_0	4	1	2	1			0	08/02/2021	2022.01	08/02/2021 03:49:43 PM Eastern Daylight Time	08/04/2021 08:07:30 AM Eastern Daylight Time	07/30/2021 10:50:08 AM Eastern Daylight Time			08/04/2021 11:43:06 PM Eastern Daylight Time	HOME STATE HEALTH PLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellMO	Wellcare Dual Access (HMO D-SNP)	01	01		1			H1664	005	0	2022	Select counties in MO		2	5977	2			1	3		1		1	www.wellcare.com/allwellMO	www.wellcare.com/allwellMO	www.wellcare.com/allwellMO	(833)298-3361		(833)298-3361		(844)917-0175		(844)917-0175		(833)298-3361		(833)298-3361		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1664	006	0	1	01	01	H1664_006_0	4	1					0	08/02/2021	2022.01	08/02/2021 05:19:10 PM Eastern Daylight Time	08/04/2021 08:01:59 AM Eastern Daylight Time	07/30/2021 10:50:26 AM Eastern Daylight Time			08/04/2021 11:43:06 PM Eastern Daylight Time	HOME STATE HEALTH PLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellMO	Wellcare Giveback (HMO)	01	01		1			H1664	006	0	2022	Section counties in MO		2	17790	2			2						www.wellcare.com/allwellMO	www.wellcare.com/allwellMO	www.wellcare.com/allwellMO	(855)766-1452		(855)766-1452		(844)917-0175		(844)917-0175		(855)766-1452		(855)766-1452		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1664	007	0	1	01	01	H1664_007_0	4	1					0	05/31/2021	2022.01	05/31/2021 06:52:05 AM Pacific Daylight Time	08/04/2021 08:13:11 AM Eastern Daylight Time	07/30/2021 10:50:46 AM Eastern Daylight Time			08/04/2021 11:43:06 PM Eastern Daylight Time	HOME STATE HEALTH PLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellMO	Wellcare Assist (HMO)	01	01		1			H1664	007	0	2022	Select counties in MO		2	3793	2			2						www.wellcare.com/allwellMO	www.wellcare.com/allwellMO	www.wellcare.com/allwellMO	(855)766-1452		(855)766-1452		(844)917-0175		(844)917-0175		(855)766-1452		(855)766-1452		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1664	801	0	1	01	01	H1664_801_0	2	1						05/03/2021	2022.01	05/03/2021 01:32:11 PM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	HOME STATE HEALTH PLAN, INC.	Wellcare by Allwell	allwell.homestatehealth.com	Allwell Group (HMO)	01	01		1			H1664	801	0	2022	Missouri		1	100	2			2						allwell.homestatehealth.com/findadoctor	allwell.homestatehealth.com/formulary	allwell.homestatehealth.com/findadoctor	(855)766-1452		(855)766-1452		(844)942-0039		(844)942-0039		(855)766-1452		(855)766-1452		(844)942-0039		(844)942-0039		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H1664	802	0	1	01	01	H1664_802_0	2	1				0	0	05/03/2021	2022.01	05/03/2021 01:32:19 PM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	HOME STATE HEALTH PLAN, INC.	Wellcare by Allwell	allwell.homestatehealth.com	Allwell Group (HMO)	01	01		1			H1664	802	0	2022	Missouri		1	100	2			2						allwell.homestatehealth.com/findadoctor	allwell.homestatehealth.com/formulary	allwell.homestatehealth.com/findadoctor	(855)766-1452		(855)766-1452		(844)942-0039		(844)942-0039										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H1664	803	0	1	01	01	H1664_803_0	2	1						05/03/2021	2022.01	05/03/2021 01:32:27 PM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	HOME STATE HEALTH PLAN, INC.	Wellcare by Allwell	allwell.homestatehealth.com	Allwell Group (HMO)	01	01		1			H1664	803	0	2022	Missouri		1	100	2			2						allwell.homestatehealth.com/findadoctor	allwell.homestatehealth.com/formulary	allwell.homestatehealth.com/findadoctor	(855)766-1452		(855)766-1452		(844)942-0039		(844)942-0039		(855)766-1452		(855)766-1452		(844)942-0039		(844)942-0039		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H1666	001	0	1	04	01	H1666_001_0	3	1					0	06/03/2021	2022.01	06/03/2021 01:50:36 PM Central Daylight Time	08/03/2021 10:29:48 AM Central Daylight Time	08/04/2021 04:58:30 PM Central Daylight Time			08/05/2021 05:38:13 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of Texas	www.getbluetx.com/mapd	Blue Cross Medicare Advantage Choice Premier (PPO)	01	04		1			H1666	001	0	2022	Austin Metro Area		2	4503	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	3	1					0	06/03/2021	2022.01	06/03/2021 01:51:27 PM Central Daylight Time	08/03/2021 10:30:14 AM Central Daylight Time	08/04/2021 04:58:50 PM Central Daylight Time			08/05/2021 05:38:13 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of Texas	www.getbluetx.com/mapd	Blue Cross Medicare Advantage Choice Premier (PPO)	01	04		1			H1666	002	0	2022	Dallas Metro Area		2	10140	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	3	1					0	06/03/2021	2022.01	06/03/2021 01:51:50 PM Central Daylight Time	08/03/2021 10:30:40 AM Central Daylight Time	08/04/2021 04:59:08 PM Central Daylight Time			08/05/2021 05:38:13 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of Texas	www.getbluetx.com/mapd	Blue Cross Medicare Advantage Choice Premier (PPO)	01	04		1			H1666	003	0	2022	Houston Metro Area		2	14730	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	3	1					0	06/03/2021	2022.01	06/03/2021 01:53:30 PM Central Daylight Time	08/03/2021 10:31:08 AM Central Daylight Time	08/04/2021 04:59:28 PM Central Daylight Time			08/05/2021 05:38:13 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of Texas	www.getbluetx.com/mapd	Blue Cross Medicare Advantage Choice Plus (PPO)	01	04		1			H1666	004	0	2022	Austin Metro Area		2	5840	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	3	1					0	06/03/2021	2022.01	06/03/2021 01:54:27 PM Central Daylight Time	08/03/2021 10:31:34 AM Central Daylight Time	08/04/2021 04:59:46 PM Central Daylight Time			08/05/2021 05:38:13 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of Texas	www.getbluetx.com/mapd	Blue Cross Medicare Advantage Choice Plus (PPO)	01	04		1			H1666	005	0	2022	Dallas Metro Area		2	15260	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	3	1					0	06/03/2021	2022.01	06/03/2021 01:55:05 PM Central Daylight Time	08/03/2021 10:32:02 AM Central Daylight Time	08/04/2021 05:00:06 PM Central Daylight Time			08/05/2021 05:38:13 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of Texas	www.getbluetx.com/mapd	Blue Cross Medicare Advantage Choice Plus (PPO)	01	04		1			H1666	006	0	2022	Houston Metro Area		2	14840	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	3	1					0	06/03/2021	2022.01	06/03/2021 01:55:39 PM Central Daylight Time	08/03/2021 10:32:28 AM Central Daylight Time	08/04/2021 05:00:24 PM Central Daylight Time			08/05/2021 05:38:13 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of Texas	www.getbluetx.com/mapd	Blue Cross Medicare Advantage Choice Plus (PPO)	01	04		1			H1666	008	0	2022	San Antonio Metro Area		2	8760	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	010	0	1	04	01	H1666_010_0	3	1					0	06/03/2021	2022.01	06/03/2021 01:56:09 PM Central Daylight Time	08/03/2021 10:32:52 AM Central Daylight Time	08/04/2021 05:00:42 PM Central Daylight Time			08/05/2021 05:38:13 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of Texas	www.getbluetx.com/mapd	Blue Cross Medicare Advantage Choice Plus (PPO)	01	04		1			H1666	010	0	2022	El Paso		2	1501	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	2	1						05/25/2021	2022.01	05/25/2021 01:52:46 PM Central Daylight Time					06/03/2021 05:04:16 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of Texas	www.getbluetx.com/mapd	Blue Cross Group Medicare Advantage Plan (PPO)	01	04		1			H1666	801	0	2022	State of Texas		1	43939	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)-		2					2						2			
H1666	803	0	1	04	01	H1666_803_0	2	1						05/25/2021	2022.01	05/25/2021 01:53:04 PM Central Daylight Time					06/03/2021 05:04:16 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of Texas	www.getbluetx.com/mapd	Blue Cross Group Medicare Advantage Plan (PPO)	01	04		1			H1666	803	0	2022	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)-		2					2						2			
H1666	805	0	1	04	01	H1666_805_0	2	1				0	0	05/25/2021	2022.01	05/25/2021 01:53:20 PM Central Daylight Time					06/03/2021 05:04:16 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of Texas	www.getbluetx.com/mapd	Blue Cross Group Medicare Advantage Plan (PPO)	01	04		1			H1666	805	0	2022	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)-										2					2						2			
H1666	807	0	1	04	01	H1666_807_0	2	1						05/25/2021	2022.01	05/25/2021 01:53:26 PM Central Daylight Time					06/03/2021 05:04:16 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of Texas	www.getbluetx.com/mapd	Blue Cross Group Medicare Advantage Plan (PPO)	01	04		1			H1666	807	0	2022	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)-		2					2						2			
H1666	808	0	1	04	01	H1666_808_0	2	1				0	0	05/25/2021	2022.01	05/25/2021 01:53:35 PM Central Daylight Time					06/03/2021 05:04:16 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of Texas	www.getbluetx.com/mapd	Blue Cross Group Medicare Advantage Plan (PPO)	01	04		1			H1666	808	0	2022	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)-										2					2						2			
H1692	002	0	1	02	01	H1692_002_0	2	1			2		0	08/02/2021	2022.01	08/02/2021 12:40:45 PM Eastern Daylight Time	08/02/2021 05:20:44 PM Eastern Daylight Time	08/02/2021 09:27:56 AM Eastern Daylight Time			08/04/2021 12:08:11 PM Eastern Daylight Time	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Silver (HMO-POS)	01	02		1			H1692	002	0	2022	Southern West Virginia		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1692	003	0	1	01	01	H1692_003_0	2	1			2		0	08/02/2021	2022.01	08/02/2021 12:41:19 PM Eastern Daylight Time	08/02/2021 05:21:32 PM Eastern Daylight Time	08/02/2021 09:28:00 AM Eastern Daylight Time			08/04/2021 12:08:11 PM Eastern Daylight Time	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Elite (HMO)	01	01		1			H1692	003	0	2022	Northern West Virginia		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1692	004	0	1	02	01	H1692_004_0	3	1			2		0	08/02/2021	2022.01	08/02/2021 12:42:02 PM Eastern Daylight Time	08/02/2021 05:22:20 PM Eastern Daylight Time	08/02/2021 09:28:04 AM Eastern Daylight Time			08/04/2021 12:08:11 PM Eastern Daylight Time	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Elite (HMO-POS)	01	02		1			H1692	004	0	2022	Southern West Virginia		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1692	005	0	1	01	01	H1692_005_0	4	1	2	1	1		0	07/08/2021	2022.01	07/08/2021 10:51:47 AM Eastern Daylight Time	08/02/2021 05:23:09 PM Eastern Daylight Time	08/02/2021 09:28:08 AM Eastern Daylight Time			08/04/2021 12:08:11 PM Eastern Daylight Time	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Cares (HMO D-SNP)	01	01		1			H1692	005	0	2022	West Virginia		2		2			1	3		1		1	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1692	006	0	1	01	01	H1692_006_0	2	1			2	0	0	06/01/2021	2022.01	06/01/2021 04:05:25 PM Eastern Daylight Time	06/01/2021 05:14:10 PM Eastern Daylight Time				06/03/2021 10:47:05 AM Eastern Daylight Time	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Eagle (HMO)	01	01		1			H1692	006	0	2022	West Virginia		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H1692	801	0	1	01	01	H1692_801_0	1	1				0	0	05/27/2021	2022.01	05/27/2021 11:10:09 PM Eastern Daylight Time					06/03/2021 12:42:10 PM Eastern Daylight Time	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (HMO)	01	01		1			H1692	801	0	2022	West Virginia		1	120	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H1692	802	0	1	01	01	H1692_802_0	1	1						05/27/2021	2022.01	05/27/2021 11:10:32 PM Eastern Daylight Time					06/03/2021 12:42:10 PM Eastern Daylight Time	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan w/Rx (HMO)	01	01		1			H1692	802	0	2022	West Virginia		1	120	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H1693	002	0	1	20	08	H1693_002_0	1	1						06/02/2021	2022.01	06/02/2021 10:12:46 AM Pacific Daylight Time		06/02/2021 10:20:34 AM Pacific Daylight Time			06/02/2021 10:23:58 AM Pacific Daylight Time	FAMILY HEALTH CENTERS OF SAN DIEGO	Family Health-Center for Older Adults	www.fhcsd.org/pace	FamilyHealth - Center for Older Adults (PACE)	08	20		1			H1693	002	0	2022	San Diego		2		1	1		2						TBD	NA												(619)515-2445				(619)515-2445												(833)530-9622				(833)530-9622																
H1693	003	0	1	20	08	H1693_003_0	1	1						06/02/2021	2022.01	06/02/2021 10:10:52 AM Pacific Daylight Time		06/02/2021 10:20:34 AM Pacific Daylight Time			06/02/2021 10:23:58 AM Pacific Daylight Time	FAMILY HEALTH CENTERS OF SAN DIEGO	Family Health-Center for Older Adults	www.fhcsd.org/pace	FamilyHealth-Center for Older Adults-Medicare-only (PACE)	08	20		1			H1693	003	0	2022	San Diego		2		1	1		2						TBD	NA												(619)515-2445				(619)515-2445												(833)530-9622				(833)530-9622																
H1714	001	0	1	20	08	H1714_001_0	1	1						06/02/2021	2022.01	06/02/2021 12:04:15 PM Central Daylight Time		05/28/2021 12:55:46 PM Central Daylight Time			06/02/2021 12:08:27 PM Central Daylight Time	VIA CHRISTI HEALTHCARE OUTREACH FOR ELDERS, INC.	Ascension Living HOPE	ascension.org/HOPEKansas	Ascension Living HOPE (PACE)	08	20		1			H1714	001	0	2022	Sedgwick County		2		2			2						www.viachristihope.com	www.viachristihope.com												(316)858-1111				(316)858-1111										(800)766-3777		(800)766-3777		(800)766-3777		(800)766-3777																
H1714	002	0	1	20	08	H1714_002_0	1	1						06/02/2021	2022.01	06/02/2021 12:04:59 PM Central Daylight Time		05/28/2021 12:56:00 PM Central Daylight Time			06/02/2021 12:08:27 PM Central Daylight Time	VIA CHRISTI HEALTHCARE OUTREACH FOR ELDERS, INC.	Ascension Living HOPE	ascension.org/HOPEKansas	Ascension Living HOPE (PACE)	08	20		1			H1714	002	0	2022	Sedgwick County		2		2			2						www.viachristihope.com	www.viachristihope.com												(316)858-1111				(316)858-1111										(800)766-3777		(800)766-3777		(800)766-3777		(800)766-3777																
H1722	002	0	1	01	01	H1722_002_0	6	1					1	08/04/2021	2022.01	08/04/2021 03:09:33 PM Eastern Daylight Time	08/05/2021 02:21:16 PM Eastern Daylight Time	08/05/2021 12:51:56 PM Eastern Daylight Time			08/05/2021 08:18:00 PM Eastern Daylight Time	HEALTHFIRST HEALTH PLAN, INC.	Healthfirst Medicare Plan	www.healthfirst.org/medicare	Healthfirst Signature (HMO)	01	01		1			H1722	002	0	2022	Orange, Rockland, Sullivan, and Westchester County		2		2			2						www.hfdocfinder.org	www.healthfirst.org/formularies	www.hfdocfinder.org	(855)771-1081		(855)771-1081		(877)237-1303		(877)237-1303		(855)771-1081		(855)771-1081		(877)237-1303		(877)237-1303		(888)542-3821		(888)542-3821		(888)542-3821		(888)542-3821		(888)542-3821		(888)542-3821		(888)542-3821		(888)542-3821		2					2					2	2			
H1723	001	0	1	48	05	H1723_001_0	2	1						05/28/2021	2022.01	05/28/2021 07:08:40 PM Eastern Daylight Time					06/04/2021 07:55:43 PM Eastern Daylight Time	ABSOLUTE TOTAL CARE, INC.	Wellcare Prime by Absolute Total Care	mmp.absolutetotalcare.com	Wellcare Prime by Absolute Total Care (Medicare-Medicaid Plan)	05	48		1			H1723	001	0	2022	South Carolina		2	49815	2			2						mmp.absolutetotalcare.com/findadoctor	mmp.absolutetotalcare.com/formulary	mmp.absolutetotalcare.com/findadoctor	(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)-																
H1732	001	0	1	01	01	H1732_001_0	6	1	2	1	1		0	07/15/2021	2022.01	07/15/2021 12:50:57 PM Eastern Daylight Time	08/03/2021 06:04:04 PM Eastern Daylight Time	08/03/2021 06:04:04 PM Eastern Daylight Time			08/04/2021 02:27:41 PM Eastern Daylight Time	HEALTHPLUS HP, LLC	Empire BlueCross BlueShield	www.empireblue.com	Empire MediBlue HealthPlus Dual Plus (HMO D-SNP)	01	01		1			H1732	001	0	2022	Select Counties in NY		2		2			1	3		1			https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	(833)713-1080		(833)713-1080		(855)593-0908		(855)593-0908		(833)498-1583		(833)498-1583		(855)948-5579		(855)948-5579		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1732	003	0	1	01	01	H1732_003_0	7	1	2	1	1		0	07/18/2021	2022.01	07/18/2021 12:42:00 PM Eastern Daylight Time	08/03/2021 06:04:04 PM Eastern Daylight Time	08/03/2021 06:04:04 PM Eastern Daylight Time			08/04/2021 02:27:41 PM Eastern Daylight Time	HEALTHPLUS HP, LLC	Empire BlueCross BlueShield	www.empireblue.com	Empire MediBlue HealthPlus Dual Connect (HMO D-SNP)	01	01		1			H1732	003	0	2022	Select Counties in NY		2		2			1	3		1			https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	(833)713-1080		(833)713-1080		(855)593-0908		(855)593-0908		(833)498-1583		(833)498-1583		(855)948-5579		(855)948-5579		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1732	004	0	1	01	01	H1732_004_0	6	1			2		0	07/18/2021	2022.01	07/18/2021 01:02:07 PM Eastern Daylight Time	08/03/2021 06:04:00 PM Eastern Daylight Time	08/03/2021 06:04:00 PM Eastern Daylight Time			08/04/2021 02:06:25 PM Eastern Daylight Time	HEALTHPLUS HP, LLC	Empire BlueCross BlueShield	https://shop.anthem.com/medicare	Empire MediBlue HealthPlus (HMO)	01	01		1			H1732	004	0	2022	Select Counties in New York		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	(833)713-1079		(833)713-1079		(855)593-0909		(855)593-0909		(833)498-1583		(833)498-1583		(855)485-0930		(855)485-0930		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1732	005	0	1	01	01	H1732_005_0	6	1			2		0	07/15/2021	2022.01	07/15/2021 10:25:52 AM Eastern Daylight Time	08/03/2021 06:04:01 PM Eastern Daylight Time	08/03/2021 06:04:01 PM Eastern Daylight Time			08/04/2021 02:06:25 PM Eastern Daylight Time	HEALTHPLUS HP, LLC	Empire BlueCross BlueShield	https://shop.anthem.com/medicare	Empire MediBlue HealthPlus (HMO)	01	01		1			H1732	005	0	2022	Orange, Rockland, Westchester Counties		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	(833)713-1079		(833)713-1079		(855)593-0909		(855)593-0909		(833)498-1583		(833)498-1583		(855)485-0930		(855)485-0930		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1732	006	0	1	01	01	H1732_006_0	6	1			2		0	07/15/2021	2022.01	07/15/2021 10:31:20 AM Eastern Daylight Time	08/03/2021 06:04:01 PM Eastern Daylight Time	08/03/2021 06:04:01 PM Eastern Daylight Time			08/04/2021 02:06:25 PM Eastern Daylight Time	HEALTHPLUS HP, LLC	Empire BlueCross BlueShield	https://shop.anthem.com/medicare	Empire MediBlue HealthPlus (HMO)	01	01		1			H1732	006	0	2022	Nassau and Suffolk Counties		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	(833)713-1079		(833)713-1079		(855)593-0909		(855)593-0909		(833)498-1583		(833)498-1583		(855)485-0930		(855)485-0930		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1732	007	0	1	01	01	H1732_007_0	8	1			2		1	07/18/2021	2022.01	07/18/2021 01:02:20 PM Eastern Daylight Time	08/03/2021 06:04:01 PM Eastern Daylight Time	08/03/2021 06:04:01 PM Eastern Daylight Time			08/04/2021 02:06:25 PM Eastern Daylight Time	HEALTHPLUS HP, LLC	Empire BlueCross BlueShield	https://shop.anthem.com/medicare	Empire MediBlue HealthPlus Select (HMO)	01	01		1			H1732	007	0	2022	Select Counties in NY		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	(833)713-1079		(833)713-1079		(855)593-0909		(855)593-0909		(833)498-1583		(833)498-1583		(855)485-0930		(855)485-0930		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1737	001	0	1	01	01	H1737_001_0	11	1					1	09/29/2021	2022.01	09/29/2021 12:03:46 PM Central Daylight Time	08/02/2021 11:48:49 PM Central Daylight Time	07/30/2021 02:09:33 PM Central Daylight Time			09/29/2021 12:45:36 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	2022	Scott County		2	5039	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	4	1				0	0	04/20/2021	2022.01	04/20/2021 04:13:03 PM US Eastern Daylight Time					06/06/2021 01:28:52 PM Eastern Daylight Time	HEALTH ALLIANCE - MIDWEST, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Medicare Employer HMO (HMO)	01	01		1			H1737	801	0	2022	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										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;7b;7c;7i;8a;8b1;8b2;9a1;9a2;9b;11a;11b;15;	1	2;	1					1				
H1737	802	0	1	01	01	H1737_802_0	4	1						04/20/2021	2022.01	04/20/2021 04:20:31 PM US Eastern Daylight Time					06/06/2021 01:28:52 PM Eastern Daylight Time	HEALTH ALLIANCE - MIDWEST, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Medicare Employer HMO Rx (HMO)	01	01		1			H1737	802	0	2022	Health Alliance Medicare		1	3603	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	1	1a;1b;2;5;7b;7c;7i;8a;8b1;8b2;9a1;9a2;9b;10a;11a;11b;15;	1	2;	2					1				
H1737	803	0	1	01	01	H1737_803_0	4	1						04/20/2021	2022.01	04/20/2021 04:24:12 PM US Eastern Daylight Time					06/06/2021 01:28:52 PM Eastern Daylight Time	HEALTH ALLIANCE - MIDWEST, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Medicare Employer HMO Rx  - non calendar year (HMO)	01	01		1			H1737	803	0	2022	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	1	1a;1b;2;5;7b;7c;7i;8a;8b1;8b2;9a1;9a2;9b;10a;11a;11b;15;	1	2;	1					1				
H1748	001	0	1	01	01	H1748_001_0	5	1					0	08/02/2021	2022.01	08/02/2021 04:43:51 PM Eastern Daylight Time	08/02/2021 05:07:51 PM Eastern Daylight Time	08/02/2021 05:12:15 PM Eastern Daylight Time			08/05/2021 11:36:52 AM Eastern Daylight Time	SONDER HEALTH PLANS, INC.	Sonder Health Plan, Inc.	www.sonderhealthplans.com	Sonder Complete Health Medicare Advantage (HMO)	01	01		1			H1748	001	0	2022	Cobb, DeKalb, Gwinnett, Fulton Counties		2	6588	2			2						www.sonderhealthplans.com	www.sonderhealthplans.com	www.sonderhealthplans.com	(800)331-2928		(404)965-5731		(800)331-2928		(404)965-5731		(800)331-2928		(404)965-5731		(800)331-2928		(404)965-5731		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1748	003	0	1	01	01	H1748_003_0	5	1		1			0	08/02/2021	2022.01	08/02/2021 04:44:33 PM Eastern Daylight Time	08/02/2021 05:07:01 PM Eastern Daylight Time	08/02/2021 05:12:58 PM Eastern Daylight Time			08/05/2021 11:36:52 AM Eastern Daylight Time	SONDER HEALTH PLANS, INC.	Sonder Health Plan, Inc.	www.sonderhealthplans.com	Sonder Diabetes Wellness (HMO C-SNP)	01	01		1			H1748	003	0	2022	Cobb, DeKalb, Gwinnett, Fulton Counties		2	549	2			1	4			00000010000000000000		www.sonderhealthplans.com	www.sonderhealthplans.com	www.sonderhealthplans.com	(800)331-2928		(404)965-5731		(800)331-2928		(404)965-5731		(800)331-2928		(404)965-5731		(800)331-2928		(404)965-5731		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1748	004	0	1	01	01	H1748_004_0	6	1		1			0	08/02/2021	2022.01	08/02/2021 04:45:06 PM Eastern Daylight Time	08/02/2021 05:06:16 PM Eastern Daylight Time	08/02/2021 05:11:09 PM Eastern Daylight Time			08/05/2021 11:36:52 AM Eastern Daylight Time	SONDER HEALTH PLANS, INC.	Sonder Health Plan, Inc.	www.sonderhealthplans.com	Sonder Heart Healthy (HMO C-SNP)	01	01		1			H1748	004	0	2022	Cobb, DeKalb, Gwinnett, Fulton Counties		2	549	2			1	4			00010000000000000000		www.sonderhealthplans.com	www.sonderhealthplans.com	www.sonderhealthplans.com	(800)331-2928		(404)965-5731		(800)331-2928		(404)965-5731		(800)331-2928		(404)965-5731		(800)331-2928		(404)965-5731		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1748	005	0	1	01	01	H1748_005_0	5	1	2	1			0	08/02/2021	2022.01	08/02/2021 04:45:35 PM Eastern Daylight Time	08/02/2021 05:05:29 PM Eastern Daylight Time	08/02/2021 05:11:40 PM Eastern Daylight Time			08/05/2021 11:36:52 AM Eastern Daylight Time	SONDER HEALTH PLANS, INC.	Sonder Health Plan, Inc.	www.sonderhealthplans.com	Sonder Dual Complete (HMO D-SNP)	01	01		1			H1748	005	0	2022	Cobb, DeKalb, Gwinnett, Fulton Counties		2	3294	2			1	3		1		1	www.sonderhealthplans.com	www.sonderhealthplans.com	www.sonderhealthplans.com	(800)331-2928		(404)965-5731		(800)331-2928		(404)965-5731		(800)331-2928		(404)965-5731		(800)331-2928		(404)965-5731		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1774	001	0	1	04	01	H1774_001_0	4	1					0	08/02/2021	2022.01	08/02/2021 04:04:18 PM Central Daylight Time	08/03/2021 10:36:22 PM Central Daylight Time	07/30/2021 09:51:08 AM Central Daylight Time			08/04/2021 10:17:29 PM Central Daylight Time	CENTENE VENTURE COMPANY INDIANA, INC.	Ascension Complete	www.ascensioncomplete.com	Ascension Complete St. Vincent Access Plus (PPO)	01	04		1			H1774	001	0	2022	Central, Southeast and Southwest Indiana Counties		2	4433	2			2						www.ascensioncomplete.com/findadoctor	www.ascensioncomplete.com/formulary	www.ascensioncomplete.com/findadoctor	(833)525-0824		(833)525-0824		(844)578-1929		(844)578-1929		(833)525-0824		(833)525-0824		(844)578-1929		(844)578-1929		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1774	002	0	1	04	01	H1774_002_0	4	1					0	08/02/2021	2022.01	08/02/2021 04:04:38 PM Central Daylight Time	08/03/2021 10:36:49 PM Central Daylight Time	07/30/2021 09:51:26 AM Central Daylight Time			08/04/2021 10:17:29 PM Central Daylight Time	CENTENE VENTURE COMPANY INDIANA, INC.	Ascension Complete	ascensioncomplete.com	Ascension Complete St. Vincent Access (PPO)	01	04		1			H1774	002	0	2022	Central, Southeast and Southwest Indiana		2	3621	2			2						ascensioncomplete.com/findadoctor	ascensioncomplete.com/formulary	ascensioncomplete.com/findadoctor	(833)525-0824		(833)525-0824		(844)578-1929		(844)578-1929		(833)525-0824		(833)525-0824		(844)578-1929		(844)578-1929		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1777	007	0	1	01	01	H1777_007_0	13	1		1	1		0	08/02/2021	2022.01	08/02/2021 05:11:38 PM Eastern Daylight Time	08/04/2021 11:00:46 AM Eastern Daylight Time	08/04/2021 10:56:00 AM Eastern Daylight Time			08/04/2021 11:13:09 AM Eastern Daylight Time	CATHOLIC SPECIAL NEEDS PLAN, LLC	ArchCare Advantage	www.archcareadvantage.org	ArchCare Advantage (HMO I-SNP)	01	01		1			H1777	007	0	2022	NYC, Westchester, Putnam, Dutchess, Orange, Ononda		2	18033	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		(800)373-3177		(800)373-3177		(800)373-3177		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1787	001	0	1	01	01	H1787_001_0	8	1		1			0	07/15/2021	2022.01	07/15/2021 12:12:35 PM Central Daylight Time	08/04/2021 11:21:33 AM Central Daylight Time	08/02/2021 11:56:01 AM Central Daylight Time			08/05/2021 11:18:13 AM Central Daylight Time	GOOD SAMARITAN INSURANCE PLAN OF SOUTH DAKOTA, INC	Great Plains Medicare Advantage	www.greatplainsmedicareadvantage.com	Great Plains Medicare Advantage (HMO I-SNP)	01	01		1			H1787	001	0	2022	South Dakota (partial)		2		2			1	1	3				www.greatplainsmedicareadvantage.com	www.greatplainsmedicareadvantage.com	www.greatplainsmedicareadvantage.com	(844)637-4760		(844)637-4760		(844)637-4760		(844)637-4760		(800)498-5428		(520)918-1254		(800)498-5428		(520)918-1254		(711)-		(711)-		(711)-		(711)-		(800)498-5428		(711)-		(800)498-5428		(711)-		2					2					2	2			
H1787	002	0	1	01	01	H1787_002_0	9	1		1			0	07/15/2021	2022.01	07/15/2021 12:15:29 PM Central Daylight Time	08/04/2021 04:28:54 PM Central Daylight Time	08/02/2021 11:48:10 AM Central Daylight Time			08/05/2021 11:18:13 AM Central Daylight Time	GOOD SAMARITAN INSURANCE PLAN OF SOUTH DAKOTA, INC	Great Plains Medicare Advantage	www.greatplainsmedicareadvantage.com	Great Plain Medicare Advantage Gold (HMO I-SNP)	01	01		1			H1787	002	0	2022	South Dakota (partial)		2		2			1	1	3				www.greatplainsmedicareadvantage.com	www.greatplainsmedicareadvantage.com	www.greatplainsmedicareadvantage.com	(844)637-4760		(844)637-4760		(844)637-4760		(844)637-4760		(800)498-5428		(520)918-1254		(800)498-5428		(520)918-1254		(711)-		(711)-		(711)-		(711)-		(800)498-5428		(711)-		(800)498-5428		(711)-		2					2					2	2			
H1799	001	0	1	01	01	H1799_001_0	5	1	2	1			0	08/05/2021	2022.01	08/05/2021 10:17:08 AM Pacific Daylight Time	08/04/2021 05:28:14 PM Pacific Daylight Time	08/04/2021 05:26:54 PM Pacific Daylight Time			08/05/2021 03:02:36 PM Pacific Daylight Time	MOLINA HEALTHCARE OF KENTUCKY, INC.	Passport Advantage	www.molinahealthcare.com/medicare	Passport Medicare Complete Care (HMO D-SNP)	01	01		1			H1799	001	0	2022	Select Counties in Kentucky		2		2			1	3		1		1	www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	(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			
H1799	002	0	1	01	01	H1799_002_0	5	1					1	08/05/2021	2022.01	08/05/2021 10:17:27 AM Pacific Daylight Time	08/04/2021 05:28:46 PM Pacific Daylight Time	08/04/2021 04:35:00 PM Pacific Daylight Time			08/05/2021 03:02:36 PM Pacific Daylight Time	MOLINA HEALTHCARE OF KENTUCKY, INC.	Passport Advantage	www.molinahealthcare.com/medicare	Passport Medicare Choice Care (HMO)	01	01		1			H1799	002	0	2022	Select Counties in Kentucky		2		2			2						www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	(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			
H1821	001	0	1	04	01	H1821_001_0	3	1					1	08/04/2021	2022.01	08/04/2021 11:05:45 AM Central Daylight Time	08/03/2021 01:09:48 PM Central Daylight Time	07/29/2021 07:38:54 PM Central Daylight Time			08/04/2021 09:10:19 PM Central Daylight Time	UNITEDHEALTHCARE OF OREGON, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H1821	001	0	2022	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			
H1821	002	0	1	04	01	H1821_002_0	3	1					1	08/04/2021	2022.01	08/04/2021 11:14:30 AM Central Daylight Time	08/03/2021 01:10:18 PM Central Daylight Time	07/29/2021 07:39:09 PM Central Daylight Time			08/04/2021 09:10:19 PM Central Daylight Time	UNITEDHEALTHCARE OF OREGON, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 1 (PPO)	01	04		1			H1821	002	0	2022	Select Counties in Washington		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			
H1821	003	0	1	04	01	H1821_003_0	3	1					1	08/04/2021	2022.01	08/04/2021 11:14:18 AM Central Daylight Time	08/03/2021 01:10:48 PM Central Daylight Time	07/29/2021 07:39:24 PM Central Daylight Time			08/04/2021 09:10:19 PM Central Daylight Time	UNITEDHEALTHCARE OF OREGON, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H1821	003	0	2022	Select Counties in Oregon		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			
H1821	004	0	1	04	01	H1821_004_0	2	1				0	0	07/14/2021	2022.01	07/14/2021 01:35:17 PM Central Daylight Time	06/03/2021 03:08:53 PM Central Daylight Time				07/16/2021 12:10:08 PM Central Daylight Time	UNITEDHEALTHCARE OF OREGON, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (PPO)	01	04		1			H1821	004	0	2022	Select Counties in Washington		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			
H1821	005	0	1	04	01	H1821_005_0	3	1					1	08/04/2021	2022.01	08/04/2021 11:34:08 AM Central Daylight Time	08/03/2021 01:11:17 PM Central Daylight Time	07/29/2021 07:39:39 PM Central Daylight Time			08/04/2021 09:10:19 PM Central Daylight Time	UNITEDHEALTHCARE OF OREGON, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 2 (PPO)	01	04		1			H1821	005	0	2022	Select Counties in Washington		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			
H1822	001	0	1	01	01	H1822_001_0	6	1					1	08/05/2021	2022.01	08/05/2021 12:57:35 PM Pacific Daylight Time	08/05/2021 01:51:16 PM Pacific Daylight Time	07/29/2021 04:00:32 PM Pacific Daylight Time			08/05/2021 05:39:13 PM Pacific Daylight Time	SCAN DESERT HEALTH PLAN, INC.	SCAN Desert Health Plan	www.scanhealthplan.com	SCAN Classic (HMO)	01	01		1			H1822	001	0	2022	Maricopa, Pima and Pinal Counties		2		2			2						https://www.scanhealthplan.com/	https://www.scanhealthplan.com/	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1822	002	0	1	01	01	H1822_002_0	5	1		1			1	08/05/2021	2022.01	08/05/2021 01:03:24 PM Pacific Daylight Time	08/05/2021 01:42:59 PM Pacific Daylight Time	07/29/2021 04:00:48 PM Pacific Daylight Time			08/05/2021 05:39:13 PM Pacific Daylight Time	SCAN DESERT HEALTH PLAN, INC.	SCAN Desert Health Plan	www.scanhealthplan.com	SCAN Balance (HMO C-SNP)	01	01		1			H1822	002	0	2022	Maricopa, Pima and Pinal Counties		2		2			1	4			00000010000000000000		https://www.scanhealthplan.com/	https://www.scanhealthplan.com/	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1822	003	0	1	01	01	H1822_003_0	5	1		1			1	08/05/2021	2022.01	08/05/2021 01:02:33 PM Pacific Daylight Time	08/05/2021 01:44:17 PM Pacific Daylight Time	07/29/2021 04:01:08 PM Pacific Daylight Time			08/05/2021 05:39:13 PM Pacific Daylight Time	SCAN DESERT HEALTH PLAN, INC.	SCAN Desert Health Plan	www.scanhealthplan.com	SCAN Heart First (HMO C-SNP)	01	01		1			H1822	003	0	2022	Maricopa, Pima and Pinal Counties		2		2			1	4			00000000000000010000		https://www.scanhealthplan.com/	https://www.scanhealthplan.com/	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1822	004	0	1	01	01	H1822_004_0	5	1					1	08/05/2021	2022.01	08/05/2021 01:01:46 PM Pacific Daylight Time	08/05/2021 01:41:31 PM Pacific Daylight Time	07/29/2021 04:01:26 PM Pacific Daylight Time			08/05/2021 05:39:13 PM Pacific Daylight Time	SCAN DESERT HEALTH PLAN, INC.	SCAN Desert Health Plan	www.scanhealthplan.com	SCAN Venture (HMO)	01	01		1			H1822	004	0	2022	Maricopa, Pima and Pinal Counties		2		2			2						https://www.scanhealthplan.com/	https://www.scanhealthplan.com/	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1822	801	0	1	01	01	H1822_801_0	2	1						05/21/2021	2022.01	05/21/2021 04:29:12 PM Pacific Daylight Time					06/04/2021 11:04:52 AM Pacific Daylight Time	SCAN DESERT HEALTH PLAN, INC.	SCAN Desert Health Plan	www.scanhealthplan.com	SCAN Retiree Group (HMO)	01	01		1			H1822	801	0	2022	Maricopa, Pima and Pinal Counties		1	500	2			2						https://www.scanhealthplan.com/	https://www.scanhealthplan.com/	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1822	802	0	1	01	01	H1822_802_0	2	1						06/04/2021	2022.01	06/04/2021 08:32:11 AM Pacific Daylight Time					06/04/2021 11:04:52 AM Pacific Daylight Time	SCAN DESERT HEALTH PLAN, INC.	SCAN Desert Health Plan	www.scanhealthplan.com	SCAN Retiree Group (HMO)	01	01		1			H1822	802	0	2022	Maricopa, Pima and Pinal Counties		1	500	2			2						https://www.scanhealthplan.com/	https://www.scanhealthplan.com/	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1846	004	0	1	04	01	H1846_004_0	5	1					1	08/04/2021	2022.01	08/04/2021 08:29:00 AM Eastern Daylight Time	08/05/2021 07:00:08 AM Eastern Daylight Time	08/05/2021 07:00:09 AM Eastern Daylight Time			08/05/2021 07:34:42 AM Eastern Daylight Time	MOUNT CARMEL HEALTH INSURANCE COMPANY	MediGold	www.MediGold.com	MediGold Flexible Choice (PPO)	01	04		1			H1846	004	0	2022	Select Counties in Ohio		2		2			2						www.MediGold.com	www.MediGold.com	www.MediGold.com	(800)240-3851		(800)240-3851		(800)964-4525		(800)964-4525		(800)240-3851		(800)240-3851		(800)964-4525		(800)964-4525		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1846	005	0	1	04	01	H1846_005_0	5	1					0	08/04/2021	2022.01	08/04/2021 08:30:33 AM Eastern Daylight Time	08/05/2021 07:00:09 AM Eastern Daylight Time	08/05/2021 07:00:10 AM Eastern Daylight Time			08/05/2021 07:34:42 AM Eastern Daylight Time	MOUNT CARMEL HEALTH INSURANCE COMPANY	MediGold	www.MediGold.com	MediGold Prime Choice (PPO)	01	04		1			H1846	005	0	2022	Select Counties in Ohio		2		2			2						www.MediGold.com	www.MediGold.com	www.MediGold.com	(800)240-3851		(800)240-3851		(800)964-4525		(800)964-4525		(800)240-3851		(800)240-3851		(800)964-4525		(800)964-4525		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1846	006	0	1	04	01	H1846_006_0	5	1					0	08/04/2021	2022.01	08/04/2021 08:32:24 AM Eastern Daylight Time	08/05/2021 07:00:32 AM Eastern Daylight Time	08/05/2021 07:00:33 AM Eastern Daylight Time			08/05/2021 07:34:42 AM Eastern Daylight Time	MOUNT CARMEL HEALTH INSURANCE COMPANY	MediGold	www.MediGold.com	MediGold Prime Choice (PPO)	01	04		1			H1846	006	0	2022	Greater Toledo Ohio		2		2			2						www.MediGold.com	www.MediGold.com	www.MediGold.com	(800)240-3851		(800)240-3851		(800)964-4525		(800)964-4525		(800)240-3851		(800)240-3851		(800)964-4525		(800)964-4525		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1846	007	0	1	04	01	H1846_007_0	5	1					1	08/04/2021	2022.01	08/04/2021 08:48:46 AM Eastern Daylight Time	08/05/2021 07:00:34 AM Eastern Daylight Time	08/05/2021 07:00:35 AM Eastern Daylight Time			08/05/2021 07:34:42 AM Eastern Daylight Time	MOUNT CARMEL HEALTH INSURANCE COMPANY	MediGold	www.MediGold.com	MediGold Prime Choice (PPO)	01	04		1			H1846	007	0	2022	Select Counties in Iowa		2		2			2						www.MediGold.com	www.MediGold.com	www.MediGold.com	(800)240-3851		(800)240-3851		(800)964-4525		(800)964-4525		(800)240-3851		(800)240-3851		(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	3	1						05/20/2021	2022.01	05/20/2021 05:17:54 PM Eastern Daylight Time					06/06/2021 10:22:15 AM Eastern Daylight Time	MOUNT CARMEL HEALTH INSURANCE COMPANY	MediGold	www.MediGold.com	EGWP MediGold Network Choice (PPO)	01	04		1			H1846	801	0	2022	Greater Central Ohio and Dayton Area		1	12	2			2						www.MediGold.com	www.MediGold.com	www.MediGold.com	(800)240-3851		(800)240-3851		(800)964-4525		(800)964-4525		(800)240-3851		(800)240-3851		(800)964-4525		(800)964-4525		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;6;8a;9a1;9b;10a;11a;11b;15;	2		1									
H1846	802	0	1	04	01	H1846_802_0	3	1				0	0	05/20/2021	2022.01	05/20/2021 05:19:05 PM Eastern Daylight Time					06/06/2021 10:22:15 AM 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	2022	Greater Central Ohio and Dayton Area		1	12	2			2						www.MediGold.com	www.MediGold.com	www.MediGold.com	(800)240-3851		(800)240-3851		(800)964-4525		(800)964-4525										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;6;8a;9a1;9b;10a;11a;11b;15;	2		1									
H1848	001	0	1	04	01	H1848_001_0	5	1					0	07/30/2021	2022.01	07/30/2021 01:23:13 PM Eastern Daylight Time	08/03/2021 11:37:17 PM Eastern Daylight Time	07/30/2021 10:51:58 AM Eastern Daylight Time			08/04/2021 09:45:33 PM Eastern Daylight Time	WELLCARE OF ALABAMA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Giveback Open (PPO)	01	04		1			H1848	001	0	2022	Select counties in AL		2	9227	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1848	002	0	1	04	01	H1848_002_0	5	1					0	07/30/2021	2022.01	07/30/2021 01:41:08 PM Eastern Daylight Time	08/03/2021 11:37:45 PM Eastern Daylight Time	07/30/2021 10:52:18 AM Eastern Daylight Time			08/04/2021 09:45:33 PM Eastern Daylight Time	WELLCARE OF ALABAMA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium Open (PPO)	01	04		1			H1848	002	0	2022	Select counties in AL		2	4837	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1848	003	0	1	04	01	H1848_003_0	5	1	2	1			0	07/18/2021	2022.01	07/18/2021 10:58:18 AM Eastern Daylight Time	08/03/2021 11:38:14 PM Eastern Daylight Time	07/30/2021 10:52:42 AM Eastern Daylight Time			08/04/2021 09:45:33 PM Eastern Daylight Time	WELLCARE OF ALABAMA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Access Open (PPO D-SNP)	01	04		1			H1848	003	0	2022	Select counties in AL		2	911	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1848	004	0	1	04	01	H1848_004_0	5	1					0	07/30/2021	2022.01	07/30/2021 01:44:42 PM Eastern Daylight Time	08/03/2021 11:38:43 PM Eastern Daylight Time	07/30/2021 10:53:04 AM Eastern Daylight Time			08/04/2021 09:45:33 PM Eastern Daylight Time	WELLCARE OF ALABAMA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Low Premium Open (PPO)	01	04		1			H1848	004	0	2022	Select counties in AL		2	1283	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1862	001	0	1	01	01	H1862_001_0	5	1					0	08/03/2021	2022.01	08/03/2021 09:56:13 AM Eastern Daylight Time	08/03/2021 11:39:13 PM Eastern Daylight Time	07/30/2021 10:53:24 AM Eastern Daylight Time			08/04/2021 11:21:47 PM Eastern Daylight Time	WELLCARE HEALTH PLANS OF VERMONT, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO)	01	01		1			H1862	001	0	2022	Select counties in VT		2	4106	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1889	002	1	1	04	01	H1889_002_1	4	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 12:33:15 PM Central Daylight Time	08/03/2021 01:09:03 PM Central Daylight Time	07/29/2021 07:39:54 PM Central Daylight Time			08/04/2021 07:39:56 PM Central Daylight Time	UNITEDHEALTHCARE OF FLORIDA, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Choice (PPO D-SNP)	01	04		1			H1889	002	1	2022	Select Counties in Florida	Northern 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			
H1889	002	2	1	04	01	H1889_002_2	4	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 12:33:40 PM Central Daylight Time	08/03/2021 01:09:37 PM Central Daylight Time	07/29/2021 07:40:08 PM Central Daylight Time			08/04/2021 07:39:56 PM Central Daylight Time	UNITEDHEALTHCARE OF FLORIDA, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Choice (PPO D-SNP)	01	04		1			H1889	002	2	2022	Select Counties in Florida	Southern 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			
H1894	001	0	1	01	01	H1894_001_0	9	1			2		0	08/02/2021	2022.01	08/02/2021 02:25:50 PM Pacific Daylight Time	08/03/2021 03:04:03 PM Pacific Daylight Time	08/03/2021 03:04:03 PM Pacific Daylight Time			08/04/2021 12:07:42 PM Pacific Daylight Time	AMERIGROUP WASHINGTON, INC.	AMERIGROUP	https://shop.amerigroup.com/medicare/	Amerivantage Classic (HMO)	01	01		1			H1894	001	0	2022	Select counties in Washington		2		2			2						www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare/	(866)805-4589		(866)805-4589		(855)593-0910		(855)593-0910		(833)293-5473		(833)293-5473		(855)485-0931		(855)485-0931		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1894	002	0	1	01	01	H1894_002_0	6	1	2	1	1		0	07/19/2021	2022.01	07/19/2021 03:13:46 PM Eastern Daylight Time	08/03/2021 06:03:58 PM Eastern Daylight Time	08/03/2021 06:03:58 PM Eastern Daylight Time			08/04/2021 03:50:55 PM Eastern Daylight Time	AMERIGROUP WASHINGTON, INC.	AMERIGROUP	https://shop.amerigroup.com/medicare/	Amerivantage Dual Coordination (HMO D-SNP)	01	01		1			H1894	002	0	2022	Select counties in Washington		2		2			1	3		2		2	www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare/	(844)209-5407		(844)209-5407		(855)593-0911		(855)593-0911		(833)293-5472		(833)293-5472		(855)485-0932		(855)485-0932		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1894	007	0	1	01	01	H1894_007_0	8	1		1	2		0	06/04/2021	2022.01	06/04/2021 07:50:36 AM Pacific Daylight Time	08/03/2021 03:04:03 PM Pacific Daylight Time	08/03/2021 03:04:03 PM Pacific Daylight Time			08/04/2021 12:07:42 PM Pacific Daylight Time	AMERIGROUP WASHINGTON, INC.	AMERIGROUP	https://shop.amerigroup.com/medicare/	Amerivantage Comfort (HMO I-SNP)	01	01		1			H1894	007	0	2022	King and Pierce Counties		2		2			1	1	3				www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare/	(866)805-4589		(866)805-4589		(855)593-0910		(855)593-0910		(833)293-5473		(833)293-5473		(855)485-0931		(855)485-0931		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1894	008	0	1	01	01	H1894_008_0	9	1		1	2		0	07/18/2021	2022.01	07/18/2021 08:06:54 PM Pacific Daylight Time		08/03/2021 03:04:03 PM Pacific Daylight Time		08/03/2021 03:04:03 PM Pacific Daylight Time	08/04/2021 12:07:42 PM Pacific Daylight Time	AMERIGROUP WASHINGTON, INC.	AMERIGROUP	https://shop.amerigroup.com/medicare/	Amerivantage ESRD Care (HMO C-SNP)	01	01		1			H1894	008	0	2022	Select Counties in WA		2		2			1	4			00000000100000000000		www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare/	(866)805-4589		(866)805-4589		(855)593-0910		(855)593-0910		(833)293-5473		(833)293-5473		(855)485-0931		(855)485-0931		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1904	001	0	1	20	08	H1904_001_0	1	1						06/04/2021	2022.01	06/04/2021 03:07:00 PM Central Daylight Time		06/04/2021 02:51:15 PM Central Daylight Time			06/04/2021 03:13:23 PM 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	2022	PACE Greater New Orleans		2	2078	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						06/04/2021	2022.01	06/04/2021 03:06:13 PM Central Daylight Time		06/04/2021 02:51:13 PM Central Daylight Time			06/04/2021 03:13:23 PM 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	2022	PACE Greater New Orleans		2	0	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																
H1914	001	0	1	04	01	H1914_001_0	6	1					0	08/03/2021	2022.01	08/03/2021 10:01:56 AM Eastern Daylight Time	08/03/2021 11:39:42 PM Eastern Daylight Time	07/30/2021 10:53:56 AM Eastern Daylight Time			08/04/2021 11:21:47 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium Open (PPO)	01	04		1			H1914	001	0	2022	All counties in CT		2	61597	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1914	002	0	1	04	01	H1914_002_0	6	1					0	08/03/2021	2022.01	08/03/2021 10:04:36 AM Eastern Daylight Time	08/03/2021 11:40:13 PM Eastern Daylight Time	07/30/2021 10:54:18 AM Eastern Daylight Time			08/04/2021 11:21:47 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Giveback Open (PPO)	01	04		1			H1914	002	0	2022	All counties in CT		2	33218	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1914	004	0	1	04	01	H1914_004_0	6	1					0	06/06/2021	2022.01	06/06/2021 10:51:49 PM Eastern Daylight Time	08/03/2021 11:40:43 PM Eastern Daylight Time	07/30/2021 10:54:38 AM Eastern Daylight Time			08/04/2021 11:21:47 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Assist Open (PPO)	01	04		1			H1914	004	0	2022	All counties in CT		2	7041	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1924	001	0		07	02	H1924_001_0	4	2				0	0	05/27/2021	2022.01	05/27/2021 09:59:41 AM Eastern Daylight Time			06/02/2021 09:53:09 AM Eastern Daylight Time		06/02/2021 09:54:03 AM Eastern Daylight Time	PORT HOLDINGS, INC.	Lasso Healthcare	lassohealthcare.com	Lasso Healthcare Growth (MSA)	02	07	2				H1924	001	0	2022	Lasso Healthcare Growth		2		1	1		2									(866)766-2583		(866)766-2583		(866)766-2583		(866)766-2583										(711)-		(711)-		(711)-		(711)-																								
H1924	004	0		07	02	H1924_004_0	4	2				0	0	05/27/2021	2022.01	05/27/2021 02:30:00 AM India Standard Time			06/02/2021 09:53:10 AM Eastern Daylight Time		06/02/2021 09:54:03 AM Eastern Daylight Time	PORT HOLDINGS, INC.	Lasso Healthcare	lassohealthcare.com	Lasso Healthcare Growth Plus (MSA)	02	07	2				H1924	004	0	2022	Lasso Healthcare Growth Plus		2		1	1		2									(866)766-2583		(866)766-2583		(866)766-2583		(866)766-2583										(711)-		(711)-		(711)-		(711)-																								
H1944	001	0	1	01	01	H1944_001_0	2	1					1	08/04/2021	2022.01	08/04/2021 01:30:07 PM Central Daylight Time	08/03/2021 01:00:50 PM Central Daylight Time	07/29/2021 07:40:24 PM Central Daylight Time			08/05/2021 02:55:32 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO)	01	01		1			H1944	001	0	2022	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	2	1					1	08/04/2021	2022.01	08/04/2021 01:31:49 PM Central Daylight Time	08/03/2021 01:01:59 PM Central Daylight Time	07/29/2021 07:40:39 PM Central Daylight Time			08/05/2021 02:55:32 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO)	01	01		1			H1944	004	0	2022	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	3	1					1	08/04/2021	2022.01	08/04/2021 01:33:15 PM Central Daylight Time	08/03/2021 01:02:38 PM Central Daylight Time	07/29/2021 07:40:53 PM Central Daylight Time			08/05/2021 02:55:32 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO)	01	01		1			H1944	005	0	2022	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	3	1					1	08/04/2021	2022.01	08/04/2021 01:34:50 PM Central Daylight Time	08/03/2021 01:03:22 PM Central Daylight Time	07/29/2021 07:41:07 PM Central Daylight Time			08/05/2021 02:55:32 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO)	01	01		1			H1944	006	0	2022	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					1	08/04/2021	2022.01	08/04/2021 01:36:18 PM Central Daylight Time	08/03/2021 07:35:31 PM Central Daylight Time	07/29/2021 07:41:23 PM Central Daylight Time			08/05/2021 02:55:32 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO)	01	01		1			H1944	009	0	2022	Select Counties in 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	010	0	1	01	01	H1944_010_0	3	1					1	08/04/2021	2022.01	08/04/2021 01:37:45 PM Central Daylight Time	08/03/2021 07:38:41 PM Central Daylight Time	07/29/2021 07:41:37 PM Central Daylight Time			08/05/2021 02:55:32 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO)	01	01		1			H1944	010	0	2022	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	3	1					1	08/04/2021	2022.01	08/04/2021 01:39:26 PM Central Daylight Time	08/03/2021 07:40:56 PM Central Daylight Time	07/29/2021 07:41:52 PM Central Daylight Time			08/05/2021 02:55:32 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO)	01	01		1			H1944	011	0	2022	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	02	01	H1944_014_0	3	1					1	08/04/2021	2022.01	08/04/2021 01:41:46 PM Central Daylight Time	08/03/2021 01:06:29 PM Central Daylight Time	07/29/2021 07:42:08 PM Central Daylight Time			08/05/2021 02:55:32 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO-POS)	01	02		1			H1944	014	0	2022	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	02	01	H1944_015_0	2	1				0	0	07/15/2021	2022.01	07/15/2021 09:59:33 AM Central Daylight Time	06/03/2021 02:46:21 PM Central Daylight Time				07/16/2021 10:09:02 AM Central Daylight Time	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (HMO-POS)	01	02		1			H1944	015	0	2022	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	02	01	H1944_016_0	3	1					1	08/04/2021	2022.01	08/04/2021 01:43:41 PM Central Daylight Time	08/03/2021 01:07:18 PM Central Daylight Time	07/29/2021 07:42:24 PM Central Daylight Time			08/05/2021 02:55:32 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO-POS)	01	02		1			H1944	016	0	2022	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					1	08/04/2021	2022.01	08/04/2021 01:45:15 PM Central Daylight Time	08/03/2021 01:08:05 PM Central Daylight Time	07/29/2021 07:42:40 PM Central Daylight Time			08/05/2021 02:55:32 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO)	01	01		1			H1944	017	0	2022	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	2	1					1	08/04/2021	2022.01	08/04/2021 01:46:42 PM Central Daylight Time	08/03/2021 01:08:50 PM Central Daylight Time	07/29/2021 07:42:55 PM Central Daylight Time			08/05/2021 02:55:32 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO)	01	01		1			H1944	018	0	2022	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	024	0	1	01	01	H1944_024_0	3	1					1	08/04/2021	2022.01	08/04/2021 01:48:20 PM Central Daylight Time	08/03/2021 07:42:00 PM Central Daylight Time	07/29/2021 07:43:11 PM Central Daylight Time			08/05/2021 02:55:32 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO)	01	01		1			H1944	024	0	2022	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	028	0	1	01	01	H1944_028_0	3	1					1	08/04/2021	2022.01	08/04/2021 01:52:56 PM Central Daylight Time	08/03/2021 01:10:26 PM Central Daylight Time	07/29/2021 07:43:26 PM Central Daylight Time			08/05/2021 02:55:32 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO)	01	01		1			H1944	028	0	2022	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				0	0	07/15/2021	2022.01	07/15/2021 03:52:38 PM Central Daylight Time	06/03/2021 02:48:45 PM Central Daylight Time				07/16/2021 10:09:02 AM Central Daylight Time	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (HMO)	01	01		1			H1944	030	0	2022	Select Counties in 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	031	0	1	01	01	H1944_031_0	3	1					1	08/04/2021	2022.01	08/04/2021 01:54:25 PM Central Daylight Time	08/03/2021 01:11:09 PM Central Daylight Time	07/29/2021 07:43:41 PM Central Daylight Time			08/05/2021 02:55:32 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 4 (HMO)	01	01		1			H1944	031	0	2022	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	032	0	1	01	01	H1944_032_0	3	1					1	08/04/2021	2022.01	08/04/2021 01:57:16 PM Central Daylight Time	08/03/2021 01:11:56 PM Central Daylight Time	07/29/2021 07:43:57 PM Central Daylight Time			08/05/2021 02:55:32 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 3 (HMO)	01	01		1			H1944	032	0	2022	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	033	0	1	01	01	H1944_033_0	3	1					1	08/04/2021	2022.01	08/04/2021 01:59:22 PM Central Daylight Time	08/03/2021 07:44:02 PM Central Daylight Time	07/29/2021 07:44:12 PM Central Daylight Time			08/05/2021 02:55:32 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO)	01	01		1			H1944	033	0	2022	Select Counties in 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	805	0	1	01	01	H1944_805_0	1	1						06/02/2021	2022.01	06/02/2021 03:57:27 PM Central Daylight Time					06/02/2021 04:20:55 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H1944	805	0	2022	Select counties in MA, NH, PA, RI, VT		1	2208	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1					1				
H1944	806	0	1	01	01	H1944_806_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 03:59:39 PM Central Daylight Time					06/02/2021 04:20:55 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H1944	806	0	2022	Select counties in MA, NH, 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										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1					1				
H1944	807	0	1	01	01	H1944_807_0	1	1						06/02/2021	2022.01	06/02/2021 04:00:20 PM Central Daylight Time					06/02/2021 04:20:55 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H1944	807	0	2022	Select counties in MA, NH, 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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1					1				
H1947	001	0	1	01	01	H1947_001_0	7	1	2	1	1		0	07/19/2021	2022.01	07/19/2021 02:41:34 PM Eastern Daylight Time	08/03/2021 06:03:59 PM Eastern Daylight Time	08/03/2021 06:03:59 PM Eastern Daylight Time			08/04/2021 02:00:52 PM Eastern Daylight Time	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Healthy Blue	shop.healthybluela.com/medicare	Healthy Blue Dual Advantage (HMO D-SNP)	01	01		1			H1947	001	0	2022	Select Parishes in Louisiana		2		2			1	3		1		1	https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	shop.healthybluela.com/medicare	(844)209-5406		(844)209-5406		(855)593-0912		(855)593-0912		(833)370-7470		(833)370-7470		(855)485-0933		(855)485-0933		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1951	013	0	1	01	01	H1951_013_0	5	1			1		1	08/02/2021	2022.01	08/02/2021 06:36:03 PM Eastern Daylight Time	08/03/2021 06:09:03 PM Eastern Daylight Time	07/30/2021 10:31:06 AM Eastern Daylight Time			08/04/2021 03:17:21 PM 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	2022	Shreveport Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		1	08/02/2021	2022.01	08/02/2021 06:37:22 PM Eastern Daylight Time	08/03/2021 05:55:51 PM Eastern Daylight Time	07/30/2021 10:31:18 AM Eastern Daylight Time			08/04/2021 03:17:21 PM 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	2022	Tangipahoa Parish		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		1	08/02/2021	2022.01	08/02/2021 06:39:01 PM Eastern Daylight Time	08/03/2021 05:56:34 PM Eastern Daylight Time	07/30/2021 10:31:30 AM Eastern Daylight Time			08/04/2021 03:17:21 PM 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	2022	Washington and St. Tammany Parishes		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	032	0	1	01	01	H1951_032_0	4	1	2	1	1		0	07/08/2021	2022.01	07/08/2021 05:36:04 PM Eastern Daylight Time	08/03/2021 06:13:02 PM Eastern Daylight Time	07/30/2021 10:31:42 AM Eastern Daylight Time			08/04/2021 03:17:21 PM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1951-032 (HMO D-SNP)	01	01		1			H1951	032	0	2022	Baton Rouge Area		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1	2	1	1		0	07/08/2021	2022.01	07/08/2021 05:39:08 PM Eastern Daylight Time	08/03/2021 05:57:16 PM Eastern Daylight Time	07/30/2021 10:31:56 AM Eastern Daylight Time			08/04/2021 03:17:21 PM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1951-033 (HMO D-SNP)	01	01		1			H1951	033	0	2022	New Orleans Area		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	1		0	07/08/2021	2022.01	07/08/2021 05:42:14 PM Eastern Daylight Time	08/03/2021 06:12:01 PM Eastern Daylight Time	07/30/2021 10:32:08 AM Eastern Daylight Time			08/04/2021 03:17:21 PM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1951-034 (HMO D-SNP)	01	01		1			H1951	034	0	2022	Washington and St. Tammany Parishes		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		1	07/08/2021	2022.01	07/08/2021 05:46:43 PM Eastern Daylight Time	08/03/2021 05:58:35 PM Eastern Daylight Time	07/30/2021 10:32:20 AM Eastern Daylight Time			08/04/2021 03:17:21 PM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Humana	www.humana.com/medicare	Humana-Ochsner Network H1951-038 (HMO)	01	01		1			H1951	038	0	2022	New Orleans Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	07/23/2021	2022.01	07/23/2021 04:06:28 PM Eastern Daylight Time	08/03/2021 05:58:01 PM Eastern Daylight Time	07/30/2021 10:32:32 AM Eastern Daylight Time			08/04/2021 03:17:21 PM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Humana	www.humana.com/medicare	Humana-Ochsner Network H1951-039 (HMO)	01	01		1			H1951	039	0	2022	Baton Rouge Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	1		0	07/08/2021	2022.01	07/08/2021 05:50:34 PM Eastern Daylight Time	08/03/2021 06:15:15 PM Eastern Daylight Time	07/30/2021 10:32:44 AM Eastern Daylight Time			08/04/2021 03:17:21 PM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1951-041 (HMO D-SNP)	01	01		1			H1951	041	0	2022	Select Louisiana Parishes		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	6	1		1	1		1	07/15/2021	2022.01	07/15/2021 03:53:07 PM Eastern Daylight Time	08/05/2021 11:28:55 AM Eastern Daylight Time	07/30/2021 10:32:56 AM Eastern Daylight Time			08/05/2021 12:03:41 PM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Humana	www.humana.com/medicare	Humana Gold Plus - Diabetes and Heart H1951-044 (HMO C-SNP)	01	01		1			H1951	044	0	2022	Jefferson and Orleans Parishes		2		2			1	4			00000000000000000010		https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		1	08/02/2021	2022.01	08/02/2021 06:40:49 PM Eastern Daylight Time	08/03/2021 06:31:31 PM Eastern Daylight Time	07/30/2021 10:33:10 AM Eastern Daylight Time			08/04/2021 03:25:51 PM 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	2022	New Orleans Area	New Orleans Area	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		1	08/02/2021	2022.01	08/02/2021 06:42:39 PM Eastern Daylight Time	08/03/2021 06:30:28 PM Eastern Daylight Time	07/30/2021 10:33:22 AM Eastern Daylight Time			08/04/2021 03:25:51 PM 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	2022	New Orleans Area	New Orleans Area	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		1	08/02/2021	2022.01	08/02/2021 06:44:44 PM Eastern Daylight Time	08/03/2021 06:29:21 PM Eastern Daylight Time	07/30/2021 10:33:34 AM Eastern Daylight Time			08/04/2021 03:25:51 PM 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	2022	Baton Rouge Area	Baton Rouge Area	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		1	08/02/2021	2022.01	08/02/2021 06:46:08 PM Eastern Daylight Time	08/03/2021 06:17:04 PM Eastern Daylight Time	07/30/2021 10:33:46 AM Eastern Daylight Time			08/04/2021 03:25:51 PM 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	2022	Baton Rouge Area	Baton Rouge Area	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		1	08/02/2021	2022.01	08/02/2021 06:47:52 PM Eastern Daylight Time	08/03/2021 06:34:02 PM Eastern Daylight Time	07/30/2021 10:33:58 AM Eastern Daylight Time			08/04/2021 03:25:51 PM 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	2022	Select Louisiana Parishes	Select Louisiana Parishes	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		1	08/02/2021	2022.01	08/02/2021 06:49:08 PM Eastern Daylight Time	08/03/2021 06:39:01 PM Eastern Daylight Time	07/30/2021 10:34:10 AM Eastern Daylight Time			08/04/2021 03:25:51 PM 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	2022	Select Louisiana Parishes	Select Louisiana Parishes	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		1	08/02/2021	2022.01	08/02/2021 06:50:44 PM Eastern Daylight Time	08/03/2021 06:39:57 PM Eastern Daylight Time	07/30/2021 10:34:24 AM Eastern Daylight Time			08/04/2021 03:25:51 PM 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	2022	Select Louisiana Parishes	Select Louisiana Parishes	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	051	0	1	01	01	H1951_051_0	4	1			1		1	07/08/2021	2022.01	07/08/2021 06:23:42 PM Eastern Daylight Time	08/03/2021 06:47:51 PM Eastern Daylight Time	07/30/2021 10:34:36 AM Eastern Daylight Time			08/04/2021 03:25:51 PM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Humana	www.humana.com/medicare	Humana LCMC Advantage H1951-051 (HMO)	01	01		1			H1951	051	0	2022	New Orleans Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	052	0	1	01	01	H1951_052_0	5	1			1		1	08/02/2021	2022.01	08/02/2021 06:51:55 PM Eastern Daylight Time	08/03/2021 06:48:50 PM Eastern Daylight Time	07/30/2021 10:34:48 AM Eastern Daylight Time			08/04/2021 03:25:51 PM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H1951-052 (HMO)	01	01		1			H1951	052	0	2022	Select Louisiana Parishes		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	053	0	1	01	01	H1951_053_0	3	1			2		1	06/03/2021	2022.01	06/03/2021 02:57:18 PM Eastern Daylight Time	08/03/2021 06:51:50 PM Eastern Daylight Time	07/30/2021 10:35:00 AM Eastern Daylight Time			08/04/2021 02:44:49 PM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Humana	www.humana.com/medicare	Humana FMOL Baton Rouge H1951-053 (HMO)	01	01		1			H1951	053	0	2022	Baton Rouge Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	054	0	1	01	01	H1951_054_0	3	1			2		1	06/03/2021	2022.01	06/03/2021 03:00:06 PM Eastern Daylight Time	08/03/2021 06:53:01 PM Eastern Daylight Time	07/30/2021 10:35:12 AM Eastern Daylight Time			08/04/2021 02:44:49 PM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Humana	www.humana.com/medicare	Humana FMOL Lafayette H1951-054 (HMO)	01	01		1			H1951	054	0	2022	Lafayette LA		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	055	0	1	01	01	H1951_055_0	4	1			2		1	06/03/2021	2022.01	06/03/2021 03:03:22 PM Eastern Daylight Time	08/03/2021 06:50:35 PM Eastern Daylight Time	07/30/2021 10:35:24 AM Eastern Daylight Time			08/04/2021 02:44:49 PM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Humana	www.humana.com/medicare	Humana BR Clinic-BR Gen H1951-055 (HMO)	01	01		1			H1951	055	0	2022	Baton Rouge Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	056	0	1	01	01	H1951_056_0	4	1	2	1	1		0	07/08/2021	2022.01	07/08/2021 04:28:12 PM Eastern Daylight Time	08/03/2021 06:58:37 PM Eastern Daylight Time	07/30/2021 10:35:38 AM Eastern Daylight Time			08/04/2021 02:44:49 PM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1951-056 (HMO D-SNP)	01	01		1			H1951	056	0	2022	LA Statewide		2		2			1	3		2		2	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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						05/25/2021	2022.01	05/25/2021 02:03:39 PM Eastern Daylight Time					06/04/2021 08:33:40 AM 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	2022	Select parishes in Louisiana		1	92313	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242		(866)396-8810		(866)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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H1951	804	0	1	01	01	H1951_804_0	1	1				0	0	05/25/2021	2022.01	05/25/2021 02:06:32 PM Eastern Daylight Time					06/04/2021 08:33:40 AM 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	2022	Select parishes in Louisiana		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H1951	807	0	1	01	01	H1951_807_0	1	1						05/27/2021	2022.01	05/27/2021 03:24:22 PM Eastern Daylight Time					06/04/2021 08:33:40 AM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H1951	807	0	2022	Select parishes in Louisiana		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242		(866)396-8810		(866)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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					2				
H1951	808	0	1	01	01	H1951_808_0	1	1				0	0	05/27/2021	2022.01	05/27/2021 03:27:10 PM Eastern Daylight Time					06/04/2021 08:33:40 AM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H1951	808	0	2022	Select parishes in Louisiana		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					2				
H1961	003	0	1	01	01	H1961_003_0	4	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 12:33:53 PM Central Daylight Time	08/03/2021 01:09:42 PM Central Daylight Time	07/29/2021 07:44:28 PM Central Daylight Time			08/04/2021 07:39:56 PM Central Daylight Time	PEOPLES HEALTH, INC.	Peoples Health	www.peopleshealth.com	Peoples Health Secure Health (HMO D-SNP)	01	01		1			H1961	003	0	2022	South Louisiana		2	250743	2			1	3		2		2	www.peopleshealth.com/pharmacies	www.peopleshealth.com/formulary	www.peopleshealth.com/physicians	(800)222-8600		(800)222-8600		(888)834-3721		(888)834-3721		(800)222-8600		(800)222-8600		(888)834-3721		(888)834-3721		(800)846-5277		(800)846-5277		(711)-		(711)-		(800)846-5277		(800)846-5277		(711)-		(711)-		2					2					2	2			
H1961	011	0	1	01	01	H1961_011_0	5	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 12:34:05 PM Central Daylight Time	08/03/2021 01:10:14 PM Central Daylight Time	07/29/2021 07:44:44 PM Central Daylight Time			08/04/2021 07:39:56 PM Central Daylight Time	PEOPLES HEALTH, INC.	Peoples Health	www.peopleshealth.com	Peoples Health Secure Choice (HMO D-SNP)	01	01		1			H1961	011	0	2022	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		(800)222-8600		(888)834-3721		(888)834-3721		(800)222-8600		(800)222-8600		(888)834-3721		(888)834-3721		(800)846-5277		(800)846-5277		(711)-		(711)-		(800)846-5277		(800)846-5277		(711)-		(711)-		2					2					2	2			
H1961	014	1	1	01	01	H1961_014_1	3	1			2		1	08/04/2021	2022.01	08/04/2021 12:34:15 PM Central Daylight Time	08/03/2021 01:10:44 PM Central Daylight Time	07/29/2021 07:45:05 PM Central Daylight Time			08/04/2021 07:39:56 PM Central Daylight Time	PEOPLES HEALTH, INC.	Peoples Health	www.peopleshealth.com	Peoples Health Choices 65 (HMO)	01	01		1			H1961	014	1	2022	New Orleans Metro Area and Northshore	Greater New Orleans and Baton Rouge area	2	443209	2			2						www.peopleshealth.com/pharmacies	www.peopleshealth.com/formulary	www.peopleshealth.com/physicians	(800)222-8600		(800)222-8600		(800)555-5757		(800)555-5757		(800)222-8600		(800)222-8600		(800)555-5757		(800)555-5757		(800)846-5277		(800)846-5277		(711)-		(711)-		(800)846-5277		(800)846-5277		(711)-		(711)-		2					2					2	2			
H1961	014	2	1	01	01	H1961_014_2	4	1			2		1	08/04/2021	2022.01	08/04/2021 12:34:27 PM Central Daylight Time	08/03/2021 01:11:14 PM Central Daylight Time	07/29/2021 07:45:20 PM Central Daylight Time			08/04/2021 07:39:56 PM Central Daylight Time	PEOPLES HEALTH, INC.	Peoples Health	www.peopleshealth.com	Peoples Health Choices 65 (HMO)	01	01		1			H1961	014	2	2022	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		(800)222-8600		(800)555-5757		(800)555-5757		(800)222-8600		(800)222-8600		(800)555-5757		(800)555-5757		(800)846-5277		(800)846-5277		(711)-		(711)-		(800)846-5277		(800)846-5277		(711)-		(711)-		2					2					2	2			
H1961	014	3	1	01	01	H1961_014_3	3	1			2		1	08/04/2021	2022.01	08/04/2021 12:34:40 PM Central Daylight Time	08/03/2021 01:11:43 PM Central Daylight Time	07/29/2021 07:45:36 PM Central Daylight Time			08/04/2021 07:39:56 PM Central Daylight Time	PEOPLES HEALTH, INC.	Peoples Health	www.peopleshealth.com	Peoples Health Choices 65 (HMO)	01	01		1			H1961	014	3	2022	New Orleans Metro Area and Northshore	Southland	2	443209	2			2						www.peopleshealth.com/pharmacies	www.peopleshealth.com/formulary	www.peopleshealth.com/physicians	(800)222-8600		(800)222-8600		(800)555-5757		(800)555-5757		(800)222-8600		(800)222-8600		(800)555-5757		(800)555-5757		(800)846-5277		(800)846-5277		(711)-		(711)-		(800)846-5277		(800)846-5277		(711)-		(711)-		2					2					2	2			
H1961	014	4	1	01	01	H1961_014_4	4	1			2		1	08/04/2021	2022.01	08/04/2021 12:35:21 PM Central Daylight Time	08/03/2021 01:22:40 PM Central Daylight Time	07/29/2021 07:45:51 PM Central Daylight Time			08/04/2021 07:39:56 PM Central Daylight Time	PEOPLES HEALTH, INC.	Peoples Health	www.peopleshealth.com	Peoples Health Choices 65 (HMO)	01	01		1			H1961	014	4	2022	New Orleans Metro Area and Northshore	Rural Southeast	2	443209	2			2						www.peopleshealth.com/pharmacies	www.peopleshealth.com/formulary	www.peopleshealth.com/physicians	(800)222-8600		(800)222-8600		(800)555-5757		(800)555-5757		(800)222-8600		(800)222-8600		(800)555-5757		(800)555-5757		(800)846-5277		(800)846-5277		(711)-		(711)-		(800)846-5277		(800)846-5277		(711)-		(711)-		2					2					2	2			
H1961	017	0	1	01	01	H1961_017_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 12:35:36 PM Central Daylight Time	08/03/2021 01:12:25 PM Central Daylight Time	07/29/2021 07:46:07 PM Central Daylight Time			08/04/2021 07:39:56 PM Central Daylight Time	PEOPLES HEALTH, INC.	Peoples Health	www.peopleshealth.com	Peoples Health Choices Gold (HMO)	01	01		1			H1961	017	0	2022	Southwest and North Louisiana		2	16037	2			2						www.peopleshealth.com/pharmacies	www.peopleshealth.com/formulary	www.peopleshealth.com/physicians	(800)222-8600		(800)222-8600		(800)555-5757		(800)555-5757		(800)222-8600		(800)222-8600		(800)555-5757		(800)555-5757		(800)846-5277		(800)846-5277		(711)-		(711)-		(800)846-5277		(800)846-5277		(711)-		(711)-		2					2					2	2			
H1961	019	0	1	01	01	H1961_019_0	4	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 12:35:56 PM Central Daylight Time	08/03/2021 01:12:54 PM Central Daylight Time	07/29/2021 07:46:22 PM Central Daylight Time			08/04/2021 07:39:56 PM Central Daylight Time	PEOPLES HEALTH, INC.	Peoples Health	www.peopleshealth.com	Peoples Health Secure Complete (HMO D-SNP)	01	01		1			H1961	019	0	2022	Louisiana		2		2			1	3		1		1	www.peopleshealth.com/pharmacies	www.peopleshealth.com/formulary	www.peopleshealth.com/physicians	(800)222-8600		(800)222-8600		(888)834-3721		(888)834-3721		(800)222-8600		(800)222-8600		(888)834-3721		(888)834-3721		(800)846-5277		(800)846-5277		(711)-		(711)-		(800)846-5277		(800)846-5277		(711)-		(711)-		2					2					2	2			
H1961	801	0	1	02	01	H1961_801_0	1	1						05/28/2021	2022.01	05/28/2021 12:35:45 PM Central Daylight Time					06/02/2021 09:35:47 AM Central Daylight Time	PEOPLES HEALTH, INC.	Peoples Health	www.peopleshealth.com	Peoples Health Group Medicare (HMO-POS)	01	02		1			H1961	801	0	2022	Nationwide		1	30936	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		1	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1	2		2		1				
H1961	802	0	1	02	01	H1961_802_0	1	1						05/24/2021	2022.01	05/24/2021 01:41:01 PM Central Daylight Time					06/02/2021 09:35:47 AM Central Daylight Time	PEOPLES HEALTH, INC.	Peoples Health	www.peopleshealth.com	Peoples Health Group Medicare (HMO-POS)	01	02		1			H1961	802	0	2022	Nationwide		1	0	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		1	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1	2		2		1				
H1961	803	0	1	01	01	H1961_803_0	1	1						05/24/2021	2022.01	05/24/2021 01:41:14 PM Central Daylight Time					06/02/2021 09:35:47 AM Central Daylight Time	PEOPLES HEALTH, INC.	Peoples Health	www.peopleshealth.com	Peoples Health Group Medicare (HMO)	01	01		1			H1961	803	0	2022	Nationwide		1	0	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		1	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1					1				
H1961	804	0	1	01	01	H1961_804_0	1	1						05/24/2021	2022.01	05/24/2021 01:41:33 PM Central Daylight Time					06/02/2021 09:35:47 AM Central Daylight Time	PEOPLES HEALTH, INC.	Peoples Health	www.peopleshealth.com	Peoples Health Group Medicare (HMO)	01	01		1			H1961	804	0	2022	Nationwide		1	0	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		1	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1					1				
H1969	002	0	1	01	01	H1969_002_0	7	1					1	08/03/2021	2022.01	08/03/2021 11:20:39 AM Pacific Daylight Time	08/04/2021 12:38:04 PM Pacific Daylight Time	08/06/2021 09:41:52 AM Pacific Daylight Time			08/09/2021 09:46:09 AM Pacific 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	2022	Ada and Canyon Counties		2	8517	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	7	1					1	08/03/2021	2022.01	08/03/2021 11:21:05 AM Pacific Daylight Time	08/04/2021 12:38:55 PM Pacific Daylight Time	08/06/2021 09:44:42 AM Pacific Daylight Time			08/09/2021 09:46:09 AM Pacific 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	2022	Ada and Canyon Counties		2	3201	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	006	0	1	01	01	H1969_006_0	4	1				0	0	07/07/2021	2022.01	07/07/2021 10:39:26 AM Pacific Daylight Time	07/01/2021 02:04:13 PM Pacific Daylight Time				07/07/2021 03:24:11 PM Pacific Daylight Time	REGENCE BLUESHIELD OF IDAHO	Regence BlueShield of Idaho	www.regence.com/medicare	Regence | St. Luke's Health Partners Align No Rx (HMO)	01	01		1			H1969	006	0	2022	Select Counties in Idaho		2	918	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										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H1969	007	3	1	01	01	H1969_007_3	8	1					1	08/03/2021	2022.01	08/03/2021 11:18:41 AM Pacific Daylight Time	08/05/2021 06:57:48 AM Pacific Daylight Time	08/06/2021 09:46:21 AM Pacific Daylight Time			08/09/2021 09:46:09 AM Pacific Daylight Time	REGENCE BLUESHIELD OF IDAHO	Regence BlueShield of Idaho	www.regence.com/medicare	Regence | St. Luke's Health Partners Align (HMO)	01	01		1			H1969	007	3	2022	Select Counties in Idaho	Select Counties in Idaho	2	12385	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	007	4	1	01	01	H1969_007_4	8	1					1	08/03/2021	2022.01	08/03/2021 11:18:19 AM Pacific Daylight Time	08/05/2021 06:58:30 AM Pacific Daylight Time	08/06/2021 09:47:57 AM Pacific Daylight Time			08/09/2021 09:46:09 AM Pacific Daylight Time	REGENCE BLUESHIELD OF IDAHO	Regence BlueShield of Idaho	www.regence.com/medicare	Regence | St. Luke's Health Partners Align (HMO)	01	01		1			H1969	007	4	2022	Select Counties in Idaho	Select Counties in Idaho	2	6202	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	008	1	1	01	01	H1969_008_1	8	1					1	08/03/2021	2022.01	08/03/2021 11:19:52 AM Pacific Daylight Time	08/05/2021 06:59:25 AM Pacific Daylight Time	08/06/2021 09:51:13 AM Pacific Daylight Time			08/09/2021 09:46:09 AM Pacific Daylight Time	REGENCE BLUESHIELD OF IDAHO	Regence BlueShield of Idaho	www.regence.com/medicare	Regence | St. Luke's Health Partners Align Plus (HMO)	01	01		1			H1969	008	1	2022	Select Counties in Idaho	Select Counties in Idaho	2	1663	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	008	2	1	01	01	H1969_008_2	8	1					1	08/03/2021	2022.01	08/03/2021 11:20:18 AM Pacific Daylight Time	08/05/2021 07:00:28 AM Pacific Daylight Time	08/06/2021 09:52:44 AM Pacific Daylight Time			08/09/2021 09:46:09 AM Pacific Daylight Time	REGENCE BLUESHIELD OF IDAHO	Regence BlueShield of Idaho	www.regence.com/medicare	Regence | St. Luke's Health Partners Align Plus (HMO)	01	01		1			H1969	008	2	2022	Select Counties in Idaho	Select Counties in Idaho	2	283	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			
H1977	001	0	1	48	05	H1977_001_0	2	1						07/08/2021	2022.01	07/08/2021 11:54:14 AM Eastern Daylight Time					07/08/2021 11:56:05 AM 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	2022	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)-																
H1993	001	0	1	01	01	H1993_001_0	9	1					1	09/27/2021	2022.01	09/27/2021 08:26:48 AM Pacific Daylight Time	08/04/2021 07:33:01 PM Pacific Daylight Time	07/29/2021 03:23:51 PM Pacific Daylight Time			09/28/2021 09:48:18 AM Pacific Daylight Time	ASTIVA HEALTH, INC.	Astiva Health	https://astivahealth.com/	Astiva Health Advantage (HMO)	01	01		1			H1993	001	0	2022	Orange County		2		2			2						https://www.elixirsolutions.com/	https://astivahealth.com/	https://astivahealth.com/	(866)688-9021		(949)393-8839		(866)688-9021		(949)393-8839		(833)697-6561		(949)393-8839		(866)688-9021		(949)393-8839		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1993	002	0	1	01	01	H1993_002_0	8	1					1	08/05/2021	2022.01	08/05/2021 03:21:14 PM Pacific Daylight Time	08/04/2021 07:33:50 PM Pacific Daylight Time	07/29/2021 03:24:24 PM Pacific Daylight Time			08/05/2021 03:23:59 PM Pacific Daylight Time	ASTIVA HEALTH, INC.	Astiva Health	https://astivahealth.com/	Astiva Health Value (HMO)	01	01		1			H1993	002	0	2022	Orange County		2		2			2						https://www.elixirsolutions.com/	https://astivahealth.com/	https://astivahealth.com/	(866)688-9021		(949)393-8839		(866)688-9021		(949)393-8839		(833)697-6561		(949)393-8839		(866)688-9021		(949)393-8839		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1993	003	0	1	01	01	H1993_003_0	9	1					1	09/27/2021	2022.01	09/27/2021 08:29:55 AM Pacific Daylight Time	08/04/2021 07:34:37 PM Pacific Daylight Time	07/29/2021 03:25:06 PM Pacific Daylight Time			09/28/2021 09:48:18 AM Pacific Daylight Time	ASTIVA HEALTH, INC.	Astiva Health	https://astivahealth.com/	Astiva Health Advantage (HMO)	01	01		1			H1993	003	0	2022	San Diego County		2		2			2						https://www.elixirsolutions.com/	https://astivahealth.com/	https://astivahealth.com/	(866)688-9021		(949)393-8839		(866)688-9021		(949)393-8839		(833)697-6561		(949)393-8839		(866)688-9021		(949)393-8839		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1993	004	0	1	01	01	H1993_004_0	8	1					1	08/05/2021	2022.01	08/05/2021 03:21:27 PM Pacific Daylight Time	08/04/2021 07:35:13 PM Pacific Daylight Time	07/29/2021 03:28:35 PM Pacific Daylight Time			08/05/2021 03:23:59 PM Pacific Daylight Time	ASTIVA HEALTH, INC.	Astiva Health	https://astivahealth.com/	Astiva Health Value (HMO)	01	01		1			H1993	004	0	2022	San Diego County		2		2			2						https://www.elixirsolutions.com/	https://astivahealth.com/	https://astivahealth.com/	(866)688-9021		(949)393-8839		(866)688-9021		(949)393-8839		(833)697-6561		(949)393-8839		(866)688-9021		(949)393-8839		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1994	001	0	1	01	01	H1994_001_0	10	1			1		1	08/05/2021	2022.01	08/05/2021 09:52:58 AM Mountain Daylight Time	08/05/2021 09:49:48 AM Mountain Daylight Time	08/05/2021 09:49:48 AM Mountain Daylight Time			08/05/2021 10:04:55 AM Mountain Daylight Time	SELECTHEALTH, INC.	SelectHealth	www.selecthealth.org/medicare	SelectHealth Advantage Essential (HMO)	01	01		1			H1994	001	0	2022	Urban and Northern Utah		2	338682	2			2						www.selecthealth.org/medicare	www.selecthealth.org/medicare	www.selecthealth.org/medicare	(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	9	1			1		1	08/05/2021	2022.01	08/05/2021 09:53:25 AM Mountain Daylight Time	08/05/2021 09:49:48 AM Mountain Daylight Time	08/05/2021 09:49:48 AM Mountain Daylight Time			08/05/2021 10:04:55 AM Mountain Daylight Time	SELECTHEALTH, INC.	SelectHealth	www.selecthealth.org/medicare	SelectHealth Advantage (HMO)	01	01		1			H1994	002	0	2022	Gar, Iron, Jua, Mil, Piu, San, Sev, Wash, Wayne Co		2	94238	2			2						www.selecthealth.org/medicare	www.selecthealth.org/medicare	www.selecthealth.org/medicare	(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			1		1	08/05/2021	2022.01	08/05/2021 09:53:49 AM Mountain Daylight Time	08/05/2021 09:49:49 AM Mountain Daylight Time	08/05/2021 09:49:49 AM Mountain Daylight Time			08/05/2021 10:04:55 AM Mountain Daylight Time	SELECTHEALTH, INC.	SelectHealth	www.selecthealth.org/medicare	SelectHealth Advantage Essential (HMO)	01	01		1			H1994	003	0	2022	Ada, Boise, and Canyon Counties		2	60996	2			2						www.selecthealth.org/medicare	www.selecthealth.org/medicare	www.selecthealth.org/medicare	(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	9	1			1		1	08/04/2021	2022.01	08/04/2021 04:47:50 PM Mountain Daylight Time	08/05/2021 09:49:49 AM Mountain Daylight Time	08/05/2021 09:49:49 AM Mountain Daylight Time			08/05/2021 10:04:55 AM Mountain Daylight Time	SELECTHEALTH, INC.	SelectHealth	www.selecthealth.org/medicare	SelectHealth Advantage (HMO)	01	01		1			H1994	004	0	2022	Twin Falls County		2	7104	2			2						www.selecthealth.org/medicare	www.selecthealth.org/medicare	www.selecthealth.org/medicare	(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	007	0	1	01	01	H1994_007_0	9	1			1		1	07/30/2021	2022.01	07/30/2021 10:38:14 AM Mountain Daylight Time	08/05/2021 09:49:49 AM Mountain Daylight Time	08/05/2021 09:49:49 AM Mountain Daylight Time			08/05/2021 10:04:55 AM Mountain Daylight Time	SELECTHEALTH, INC.	SelectHealth	www.selecthealth.org/medicare	SelectHealth Advantage Enhanced (HMO)	01	01		1			H1994	007	0	2022	Urban and Northern Utah		2	21780	2			2						www.selecthealth.org/medicare	www.selecthealth.org/medicare	www.selecthealth.org/medicare	(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	10	1			1		1	07/28/2021	2022.01	07/28/2021 09:35:10 AM Mountain Daylight Time	08/05/2021 09:49:49 AM Mountain Daylight Time	08/05/2021 09:49:49 AM Mountain Daylight Time			08/05/2021 10:04:55 AM Mountain Daylight Time	SELECTHEALTH, INC.	SelectHealth	www.selecthealth.org/medicare	SelectHealth Advantage Enhanced (HMO)	01	01		1			H1994	008	0	2022	Ada, Boise, and Canyon Counties		2	13680	2			2						www.selecthealth.org/medicare	www.selecthealth.org/medicare	www.selecthealth.org/medicare	(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	012	0	1	01	01	H1994_012_0	10	1			2		1	08/05/2021	2022.01	08/05/2021 09:55:15 AM Mountain Daylight Time	08/05/2021 09:49:49 AM Mountain Daylight Time	08/05/2021 09:49:49 AM Mountain Daylight Time			08/05/2021 10:04:55 AM Mountain Daylight Time	SELECTHEALTH, INC.	SelectHealth	www.selecthealth.org/medicare	SelectHealth Advantage (HMO)	01	01		1			H1994	012	0	2022	Clark and Nye Counties		2	36209	2			2						www.selecthealth.org/medicare	www.selecthealth.org/medicare	www.selecthealth.org/medicare	(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	013	0	1	01	01	H1994_013_0	9	1			2		1	07/06/2021	2022.01	07/06/2021 04:42:17 PM Mountain Daylight Time	08/05/2021 09:49:49 AM Mountain Daylight Time	08/05/2021 09:49:48 AM Mountain Daylight Time			08/05/2021 10:04:55 AM Mountain Daylight Time	SELECTHEALTH, INC.	SelectHealth	www.selecthealth.org/medicare	SelectHealth Advantage (HMO)	01	01		1			H1994	013	0	2022	Southwest Idaho		2	17377	2			2						www.selecthealth.org/medicare	www.selecthealth.org/medicare	www.selecthealth.org/medicare	(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	014	0	1	01	01	H1994_014_0	9	1			2		1	07/06/2021	2022.01	07/06/2021 01:49:26 PM Mountain Daylight Time	08/05/2021 09:49:48 AM Mountain Daylight Time	08/05/2021 09:49:48 AM Mountain Daylight Time			08/05/2021 10:04:55 AM Mountain Daylight Time	SELECTHEALTH, INC.	SelectHealth	www.selecthealth.org/medicare	SelectHealth Advantage (HMO)	01	01		1			H1994	014	0	2022	Cassia, Gooding, Jerome, and Minidoka Counties		2	9697	2			2						www.selecthealth.org/medicare	www.selecthealth.org/medicare	www.selecthealth.org/medicare	(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	015	0	1	01	01	H1994_015_0	6	1	2	1	1		0	08/05/2021	2022.01	08/05/2021 09:27:24 AM Mountain Daylight Time	08/05/2021 09:22:48 AM Mountain Daylight Time	08/05/2021 09:22:49 AM Mountain Daylight Time			08/05/2021 09:32:59 AM Mountain Daylight Time	SELECTHEALTH, INC.	SelectHealth	www.selecthealth.org/medicare	SelectHealth Community Advantage (HMO D-SNP)	01	01		1			H1994	015	0	2022	Davis, Salt Lake, Utah, and Weber Counties		2		2			1	3		1		1	www.selecthealth.org/medicare	www.selecthealth.org/medicare	www.selecthealth.org/medicare	(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	016	0	1	01	01	H1994_016_0	7	1			1	0	0	07/26/2021	2022.01	07/26/2021 10:25:27 AM Mountain Daylight Time	06/07/2021 10:46:49 PM Mountain Daylight Time				07/26/2021 10:26:50 AM Mountain Daylight Time	SELECTHEALTH, INC.	SelectHealth	www.selecthealth.org/medicare	SelectHealth Veteran Advantage (HMO)	01	01		1			H1994	016	0	2022	Davis, Salt Lake, Utah, and Weber Counties		2	3660	2			2						www.selecthealth.org/medicare	www.selecthealth.org/medicare	www.selecthealth.org/medicare	(855)442-9900		(801)442-9900		(855)442-9940		(801)442-9940										(800)346-4128		(711)-		(800)346-4128		(711)-										2					2					2	2			
H1994	801	0	1	01	01	H1994_801_0	4	1						06/03/2021	2022.01	06/03/2021 09:59:28 PM Mountain Daylight Time					06/07/2021 10:59:14 PM Mountain Daylight Time	SELECTHEALTH, INC.	SelectHealth	www.selecthealth.org/medicare	SelectHealth Advantage (HMO)	01	01		1			H1994	801	0	2022	Utah and Idaho, and Clark and Nye Counties Nevada		1	300	2			2						www.selecthealth.org/medicare	www.selecthealth.org/medicare	www.selecthealth.org/medicare	(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	4	1				0	0	06/03/2021	2022.01	06/03/2021 10:00:39 PM Mountain Daylight Time					06/07/2021 10:59:14 PM Mountain Daylight Time	SELECTHEALTH, INC.	SelectHealth	www.selecthealth.org/medicare	SelectHealth Advantage (HMO)	01	01		1			H1994	802	0	2022	Utah and Idaho, and Clark and Nye Counties Nevada		1	300	2			2						www.selecthealth.org/medicare	www.selecthealth.org/medicare	www.selecthealth.org/medicare	(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	4	1						06/03/2021	2022.01	06/03/2021 10:01:45 PM Mountain Daylight Time					06/07/2021 10:59:14 PM Mountain Daylight Time	SELECTHEALTH, INC.	SelectHealth	www.selecthealth.org/medicare	SelectHealth Advantage (HMO)	01	01		1			H1994	803	0	2022	Utah and Idaho, and Clark and Nye Counties Nevada		1	300	2			2						www.selecthealth.org/medicare	www.selecthealth.org/medicare	www.selecthealth.org/medicare	(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	7	1					1	08/03/2021	2022.01	08/03/2021 01:43:39 PM Pacific Daylight Time	08/04/2021 12:42:21 PM Pacific Daylight Time	08/06/2021 09:54:20 AM Pacific Daylight Time			08/09/2021 09:46:09 AM Pacific Daylight Time	REGENCE BLUESHIELD	Regence BlueShield	www.regence.com/medicare	Regence BlueAdvantage HMO Plus (HMO)	01	01		1			H1997	002	0	2022	King, Kitsap, Pierce, Snohomish Counties		2	18121	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	008	0	1	01	01	H1997_008_0	4	1				0	0	07/07/2021	2022.01	07/07/2021 10:52:28 AM Pacific Daylight Time	07/01/2021 02:09:09 PM Pacific Daylight Time				07/07/2021 03:24:11 PM Pacific Daylight Time	REGENCE BLUESHIELD	Regence BlueShield	www.regence.com/medicare	Regence Valiance (HMO)	01	01		1			H1997	008	0	2022	Select Counties in Washington		2	1329	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										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H1997	009	0	1	01	01	H1997_009_0	7	1					1	08/03/2021	2022.01	08/03/2021 01:41:38 PM Pacific Daylight Time	08/04/2021 12:43:01 PM Pacific Daylight Time	08/06/2021 09:56:00 AM Pacific Daylight Time			08/09/2021 09:46:09 AM Pacific Daylight Time	REGENCE BLUESHIELD	Regence BlueShield	www.regence.com/medicare	Regence BlueAdvantage HMO (HMO)	01	01		1			H1997	009	0	2022	King, Kitsap, Pierce, Snohomish Counties		2	22169	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	010	0	1	01	01	H1997_010_0	8	1					1	08/03/2021	2022.01	08/03/2021 01:42:54 PM Pacific Daylight Time	08/05/2021 07:01:27 AM Pacific Daylight Time	08/06/2021 09:57:45 AM Pacific Daylight Time			08/09/2021 09:46:09 AM Pacific Daylight Time	REGENCE BLUESHIELD	Regence BlueShield	www.regence.com/medicare	Regence Align (HMO)	01	01		1			H1997	010	0	2022	Whatcom and Skagit Counties		2	14997	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	011	0	1	01	01	H1997_011_0	8	1					1	08/03/2021	2022.01	08/03/2021 01:44:32 PM Pacific Daylight Time	08/05/2021 07:02:17 AM Pacific Daylight Time	08/06/2021 09:59:26 AM Pacific Daylight Time			08/09/2021 09:46:09 AM Pacific Daylight Time	REGENCE BLUESHIELD	Regence BlueShield	www.regence.com/medicare	Regence Align Plus (HMO)	01	01		1			H1997	011	0	2022	Whatcom and Skagit Counties		2	4543	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			
H2001	001	0	1	04	01	H2001_001_0	3	1					1	08/04/2021	2022.01	08/04/2021 02:02:52 PM Central Daylight Time	08/03/2021 11:44:06 AM Central Daylight Time	07/29/2021 07:46:37 PM Central Daylight Time			08/05/2021 03:09:42 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 1 (PPO)	01	04		1			H2001	001	0	2022	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	3	1					1	08/04/2021	2022.01	08/04/2021 02:04:33 PM Central Daylight Time	08/03/2021 11:44:35 AM Central Daylight Time	07/29/2021 07:46:52 PM Central Daylight Time			08/05/2021 03:09:42 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 2 (PPO)	01	04		1			H2001	010	0	2022	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	4	1					1	08/04/2021	2022.01	08/04/2021 11:37:43 AM Central Daylight Time	08/03/2021 11:45:03 AM Central Daylight Time	07/29/2021 07:47:08 PM Central Daylight Time			08/04/2021 09:10:19 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Choice Plan 1 (PPO)	01	04		1			H2001	017	0	2022	Iron and Washington Counties		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	018	0	1	04	01	H2001_018_0	3	1					1	08/04/2021	2022.01	08/04/2021 02:05:54 PM Central Daylight Time	08/03/2021 11:45:32 AM Central Daylight Time	07/29/2021 07:47:24 PM Central Daylight Time			08/05/2021 03:09:42 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 1 (PPO)	01	04		1			H2001	018	0	2022	North 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	019	0	1	04	01	H2001_019_0	3	1					1	08/04/2021	2022.01	08/04/2021 02:07:39 PM Central Daylight Time	08/03/2021 11:46:03 AM Central Daylight Time	07/29/2021 07:47:39 PM Central Daylight Time			08/05/2021 03:09:42 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 3 (PPO)	01	04		1			H2001	019	0	2022	South 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	021	0	1	04	01	H2001_021_0	2	1				0	0	07/15/2021	2022.01	07/15/2021 10:43:35 AM Central Daylight Time	06/03/2021 02:36:09 PM Central Daylight Time				07/16/2021 10:39:54 AM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (PPO)	01	04		1			H2001	021	0	2022	Counties in ME		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			
H2001	816	0	1	04	01	H2001_816_0	2	1						05/24/2021	2022.01	05/24/2021 04:11:06 PM Eastern Daylight Time					06/02/2021 10:26:33 AM Eastern Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	816	0	2022	National Service Area		1	7535352	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2001	817	0	1	04	01	H2001_817_0	2	1				0	0	05/24/2021	2022.01	05/24/2021 04:15:32 PM Eastern Daylight Time					06/02/2021 10:26:33 AM Eastern Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	817	0	2022	National Service Area		1	7705896	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2001	818	0	1	04	01	H2001_818_0	2	1						05/24/2021	2022.01	05/24/2021 04:16:42 PM Eastern Daylight Time					06/02/2021 10:26:33 AM Eastern Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	818	0	2022	National Service Area		1	2412	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2001	819	0	2	04	01	H2001_819_0	2	1						05/24/2021	2022.01	05/24/2021 04:18:50 PM Eastern Daylight Time					06/02/2021 10:26:33 AM Eastern 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	2022	National Service Area		1	14220	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2001	820	0	2	04	01	H2001_820_0	2	1				0	0	05/24/2021	2022.01	05/24/2021 04:19:38 PM Eastern Daylight Time					06/02/2021 10:26:33 AM Eastern 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	2022	National Service Area		1	99888	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2001	821	0	2	04	01	H2001_821_0	2	1						05/24/2021	2022.01	05/24/2021 04:19:57 PM Eastern Daylight Time					06/02/2021 10:26:33 AM Eastern 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	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;17a;18a;	2		1									
H2001	822	0	1	04	01	H2001_822_0	2	1						05/24/2021	2022.01	05/24/2021 04:20:28 PM Eastern Daylight Time					06/02/2021 10:26:33 AM Eastern Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	822	0	2022	Select Counties		1	3336	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H2001	823	0	1	04	01	H2001_823_0	2	1				0	0	05/24/2021	2022.01	05/24/2021 04:21:12 PM Eastern Daylight Time					06/02/2021 10:26:33 AM Eastern Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	823	0	2022	Select Counties		1	492	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7c;7d;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H2001	824	0	1	04	01	H2001_824_0	2	1						05/24/2021	2022.01	05/24/2021 04:22:58 PM Eastern Daylight Time					06/02/2021 10:26:33 AM Eastern Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	824	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;17a;18a;	2		1									
H2001	825	0	1	04	01	H2001_825_0	2	1						05/24/2021	2022.01	05/24/2021 04:23:25 PM Eastern Daylight Time					06/02/2021 10:26:33 AM Eastern Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	825	0	2022	Select Counties		1	38232	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2001	826	0	1	04	01	H2001_826_0	2	1						05/24/2021	2022.01	05/24/2021 04:23:52 PM Eastern Daylight Time					06/02/2021 10:26:33 AM Eastern Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	826	0	2022	Select Counties		1	40416	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2001	827	0	1	04	01	H2001_827_0	2	1						05/24/2021	2022.01	05/24/2021 04:24:16 PM Eastern Daylight Time					06/02/2021 10:26:33 AM Eastern Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	827	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;15;16b;17a;18a;	2		1									
H2001	828	0	1	04	01	H2001_828_0	2	1						05/24/2021	2022.01	05/24/2021 04:24:41 PM Eastern Daylight Time					06/02/2021 10:26:33 AM Eastern Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	828	0	2022	National Service Area		1	312	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;15;16b;17a;18a;	2		1									
H2001	829	0	1	04	01	H2001_829_0	2	1						05/24/2021	2022.01	05/24/2021 04:25:06 PM Eastern Daylight Time					06/02/2021 10:26:33 AM Eastern Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	829	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;15;16b;17a;18a;	2		1									
H2001	830	0	1	04	01	H2001_830_0	2	1				0	0	05/24/2021	2022.01	05/24/2021 04:25:45 PM Eastern Daylight Time					06/02/2021 10:26:33 AM Eastern Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	830	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;15;16b;17a;17b;	2		1									
H2001	831	0	1	04	01	H2001_831_0	2	1						05/24/2021	2022.01	05/24/2021 04:26:11 PM Eastern Daylight Time					06/02/2021 10:26:33 AM Eastern Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	831	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2001	832	0	2	04	01	H2001_832_0	2	1						05/24/2021	2022.01	05/24/2021 04:26:29 PM Eastern Daylight Time					06/02/2021 10:26:33 AM Eastern 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	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2001	833	0	2	04	01	H2001_833_0	2	1				0	0	05/24/2021	2022.01	05/24/2021 04:27:03 PM Eastern Daylight Time					06/02/2021 10:26:33 AM Eastern 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	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2001	834	0	2	04	01	H2001_834_0	2	1						05/24/2021	2022.01	05/24/2021 04:27:22 PM Eastern Daylight Time					06/02/2021 10:26:33 AM Eastern 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	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2001	835	0	1	04	01	H2001_835_0	2	1						05/24/2021	2022.01	05/24/2021 04:27:48 PM Eastern Daylight Time					06/02/2021 10:26:33 AM Eastern Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	835	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2001	836	0	1	04	01	H2001_836_0	2	1						05/24/2021	2022.01	05/24/2021 04:28:13 PM Eastern Daylight Time					06/02/2021 10:26:33 AM Eastern Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	836	0	2022	Nationwide		1	100356	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2001	837	0	1	04	01	H2001_837_0	2	1						05/24/2021	2022.01	05/24/2021 04:28:36 PM Eastern Daylight Time					06/02/2021 10:26:33 AM Eastern Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	837	0	2022	Nationwide		1	1226520	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2001	838	0	1	04	01	H2001_838_0	2	1						05/24/2021	2022.01	05/24/2021 04:29:00 PM Eastern Daylight Time					06/02/2021 10:26:33 AM Eastern Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	838	0	2022	Nationwide		1	618720	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2001	839	0	2	04	01	H2001_839_0	2	1						05/24/2021	2022.01	05/24/2021 04:29:32 PM Eastern Daylight Time					06/02/2021 10:26:33 AM Eastern 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	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2001	840	0	1	04	01	H2001_840_0	2	1				0	0	05/24/2021	2022.01	05/24/2021 04:30:08 PM Eastern Daylight Time					06/02/2021 10:26:33 AM Eastern Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	840	0	2022	Nationwide		1	57576	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2001	841	0	1	04	01	H2001_841_0	2	1						05/24/2021	2022.01	05/24/2021 04:30:34 PM Eastern Daylight Time					06/02/2021 10:26:33 AM Eastern Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	841	0	2022	Nationwide		1	48	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2001	842	0	1	04	01	H2001_842_0	2	1						05/24/2021	2022.01	05/24/2021 04:30:58 PM Eastern Daylight Time					06/02/2021 10:26:33 AM Eastern Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	842	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2001	843	0	1	04	01	H2001_843_0	2	1						05/24/2021	2022.01	05/24/2021 04:31:22 PM Eastern Daylight Time					06/02/2021 10:26:33 AM Eastern Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	843	0	2022	Nationwide		1	3276	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2001	844	0	1	04	01	H2001_844_0	2	1						05/24/2021	2022.01	05/24/2021 04:31:46 PM Eastern Daylight Time					06/02/2021 10:26:33 AM Eastern Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	844	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2001	845	0	1	04	01	H2001_845_0	2	1						05/24/2021	2022.01	05/24/2021 04:32:09 PM Eastern Daylight Time					06/02/2021 10:26:33 AM Eastern Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	845	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2001	846	0	1	04	01	H2001_846_0	2	1						05/24/2021	2022.01	05/24/2021 04:32:34 PM Eastern Daylight Time					06/02/2021 10:26:33 AM Eastern Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	846	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2001	847	0	1	04	01	H2001_847_0	2	1						05/24/2021	2022.01	05/24/2021 04:32:58 PM Eastern Daylight Time					06/02/2021 10:26:33 AM Eastern Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	847	0	2022	Nationwide		1	281016	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2001	848	0	1	04	01	H2001_848_0	2	1						05/24/2021	2022.01	05/24/2021 04:33:22 PM Eastern Daylight Time					06/02/2021 10:26:33 AM Eastern Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	848	0	2022	Nationwide		1	9516	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2001	849	0	1	04	01	H2001_849_0	2	1				0	0	05/24/2021	2022.01	05/24/2021 04:34:01 PM Eastern Daylight Time					06/02/2021 10:26:33 AM Eastern Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	849	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2001	850	0	1	04	01	H2001_850_0	2	1				0	0	05/24/2021	2022.01	05/24/2021 04:34:38 PM Eastern Daylight Time					06/02/2021 10:26:33 AM Eastern Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	850	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2001	851	0	1	04	01	H2001_851_0	2	1				0	0	05/24/2021	2022.01	05/24/2021 04:35:36 PM Eastern Daylight Time					06/02/2021 10:26:33 AM Eastern Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	851	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2001	852	0	1	04	01	H2001_852_0	2	1				0	0	05/24/2021	2022.01	05/24/2021 04:36:24 PM Eastern Daylight Time					06/02/2021 10:26:33 AM Eastern Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	852	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2001	853	0	1	04	01	H2001_853_0	2	1						05/24/2021	2022.01	05/24/2021 04:38:10 PM Eastern Daylight Time					06/02/2021 10:26:33 AM Eastern Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	853	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2001	854	0	1	04	01	H2001_854_0	2	1				0	0	05/24/2021	2022.01	05/24/2021 04:38:52 PM Eastern Daylight Time					06/02/2021 10:26:33 AM Eastern Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	854	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2001	855	0	1	04	01	H2001_855_0	2	1						05/24/2021	2022.01	05/24/2021 04:39:17 PM Eastern Daylight Time					06/02/2021 10:26:33 AM Eastern Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	855	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2001	856	0	1	04	01	H2001_856_0	2	1				0	0	05/24/2021	2022.01	05/24/2021 04:39:56 PM Eastern Daylight Time					06/02/2021 10:26:33 AM Eastern Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	856	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2001	857	0	1	04	01	H2001_857_0	2	1						05/24/2021	2022.01	05/24/2021 04:40:35 PM Eastern Daylight Time					06/02/2021 10:26:33 AM Eastern Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	857	0	2022	Nationwide		1	83616	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2001	858	0	1	04	01	H2001_858_0	2	1						05/24/2021	2022.01	05/24/2021 04:41:04 PM Eastern Daylight Time					06/02/2021 10:26:33 AM Eastern Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	858	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2001	859	0	1	04	01	H2001_859_0	2	1						05/24/2021	2022.01	05/24/2021 04:41:28 PM Eastern Daylight Time					06/02/2021 10:26:33 AM Eastern Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	859	0	2022	Nationwide		1	62256	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2001	860	0	1	04	01	H2001_860_0	2	1						05/24/2021	2022.01	05/24/2021 04:41:53 PM Eastern Daylight Time					06/02/2021 10:26:33 AM Eastern Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	860	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2001	861	0	1	04	01	H2001_861_0	2	1						05/24/2021	2022.01	05/24/2021 04:42:15 PM Eastern Daylight Time					06/02/2021 10:26:33 AM Eastern Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	861	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2001	862	0	1	04	01	H2001_862_0	2	1						05/24/2021	2022.01	05/24/2021 04:42:40 PM Eastern Daylight Time					06/02/2021 10:26:33 AM Eastern Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	862	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2001	863	0	1	04	01	H2001_863_0	2	1						05/24/2021	2022.01	05/24/2021 04:43:03 PM Eastern Daylight Time					06/02/2021 10:26:33 AM Eastern Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	863	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2001	864	0	1	04	01	H2001_864_0	2	1						05/24/2021	2022.01	05/24/2021 04:43:25 PM Eastern Daylight Time					06/02/2021 10:26:33 AM Eastern Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	864	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2001	865	0	1	04	01	H2001_865_0	2	1						05/24/2021	2022.01	05/24/2021 04:43:47 PM Eastern Daylight Time					06/02/2021 10:26:33 AM Eastern Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	865	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2001	866	0	1	04	01	H2001_866_0	2	1						05/24/2021	2022.01	05/24/2021 04:44:12 PM Eastern Daylight Time					06/02/2021 10:26:33 AM Eastern Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	866	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2001	867	0	1	04	01	H2001_867_0	2	1						05/24/2021	2022.01	05/24/2021 04:44:34 PM Eastern Daylight Time					06/02/2021 10:26:33 AM Eastern Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	867	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2001	868	0	1	04	01	H2001_868_0	2	1						05/24/2021	2022.01	05/24/2021 04:44:58 PM Eastern Daylight Time					06/02/2021 10:26:33 AM Eastern Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	868	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2001	869	0	1	04	01	H2001_869_0	2	1				0	0	05/24/2021	2022.01	05/24/2021 04:45:33 PM Eastern Daylight Time					06/02/2021 10:26:33 AM Eastern Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	869	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2001	870	0	1	04	01	H2001_870_0	2	1						05/24/2021	2022.01	05/24/2021 04:45:56 PM Eastern Daylight Time					06/02/2021 10:26:33 AM Eastern Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	870	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2001	871	0	1	04	01	H2001_871_0	2	1				0	0	05/24/2021	2022.01	05/24/2021 04:46:33 PM Eastern Daylight Time					06/02/2021 10:26:33 AM Eastern Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	871	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2001	872	0	1	04	01	H2001_872_0	2	1				0	0	05/24/2021	2022.01	05/24/2021 04:47:07 PM Eastern Daylight Time					06/02/2021 10:26:33 AM Eastern Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	872	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2001	873	0	1	04	01	H2001_873_0	2	1						05/24/2021	2022.01	05/24/2021 04:47:29 PM Eastern Daylight Time					06/02/2021 10:26:33 AM Eastern Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	873	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2020	001	0	1	04	01	H2020_001_0	7	1					1	08/05/2021	2022.01	08/05/2021 07:58:35 AM Central Daylight Time	08/05/2021 02:09:32 PM Central Daylight Time	08/05/2021 02:08:48 PM Central Daylight Time			08/05/2021 06:05:28 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	2022	Metro Denver, Boulder and Ft. Collins		2		2			2						www.clearspringhealthcare.com	www.clearspringhealthcare.com	www.clearspringhealthcare.com	(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2020	002	0	1	04	01	H2020_002_0	6	1					1	08/05/2021	2022.01	08/05/2021 08:00:52 AM Central Daylight Time	08/05/2021 02:09:12 PM Central Daylight Time	08/05/2021 02:08:51 PM Central Daylight Time			08/05/2021 06:05:28 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	2022	Metro Richmond		2		2			2						www.clearspringhealthcare.com	www.clearspringhealthcare.com	www.clearspringhealthcare.com	(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2020	003	0	1	04	01	H2020_003_0	7	1					1	08/05/2021	2022.01	08/05/2021 08:02:26 AM Central Daylight Time	08/05/2021 02:09:13 PM Central Daylight Time	08/05/2021 02:08:55 PM Central Daylight Time			08/05/2021 06:05:28 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	2022	Robeson and Scotland Counties		2		2			2						www.clearspringhealthcare.com	www.clearspringhealthcare.com	www.clearspringhealthcare.com	(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2020	005	0	1	04	01	H2020_005_0	6	1					1	08/05/2021	2022.01	08/05/2021 08:07:38 AM Central Daylight Time	08/05/2021 02:09:15 PM Central Daylight Time	08/05/2021 02:08:59 PM Central Daylight Time			08/05/2021 06:05:28 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	2022	Robeson and Scotland Counties		2		2			2						www.clearspringhealthcare.com	www.clearspringhealthcare.com	www.clearspringhealthcare.com	(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2029	001	0	1	04	01	H2029_001_0	3	1					1	08/01/2021	2022.01	08/01/2021 10:20:03 AM Eastern Daylight Time	08/03/2021 07:48:30 PM Eastern Daylight Time	07/30/2021 10:35:50 AM Eastern Daylight Time			08/04/2021 01:25:17 PM 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	2022	Puerto Rico Island Wide		2		2			2						https://www.humana.com/pharmacy/	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						05/24/2021	2022.01	05/24/2021 02:13:44 PM Eastern Daylight Time					06/03/2021 01:38:12 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	2022	Puerto Rico - Island Wide		1	1200	2			2						https://www.humana.com/pharmacy/	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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H2029	802	0	1	04	01	H2029_802_0	1	1				0	0	05/24/2021	2022.01	05/24/2021 02:14:13 PM Eastern Daylight Time					06/03/2021 01:38:12 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	2022	Puerto Rico - Island Wide		1	1200	2			2						https://www.humana.com/pharmacy/	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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H2029	805	0	2	04	01	H2029_805_0	1	1						05/24/2021	2022.01	05/24/2021 02:19:10 PM Eastern Daylight Time					06/03/2021 01:38:12 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	2022	Puerto Rico - Island Wide		1	1200	2			2						https://www.humana.com/pharmacy/	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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H2029	806	0	2	04	01	H2029_806_0	1	1				0	0	05/24/2021	2022.01	05/24/2021 02:26:54 PM Eastern Daylight Time					06/03/2021 01:38:12 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	2022	Puerto Rico - Island Wide		1	1200	2			2						https://www.humana.com/pharmacy/	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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H2029	809	0	1	04	01	H2029_809_0	1	1						05/24/2021	2022.01	05/24/2021 02:46:09 PM Eastern Daylight Time					06/03/2021 01:38:12 PM Eastern Daylight Time	HUMANA INSURANCE OF PUERTO RICO, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H2029	809	0	2022	Puerto Rico - Island Wide		1	1200	2			2						https://www.humana.com/pharmacy/	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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H2029	810	0	1	04	01	H2029_810_0	1	1				0	0	05/24/2021	2022.01	05/24/2021 02:52:02 PM Eastern Daylight Time					06/03/2021 01:38:12 PM Eastern Daylight Time	HUMANA INSURANCE OF PUERTO RICO, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H2029	810	0	2022	Puerto Rico - Island Wide		1	1200	2			2						https://www.humana.com/pharmacy/	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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H2029	811	0	1	04	01	H2029_811_0	1	1						05/24/2021	2022.01	05/24/2021 03:19:43 PM Eastern Daylight Time					06/03/2021 01:38:12 PM Eastern Daylight Time	HUMANA INSURANCE OF PUERTO RICO, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H2029	811	0	2022	Puerto Rico - Island Wide		1	1200	2			2						https://www.humana.com/pharmacy/	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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H2029	812	0	1	04	01	H2029_812_0	1	1				0	0	05/24/2021	2022.01	05/24/2021 03:24:30 PM Eastern Daylight Time					06/03/2021 01:38:12 PM Eastern Daylight Time	HUMANA INSURANCE OF PUERTO RICO, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H2029	812	0	2022	Puerto Rico - Island Wide		1	1200	2			2						https://www.humana.com/pharmacy/	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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H2029	813	0	1	04	01	H2029_813_0	1	1						05/27/2021	2022.01	05/27/2021 12:17:58 PM Eastern Daylight Time					06/03/2021 01:38:12 PM Eastern Daylight Time	HUMANA INSURANCE OF PUERTO RICO, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H2029	813	0	2022	Puerto Rico - Island Wide		1	1200	2			2						https://www.humana.com/pharmacy/	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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H2029	814	0	1	04	01	H2029_814_0	1	1				0	0	05/24/2021	2022.01	05/24/2021 03:34:51 PM Eastern Daylight Time					06/03/2021 01:38:12 PM Eastern Daylight Time	HUMANA INSURANCE OF PUERTO RICO, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H2029	814	0	2022	Puerto Rico - Island Wide		1	1200	2			2						https://www.humana.com/pharmacy/	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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H2029	815	0	1	04	01	H2029_815_0	1	1						05/28/2021	2022.01	05/28/2021 09:37:47 AM Eastern Daylight Time					06/03/2021 01:38:12 PM Eastern Daylight Time	HUMANA INSURANCE OF PUERTO RICO, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H2029	815	0	2022	Puerto Rico - Island Wide		1	1200	2			2						https://www.humana.com/pharmacy/	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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H2029	816	0	1	04	01	H2029_816_0	1	1				0	0	05/28/2021	2022.01	05/28/2021 09:44:44 AM Eastern Daylight Time					06/03/2021 01:38:12 PM Eastern Daylight Time	HUMANA INSURANCE OF PUERTO RICO, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H2029	816	0	2022	Puerto Rico - Island Wide		1	1200	2			2						https://www.humana.com/pharmacy/	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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H2032	001	0	1	04	01	H2032_001_0	4	1					1	08/05/2021	2022.01	08/05/2021 07:51:21 AM Central Daylight Time	08/04/2021 11:02:32 AM Central Daylight Time	08/04/2021 09:54:56 AM Central Daylight Time			08/05/2021 09:00:08 AM Central Daylight Time	INSURANCE COMPANY OF SCOTT AND WHITE	Scott and White Health Plan	advantage.swhp.org	BSW SeniorCare Advantage (PPO)	01	04		1			H2032	001	0	2022	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	4	1					1	08/05/2021	2022.01	08/05/2021 07:56:36 AM Central Daylight Time	08/04/2021 11:03:22 AM Central Daylight Time	08/04/2021 09:55:28 AM Central Daylight Time			08/05/2021 09:00:08 AM Central Daylight Time	INSURANCE COMPANY OF SCOTT AND WHITE	Scott and White Health Plan	advantage.swhp.org	BSW SeniorCare Advantage Basic (PPO)	01	04		1			H2032	002	0	2022	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	6	1					1	08/05/2021	2022.01	08/05/2021 08:00:08 AM Central Daylight Time	08/04/2021 09:39:20 AM Central Daylight Time	08/04/2021 09:55:56 AM Central Daylight Time			08/05/2021 09:00:08 AM Central Daylight Time	INSURANCE COMPANY OF SCOTT AND WHITE	Scott and White Health Plan	advantage.swhp.org	BSW SeniorCare Advantage Platinum (PPO)	01	04		1			H2032	003	0	2022	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	801	0	1	04	01	H2032_801_0	3	1						05/03/2021	2022.01	05/03/2021 02:24:47 PM Central Daylight Time					06/07/2021 03:27:16 PM Central Daylight Time	INSURANCE COMPANY OF SCOTT AND WHITE	Scott and White Health Plan	advantage.swhp.org	BSW SeniorCare Advantage EGWP CY Rx (PPO)	01	04		1			H2032	801	0	2022	North and Central Texas		1	1200	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)-		1	2		2		1									
H2032	802	0	1	04	01	H2032_802_0	3	1				0	0	05/03/2021	2022.01	05/03/2021 02:38:17 PM Central Daylight Time					06/07/2021 03:27:16 PM Central Daylight Time	INSURANCE COMPANY OF SCOTT AND WHITE	Scott and White Health Plan	advantage.swhp.org	BSW SeniorCare Advantage EGWP CY (PPO)	01	04		1			H2032	802	0	2022	North and Central Texas		1	1200	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)-										1	2		2		1									
H2032	803	0	1	04	01	H2032_803_0	3	1						05/11/2021	2022.01	05/11/2021 10:36:45 AM Central Daylight Time					06/07/2021 03:27:16 PM Central Daylight Time	INSURANCE COMPANY OF SCOTT AND WHITE	Scott and White Health Plan	advantage.swhp.org	BSW SeniorCare Advantage EGWP FY Rx (PPO)	01	04		1			H2032	803	0	2022	North and Central Texas		1	1200	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)-		1	2		2		1									
H2032	804	0	1	04	01	H2032_804_0	3	1				0	0	05/11/2021	2022.01	05/11/2021 10:54:07 AM Central Daylight Time					06/07/2021 03:27:16 PM Central Daylight Time	INSURANCE COMPANY OF SCOTT AND WHITE	Scott and White Health Plan	advantage.swhp.org	BSW SeniorCare Advantage EGWP FY (PPO)	01	04		1			H2032	804	0	2022	North and Central Texas		1	1200	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)-										1	2		2		1									
H2034	001	0	1	01	01	H2034_001_0	4	1	2	1			0	08/03/2021	2022.01	08/03/2021 11:27:50 AM Central Daylight Time	08/05/2021 10:20:38 AM Central Daylight Time	08/05/2021 10:20:38 AM Central Daylight Time			08/05/2021 10:48:59 AM Central Daylight Time	COMMUNITY CARE HEALTH PLAN, INC.	Community Care	www.communitycareinc.org	Community Care's  Partnership Program (HMO D-SNP)	01	01		1			H2034	001	0	2022	Eastern Wisconsin		2	6075	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			
H2056	001	0	1	02	01	H2056_001_0	2	1					0	08/02/2021	2022.01	08/02/2021 05:21:45 PM Eastern Daylight Time	08/02/2021 02:31:38 PM Eastern Daylight Time	08/02/2021 09:28:13 AM Eastern Daylight Time			08/04/2021 01:38:04 PM Eastern Daylight Time	AETNA BETTER HEALTH OF MICHIGAN INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite Plan (HMO-POS)	01	02		1			H2056	001	0	2022	Treasure Valley Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2056	002	0	1	02	01	H2056_002_0	2	1					0	08/02/2021	2022.01	08/02/2021 05:22:57 PM Eastern Daylight Time	08/02/2021 02:33:31 PM Eastern Daylight Time	08/02/2021 09:28:17 AM Eastern Daylight Time			08/04/2021 01:38:04 PM Eastern Daylight Time	AETNA BETTER HEALTH OF MICHIGAN INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO-POS)	01	02		1			H2056	002	0	2022	Treasure Valley Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2056	003	0	1	02	01	H2056_003_0	2	1					0	08/02/2021	2022.01	08/02/2021 05:23:46 PM Eastern Daylight Time	08/02/2021 02:35:20 PM Eastern Daylight Time	08/02/2021 09:28:21 AM Eastern Daylight Time			08/04/2021 01:38:04 PM Eastern Daylight Time	AETNA BETTER HEALTH OF MICHIGAN INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite Plan (HMO-POS)	01	02		1			H2056	003	0	2022	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		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2056	004	0	1	02	01	H2056_004_0	2	1					0	08/02/2021	2022.01	08/02/2021 05:24:27 PM Eastern Daylight Time	08/02/2021 02:37:28 PM Eastern Daylight Time	08/02/2021 09:28:25 AM Eastern Daylight Time			08/04/2021 01:38:04 PM Eastern Daylight Time	AETNA BETTER HEALTH OF MICHIGAN INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO-POS)	01	02		1			H2056	004	0	2022	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		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2056	005	0	1	02	01	H2056_005_0	3	1					0	08/02/2021	2022.01	08/02/2021 01:17:19 PM Eastern Daylight Time	08/02/2021 02:38:46 PM Eastern Daylight Time	08/02/2021 09:28:29 AM Eastern Daylight Time			08/04/2021 01:38:04 PM Eastern Daylight Time	AETNA BETTER HEALTH OF MICHIGAN INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite Plan (HMO-POS)	01	02		1			H2056	005	0	2022	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		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2056	801	0	1	01	01	H2056_801_0	1	1				0	0	06/01/2021	2022.01	06/01/2021 02:47:15 PM Eastern Daylight Time					06/03/2021 12:46:31 PM Eastern Daylight Time	AETNA BETTER HEALTH OF MICHIGAN INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (HMO)	01	01		1			H2056	801	0	2022	Idaho and Oregon		1	120	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H2056	802	0	1	01	01	H2056_802_0	1	1						05/27/2021	2022.01	05/27/2021 11:11:24 PM Eastern Daylight Time					06/03/2021 12:46:31 PM Eastern Daylight Time	AETNA BETTER HEALTH OF MICHIGAN INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan w/Rx (HMO)	01	01		1			H2056	802	0	2022	Idaho and Oregon		1	120	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H2064	001	0	1	20	08	H2064_001_0	2	1						06/04/2021	2022.01	06/04/2021 11:39:59 AM Eastern Daylight Time		06/29/2021 09:34:57 AM Eastern Daylight Time			06/29/2021 03:18:30 PM Eastern Daylight Time	GEISINGER COMMUNITY HEALTH SERVICES	LIFE Geisinger	www.lifegeisinger.org	LIFE Geisinger (PACE)	08	20		1			H2064	001	0	2022	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	2	1						06/04/2021	2022.01	06/04/2021 11:40:36 AM Eastern Daylight Time		06/29/2021 09:37:54 AM Eastern Daylight Time			06/29/2021 03:18:30 PM Eastern Daylight Time	GEISINGER COMMUNITY HEALTH SERVICES	LIFE Geisinger	www.lifegeisinger.org	LIFE Geisinger (PACE)	08	20		1			H2064	002	0	2022	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	5	1	2	1	1		0	06/02/2021	2022.01	06/02/2021 09:26:16 AM Central Daylight Time	08/20/2021 03:10:07 PM Central Daylight Time	08/23/2021 11:28:58 AM Central Daylight Time			08/24/2021 10:54:09 AM Central Daylight Time	BRAVO HEALTH MID-ATLANTIC, INC.	Cigna	www.cignamedicare.com	Cigna TotalCare (HMO D-SNP)	01	01		1			H2108	001	0	2022	Maryland, Washington DC and Delaware		2		2			1	3		2		2	www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.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	3	1			2		0	06/01/2021	2022.01	06/01/2021 03:40:24 PM Central Daylight Time	08/03/2021 08:24:43 AM Central Daylight Time	07/30/2021 11:29:30 AM Central Daylight Time			08/04/2021 10:14:42 AM Central Daylight Time	BRAVO HEALTH MID-ATLANTIC, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Plus Medicare (HMO)	01	01		1			H2108	022	0	2022	Baltimore Area		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.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			
H2108	028	0	1	01	01	H2108_028_0	3	1			2		0	08/02/2021	2022.01	08/02/2021 06:06:24 PM Central Daylight Time	08/03/2021 03:17:12 PM Central Daylight Time	07/30/2021 11:29:53 AM Central Daylight Time			08/04/2021 10:14:42 AM Central Daylight Time	BRAVO HEALTH MID-ATLANTIC, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H2108	028	0	2022	Washington DC and Delaware		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.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			
H2108	029	0	1	01	01	H2108_029_0	3	1		1	2		0	06/02/2021	2022.01	06/02/2021 09:46:41 AM Central Daylight Time	08/03/2021 08:30:29 AM Central Daylight Time	07/30/2021 11:30:16 AM Central Daylight Time			08/04/2021 10:14:42 AM Central Daylight Time	BRAVO HEALTH MID-ATLANTIC, INC.	Cigna	www.cignamedicare.com	Cigna Achieve Medicare (HMO C-SNP)	01	01		1			H2108	029	0	2022	Washington DC and Delaware		2		2			1	4			00000010000000000000		www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.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			
H2108	030	0	1	01	01	H2108_030_0	3	1		1	2		0	06/01/2021	2022.01	06/01/2021 03:42:57 PM Central Daylight Time	08/03/2021 08:32:07 AM Central Daylight Time	07/30/2021 11:30:40 AM Central Daylight Time			08/04/2021 10:14:42 AM Central Daylight Time	BRAVO HEALTH MID-ATLANTIC, INC.	Cigna	www.cignamedicare.com	Cigna Achieve Medicare (HMO C-SNP)	01	01		1			H2108	030	0	2022	Baltimore Area		2		2			1	4			00000010000000000000		www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.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			
H2108	034	0	1	01	01	H2108_034_0	3	1			2		0	06/01/2021	2022.01	06/01/2021 03:43:40 PM Central Daylight Time	08/03/2021 08:33:27 AM Central Daylight Time	07/30/2021 11:31:04 AM Central Daylight Time			08/04/2021 10:14:42 AM Central Daylight Time	BRAVO HEALTH MID-ATLANTIC, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H2108	034	0	2022	Maryland DC Suburbs		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.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			
H2108	036	0	1	01	01	H2108_036_0	3	1			2		0	06/01/2021	2022.01	06/01/2021 03:44:19 PM Central Daylight Time	08/03/2021 08:35:06 AM Central Daylight Time	07/30/2021 11:31:27 AM Central Daylight Time			08/04/2021 10:14:42 AM Central Daylight Time	BRAVO HEALTH MID-ATLANTIC, INC.	Cigna	www.cignamedicare.com	Cigna Alliance Medicare (HMO)	01	01		1			H2108	036	0	2022	Baltimore Area		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.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			
H2108	039	0	1	01	01	H2108_039_0	5	1	2	1	1		0	08/17/2021	2022.01	08/17/2021 03:45:16 PM Central Daylight Time	08/03/2021 08:37:42 AM Central Daylight Time	07/30/2021 11:32:16 AM Central Daylight Time			08/17/2021 04:34:17 PM Central Daylight Time	BRAVO HEALTH MID-ATLANTIC, INC.	Cigna	www.cignamedicare.com	Cigna TotalCare Plus (HMO D-SNP)	01	01		1			H2108	039	0	2022	Delaware		2		2			1	3		1		2	www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.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			
H2108	801	0	1	01	01	H2108_801_0	2	1						05/10/2021	2022.01	05/10/2021 10:21:43 AM Central Daylight Time					06/02/2021 02:25:04 PM Central Daylight Time	BRAVO HEALTH MID-ATLANTIC, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H2108	801	0	2022	Statewide MD, DC and DE		1	600	2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(888)281-7867		(888)281-7867		(888)281-7867		(888)281-7867		(888)281-7867		(888)281-7867		(888)281-7867		(888)281-7867		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H2109	001	0	1	20	08	H2109_001_0	2	1						05/25/2021	2022.01	05/25/2021 12:10:39 PM Eastern Daylight Time		05/25/2021 10:45:12 AM Eastern Daylight Time			05/25/2021 12:11:19 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	2022	Parts of Baltimore City and County, Maryland		2	1788	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	2	1						05/19/2021	2022.01	05/19/2021 03:48:37 PM Eastern Daylight Time		05/25/2021 10:45:12 AM Eastern Daylight Time			05/25/2021 12:11:19 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	2022	Parts of Baltimore City and County, Maryland		2	1788	2			2						http://www.hopkinsbayview.org/hopkinselderplus	http://www.hopkinsbayview.org/hopkinselderplus												(410)550-7044				(410)550-7044												(410)550-0316				(410)550-0316																
H2117	001	0	1	04	01	H2117_001_0	5	1					0	08/03/2021	2022.01	08/03/2021 11:31:47 AM Eastern Daylight Time	08/03/2021 11:41:13 PM Eastern Daylight Time	07/30/2021 10:54:58 AM Eastern Daylight Time			08/04/2021 09:45:33 PM Eastern Daylight Time	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium Open (PPO)	01	04		1			H2117	001	0	2022	Select counties in MI		2	23951	2			2						https://wellcare.mimeridian.com/findadoctor	https://wellcare.mimeridian.com/formulary	https://wellcare.mimeridian.com/findadoctor	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2117	002	0	1	04	01	H2117_002_0	4	1	2	1			0	07/18/2021	2022.01	07/18/2021 11:15:51 AM Eastern Daylight Time	08/03/2021 11:41:42 PM Eastern Daylight Time	07/30/2021 10:55:16 AM Eastern Daylight Time			08/04/2021 09:45:33 PM Eastern Daylight Time	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Access Open (PPO D-SNP)	01	04		1			H2117	002	0	2022	Select counties in MI		2	19012	2			1	3		1		1	https://wellcare.mimeridian.com/findadoctor	https://wellcare.mimeridian.com/formulary	https://wellcare.mimeridian.com/findadoctor	(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2117	003	0	1	04	01	H2117_003_0	3	1				0	0	06/03/2021	2022.01	06/03/2021 06:29:30 PM Eastern Daylight Time	06/04/2021 07:49:37 PM Eastern Daylight Time				07/19/2021 05:05:07 PM Eastern Daylight Time	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Patriot Giveback Open (PPO)	01	04		1			H2117	003	0	2022	Select counties in MI		2	3910	2			2						https://wellcare.mimeridian.com/findadoctor	https://wellcare.mimeridian.com/formulary	https://wellcare.mimeridian.com/findadoctor	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175										(711)-		(711)-		(711)-		(711)-										2					2						2			
H2117	004	0	1	04	01	H2117_004_0	4	1					0	08/03/2021	2022.01	08/03/2021 11:33:35 AM Eastern Daylight Time	08/03/2021 11:42:49 PM Eastern Daylight Time	07/30/2021 10:55:52 AM Eastern Daylight Time			08/04/2021 09:45:33 PM Eastern Daylight Time	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Community Assist (PPO)	01	04		1			H2117	004	0	2022	Select counties in MI		2	0	2			2						https://wellcare.mimeridian.com/findadoctor	https://wellcare.mimeridian.com/formulary	https://wellcare.mimeridian.com/findadoctor	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2128	001	0	1	04	01	H2128_001_0	4	1					0	06/04/2021	2022.01	06/04/2021 01:08:34 PM Eastern Daylight Time	08/03/2021 11:43:34 PM Eastern Daylight Time	07/30/2021 10:56:12 AM Eastern Daylight Time			08/04/2021 09:45:33 PM Eastern Daylight Time	CELTIC INSURANCE COMPANY	Wellcare	www.wellcare.com/allwellPA	Wellcare Assist Open (PPO)	01	04		1			H2128	001	0	2022	Select Counties in PA		2	3757	2			2						www.wellcare.com/allwellPA	www.wellcare.com/allwellPA	www.wellcare.com/allwellPA	(855)766-1456		(855)766-1456		(844)917-0175		(844)917-0175		(855)766-1456		(855)766-1456		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2128	002	0	1	04	01	H2128_002_0	4	1					0	08/03/2021	2022.01	08/03/2021 11:29:32 AM Eastern Daylight Time	08/03/2021 11:44:14 PM Eastern Daylight Time	07/30/2021 10:56:36 AM Eastern Daylight Time			08/04/2021 09:45:33 PM Eastern Daylight Time	CELTIC INSURANCE COMPANY	Wellcare	www.wellcare.com/allwellPA	Wellcare No Premium Open (PPO)	01	04		1			H2128	002	0	2022	Select Counties in PA		2	5646	2			2						www.wellcare.com/allwellPA	www.wellcare.com/allwellPA	www.wellcare.com/allwellPA	(855)766-1456		(855)766-1456		(844)917-0175		(844)917-0175		(855)766-1456		(855)766-1456		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2128	003	0	1	04	01	H2128_003_0	4	1					0	08/03/2021	2022.01	08/03/2021 11:28:30 AM Eastern Daylight Time	08/03/2021 11:44:46 PM Eastern Daylight Time	07/30/2021 10:56:56 AM Eastern Daylight Time			08/04/2021 09:45:33 PM Eastern Daylight Time	CELTIC INSURANCE COMPANY	Wellcare	www.wellcare.com/allwellPA	Wellcare Low Premium Open (PPO)	01	04		1			H2128	003	0	2022	Select Counties in PA		2	1889	2			2						www.wellcare.com/allwellPA	www.wellcare.com/allwellPA	www.wellcare.com/allwellPA	(855)766-1456		(855)766-1456		(844)917-0175		(844)917-0175		(855)766-1456		(855)766-1456		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2128	004	0	1	04	01	H2128_004_0	4	1					0	08/03/2021	2022.01	08/03/2021 03:15:38 PM Eastern Daylight Time	08/03/2021 11:45:16 PM Eastern Daylight Time	07/30/2021 10:57:28 AM Eastern Daylight Time			08/04/2021 09:45:33 PM Eastern Daylight Time	CELTIC INSURANCE COMPANY	Wellcare	www.wellcare.com/allwellPA	Wellcare Giveback Open (PPO)	01	04		1			H2128	004	0	2022	Select Counties in PA		2	7525	2			2						www.wellcare.com/allwellPA	www.wellcare.com/allwellPA	www.wellcare.com/allwellPA	(855)766-1456		(855)766-1456		(844)917-0175		(844)917-0175		(855)766-1456		(855)766-1456		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2134	001	0	1	01	01	H2134_001_0	4	1	2	1			0	08/02/2021	2022.01	08/02/2021 02:17:02 PM Eastern Daylight Time	08/03/2021 11:45:43 PM Eastern Daylight Time	07/30/2021 10:57:46 AM Eastern Daylight Time			08/04/2021 11:54:32 PM Eastern Daylight Time	WESTERN SKY COMMUNITY CARE, INC.	Wellcare by Allwell	www.wellcare.com/allwellNM	Wellcare Dual Liberty (HMO D-SNP)	01	01		1			H2134	001	0	2022	Select counties in NM		2	44256	2			1	3		1		1	www.wellcare.com/allwellNM	www.wellcare.com/allwellNM	www.wellcare.com/allwellNM	(844)810-7965		(844)810-7965		(866)277-6583		(866)277-6583		(844)810-7965		(844)810-7965		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2134	002	0	1	01	01	H2134_002_0	4	1					0	08/02/2021	2022.01	08/02/2021 01:19:26 PM Eastern Daylight Time	08/03/2021 11:46:12 PM Eastern Daylight Time	07/30/2021 10:58:06 AM Eastern Daylight Time			08/04/2021 11:54:32 PM Eastern Daylight Time	WESTERN SKY COMMUNITY CARE, INC.	Wellcare by Allwell	www.wellcare.com/allwellNM	Wellcare Giveback (HMO)	01	01		1			H2134	002	0	2022	Select counties in NM		2	690	2			2						www.wellcare.com/allwellNM	www.wellcare.com/allwellNM	www.wellcare.com/allwellNM	(833)543-0246		(833)543-0246		(866)277-6583		(866)277-6583		(833)543-0246		(833)543-0246		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2134	003	0	1	01	01	H2134_003_0	4	1	2	1			0	08/02/2021	2022.01	08/02/2021 02:24:45 PM Eastern Daylight Time	08/03/2021 11:46:41 PM Eastern Daylight Time	07/30/2021 10:58:38 AM Eastern Daylight Time			08/04/2021 11:54:32 PM Eastern Daylight Time	WESTERN SKY COMMUNITY CARE, INC.	Wellcare by Allwell	www.wellcare.com/allwellNM	Wellcare Dual Access (HMO D-SNP)	01	01		1			H2134	003	0	2022	Select counties in NM		2	3188	2			1	3		1		1	www.wellcare.com/allwellNM	www.wellcare.com/allwellNM	www.wellcare.com/allwellNM	(844)810-7965		(844)810-7965		(866)277-6583		(866)277-6583		(844)810-7965		(844)810-7965		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2134	004	0	1	01	01	H2134_004_0	4	1					0	07/18/2021	2022.01	07/18/2021 05:36:21 PM Eastern Daylight Time	08/03/2021 11:47:10 PM Eastern Daylight Time	07/30/2021 10:58:58 AM Eastern Daylight Time			08/04/2021 11:54:32 PM Eastern Daylight Time	WESTERN SKY COMMUNITY CARE, INC.	Wellcare by Allwell	www.wellcare.com/allwellNM	Wellcare Assist (HMO)	01	01		1			H2134	004	0	2022	Select counties in NM		2	535	2			2						www.wellcare.com/allwellNM	www.wellcare.com/allwellNM	www.wellcare.com/allwellNM	(833)543-0246		(833)543-0246		(866)277-6583		(866)277-6583		(833)543-0246		(833)543-0246		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2134	005	0	1	01	01	H2134_005_0	4	1					0	08/02/2021	2022.01	08/02/2021 01:16:22 PM Eastern Daylight Time	08/03/2021 11:47:39 PM Eastern Daylight Time	07/30/2021 10:59:18 AM Eastern Daylight Time			08/04/2021 11:54:32 PM Eastern Daylight Time	WESTERN SKY COMMUNITY CARE, INC.	Wellcare by Allwell	www.wellcare.com/allwellNM	Wellcare No Premium (HMO)	01	01		1			H2134	005	0	2022	Select counties in NM		2	9096	2			2						www.wellcare.com/allwellNM	www.wellcare.com/allwellNM	www.wellcare.com/allwellNM	(833)543-0246		(833)543-0246		(866)277-6583		(866)277-6583		(833)543-0246		(833)543-0246		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2134	006	0	1	01	01	H2134_006_0	3	1				0	0	07/18/2021	2022.01	07/18/2021 05:39:40 PM Eastern Daylight Time	06/04/2021 11:51:27 AM Eastern Daylight Time				07/19/2021 06:09:31 PM Eastern Daylight Time	WESTERN SKY COMMUNITY CARE, INC.	Wellcare by Allwell	www.wellcare.com/allwellNM	Wellcare Patriot No Premium (HMO)	01	01		1			H2134	006	0	2022	Select counties in NM		2	558	2			2						www.wellcare.com/allwellNM	www.wellcare.com/allwellNM	www.wellcare.com/allwellNM	(833)543-0246		(833)543-0246		(866)277-6583		(866)277-6583										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2134	801	0	1	01	01	H2134_801_0	2	1						05/03/2021	2022.01	05/03/2021 01:32:40 PM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	WESTERN SKY COMMUNITY CARE, INC.	Wellcare by Allwell	allwell.westernskycommunity.com	Allwell Group (HMO)	01	01		1			H2134	801	0	2022	Statewide		1	100	2			2						allwell.westernskycommunity.com/findadoctor	allwell.westernskycommunity.com/formulary	allwell.westernskycommunity.com/findadoctor	(844)810-7965		(844)810-7965		(844)942-0039		(844)942-0039		(844)810-7965		(844)810-7965		(844)942-0039		(844)942-0039		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H2134	802	0	1	01	01	H2134_802_0	2	1				0	0	05/03/2021	2022.01	05/03/2021 01:32:49 PM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	WESTERN SKY COMMUNITY CARE, INC.	Wellcare by Allwell	allwell.westernskycommunity.com	Allwell Group (HMO)	01	01		1			H2134	802	0	2022	Statewide		1	100	2			2						allwell.westernskycommunity.com/findadoctor	allwell.westernskycommunity.com/formulary	allwell.westernskycommunity.com/findadoctor	(844)810-7965		(844)810-7965		(844)942-0039		(844)942-0039										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H2134	803	0	1	01	01	H2134_803_0	2	1						05/03/2021	2022.01	05/03/2021 01:32:57 PM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	WESTERN SKY COMMUNITY CARE, INC.	Wellcare by Allwell	allwell.westernskycommunity.com	Allwell Group (HMO)	01	01		1			H2134	803	0	2022	Statewide		1	100	2			2						allwell.westernskycommunity.com/findadoctor	allwell.westernskycommunity.com/formulary	allwell.westernskycommunity.com/findadoctor	(844)810-7965		(844)810-7965		(844)942-0039		(844)942-0039		(844)810-7965		(844)810-7965		(844)942-0039		(844)942-0039		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H2161	002	0	1	02	01	H2161_002_0	5	1					0	08/03/2021	2022.01	08/03/2021 08:55:49 AM Eastern Daylight Time	08/05/2021 09:13:23 AM Eastern Daylight Time	08/05/2021 09:13:19 AM Eastern Daylight Time			08/05/2021 09:16:27 AM Eastern Daylight Time	UPPER PENINSULA HEALTH PLAN, LLC	Upper Peninsula Health Plan	www.uphp.com/medicare	Upper Peninsula Health Plan Advantage (HMO-POS)	01	02		1			H2161	002	0	2022	Upper Peninsula of Michigan		2	3120	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	5	1					0	08/03/2021	2022.01	08/03/2021 08:55:57 AM Eastern Daylight Time	08/05/2021 09:13:20 AM Eastern Daylight Time	08/05/2021 09:13:20 AM Eastern Daylight Time			08/05/2021 09:40:24 AM 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	2022	Upper Peninsula of Michigan		2	9000	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			
H2162	001	0	1	01	01	H2162_001_0	5	1					0	08/03/2021	2022.01	08/03/2021 11:45:07 AM Eastern Daylight Time	08/03/2021 11:48:37 PM Eastern Daylight Time	07/30/2021 10:59:38 AM Eastern Daylight Time			08/04/2021 10:12:55 PM Eastern Daylight Time	WELLCARE OF NEW HAMPSHIRE, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO)	01	01		1			H2162	001	0	2022	Select counties in NH		2	1623	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2162	002	0	1	01	01	H2162_002_0	5	1					0	08/03/2021	2022.01	08/03/2021 11:53:14 AM Eastern Daylight Time	08/03/2021 11:49:05 PM Eastern Daylight Time	07/30/2021 10:59:56 AM Eastern Daylight Time			08/04/2021 10:12:55 PM Eastern Daylight Time	WELLCARE OF NEW HAMPSHIRE, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Plus (HMO)	01	01		1			H2162	002	0	2022	Select counties in NH		2	1245	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2168	001	0	1	01	01	H2168_001_0	4	1	2	1			0	08/05/2021	2022.01	08/05/2021 04:14:27 PM Eastern Daylight Time	08/04/2021 01:33:06 PM Eastern Daylight Time	08/03/2021 11:46:25 AM Eastern Daylight Time			08/05/2021 04:16:12 PM Eastern Daylight Time	VILLAGE SENIOR SERVICES CORPORATION	VillageCareMAX	www.villagecaremax.org	VillageCareMAX Medicare Health Advantage (HMO D-SNP)	01	01		1			H2168	001	0	2022	Bronx, Kings, New York, and Queens counties		2	7574	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	4	1	2	1			0	08/04/2021	2022.01	08/04/2021 02:06:38 PM Eastern Daylight Time	08/03/2021 11:35:29 AM Eastern Daylight Time	08/03/2021 11:47:14 AM Eastern Daylight Time			08/05/2021 04:16:12 PM Eastern Daylight Time	VILLAGE SENIOR SERVICES CORPORATION	VillageCareMAX	www.villagecaremax.org	VillageCareMAX Medicare Total Advantage (HMO D-SNP)	01	01		1			H2168	002	0	2022	Bronx, Kings, New York, and Queens counties		2	41542	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	8	1					1	07/15/2021	2022.01	07/15/2021 03:35:44 PM Eastern Daylight Time	07/30/2021 12:06:06 PM Eastern Daylight Time	07/30/2021 12:09:30 PM Eastern Daylight Time			08/04/2021 11:16:07 AM 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	2022	Dallas Fort Worth Metro Area		2	44110	2			2						www.cnchealthplan.com	www.cnchealthplan.com	www.cnchealthplan.com	(877)374-7993		(877)374-7993		(877)665-2622		(877)665-2622		(877)374-7993		(877)374-7993		(877)665-2622		(877)665-2622		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2171	003	0	1	01	01	H2171_003_0	6	1					1	07/15/2021	2022.01	07/15/2021 03:35:57 PM Eastern Daylight Time	07/30/2021 12:06:39 PM Eastern Daylight Time	07/30/2021 12:09:53 PM Eastern Daylight Time			08/04/2021 11:16:07 AM Eastern Daylight Time	CARE N' CARE INSURANCE COMPANY, INC.	Care N' Care Insurance Company	www.cnchealthplan.com	Southwestern Health Select (HMO)	01	01		1			H2171	003	0	2022	Dallas Fort Worth Metro Area		2	11922	2			2						www.cnchealthplan.com	www.cnchealthplan.com	www.cnchealthplan.com	(877)374-7993		(877)374-7993		(877)665-2622		(877)665-2622		(877)374-7993		(877)374-7993		(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	2	1						06/06/2021	2022.01	06/06/2021 08:26:44 AM Eastern Daylight Time					06/07/2021 03:16:13 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	2022	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		(877)374-7993		(877)374-7993		(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	2	1						06/06/2021	2022.01	06/06/2021 08:27:16 AM Eastern Daylight Time					06/07/2021 03:16:13 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	2022	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		(877)374-7993		(877)374-7993		(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	2	1				0	0	06/06/2021	2022.01	06/06/2021 08:27:58 AM Eastern Daylight Time					06/07/2021 03:16:13 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	2022	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	2	1				0	0	06/06/2021	2022.01	06/06/2021 08:28:28 AM Eastern Daylight Time					06/07/2021 03:16:13 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	2022	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					0	07/31/2021	2022.01	07/31/2021 07:56:48 AM Eastern Daylight Time	07/30/2021 04:50:30 PM Eastern Daylight Time	07/30/2021 04:47:02 PM Eastern Daylight Time			08/04/2021 03:51:07 PM 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	2022	DC		2		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					0	07/31/2021	2022.01	07/31/2021 07:58:13 AM Eastern Daylight Time	07/30/2021 04:50:56 PM Eastern Daylight Time	07/30/2021 04:48:05 PM Eastern Daylight Time			08/04/2021 03:51:07 PM 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	2022	MD		2		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					0	07/30/2021	2022.01	07/30/2021 04:28:30 PM Eastern Daylight Time	07/30/2021 04:51:21 PM Eastern Daylight Time	07/30/2021 04:49:05 PM Eastern Daylight Time			08/04/2021 03:51:07 PM 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	2022	DC		2		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	8	1					0	07/30/2021	2022.01	07/30/2021 04:29:58 PM Eastern Daylight Time	07/30/2021 04:51:46 PM Eastern Daylight Time	07/30/2021 04:50:08 PM Eastern Daylight Time			08/04/2021 03:51:07 PM 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	2022	MD		2		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	6	1				0	0	05/27/2021	2022.01	05/27/2021 09:07:09 AM Eastern Daylight Time	07/21/2021 09:45:00 PM Eastern Daylight Time				07/22/2021 02:30:54 PM Eastern Daylight Time	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Medicare Advantage Liberty (HMO)	01	01		1			H2172	005	0	2022	DC, MD, VA		2		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	8	1					0	07/30/2021	2022.01	07/30/2021 04:32:07 PM Eastern Daylight Time	07/30/2021 04:52:38 PM Eastern Daylight Time	07/30/2021 04:51:13 PM Eastern Daylight Time			08/04/2021 03:51:07 PM Eastern Daylight Time	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Medicare Advantage Value Balt (HMO)	01	01		1			H2172	006	0	2022	Baltimore City and Baltimore County		2		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	008	0	1	01	01	H2172_008_0	8	1					0	07/31/2021	2022.01	07/31/2021 07:59:00 AM Eastern Daylight Time	07/30/2021 04:53:05 PM Eastern Daylight Time	07/30/2021 04:52:13 PM Eastern Daylight Time			08/04/2021 03:51:07 PM Eastern Daylight Time	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Medicare Advantage High VA (HMO)	01	01		1			H2172	008	0	2022	Northern Virginia		2		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	009	0	1	01	01	H2172_009_0	7	1					0	07/31/2021	2022.01	07/31/2021 08:00:00 AM Eastern Daylight Time	07/30/2021 04:53:32 PM Eastern Daylight Time	07/30/2021 04:53:13 PM Eastern Daylight Time			08/04/2021 03:51:07 PM Eastern Daylight Time	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Medicare Advantage Standard VA (HMO)	01	01		1			H2172	009	0	2022	Northern Virginia		2		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	010	0	1	01	01	H2172_010_0	7	1					0	07/30/2021	2022.01	07/30/2021 04:38:07 PM Eastern Daylight Time	07/30/2021 04:53:57 PM Eastern Daylight Time	07/30/2021 04:54:16 PM Eastern Daylight Time			08/04/2021 03:51:07 PM Eastern Daylight Time	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Medicare Advantage Value VA (HMO)	01	01		1			H2172	010	0	2022	Northern Virginia		2		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	011	0	1	01	01	H2172_011_0	7	1					0	07/30/2021	2022.01	07/30/2021 04:39:41 PM Eastern Daylight Time	07/30/2021 04:54:22 PM Eastern Daylight Time	07/30/2021 04:55:20 PM Eastern Daylight Time			08/04/2021 03:51:07 PM Eastern Daylight Time	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Medicare Advantage Value MD (HMO)	01	01		1			H2172	011	0	2022	Counties: AA, CH, CR, CV, FR, HA, HO, PG, MO		2		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	012	0	1	01	01	H2172_012_0	7	1					0	07/30/2021	2022.01	07/30/2021 04:40:18 PM Eastern Daylight Time	07/30/2021 04:54:46 PM Eastern Daylight Time	07/30/2021 04:56:33 PM Eastern Daylight Time			08/04/2021 03:51:07 PM Eastern Daylight Time	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Medicare Advantage Value DC (HMO)	01	01		1			H2172	012	0	2022	DC		2		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						05/19/2021	2022.01	05/19/2021 07:55:55 AM Eastern Daylight Time					06/07/2021 04:51:22 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	2022	DC, MD, VA		1	175935	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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;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;3-4;5;6;7b;7c;7d;7f;7g;7h;7i;7k;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						05/19/2021	2022.01	05/19/2021 07:56:31 AM Eastern Daylight Time					06/07/2021 04:51:22 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	2022	DC, MD, VA		1	147533	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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;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;3-4;5;6;7b;7c;7d;7f;7g;7h;7i;7k;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						05/19/2021	2022.01	05/19/2021 07:56:53 AM Eastern Daylight Time					06/07/2021 04:51:22 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	2022	DC, MD, VA		1	916	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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;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;3-4;5;6;7b;7c;7d;7f;7g;7h;7i;7k;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				0	0	05/19/2021	2022.01	05/19/2021 07:57:21 AM Eastern Daylight Time					06/07/2021 04:51:22 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	2022	DC, MD, VA		1	138	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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;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;3-4;5;6;7b;7c;7d;7f;7g;7h;7i;7k;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			0	08/02/2021	2022.01	08/02/2021 02:26:01 PM Eastern Daylight Time	08/03/2021 11:49:34 PM Eastern Daylight Time	07/30/2021 11:00:16 AM Eastern Daylight Time			08/04/2021 11:54:32 PM Eastern Daylight Time	TRILLIUM COMMUNITY HEALTH PLAN	Wellcare by Trillium	www.wellcare.com/trilliumOR	Wellcare Dual Select (HMO D-SNP)	01	01		1			H2174	001	0	2022	Select counties in OR		2	13119	2			1	3		2		2	www.wellcare.com/trilliumOR	www.wellcare.com/trilliumOR	www.wellcare.com/trilliumOR	(844)867-1156		(844)867-1156		(866)277-6583		(866)277-6583		(844)867-1156		(844)867-1156		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2185	001	0	1	01	01	H2185_001_0	6	1		1			0	08/04/2021	2022.01	08/04/2021 08:36:35 AM Central Daylight Time	08/04/2021 11:27:06 AM Central Daylight Time	08/02/2021 12:18:47 PM Central Daylight Time			08/05/2021 11:18:13 AM Central Daylight Time	LIFEWORKS ADVANTAGE, LLC	LifeWorks Advantage	www.lifeworksadvantage.com	LifeWorks Advantage I-SNP (HMO I-SNP)	01	01		1			H2185	001	0	2022	Virginia (partial)		2		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			
H2196	001	0	1	01	01	H2196_001_0	3	1					1	08/04/2021	2022.01	08/04/2021 12:36:52 PM Central Daylight Time	08/03/2021 12:17:26 PM Central Daylight Time	07/29/2021 07:47:55 PM Central Daylight Time			08/04/2021 07:39:56 PM Central Daylight Time	UNITEDHEALTHCARE OF MISSISSIPPI, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO)	01	01		1			H2196	001	0	2022	Select Counties in North MS		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			
H2196	002	0	1	01	01	H2196_002_0	3	1					1	08/04/2021	2022.01	08/04/2021 12:36:41 PM Central Daylight Time	08/03/2021 12:17:57 PM Central Daylight Time	07/29/2021 07:48:10 PM Central Daylight Time			08/04/2021 07:39:56 PM Central Daylight Time	UNITEDHEALTHCARE OF MISSISSIPPI, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO)	01	01		1			H2196	002	0	2022	Select Counties in South MS		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			
H2218	001	0	1	20	08	H2218_001_0	1	1						06/02/2021	2022.01	06/02/2021 12:50:31 PM Eastern Daylight Time		06/02/2021 11:48:32 AM Eastern Daylight Time			06/02/2021 12:52:45 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	2022	Norfolk,Suffolk, Plymouth,Bristol & Middlesex cty		2		2			2						www.eatonapothecary.com	www.elderserviceplan.org												(617)533-2426				(617)533-2400												(617)533-2404				(617)533-2404																
H2218	002	0	1	20	08	H2218_002_0	1	1						06/02/2021	2022.01	06/02/2021 12:51:13 PM Eastern Daylight Time		06/02/2021 11:50:28 AM Eastern Daylight Time			06/02/2021 12:52:45 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	2022	Norfolk,Suffolk,Middlesex,Plymouth & Bristol Cty		2		2			2						www.eatonapothecary.com	www.elderserviceplan.org												(617)533-2426				(617)533-2400												(617)533-2404				(617)533-2404																
H2219	001	0	1	20	08	H2219_001_0	1	1						06/02/2021	2022.01	06/02/2021 02:30:49 PM Eastern Daylight Time		06/02/2021 01:08:55 PM Eastern Daylight Time			06/02/2021 02:39:56 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	2022	Full: Worc,Hampden Part: Essex,Hampshire,Middlesex		2	14108	2			2						Not Applicable	www.fallonhealth.org/summit	www.fallonhealth.org/summit									(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						06/02/2021	2022.01	06/02/2021 01:26:29 PM Eastern Daylight Time		06/02/2021 02:08:07 PM Eastern Daylight Time			06/02/2021 02:39:56 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	2022	Full: Worc,Hampden Part: Essex,Hampshire,Middlesex		2	72	2			2						Not Applicable	www.fallonhealth.org/summit	www.fallonhealth.org/summit									(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						06/02/2021	2022.01	06/02/2021 01:51:24 PM Eastern Daylight Time		06/02/2021 01:50:38 PM Eastern Daylight Time			06/02/2021 02:12:57 PM Eastern Daylight Time	UPHAMS CORNER HEALTH COMMITTEE, INC.	Uphams Corner Health Committee, Inc.	www.uphamselderserviceplan.org	Upham's Corner Health Committee, Inc. (PACE)	08	20		1			H2220	001	0	2022	Upham's PACE		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	1	1						06/02/2021	2022.01	06/02/2021 01:51:32 PM Eastern Daylight Time		06/02/2021 01:50:38 PM Eastern Daylight Time			06/02/2021 02:12:57 PM Eastern Daylight Time	UPHAMS CORNER HEALTH COMMITTEE, INC.	Uphams Corner Health Committee, Inc.	www.uphamselderserviceplan.org	Uphams Corner Health Committee, Inc. (PACE)	08	20		1			H2220	002	0	2022	Upham's PACE		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						06/02/2021	2022.01	06/02/2021 11:12:02 AM Eastern Daylight Time		06/02/2021 10:30:37 AM Eastern Daylight Time			06/02/2021 11:29:15 AM Eastern Daylight Time	CAMBRIDGE PUBLIC HEALTH COMMISSION	CHA PACE	http://www.challiance.org/esp/elder-service-plan	CHA PACE fka ESP of CHA (PACE)	08	20		1			H2221	001	0	2022	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						06/02/2021	2022.01	06/02/2021 11:12:52 AM Eastern Daylight Time		06/02/2021 10:32:37 AM Eastern Daylight Time			06/02/2021 11:29:15 AM Eastern Daylight Time	CAMBRIDGE PUBLIC HEALTH COMMISSION	CHA PACE	https://www.challiance.org/esp/elder-service-plan	CHA PACE fka ESP of CHA (PACE)	08	20		1			H2221	002	0	2022	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						06/01/2021	2022.01	06/01/2021 10:03:35 AM Eastern Daylight Time		06/01/2021 09:49:43 AM Eastern Daylight Time			06/01/2021 10:06:39 AM Eastern Daylight Time	ELEMENT CARE, INC.	Element Care, Inc	www.elementcare.org	Element Care (PACE)	08	20		1			H2222	002	0	2022	Essex, Middlesex counties		2	11674	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						06/01/2021	2022.01	06/01/2021 10:04:04 AM Eastern Daylight Time		06/01/2021 09:49:43 AM Eastern Daylight Time			06/01/2021 10:06:39 AM Eastern Daylight Time	ELEMENT CARE, INC.	Element Care, Inc	www.elementcare.org	Element Care (PACE)	08	20		1			H2222	003	0	2022	Essex, Middlesex counties		2	11674	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						06/04/2021	2022.01	06/04/2021 04:15:07 PM Eastern Daylight Time		06/03/2021 03:00:21 PM Eastern Daylight Time			06/04/2021 04:18:26 PM 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	2022	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						06/04/2021	2022.01	06/04/2021 04:15:22 PM Eastern Daylight Time		06/03/2021 03:00:22 PM Eastern Daylight Time			06/04/2021 04:18:26 PM 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	2022	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	6	1	2	1			0	08/04/2021	2022.01	08/04/2021 02:23:21 PM Pacific Daylight Time	08/04/2021 09:33:02 AM Pacific Daylight Time	08/02/2021 11:38:24 AM Pacific Daylight Time			08/05/2021 03:02:36 PM Pacific Daylight Time	SENIOR WHOLE HEALTH, LLC	Senior Whole Health	www.seniorwholehealthMA.com	Senior Whole Health (HMO D-SNP)	01	01		1			H2224	001	0	2022	Brstl, Essx, Hmpdn, Mdlsx, Nrflk, Plmth, Sflk, Wor		2	99650	2			1	3		1		1	www.seniorwholehealth.com	www.seniorwholehealth.com	www.seniorwholehealthMA.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	6	1	2	1			0	08/04/2021	2022.01	08/04/2021 02:23:33 PM Pacific Daylight Time	08/04/2021 09:35:46 AM Pacific Daylight Time	08/02/2021 11:40:22 AM Pacific Daylight Time			08/05/2021 03:02:36 PM Pacific Daylight Time	SENIOR WHOLE HEALTH, LLC	Senior Whole Health	www.seniorwholehealthMA.com	Senior Whole Health NHC (HMO D-SNP)	01	01		1			H2224	003	0	2022	Brstl, Essx, Hmpdn, Mdlsx, Nrflk, Plmth, Sflk, Wor		2	73012	2			1	3		1		1	www.seniorwholehealth.com	www.seniorwholehealth.com	www.seniorwholehealthMA.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	11	1	2	1			0	08/10/2021	2022.01	08/10/2021 02:52:03 PM Eastern Daylight Time	08/05/2021 04:00:26 PM Eastern Daylight Time	08/05/2021 04:00:26 PM Eastern Daylight Time			08/10/2021 04:54:35 PM Eastern Daylight Time	COMMONWEALTH CARE ALLIANCE, INC.	Commonwealth Care Alliance, Inc.	www.commonwealthcarealliance.org/become-a-member	Senior Care Options Program (HMO D-SNP)	01	01		1			H2225	001	0	2022	BRI, ESS, FRA, HMD, HMP, MID, NOR, PLY, SUF, WOR		2		2			1	3		1		1	http://www.commonwealthcarealliance.org/members/pharmacy-program	https://www.commonwealthcarealliance.org/members/sco/2021-senior-care-options-formulary/	provider-directory.commonwealthcarealliance.org/	(866)610-2273		(866)610-2273		(866)275-1222		(866)275-1222		(866)610-2273		(866)610-2273		(866)275-1222		(866)275-1222		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2226	001	0	1	01	01	H2226_001_0	3	1	2	1	1		0	08/05/2021	2022.01	08/05/2021 10:58:53 AM Central Daylight Time	08/03/2021 01:42:21 PM Central Daylight Time	07/29/2021 07:48:26 PM Central Daylight Time			08/05/2021 03:21:32 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Senior Care Options (HMO D-SNP)	01	01		1			H2226	001	0	2022	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			
H2226	003	0	1	01	01	H2226_003_0	3	1	2	1	1		0	08/05/2021	2022.01	08/05/2021 11:00:16 AM Central Daylight Time	08/03/2021 01:42:54 PM Central Daylight Time	07/29/2021 07:48:44 PM Central Daylight Time			08/05/2021 03:21:32 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Senior Care Options NHC (HMO D-SNP)	01	01		1			H2226	003	0	2022	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	002	0	1	04	01	H2228_002_0	2	1		1	2		0	08/04/2021	2022.01	08/04/2021 09:21:39 AM Central Daylight Time	08/03/2021 11:48:55 AM Central Daylight Time	07/29/2021 07:49:00 PM Central Daylight Time			08/04/2021 02:34:39 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan 1 (PPO I-SNP)	01	04		1			H2228	002	0	2022	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	3	1		1	2		0	08/04/2021	2022.01	08/04/2021 09:23:19 AM Central Daylight Time	08/03/2021 11:49:24 AM Central Daylight Time	07/29/2021 07:49:16 PM Central Daylight Time			08/04/2021 02:34:39 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan 1 (PPO I-SNP)	01	04		1			H2228	010	0	2022	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	2		1	08/04/2021	2022.01	08/04/2021 09:25:03 AM Central Daylight Time	08/03/2021 11:49:54 AM Central Daylight Time	07/29/2021 07:49:31 PM Central Daylight Time			08/04/2021 02:34:39 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Assisted Living Plan (PPO I-SNP)	01	04		1			H2228	011	0	2022	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	3	1		1	2		0	08/04/2021	2022.01	08/04/2021 09:27:23 AM Central Daylight Time	08/03/2021 11:50:23 AM Central Daylight Time	07/29/2021 07:49:47 PM Central Daylight Time			08/04/2021 02:34:39 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan 1 (PPO I-SNP)	01	04		1			H2228	013	0	2022	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	2		0	08/04/2021	2022.01	08/04/2021 09:30:15 AM Central Daylight Time	08/03/2021 11:50:53 AM Central Daylight Time	07/29/2021 07:50:02 PM Central Daylight Time			08/04/2021 02:34:39 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan 1 (PPO I-SNP)	01	04		1			H2228	016	0	2022	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	3	1		1	2		1	08/04/2021	2022.01	08/04/2021 09:32:15 AM Central Daylight Time	08/03/2021 11:51:23 AM Central Daylight Time	07/29/2021 07:50:18 PM Central Daylight Time			08/04/2021 02:34:39 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Assisted Living Plan 1 (PPO I-SNP)	01	04		1			H2228	017	0	2022	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	3	1			2		1	08/04/2021	2022.01	08/04/2021 08:41:24 AM Central Daylight Time	08/03/2021 11:51:53 AM Central Daylight Time	07/29/2021 07:50:33 PM Central Daylight Time			08/04/2021 04:11:22 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H2228	018	0	2022	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	3	1			2		1	08/04/2021	2022.01	08/04/2021 09:27:29 AM Central Daylight Time	08/03/2021 11:52:23 AM Central Daylight Time	07/29/2021 07:50:49 PM Central Daylight Time			08/05/2021 01:02:02 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 1 (PPO)	01	04		1			H2228	019	0	2022	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			
H2228	020	0	1	04	01	H2228_020_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 09:30:11 AM Central Daylight Time	08/03/2021 11:52:54 AM Central Daylight Time	07/29/2021 07:51:03 PM Central Daylight Time			08/05/2021 01:02:02 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Focus (PPO)	01	04		1			H2228	020	0	2022	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	3	1			2		1	08/04/2021	2022.01	08/04/2021 09:33:37 AM Central Daylight Time	08/03/2021 11:53:23 AM Central Daylight Time	07/29/2021 07:51:19 PM Central Daylight Time			08/05/2021 01:02:02 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 1 (PPO)	01	04		1			H2228	021	0	2022	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	3	1			2		1	08/05/2021	2022.01	08/05/2021 10:10:36 AM Central Daylight Time	08/03/2021 11:53:52 AM Central Daylight Time	07/29/2021 07:51:34 PM Central Daylight Time			08/05/2021 01:02:02 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 1 (PPO)	01	04		1			H2228	022	0	2022	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	3	1			2		1	08/04/2021	2022.01	08/04/2021 08:52:58 AM Central Daylight Time	08/03/2021 11:54:22 AM Central Daylight Time	07/29/2021 07:51:49 PM Central Daylight Time			08/04/2021 03:08:12 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H2228	023	0	2022	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			2		1	08/04/2021	2022.01	08/04/2021 09:34:15 AM Central Daylight Time	08/03/2021 11:54:52 AM Central Daylight Time	07/29/2021 07:52:05 PM Central Daylight Time			08/04/2021 02:34:39 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 1 (PPO)	01	04		1			H2228	024	0	2022	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			2	0	0	07/15/2021	2022.01	07/15/2021 09:23:15 AM Central Daylight Time	06/03/2021 02:45:14 PM Central Daylight Time				07/15/2021 12:46:14 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (PPO)	01	04		1			H2228	025	0	2022	Honolulu, Maui, and Kauai 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										(711)-		(711)-		(711)-		(711)-										2					2						2			
H2228	029	0	1	04	01	H2228_029_0	3	1					1	08/04/2021	2022.01	08/04/2021 11:39:46 AM Central Daylight Time	08/03/2021 11:55:21 AM Central Daylight Time	07/29/2021 07:52:20 PM Central Daylight Time			08/04/2021 09:19:07 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H2228	029	0	2022	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			2		1	08/04/2021	2022.01	08/04/2021 10:47:21 AM Central Daylight Time	08/03/2021 11:55:50 AM Central Daylight Time	07/29/2021 07:52:36 PM Central Daylight Time			08/05/2021 12:04:43 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H2228	030	0	2022	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	4	1					1	08/04/2021	2022.01	08/04/2021 11:42:43 AM Central Daylight Time	08/03/2021 11:56:20 AM Central Daylight Time	07/29/2021 07:52:51 PM Central Daylight Time			08/04/2021 09:19:07 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 1 (PPO)	01	04		1			H2228	031	0	2022	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					1	08/04/2021	2022.01	08/04/2021 11:46:53 AM Central Daylight Time	08/03/2021 11:56:49 AM Central Daylight Time	07/29/2021 07:53:07 PM Central Daylight Time			08/04/2021 09:19:07 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 2 (PPO)	01	04		1			H2228	032	0	2022	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			2		1	08/04/2021	2022.01	08/04/2021 02:21:09 PM Central Daylight Time	08/03/2021 07:46:09 PM Central Daylight Time	07/29/2021 07:53:22 PM Central Daylight Time			08/05/2021 03:34:42 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 1 (PPO)	01	04		1			H2228	035	0	2022	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			2		1	08/04/2021	2022.01	08/04/2021 02:29:13 PM Central Daylight Time	08/03/2021 07:47:59 PM Central Daylight Time	07/29/2021 07:53:38 PM Central Daylight Time			08/05/2021 03:34:42 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 2 (PPO)	01	04		1			H2228	036	0	2022	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			2		1	08/04/2021	2022.01	08/04/2021 02:30:34 PM Central Daylight Time	08/03/2021 07:50:00 PM Central Daylight Time	07/29/2021 07:53:53 PM Central Daylight Time			08/05/2021 03:34:42 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 1 (PPO)	01	04		1			H2228	037	0	2022	Select Counties in Pennsylvania		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	2		1	08/04/2021	2022.01	08/04/2021 09:38:05 AM Central Daylight Time	08/03/2021 11:58:48 AM Central Daylight Time	07/29/2021 07:54:09 PM Central Daylight Time			08/04/2021 02:34:39 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Assisted Living Plan 1 (PPO I-SNP)	01	04		1			H2228	039	0	2022	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	6	1	2	1	1		0	08/17/2021	2022.01	08/17/2021 11:25:07 AM Central Daylight Time	08/03/2021 11:59:17 AM Central Daylight Time	07/29/2021 07:54:25 PM Central Daylight Time			08/17/2021 11:28:29 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Choice Premier (PPO D-SNP)	01	04		1			H2228	041	0	2022	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	043	0	1	04	01	H2228_043_0	4	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 09:40:28 AM Central Daylight Time	08/03/2021 11:59:46 AM Central Daylight Time	07/29/2021 07:54:40 PM Central Daylight Time			08/04/2021 02:34:39 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (PPO D-SNP)	01	04		1			H2228	043	0	2022	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	6	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 10:42:13 AM Central Daylight Time	08/03/2021 12:00:15 PM Central Daylight Time	07/29/2021 07:54:57 PM Central Daylight Time			08/04/2021 01:23:58 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (PPO D-SNP)	01	04		1			H2228	044	0	2022	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	4	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 08:47:07 AM Central Daylight Time	08/03/2021 12:00:43 PM Central Daylight Time	07/29/2021 07:55:12 PM Central Daylight Time			08/04/2021 04:11:22 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (PPO D-SNP)	01	04		1			H2228	045	0	2022	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	047	0	1	04	01	H2228_047_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 10:00:29 AM Central Daylight Time	08/03/2021 12:01:13 PM Central Daylight Time	07/29/2021 07:55:28 PM Central Daylight Time			08/04/2021 06:48:07 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 2 (PPO)	01	04		1			H2228	047	0	2022	Albuquerque 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	3	1			2		1	08/04/2021	2022.01	08/04/2021 10:01:45 AM Central Daylight Time	08/03/2021 12:01:42 PM Central Daylight Time	07/29/2021 07:55:44 PM Central Daylight Time			08/04/2021 06:48:07 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 2 (PPO)	01	04		1			H2228	049	0	2022	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	3	1			2		1	08/04/2021	2022.01	08/04/2021 09:37:53 AM Central Daylight Time	08/03/2021 12:02:12 PM Central Daylight Time	07/29/2021 07:55:59 PM Central Daylight Time			08/05/2021 01:02:02 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 1 (PPO)	01	04		1			H2228	064	0	2022	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	3	1			2		1	08/04/2021	2022.01	08/04/2021 09:40:05 AM Central Daylight Time	08/03/2021 12:02:42 PM Central Daylight Time	07/29/2021 07:56:20 PM Central Daylight Time			08/05/2021 01:02:02 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H2228	065	0	2022	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	3	1			2		1	08/04/2021	2022.01	08/04/2021 09:42:29 AM Central Daylight Time	08/03/2021 12:03:11 PM Central Daylight Time	07/29/2021 07:56:35 PM Central Daylight Time			08/05/2021 01:02:02 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H2228	066	0	2022	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	3	1			2		1	08/04/2021	2022.01	08/04/2021 09:42:57 AM Central Daylight Time	08/03/2021 12:03:39 PM Central Daylight Time	07/29/2021 07:56:50 PM Central Daylight Time			08/04/2021 02:34:39 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 2 (PPO)	01	04		1			H2228	067	0	2022	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	3	1			2		1	08/04/2021	2022.01	08/04/2021 09:44:46 AM Central Daylight Time	08/03/2021 12:04:09 PM Central Daylight Time	07/29/2021 07:57:06 PM Central Daylight Time			08/04/2021 02:34:39 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H2228	068	0	2022	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	3	1			2		1	08/04/2021	2022.01	08/04/2021 10:48:40 AM Central Daylight Time	08/03/2021 11:39:35 AM Central Daylight Time	07/29/2021 07:57:22 PM Central Daylight Time			08/05/2021 12:04:43 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 1 (PPO)	01	04		1			H2228	071	0	2022	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			
H2228	074	0	1	04	01	H2228_074_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 10:02:43 AM Central Daylight Time	08/03/2021 11:40:09 AM Central Daylight Time	07/29/2021 07:57:38 PM Central Daylight Time			08/04/2021 06:48:07 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Walgreens Plan 1 (PPO)	01	04		1			H2228	074	0	2022	Maricopa 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			
H2228	075	0	1	04	01	H2228_075_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 10:06:06 AM Central Daylight Time	08/03/2021 11:40:43 AM Central Daylight Time	07/29/2021 07:57:53 PM Central Daylight Time			08/04/2021 08:05:11 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Walgreens Plan 1 (PPO)	01	04		1			H2228	075	0	2022	Pima 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			
H2228	076	0	1	04	01	H2228_076_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 10:08:50 AM Central Daylight Time	08/03/2021 11:41:20 AM Central Daylight Time	07/29/2021 07:58:09 PM Central Daylight Time			08/04/2021 08:05:11 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 1 (PPO)	01	04		1			H2228	076	0	2022	Greater AZ 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	077	0	1	04	01	H2228_077_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 10:09:55 AM Central Daylight Time	08/03/2021 11:41:56 AM Central Daylight Time	07/29/2021 07:58:24 PM Central Daylight Time			08/04/2021 08:05:11 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Walgreens Plan 2 (PPO)	01	04		1			H2228	077	0	2022	Maricopa 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			
H2228	079	0	1	04	01	H2228_079_0	3	1					1	08/04/2021	2022.01	08/04/2021 12:36:15 PM Central Daylight Time	08/03/2021 11:42:29 AM Central Daylight Time	07/29/2021 07:58:47 PM Central Daylight Time			08/04/2021 09:19:07 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Walgreens (PPO)	01	04		1			H2228	079	0	2022	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	080	0	1	04	01	H2228_080_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 09:45:11 AM Central Daylight Time	08/03/2021 11:43:02 AM Central Daylight Time	07/29/2021 07:59:02 PM Central Daylight Time			08/05/2021 01:02:02 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 2 (PPO)	01	04		1			H2228	080	0	2022	Fort Wayne 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	081	0	1	04	01	H2228_081_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 09:46:43 AM Central Daylight Time	08/03/2021 11:43:37 AM Central Daylight Time	07/29/2021 07:59:18 PM Central Daylight Time			08/05/2021 01:02:02 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 2 (PPO)	01	04		1			H2228	081	0	2022	Indianapolis 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	082	0	1	04	01	H2228_082_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 10:49:52 AM Central Daylight Time	08/03/2021 11:44:11 AM Central Daylight Time	07/29/2021 07:59:33 PM Central Daylight Time			08/05/2021 12:04:43 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H2228	082	0	2022	Southeast Missouri 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	083	0	1	04	01	H2228_083_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 10:50:59 AM Central Daylight Time	08/03/2021 11:44:46 AM Central Daylight Time	07/29/2021 07:59:48 PM Central Daylight Time			08/05/2021 12:04:43 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Walgreens (PPO)	01	04		1			H2228	083	0	2022	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	084	0	1	04	01	H2228_084_0	3	1					1	08/04/2021	2022.01	08/04/2021 03:02:53 PM Central Daylight Time	08/03/2021 11:45:20 AM Central Daylight Time	07/29/2021 08:00:04 PM Central Daylight Time			08/04/2021 09:19:07 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Walgreens (PPO)	01	04		1			H2228	084	0	2022	Select counties in Portland		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	085	0	1	04	01	H2228_085_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 02:32:18 PM Central Daylight Time	08/03/2021 07:51:35 PM Central Daylight Time	07/29/2021 08:00:19 PM Central Daylight Time			08/05/2021 03:34:42 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 2 (PPO)	01	04		1			H2228	085	0	2022	Select Counties in 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			
H2228	086	0	1	04	01	H2228_086_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 02:33:46 PM Central Daylight Time	08/03/2021 07:53:10 PM Central Daylight Time	07/29/2021 08:00:33 PM Central Daylight Time			08/05/2021 03:34:42 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 3 (PPO)	01	04		1			H2228	086	0	2022	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	088	0	1	04	01	H2228_088_0	2	1				0	0	07/14/2021	2022.01	07/14/2021 02:01:20 PM Central Daylight Time	06/03/2021 02:46:45 PM Central Daylight Time				07/16/2021 12:31:52 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (PPO)	01	04		1			H2228	088	0	2022	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										(711)-		(711)-		(711)-		(711)-										2					2						2			
H2228	091	0	1	04	01	H2228_091_0	2	1			2	0	0	07/15/2021	2022.01	07/15/2021 12:00:50 PM Central Daylight Time	06/03/2021 02:47:08 PM Central Daylight Time				07/15/2021 05:21:04 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (PPO)	01	04		1			H2228	091	0	2022	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										(711)-		(711)-		(711)-		(711)-										2					2						2			
H2228	093	0	1	04	01	H2228_093_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 02:35:37 PM Central Daylight Time	08/03/2021 11:47:03 AM Central Daylight Time	07/29/2021 08:00:49 PM Central Daylight Time			08/05/2021 03:34:42 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H2228	093	0	2022	Kent, New Castle, and Sussex 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	094	0	1	04	01	H2228_094_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 10:10:58 AM Central Daylight Time	08/03/2021 11:47:39 AM Central Daylight Time	07/29/2021 08:01:09 PM Central Daylight Time			08/04/2021 08:05:11 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 2 (PPO)	01	04		1			H2228	094	0	2022	Greater AZ 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	095	0	1	04	01	H2228_095_0	2	1			2	0	0	07/14/2021	2022.01	07/14/2021 04:40:22 PM Central Daylight Time	06/03/2021 02:48:15 PM Central Daylight Time				07/15/2021 06:54:47 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (PPO)	01	04		1			H2228	095	0	2022	Greater AZ 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										(711)-		(711)-		(711)-		(711)-										2					2						2			
H2228	096	0	1	04	01	H2228_096_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 10:36:16 AM Central Daylight Time	08/03/2021 11:48:17 AM Central Daylight Time	07/29/2021 08:01:24 PM Central Daylight Time			08/04/2021 08:05:11 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Walgreens Plan 2 (PPO)	01	04		1			H2228	096	0	2022	Pima 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			
H2228	097	0	1	04	01	H2228_097_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 10:37:24 AM Central Daylight Time	08/03/2021 11:48:53 AM Central Daylight Time	07/29/2021 08:01:38 PM Central Daylight Time			08/04/2021 08:05:11 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Walgreens Plan 3 (PPO)	01	04		1			H2228	097	0	2022	Maricopa 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			
H2228	098	0	1	04	01	H2228_098_0	2	1			2	0	0	07/14/2021	2022.01	07/14/2021 04:40:29 PM Central Daylight Time	06/03/2021 02:49:23 PM Central Daylight Time				07/15/2021 06:54:47 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (PPO)	01	04		1			H2228	098	0	2022	Select Counties Greater NM 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										(711)-		(711)-		(711)-		(711)-										2					2						2			
H2228	099	0	1	04	01	H2228_099_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 08:48:52 AM Central Daylight Time	08/03/2021 11:49:29 AM Central Daylight Time	07/29/2021 08:01:53 PM Central Daylight Time			08/04/2021 04:11:22 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 1 (PPO)	01	04		1			H2228	099	0	2022	Washington, DC		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	100	0	1	04	01	H2228_100_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 08:51:40 AM Central Daylight Time	08/03/2021 11:50:05 AM Central Daylight Time	07/29/2021 08:02:07 PM Central Daylight Time			08/04/2021 04:11:22 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 2 (PPO)	01	04		1			H2228	100	0	2022	Washington, DC		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	101	0	1	04	01	H2228_101_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 08:53:20 AM Central Daylight Time	08/03/2021 11:50:42 AM Central Daylight Time	07/29/2021 08:02:22 PM Central Daylight Time			08/04/2021 04:11:22 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 1 (PPO)	01	04		1			H2228	101	0	2022	Select Counties in Maryland		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	102	0	1	04	01	H2228_102_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 08:55:59 AM Central Daylight Time	08/03/2021 11:51:19 AM Central Daylight Time	07/29/2021 08:02:37 PM Central Daylight Time			08/04/2021 04:11:22 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 2 (PPO)	01	04		1			H2228	102	0	2022	Select Counties in Maryland		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	103	0	1	04	01	H2228_103_0	2	1			2	0	0	07/15/2021	2022.01	07/15/2021 03:57:39 PM Central Daylight Time	06/03/2021 02:51:15 PM Central Daylight Time				07/16/2021 12:36:20 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (PPO)	01	04		1			H2228	103	0	2022	Select Counties in Maryland and Washington, DC		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			
H2228	110	0	1	04	01	H2228_110_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 09:48:46 AM Central Daylight Time	08/03/2021 11:51:55 AM Central Daylight Time	07/29/2021 08:02:52 PM Central Daylight Time			08/05/2021 01:02:02 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 2 (PPO)	01	04		1			H2228	110	0	2022	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	111	0	1	04	01	H2228_111_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 09:51:07 AM Central Daylight Time	08/03/2021 11:52:31 AM Central Daylight Time	07/29/2021 08:03:08 PM Central Daylight Time			08/05/2021 01:02:02 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 2 (PPO)	01	04		1			H2228	111	0	2022	Southeast / Evansville 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	115	0	1	04	01	H2228_115_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 10:39:19 AM Central Daylight Time	08/03/2021 11:53:08 AM Central Daylight Time	07/29/2021 08:03:22 PM Central Daylight Time			08/04/2021 08:05:11 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 2 (PPO)	01	04		1			H2228	115	0	2022	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			
H2228	116	0	1	04	01	H2228_116_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 10:40:25 AM Central Daylight Time	08/03/2021 11:53:44 AM Central Daylight Time	07/29/2021 08:03:37 PM Central Daylight Time			08/04/2021 08:05:11 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 1 (PPO)	01	04		1			H2228	116	0	2022	Albuquerque 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	117	0	1	04	01	H2228_117_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 10:41:17 AM Central Daylight Time	08/03/2021 11:54:21 AM Central Daylight Time	07/29/2021 08:03:52 PM Central Daylight Time			08/04/2021 08:05:11 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 1 (PPO)	01	04		1			H2228	117	0	2022	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	118	0	1	04	01	H2228_118_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 10:42:14 AM Central Daylight Time	08/03/2021 11:54:58 AM Central Daylight Time	07/29/2021 08:04:07 PM Central Daylight Time			08/04/2021 08:05:11 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 1 (PPO)	01	04		1			H2228	118	0	2022	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			
H2228	119	0	1	04	01	H2228_119_0	2	1			2	0	0	07/14/2021	2022.01	07/14/2021 04:40:36 PM Central Daylight Time	06/03/2021 02:53:53 PM Central Daylight Time				07/15/2021 06:54:47 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (PPO)	01	04		1			H2228	119	0	2022	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										(711)-		(711)-		(711)-		(711)-										2					2						2			
H2228	805	0	1	04	01	H2228_805_0	1	1						05/24/2021	2022.01	05/24/2021 11:45:12 AM Eastern Daylight Time					06/03/2021 09:51:15 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2228	805	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2228	807	0	1	04	01	H2228_807_0	1	1				0	0	06/03/2021	2022.01	06/03/2021 09:38:03 AM Eastern Daylight Time					06/03/2021 09:51:15 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2228	807	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2228	808	0	1	04	01	H2228_808_0	1	1						05/24/2021	2022.01	05/24/2021 11:48:41 AM Eastern Daylight Time					06/03/2021 09:51:15 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2228	808	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2228	809	0	2	04	01	H2228_809_0	1	1						05/24/2021	2022.01	05/24/2021 11:49:23 AM Eastern Daylight Time					06/03/2021 09:51:15 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H2228	809	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2228	810	0	2	04	01	H2228_810_0	1	1				0	0	06/03/2021	2022.01	06/03/2021 09:38:38 AM Eastern Daylight Time					06/03/2021 09:51:15 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H2228	810	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2228	811	0	2	04	01	H2228_811_0	1	1						05/24/2021	2022.01	05/24/2021 11:58:08 AM Eastern Daylight Time					06/03/2021 09:51:15 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H2228	811	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2228	812	0	1	04	01	H2228_812_0	1	1						05/24/2021	2022.01	05/24/2021 11:58:43 AM Eastern Daylight Time					06/03/2021 09:51:15 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2228	812	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2228	813	0	1	04	01	H2228_813_0	1	1						05/24/2021	2022.01	05/24/2021 12:06:21 PM Eastern Daylight Time					06/03/2021 09:51:15 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2228	813	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2228	814	0	1	04	01	H2228_814_0	1	1						05/24/2021	2022.01	05/24/2021 12:10:15 PM Eastern Daylight Time					06/03/2021 09:51:15 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2228	814	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2228	815	0	1	04	01	H2228_815_0	1	1				0	0	06/03/2021	2022.01	06/03/2021 09:39:13 AM Eastern Daylight Time					06/03/2021 09:51:15 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2228	815	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2228	816	0	1	04	01	H2228_816_0	1	1						05/24/2021	2022.01	05/24/2021 12:11:26 PM Eastern Daylight Time					06/03/2021 09:51:15 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2228	816	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2228	817	0	2	04	01	H2228_817_0	1	1						05/24/2021	2022.01	05/24/2021 12:11:54 PM Eastern Daylight Time					06/03/2021 09:51:15 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H2228	817	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2228	818	0	2	04	01	H2228_818_0	1	1				0	0	06/03/2021	2022.01	06/03/2021 09:39:42 AM Eastern Daylight Time					06/03/2021 09:51:15 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H2228	818	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2228	819	0	2	04	01	H2228_819_0	1	1						05/24/2021	2022.01	05/24/2021 12:13:20 PM Eastern Daylight Time					06/03/2021 09:51:15 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H2228	819	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2228	820	0	1	04	01	H2228_820_0	1	1						05/24/2021	2022.01	05/24/2021 12:16:17 PM Eastern Daylight Time					06/03/2021 09:51:15 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2228	820	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2228	821	0	1	04	01	H2228_821_0	1	1						05/24/2021	2022.01	05/24/2021 12:16:52 PM Eastern Daylight Time					06/03/2021 09:51:15 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2228	821	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2228	822	0	1	04	01	H2228_822_0	1	1				0	0	06/03/2021	2022.01	06/03/2021 09:40:10 AM Eastern Daylight Time					06/03/2021 09:51:15 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2228	822	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2228	823	0	1	04	01	H2228_823_0	1	1						05/24/2021	2022.01	05/24/2021 12:18:39 PM Eastern Daylight Time					06/03/2021 09:51:15 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2228	823	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2228	824	0	1	04	01	H2228_824_0	1	1						05/24/2021	2022.01	05/24/2021 12:19:40 PM Eastern Daylight Time					06/03/2021 09:51:15 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2228	824	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2228	825	0	1	04	01	H2228_825_0	1	1						05/24/2021	2022.01	05/24/2021 12:20:43 PM Eastern Daylight Time					06/03/2021 09:51:15 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2228	825	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2228	826	0	1	04	01	H2228_826_0	1	1						05/24/2021	2022.01	05/24/2021 12:21:10 PM Eastern Daylight Time					06/03/2021 09:51:15 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2228	826	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2228	827	0	1	04	01	H2228_827_0	1	1						05/24/2021	2022.01	05/24/2021 12:21:51 PM Eastern Daylight Time					06/03/2021 09:51:15 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2228	827	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2228	828	0	1	04	01	H2228_828_0	1	1						05/24/2021	2022.01	05/24/2021 12:22:24 PM Eastern Daylight Time					06/03/2021 09:51:15 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2228	828	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2228	829	0	2	04	01	H2228_829_0	1	1						05/24/2021	2022.01	05/24/2021 12:23:01 PM Eastern Daylight Time					06/03/2021 09:51:15 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H2228	829	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2228	830	0	1	04	01	H2228_830_0	1	1				0	0	06/03/2021	2022.01	06/03/2021 09:40:43 AM Eastern Daylight Time					06/03/2021 09:51:15 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2228	830	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2228	831	0	1	04	01	H2228_831_0	1	1						05/24/2021	2022.01	05/24/2021 12:24:44 PM Eastern Daylight Time					06/03/2021 09:51:15 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2228	831	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2228	832	0	1	04	01	H2228_832_0	1	1						05/24/2021	2022.01	05/24/2021 12:25:15 PM Eastern Daylight Time					06/03/2021 09:51:15 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2228	832	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2228	833	0	1	04	01	H2228_833_0	1	1						05/24/2021	2022.01	05/24/2021 12:25:51 PM Eastern Daylight Time					06/03/2021 09:51:15 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2228	833	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2228	834	0	1	04	01	H2228_834_0	1	1						05/24/2021	2022.01	05/24/2021 12:26:18 PM Eastern Daylight Time					06/03/2021 09:51:15 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2228	834	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2228	835	0	1	04	01	H2228_835_0	1	1						05/24/2021	2022.01	05/24/2021 12:28:08 PM Eastern Daylight Time					06/03/2021 09:51:15 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2228	835	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2228	836	0	1	04	01	H2228_836_0	1	1						05/24/2021	2022.01	05/24/2021 12:28:33 PM Eastern Daylight Time					06/03/2021 09:51:15 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2228	836	0	2022	Nationwide		1	20472	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2228	837	0	1	04	01	H2228_837_0	1	1						05/24/2021	2022.01	05/24/2021 12:29:26 PM Eastern Daylight Time					06/03/2021 09:51:15 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2228	837	0	2022	Nationwide		1	1428	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2228	838	0	1	04	01	H2228_838_0	1	1						05/24/2021	2022.01	05/24/2021 12:29:56 PM Eastern Daylight Time					06/03/2021 09:51:15 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2228	838	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
H2230	002	0	1	04	01	H2230_002_0	6	1					0	08/04/2021	2022.01	08/04/2021 12:07:54 PM Eastern Daylight Time	08/04/2021 11:36:04 AM Eastern Daylight Time	08/04/2021 04:33:00 PM Eastern Daylight Time			08/04/2021 04:43:04 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	2022	Massachusetts except Berkshire Dukes and Nantucket		2	57008	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	6	1					0	08/04/2021	2022.01	08/04/2021 12:07:59 PM Eastern Daylight Time	08/04/2021 11:36:38 AM Eastern Daylight Time	08/04/2021 11:52:05 AM Eastern Daylight Time			08/04/2021 04:43:04 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	2022	Massachusetts except Berkshire Dukes and Nantucket		2	246078	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	6	1					0	08/04/2021	2022.01	08/04/2021 12:08:03 PM Eastern Daylight Time	08/04/2021 11:37:12 AM Eastern Daylight Time	08/04/2021 11:52:27 AM Eastern Daylight Time			08/04/2021 04:43:04 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	2022	Massachusetts except Berkshire Dukes and Nantucket	Massachusetts except BER, DUK, NAN, WOR	2	316004	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	6	1					0	08/04/2021	2022.01	08/04/2021 01:17:15 PM Eastern Daylight Time	08/04/2021 11:37:46 AM Eastern Daylight Time	08/04/2021 11:52:49 AM Eastern Daylight Time			08/04/2021 04:43:04 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	2022	Massachusetts except Berkshire Dukes and Nantucket	Worcester, MA	2	63213	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	2	1						06/02/2021	2022.01	06/02/2021 10:25:46 AM Eastern Daylight Time					06/06/2021 10:45:34 PM 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	2022	National Network		1	1338	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;7e;7h;8a;8b1;9a1;9b;9c;10a;11a;11c;15;	2		1									
H2230	809	0	1	04	01	H2230_809_0	2	1				0	0	06/02/2021	2022.01	06/02/2021 10:25:56 AM Eastern Daylight Time					06/06/2021 10:45:34 PM 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	2022	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;7e;7h;8a;8b1;9a1;9b;9c;10a;11a;11c;15;	2		1									
H2235	001	0	1	01	01	H2235_001_0	10	1					1	08/02/2021	2022.01	08/02/2021 09:33:22 AM Central Daylight Time	07/30/2021 02:21:23 PM Central Daylight Time	07/30/2021 02:26:23 PM Central Daylight Time			08/02/2021 01:03:11 PM Central Daylight Time	BAYCARE SELECT HEALTH PLANS, INC.	BayCare Health Plans	BayCarePlus.org	BayCarePlus Complete (HMO)	01	01		1			H2235	001	0	2022	Hillsborough, Pasco, Pinellas and Polk counties		2		2			2						www.baycarehealthplans.com	www.baycarehealthplans.com	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	9	1					0	07/15/2021	2022.01	07/15/2021 08:00:56 AM Central Daylight Time	07/30/2021 02:06:20 PM Central Daylight Time	07/30/2021 02:13:17 PM Central Daylight Time			08/02/2021 01:03:11 PM Central Daylight Time	BAYCARE SELECT HEALTH PLANS, INC.	BayCare Health Plans	BayCarePlus.org	BayCarePlus Rewards (HMO)	01	01		1			H2235	002	0	2022	Hillborough, Pasco, Pinellas and Polk Counties		2		2			2						www.baycarehealthplans.com	www.baycarehealthplans.com	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	003	0	1	01	01	H2235_003_0	10	1					1	07/15/2021	2022.01	07/15/2021 08:00:28 AM Central Daylight Time	07/30/2021 01:53:48 PM Central Daylight Time	07/30/2021 02:01:16 PM Central Daylight Time			08/02/2021 01:03:11 PM Central Daylight Time	BAYCARE SELECT HEALTH PLANS, INC.	BayCare Health Plans	BayCarePlus.org	BayCarePlus Premier (HMO)	01	01		1			H2235	003	0	2022	Hillsborough, Pasco, Pinellas and Polk counties		2		2			2						www.baycarehealthplans.com	www.baycarehealthplans.com	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	2	1						05/26/2021	2022.01	05/26/2021 02:51:30 PM Central Daylight Time					05/28/2021 10:35:35 AM Central Daylight Time	BAYCARE SELECT HEALTH PLANS, INC.	BayCare Health Plans	BayCarePlus.org	BayCarePlus EGWP MAPD calendar (HMO)	01	01		1			H2235	801	0	2022	Hillsborough, Pasco, Pinellas and Polk counties		1	300	2			2						www.baycarehealthplans.com	www.baycarehealthplans.com	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;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H2235	802	0	1	01	01	H2235_802_0	2	1						05/26/2021	2022.01	05/26/2021 02:18:32 PM Central Daylight Time					05/28/2021 10:35:35 AM Central Daylight Time	BAYCARE SELECT HEALTH PLANS, INC.	BayCare Health Plans	BayCarePlus.org	BayCarePlus EGWP MAPD non calendar (HMO)	01	01		1			H2235	802	0	2022	Hillsborough, Pasco, Pinellas and Polk counties		1	300	2			2						www.baycarehealthplans.com	www.baycarehealthplans.com	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;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H2235	803	0	1	01	01	H2235_803_0	2	1				0	0	05/26/2021	2022.01	05/26/2021 02:18:55 PM Central Daylight Time					05/28/2021 10:35:35 AM Central Daylight Time	BAYCARE SELECT HEALTH PLANS, INC.	BayCare Health Plans	BayCarePlus.org	BayCarePlus EGWP MA Only Calendar Year (HMO)	01	01		1			H2235	803	0	2022	Hillsborough, Pasco, Pinellas and Polk counties		1	300	2			2						www.baycarehealthplans.com	www.baycarehealthplans.com	BayCarePlus.org	(866)509-5396		(866)509-5396		(866)947-5820		(866)947-5820										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H2235	804	0	1	01	01	H2235_804_0	3	1				0	0	05/26/2021	2022.01	05/26/2021 02:19:19 PM Central Daylight Time					05/28/2021 10:43:47 AM Central Daylight Time	BAYCARE SELECT HEALTH PLANS, INC.	BayCare Health Plans	BayCarePlus.org	BayCarePlus EGWP MA Only non-Calendar Year (HMO)	01	01		1			H2235	804	0	2022	Hillsborough, Pasco, Pinellas and Polk counties		1	300	2			2						www.baycarehealthplans.com	www.baycarehealthplans.com	BayCarePlus.org	(866)509-5396		(866)509-5396		(866)947-5820		(866)947-5820										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H2237	001	0	1	01	01	H2237_001_0	13	1	2	1	1		0	08/03/2021	2022.01	08/03/2021 04:26:31 PM Central Daylight Time	08/03/2021 03:03:52 PM Central Daylight Time	08/03/2021 02:49:27 PM Central Daylight Time			08/05/2021 04:23:32 PM Central Daylight Time	INDEPENDENT CARE HEALTH PLAN, INC.	iCare	www.icarehealthplan.org	iCare Medicare Plan (HMO D-SNP)	01	01		1			H2237	001	0	2022	Eastern, South Central and Western Wisconsin		2		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	12	1	2	1	1		0	08/03/2021	2022.01	08/03/2021 02:21:30 PM Central Daylight Time	08/03/2021 03:52:09 PM Central Daylight Time	08/03/2021 02:51:53 PM Central Daylight Time			08/05/2021 04:23:32 PM Central Daylight Time	INDEPENDENT CARE HEALTH PLAN, INC.	iCare	www.icarehealthplan.org	iCare Family Care Partnership (HMO D-SNP)	01	01		1			H2237	007	0	2022	Milwaukee, Racine, Kenosha, Dane and Sauk Counties		2		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			
H2241	007	1	1	01	01	H2241_007_1	2	1					1	08/04/2021	2022.01	08/04/2021 12:27:06 PM Pacific Daylight Time	08/04/2021 09:39:14 AM Pacific Daylight Time	07/31/2021 12:47:25 PM Pacific Daylight Time			08/04/2021 01:21:19 PM Pacific Daylight Time	GOLDEN STATE MEDICARE HEALTH PLAN	Golden State	www.gsmhp.com	Connected Care (HMO)	01	01		1			H2241	007	1	2022	Stanislaus and San Luis Obispo Counties	Stanislaus County	2		2			2						www.gsmhp.com	www.gsmhp.com	www.gsmhp.com	(877)541-4111		(877)541-4111		(877)541-4111		(877)541-4111		(877)541-4111		(877)541-4111		(877)541-4111		(877)541-4111		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2241	007	2	1	01	01	H2241_007_2	4	1					1	08/04/2021	2022.01	08/04/2021 02:09:08 PM Pacific Daylight Time	08/04/2021 09:48:15 AM Pacific Daylight Time	07/31/2021 12:48:34 PM Pacific Daylight Time			08/04/2021 02:10:05 PM Pacific Daylight Time	GOLDEN STATE MEDICARE HEALTH PLAN	Golden State	www.gsmhp.com	Connected Care (HMO)	01	01		1			H2241	007	2	2022	Stanislaus and San Luis Obispo Counties	San Luis Obispo County	2		2			2						www.gsmhp.com	www.gsmhp.com	www.gsmhp.com	(877)541-4111		(877)541-4111		(877)541-4111		(877)541-4111		(877)541-4111		(877)541-4111		(877)541-4111		(877)541-4111		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2241	012	0	1	01	01	H2241_012_0	2	1					1	08/04/2021	2022.01	08/04/2021 12:30:47 PM Pacific Daylight Time	08/03/2021 02:59:27 PM Pacific Daylight Time	07/31/2021 12:50:15 PM Pacific Daylight Time			08/04/2021 01:21:19 PM Pacific Daylight Time	GOLDEN STATE MEDICARE HEALTH PLAN	Golden State	www.gsmhp.com	Connected Care (HMO)	01	01		1			H2241	012	0	2022	Los Angeles County		2		2			2						www.gsmhp.com	www.gsmhp.com	www.gsmhp.com	(877)541-4111		(877)541-4111		(877)541-4111		(877)541-4111		(877)541-4111		(877)541-4111		(877)541-4111		(877)541-4111		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2241	013	0	1	01	01	H2241_013_0	3	1					1	08/04/2021	2022.01	08/04/2021 12:31:19 PM Pacific Daylight Time	08/03/2021 03:15:27 PM Pacific Daylight Time	07/31/2021 01:03:33 PM Pacific Daylight Time			08/04/2021 01:21:19 PM Pacific Daylight Time	GOLDEN STATE MEDICARE HEALTH PLAN	Golden State	www.gsmhp.com	Connected Care (HMO)	01	01		1			H2241	013	0	2022	Orange and Riverside Counties		2		2			2						www.gsmhp.com	www.gsmhp.com	www.gsmhp.com	(877)541-4111		(877)541-4111		(877)541-4111		(877)541-4111		(877)541-4111		(877)541-4111		(877)541-4111		(877)541-4111		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2241	014	0	1	01	01	H2241_014_0	3	1					1	08/04/2021	2022.01	08/04/2021 12:35:17 PM Pacific Daylight Time	08/03/2021 03:23:26 PM Pacific Daylight Time	07/31/2021 01:04:52 PM Pacific Daylight Time			08/04/2021 01:21:19 PM Pacific Daylight Time	GOLDEN STATE MEDICARE HEALTH PLAN	Golden State	www.gsmhp.com	Golden State Senior Health Plan (HMO)	01	01		1			H2241	014	0	2022	San Francisco County		2		2			2						www.gsmhp.com	www.gsmhp.com	www.gsmhp.com	(877)541-4111		(877)541-4111		(877)541-4111		(877)541-4111		(877)541-4111		(877)541-4111		(877)541-4111		(877)541-4111		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2241	016	0	1	01	01	H2241_016_0	2	1					1	08/04/2021	2022.01	08/04/2021 12:35:32 PM Pacific Daylight Time	08/03/2021 03:30:06 PM Pacific Daylight Time	07/31/2021 01:05:51 PM Pacific Daylight Time			08/04/2021 01:21:19 PM Pacific Daylight Time	GOLDEN STATE MEDICARE HEALTH PLAN	Golden State	www.gsmhp.com	Connected Care (HMO)	01	01		1			H2241	016	0	2022	San Bernardino County		2		2			2						www.gsmhp.com	www.gsmhp.com	www.gsmhp.com	(877)541-4111		(877)541-4111		(877)541-4111		(877)541-4111		(877)541-4111		(877)541-4111		(877)541-4111		(877)541-4111		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2241	017	0	1	01	01	H2241_017_0	2	1					1	08/04/2021	2022.01	08/04/2021 12:33:08 PM Pacific Daylight Time	08/03/2021 03:36:25 PM Pacific Daylight Time	07/31/2021 01:06:52 PM Pacific Daylight Time			08/04/2021 01:21:19 PM Pacific Daylight Time	GOLDEN STATE MEDICARE HEALTH PLAN	Golden State	www.gsmhp.com	Connected Care (HMO)	01	01		1			H2241	017	0	2022	San Diego County		2		2			2						www.gsmhp.com	www.gsmhp.com	www.gsmhp.com	(877)541-4111		(877)541-4111		(877)541-4111		(877)541-4111		(877)541-4111		(877)541-4111		(877)541-4111		(877)541-4111		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2241	018	0	1	01	01	H2241_018_0	3	1		1			1	08/04/2021	2022.01	08/04/2021 12:33:38 PM Pacific Daylight Time	08/04/2021 06:16:28 AM Pacific Daylight Time	07/31/2021 01:08:06 PM Pacific Daylight Time			08/04/2021 01:21:19 PM Pacific Daylight Time	GOLDEN STATE MEDICARE HEALTH PLAN	Golden State	www.gsmhp.com	Connected Care Select (HMO C-SNP)	01	01		1			H2241	018	0	2022	Los Angeles County		2		2			1	4			00000000000000000010		www.gsmhp.com	www.gsmhp.com	www.gsmhp.com	(877)541-4111		(877)541-4111		(877)541-4111		(877)541-4111		(877)541-4111		(877)541-4111		(877)541-4111		(877)541-4111		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2241	019	0	1	01	01	H2241_019_0	4	1		1			1	08/04/2021	2022.01	08/04/2021 12:34:00 PM Pacific Daylight Time	08/04/2021 06:28:13 AM Pacific Daylight Time	07/31/2021 01:09:32 PM Pacific Daylight Time			08/04/2021 01:21:19 PM Pacific Daylight Time	GOLDEN STATE MEDICARE HEALTH PLAN	Golden State	www.gsmhp.com	Connected Care Select (HMO C-SNP)	01	01		1			H2241	019	0	2022	Orange and Riverside Counties		2		2			1	4			00000000000000000010		www.gsmhp.com	www.gsmhp.com	www.gsmhp.com	(877)541-4111		(877)541-4111		(877)541-4111		(877)541-4111		(877)541-4111		(877)541-4111		(877)541-4111		(877)541-4111		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2241	020	0	1	01	01	H2241_020_0	3	1		1			1	08/04/2021	2022.01	08/04/2021 12:34:30 PM Pacific Daylight Time	08/04/2021 06:39:17 AM Pacific Daylight Time	07/31/2021 01:10:41 PM Pacific Daylight Time			08/04/2021 01:21:19 PM Pacific Daylight Time	GOLDEN STATE MEDICARE HEALTH PLAN	Golden State	www.gsmhp.com	Connected Care Select (HMO C-SNP)	01	01		1			H2241	020	0	2022	San Luis Obispo County		2		2			1	4			00000000000000000010		www.gsmhp.com	www.gsmhp.com	www.gsmhp.com	(877)541-4111		(877)541-4111		(877)541-4111		(877)541-4111		(877)541-4111		(877)541-4111		(877)541-4111		(877)541-4111		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2241	021	0	1	01	01	H2241_021_0	3	1		1			1	08/04/2021	2022.01	08/04/2021 12:34:53 PM Pacific Daylight Time	08/04/2021 06:48:45 AM Pacific Daylight Time	07/31/2021 01:11:39 PM Pacific Daylight Time			08/04/2021 01:21:19 PM Pacific Daylight Time	GOLDEN STATE MEDICARE HEALTH PLAN	Golden State	www.gsmhp.com	Connected Care Select (HMO C-SNP)	01	01		1			H2241	021	0	2022	Stanislaus County		2		2			1	4			00000000000000000010		www.gsmhp.com	www.gsmhp.com	www.gsmhp.com	(877)541-4111		(877)541-4111		(877)541-4111		(877)541-4111		(877)541-4111		(877)541-4111		(877)541-4111		(877)541-4111		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2247	001	0	1	01	01	H2247_001_0	4	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 10:00:50 AM Central Daylight Time	08/03/2021 01:41:01 PM Central Daylight Time	07/29/2021 08:04:29 PM Central Daylight Time			08/04/2021 04:11:27 PM Central Daylight Time	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO D-SNP)	01	01		1			H2247	001	0	2022	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	6	1					0	07/02/2021	2022.01	07/02/2021 04:18:16 PM Eastern Daylight Time	08/03/2021 01:20:10 PM Eastern Daylight Time	08/02/2021 01:31:44 PM Eastern Daylight Time			08/05/2021 11:00:35 AM 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	2022	Most of Massachusetts	Essex and Suffolk Counties	2		2			2						www.tuftsmedicarepreferred.org/doctor-search	tuftsmedicarepreferred.org/drug-coverage	www.tuftsmedicarepreferred.org/doctor-search	(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	6	1					0	06/07/2021	2022.01	06/07/2021 11:04:14 AM Eastern Daylight Time	08/03/2021 01:31:20 PM Eastern Daylight Time	08/02/2021 01:32:06 PM Eastern Daylight Time			08/05/2021 11:00:35 AM 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	2022	Most of Massachusetts	BARN, BRIS, MIDD, NORF, PLYM Counties	2		2			2						www.tuftsmedicarepreferred.org/doctor-search	tuftsmedicarepreferred.org/drug-coverage	www.tuftsmedicarepreferred.org/doctor-search	(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	6	1					0	06/07/2021	2022.01	06/07/2021 11:05:04 AM Eastern Daylight Time	08/03/2021 01:42:16 PM Eastern Daylight Time	08/02/2021 01:32:28 PM Eastern Daylight Time			08/05/2021 11:00:35 AM 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	2022	Most of Massachusetts	Hampden and Hampshire Counties	2		2			2						www.tuftsmedicarepreferred.org/doctor-search	tuftsmedicarepreferred.org/drug-coverage	www.tuftsmedicarepreferred.org/doctor-search	(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					0	08/17/2021	2022.01	08/17/2021 02:40:47 PM Eastern Daylight Time	08/03/2021 01:53:04 PM Eastern Daylight Time	08/02/2021 01:32:50 PM Eastern Daylight Time			08/17/2021 02:46:52 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	2022	Most of Massachusetts	Essex and Suffolk Counties	2		2			2						www.tuftsmedicarepreferred.org/doctor-search	tuftsmedicarepreferred.org/drug-coverage	www.tuftsmedicarepreferred.org/doctor-search	(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					0	08/17/2021	2022.01	08/17/2021 02:41:06 PM Eastern Daylight Time	08/03/2021 02:04:46 PM Eastern Daylight Time	08/02/2021 01:33:14 PM Eastern Daylight Time			08/17/2021 02:46:52 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	2022	Most of Massachusetts	BARN, BRIS, MIDD, NORF, PLYM Counties	2		2			2						www.tuftsmedicarepreferred.org/doctor-search	tuftsmedicarepreferred.org/drug-coverage	www.tuftsmedicarepreferred.org/doctor-search	(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					0	08/17/2021	2022.01	08/17/2021 02:41:18 PM Eastern Daylight Time	08/03/2021 02:15:56 PM Eastern Daylight Time	08/02/2021 01:33:36 PM Eastern Daylight Time			08/17/2021 02:46:52 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	2022	Most of Massachusetts	Hampden and Hampshire Counties	2		2			2						www.tuftsmedicarepreferred.org/doctor-search	tuftsmedicarepreferred.org/drug-coverage	www.tuftsmedicarepreferred.org/doctor-search	(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	7	1				0	0	08/17/2021	2022.01	08/17/2021 02:41:28 PM Eastern Daylight Time	06/04/2021 05:00:44 PM Eastern Daylight Time				08/17/2021 02:46:52 PM 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	2022	Most of Massachusetts	Essex and Suffolk Counties	2		2			2						www.tuftsmedicarepreferred.org/doctor-search	tuftsmedicarepreferred.org/drug-coverage	www.tuftsmedicarepreferred.org/doctor-search	(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				0	0	08/17/2021	2022.01	08/17/2021 02:41:39 PM Eastern Daylight Time	06/04/2021 05:06:04 PM Eastern Daylight Time				08/17/2021 02:46:52 PM 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	2022	Most of Massachusetts	BARN, BRIS, MIDD, NORF, PLYM Counties	2		2			2						www.tuftsmedicarepreferred.org/doctor-search	tuftsmedicarepreferred.org/drug-coverage	www.tuftsmedicarepreferred.org/doctor-search	(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	6	1					0	06/07/2021	2022.01	06/07/2021 11:08:29 AM Eastern Daylight Time	08/03/2021 02:26:56 PM Eastern Daylight Time	08/02/2021 01:34:00 PM Eastern Daylight Time			08/05/2021 11:00:35 AM 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	2022	Most of Massachusetts	Essex and Suffolk Counties	2		2			2						www.tuftsmedicarepreferred.org/doctor-search	tuftsmedicarepreferred.org/drug-coverage	www.tuftsmedicarepreferred.org/doctor-search	(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	6	1					0	06/07/2021	2022.01	06/07/2021 11:09:05 AM Eastern Daylight Time	08/03/2021 02:38:06 PM Eastern Daylight Time	08/02/2021 01:34:22 PM Eastern Daylight Time			08/05/2021 11:00:35 AM 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	2022	Most of Massachusetts	BARN, BRIS, MIDD, NORF, PLYM Counties	2		2			2						www.tuftsmedicarepreferred.org/doctor-search	tuftsmedicarepreferred.org/drug-coverage	www.tuftsmedicarepreferred.org/doctor-search	(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	6	1					0	06/07/2021	2022.01	06/07/2021 11:09:32 AM Eastern Daylight Time	08/03/2021 02:49:08 PM Eastern Daylight Time	08/02/2021 01:34:44 PM Eastern Daylight Time			08/05/2021 11:00:35 AM 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	2022	Most of Massachusetts	Hampden and Hampshire Counties	2		2			2						www.tuftsmedicarepreferred.org/doctor-search	tuftsmedicarepreferred.org/drug-coverage	www.tuftsmedicarepreferred.org/doctor-search	(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	5	1				0	0	06/07/2021	2022.01	06/07/2021 11:10:03 AM Eastern Daylight Time	06/04/2021 05:28:22 PM Eastern Daylight Time				06/07/2021 02:08:35 PM 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	2022	Most of Massachusetts	Essex and Suffolk Counties	2		2			2						www.tuftsmedicarepreferred.org/doctor-search	tuftsmedicarepreferred.org/drug-coverage	www.tuftsmedicarepreferred.org/doctor-search	(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	5	1				0	0	06/07/2021	2022.01	06/07/2021 11:10:35 AM Eastern Daylight Time	06/04/2021 05:33:48 PM Eastern Daylight Time				06/07/2021 02:08:35 PM 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	2022	Most of Massachusetts	BARN, BRIS, MIDD, NORF, PLYM Counties	2		2			2						www.tuftsmedicarepreferred.org/doctor-search	tuftsmedicarepreferred.org/drug-coverage	www.tuftsmedicarepreferred.org/doctor-search	(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	6	1					0	06/07/2021	2022.01	06/07/2021 11:11:06 AM Eastern Daylight Time	08/03/2021 03:00:04 PM Eastern Daylight Time	08/02/2021 01:35:06 PM Eastern Daylight Time			08/05/2021 11:00:35 AM 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	2022	Most of Massachusetts	Essex and Suffolk Counties	2		2			2						www.tuftsmedicarepreferred.org/doctor-search	tuftsmedicarepreferred.org/drug-coverage	www.tuftsmedicarepreferred.org/doctor-search	(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	6	1					0	06/07/2021	2022.01	06/07/2021 11:11:45 AM Eastern Daylight Time	08/03/2021 03:11:56 PM Eastern Daylight Time	08/02/2021 01:35:30 PM Eastern Daylight Time			08/05/2021 11:00:35 AM 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	2022	Most of Massachusetts	BARN, BRIS, MIDD, NORF, PLYM Counties	2		2			2						www.tuftsmedicarepreferred.org/doctor-search	tuftsmedicarepreferred.org/drug-coverage	www.tuftsmedicarepreferred.org/doctor-search	(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	6	1					0	06/07/2021	2022.01	06/07/2021 11:12:41 AM Eastern Daylight Time	08/03/2021 03:24:24 PM Eastern Daylight Time	08/02/2021 01:35:52 PM Eastern Daylight Time			08/05/2021 11:00:35 AM 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	2022	Most of Massachusetts	Hampden and Hampshire Counties	2		2			2						www.tuftsmedicarepreferred.org/doctor-search	tuftsmedicarepreferred.org/drug-coverage	www.tuftsmedicarepreferred.org/doctor-search	(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	6	1					0	06/07/2021	2022.01	06/07/2021 11:13:35 AM Eastern Daylight Time	08/03/2021 04:33:48 PM Eastern Daylight Time	08/02/2021 01:36:14 PM Eastern Daylight Time			08/05/2021 11:00:35 AM 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	2022	Most of Massachusetts		2		2			2						www.tuftsmedicarepreferred.org/doctor-search	tuftsmedicarepreferred.org/drug-coverage	www.tuftsmedicarepreferred.org/doctor-search	(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	033	0	1	01	01	H2256_033_0	8	1					0	08/17/2021	2022.01	08/17/2021 02:41:52 PM Eastern Daylight Time	08/05/2021 12:08:00 PM Eastern Daylight Time	08/02/2021 01:36:36 PM Eastern Daylight Time			08/17/2021 02:46:52 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	2022	Worcester County		2		2			2						www.tuftsmedicarepreferred.org/doctor-search	tuftsmedicarepreferred.org/drug-coverage	www.tuftsmedicarepreferred.org/doctor-search	(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	6	1					0	06/07/2021	2022.01	06/07/2021 11:14:40 AM Eastern Daylight Time	08/03/2021 03:49:40 PM Eastern Daylight Time	08/02/2021 01:36:58 PM Eastern Daylight Time			08/05/2021 11:00:35 AM 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	2022	Worcester County		2		2			2						www.tuftsmedicarepreferred.org/doctor-search	tuftsmedicarepreferred.org/drug-coverage	www.tuftsmedicarepreferred.org/doctor-search	(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	6	1					0	06/07/2021	2022.01	06/07/2021 11:15:14 AM Eastern Daylight Time	08/03/2021 04:01:22 PM Eastern Daylight Time	08/02/2021 01:37:20 PM Eastern Daylight Time			08/05/2021 11:00:35 AM 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	2022	Worcester County		2		2			2						www.tuftsmedicarepreferred.org/doctor-search	tuftsmedicarepreferred.org/drug-coverage	www.tuftsmedicarepreferred.org/doctor-search	(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				0	0	08/17/2021	2022.01	08/17/2021 02:42:07 PM Eastern Daylight Time	06/04/2021 05:19:20 PM Eastern Daylight Time				08/17/2021 02:46:52 PM 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	2022	Worcester County		2		2			2						www.tuftsmedicarepreferred.org/doctor-search	tuftsmedicarepreferred.org/drug-coverage	www.tuftsmedicarepreferred.org/doctor-search	(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	5	1				0	0	06/07/2021	2022.01	06/07/2021 11:16:16 AM Eastern Daylight Time	06/04/2021 05:26:28 PM Eastern Daylight Time				06/07/2021 02:08:35 PM 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	2022	Worcester County		2		2			2						www.tuftsmedicarepreferred.org/doctor-search	tuftsmedicarepreferred.org/drug-coverage	www.tuftsmedicarepreferred.org/doctor-search	(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	5	1				0	0	06/07/2021	2022.01	06/07/2021 11:16:43 AM Eastern Daylight Time	06/04/2021 05:33:38 PM Eastern Daylight Time				06/07/2021 02:08:35 PM 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	2022	Worcester County		2		2			2						www.tuftsmedicarepreferred.org/doctor-search	tuftsmedicarepreferred.org/drug-coverage	www.tuftsmedicarepreferred.org/doctor-search	(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	5	1				0	0	06/07/2021	2022.01	06/07/2021 11:17:10 AM Eastern Daylight Time	06/04/2021 05:40:48 PM Eastern Daylight Time				06/07/2021 02:08:35 PM 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	2022	Essex and Suffolk Counties		2		2			2						www.tuftsmedicarepreferred.org/doctor-search	tuftsmedicarepreferred.org/drug-coverage	www.tuftsmedicarepreferred.org/doctor-search	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2256	046	0	1	01	01	H2256_046_0	7	1					0	09/27/2021	2022.01	09/27/2021 04:31:22 PM Eastern Daylight Time	08/03/2021 04:14:46 PM Eastern Daylight Time	08/02/2021 01:37:42 PM Eastern Daylight Time			09/27/2021 04:43:15 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Smart Saver Rx (HMO)	01	01		1			H2256	046	0	2022	Most of Massachusetts		2		2			2						tuftsmedicarepreferred.org/doctor-search	tuftsmedicarepreferred.org/drug-coverage	tuftsmedicarepreferred.org/doctor-search	(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	801	0	1	01	01	H2256_801_0	5	1						06/07/2021	2022.01	06/07/2021 01:31:21 PM Eastern Daylight Time					06/07/2021 02:08:35 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	2022	Most of Massachusetts		1	79134	2			2						www.tuftsmedicarepreferred.org/doctor-search	tuftsmedicarepreferred.org/drug-coverage	www.tuftsmedicarepreferred.org/doctor-search	(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				0	0	06/07/2021	2022.01	06/07/2021 01:31:47 PM Eastern Daylight Time					06/07/2021 02:08:35 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	2022	Most of Massachusetts		1	5936	2			2						www.tuftsmedicarepreferred.org/doctor-search	tuftsmedicarepreferred.org/drug-coverage	www.tuftsmedicarepreferred.org/doctor-search	(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						06/07/2021	2022.01	06/07/2021 01:32:21 PM Eastern Daylight Time					06/07/2021 02:08:35 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	2022	Most of Massachusetts		1	0	2			2						www.tuftsmedicarepreferred.org/doctor-search	tuftsmedicarepreferred.org/drug-coverage	www.tuftsmedicarepreferred.org/doctor-search	(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				0	0	06/07/2021	2022.01	06/07/2021 01:32:51 PM Eastern Daylight Time					06/07/2021 02:08:35 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	2022	Most of Massachusetts		1	56185	2			2						https://www.tuftsmedicarepreferred.org/drug-coverage	tuftsmedicarepreferred.org/drug-coverage	https://www.tuftsmedicarepreferred.org/tufts-health-plan-doctor-search	(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					0	08/04/2021	2022.01	08/04/2021 01:19:23 PM Eastern Daylight Time	08/04/2021 11:38:19 AM Eastern Daylight Time	08/04/2021 11:53:11 AM Eastern Daylight Time			08/04/2021 04:43:04 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	2022	Massachusetts except Berkshire Dukes and Nantucket		2	20664	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	6	1					0	08/04/2021	2022.01	08/04/2021 12:07:29 PM Eastern Daylight Time	08/04/2021 11:38:54 AM Eastern Daylight Time	08/04/2021 11:53:33 AM Eastern Daylight Time			08/04/2021 04:43:04 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	2022	Massachusetts except Berkshire, Dukes, Nantucket	Massachusetts except BER, DUK, NAN, WOR	2	61548	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	6	1					0	08/04/2021	2022.01	08/04/2021 12:07:18 PM Eastern Daylight Time	08/04/2021 11:39:28 AM Eastern Daylight Time	08/04/2021 11:53:55 AM Eastern Daylight Time			08/04/2021 04:43:04 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	2022	Massachusetts except Berkshire, Dukes, Nantucket	Worcester county	2	11460	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					0	08/04/2021	2022.01	08/04/2021 12:07:34 PM Eastern Daylight Time	08/04/2021 11:40:02 AM Eastern Daylight Time	08/04/2021 11:54:18 AM Eastern Daylight Time			08/04/2021 04:43:04 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	2022	Massachusetts except Berkshire Dukes and Nantucket	Massachusetts except BER, DUK, NAN, WOR	2	28351	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					0	08/04/2021	2022.01	08/04/2021 12:07:40 PM Eastern Daylight Time	08/04/2021 11:40:35 AM Eastern Daylight Time	08/04/2021 11:54:40 AM Eastern Daylight Time			08/04/2021 04:43:04 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	2022	Massachusetts except Berkshire Dukes and Nantucket	Worcester, MA	2	7238	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	6	1					0	08/04/2021	2022.01	08/04/2021 12:07:46 PM Eastern Daylight Time	08/04/2021 11:41:09 AM Eastern Daylight Time	08/04/2021 11:55:03 AM Eastern Daylight Time			08/04/2021 04:43:04 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	2022	Massachusetts except Berkshire Dukes and Nantucket		2	52563	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	2	1						06/02/2021	2022.01	06/02/2021 11:42:37 AM Eastern Daylight Time					06/06/2021 10:45:34 PM 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	2022	Massachusetts except Berkshire Dukes and Nantucket		1	13162	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;7e;7h;7i;8a;8b1;9a1;11c;12;15;	1	7d;7f;7i;14e3;	1					2				
H2261	809	0	1	01	01	H2261_809_0	2	1				0	0	06/02/2021	2022.01	06/02/2021 10:24:04 AM Eastern Daylight Time					06/06/2021 10:45:34 PM 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	2022	Massachusetts except Berkshire Dukes and Nantucket		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;6;7c;7d;7e;7h;7i;8a;8b1;9a1;9b;9c;10a;11a;11c;12;15;	1	7d;7f;7i;14e3;	1					2				
H2288	001	0	1	01	01	H2288_001_0	6	1					0	08/05/2021	2022.01	08/05/2021 04:30:10 PM Central Daylight Time	08/05/2021 05:33:36 PM Central Daylight Time	08/05/2021 05:34:57 PM Central Daylight Time			08/05/2021 06:07:11 PM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY OF NEW YORK	Bright Health	brighthealthcare.com/medicare	Bright Advantage Classic Care Plan (HMO)	01	01		1			H2288	001	0	2022	Kings, New York, and Queens Counties		2	10547	2			2						brighthealthcare.com/madoctors	brighthealthcare.com/drug-search/ma	brighthealthcare.com/madoctors	(844)926-4521		(844)926-4521		(844)679-2028		(844)679-2028		(844)926-4521		(844)926-4521		(844)679-2028		(844)679-2028		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2288	002	0	1	01	01	H2288_002_0	6	1					0	08/03/2021	2022.01	08/03/2021 03:56:33 PM Central Daylight Time	08/05/2021 05:33:36 PM Central Daylight Time	08/05/2021 05:34:57 PM Central Daylight Time			08/05/2021 06:07:11 PM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY OF NEW YORK	Bright Health	brighthealthcare.com/medicare	Bright Advantage Classic Plus Plan (HMO)	01	01		1			H2288	002	0	2022	Kings, New York, and Queens Counties		2	555	2			2						brighthealthcare.com/madoctors	brighthealthcare.com/drug-search/ma	brighthealthcare.com/madoctors	(844)926-4521		(844)926-4521		(844)679-2028		(844)679-2028		(844)926-4521		(844)926-4521		(844)679-2028		(844)679-2028		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2288	003	0	1	01	01	H2288_003_0	5	1	2	1			0	08/03/2021	2022.01	08/03/2021 03:31:46 PM Central Daylight Time	08/05/2021 03:37:47 PM Central Daylight Time	08/05/2021 03:37:50 PM Central Daylight Time			08/05/2021 04:33:38 PM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY OF NEW YORK	Bright Health	brighthealthcare.com/medicare	Bright Advantage Dual Access Plan (HMO D-SNP)	01	01		1			H2288	003	0	2022	Kings, New York, and Queens Counties		2	1902	2			1	3		1		1	brighthealthcare.com/madoctors	brighthealthcare.com/drug-search/ma	brighthealthcare.com/madoctors	(844)926-4521		(844)926-4521		(844)679-2028		(844)679-2028		(844)926-4521		(844)926-4521		(844)679-2028		(844)679-2028		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2288	009	0	1	01	01	H2288_009_0	6	1		1			1	08/03/2021	2022.01	08/03/2021 03:32:06 PM Central Daylight Time	08/05/2021 05:33:36 PM Central Daylight Time	08/05/2021 05:34:57 PM Central Daylight Time			08/05/2021 06:07:11 PM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY OF NEW YORK	Bright Health	brighthealthcare.com/medicare	Bright Advantage Embrace Care Plan (HMO C-SNP)	01	01		1			H2288	009	0	2022	Kings, New York, and Queens Counties		2	4756	2			1	4			00000000000000000010		brighthealthcare.com/madoctors	brighthealthcare.com/drug-search/ma	brighthealthcare.com/madoctors	(844)926-4521		(844)926-4521		(844)679-2028		(844)679-2028		(844)926-4521		(844)926-4521		(844)679-2028		(844)679-2028		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2288	010	0	1	01	01	H2288_010_0	5	1		1			0	08/03/2021	2022.01	08/03/2021 03:32:26 PM Central Daylight Time	08/05/2021 03:37:47 PM Central Daylight Time	08/05/2021 03:37:51 PM Central Daylight Time			08/05/2021 04:33:38 PM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY OF NEW YORK	Bright Health	brighthealthcare.com/medicare	Bright Advantage Embrace Choice Plan (HMO C-SNP)	01	01		1			H2288	010	0	2022	Kings, New York, and Queens Counties		2	951	2			1	4			00000000000000000010		brighthealthcare.com/madoctors	brighthealthcare.com/drug-search/ma	brighthealthcare.com/madoctors	(844)926-4521		(844)926-4521		(844)679-2028		(844)679-2028		(844)926-4521		(844)926-4521		(844)679-2028		(844)679-2028		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2292	001	0	1	04	01	H2292_001_0	3	1		1			0	08/04/2021	2022.01	08/04/2021 09:50:58 AM Central Daylight Time	08/03/2021 01:29:22 PM Central Daylight Time	07/29/2021 08:04:44 PM Central Daylight Time			08/04/2021 02:38:35 PM Central Daylight Time	OXFORD HEALTH INSURANCE, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan 1 (PPO I-SNP)	01	04		1			H2292	001	0	2022	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			0	08/04/2021	2022.01	08/04/2021 11:07:48 AM Central Daylight Time	08/04/2021 02:23:23 PM Central Daylight Time	07/29/2021 08:04:58 PM Central Daylight Time			08/04/2021 02:48:28 PM Central Daylight Time	OXFORD HEALTH INSURANCE, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan 1 (PPO I-SNP)	01	04		1			H2292	002	0	2022	New York City		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	003	0	1	04	01	H2292_003_0	3	1		1			1	08/04/2021	2022.01	08/04/2021 09:54:32 AM Central Daylight Time	08/03/2021 01:30:57 PM Central Daylight Time	07/29/2021 08:05:12 PM Central Daylight Time			08/04/2021 02:38:35 PM Central Daylight Time	OXFORD HEALTH INSURANCE, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Assisted Living Plan (PPO I-SNP)	01	04		1			H2292	003	0	2022	Select Counties in New York		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			
H2318	001	0	1	20	08	H2318_001_0	2	1						06/03/2021	2022.01	06/03/2021 09:15:47 AM Eastern Daylight Time		06/30/2021 10:26:47 AM Eastern Daylight Time			06/30/2021 10:36:45 AM Eastern Daylight Time	PACE SOUTHEAST MICHIGAN	PACE Southeast Michigan	www.pacesemi.org	PACE Southeast Michigan (PACE)	08	20		1			H2318	001	0	2022	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	2	1						06/03/2021	2022.01	06/03/2021 09:16:18 AM Eastern Daylight Time		06/30/2021 10:26:50 AM Eastern Daylight Time			06/30/2021 10:36:45 AM Eastern Daylight Time	PACE SOUTHEAST MICHIGAN	PACE Southeast Michigan	www.pacesemi.org	PACE Southeast Michigan (PACE)	08	20		1			H2318	002	0	2022	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	022	1	1	02	01	H2320_022_1	9	1					1	08/05/2021	2022.01	08/05/2021 11:12:55 AM Eastern Daylight Time	08/03/2021 11:36:32 PM Eastern Daylight Time	07/30/2021 02:24:00 PM Eastern Daylight Time			08/05/2021 11:58:59 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Key (HMO-POS)	01	02		1			H2320	022	1	2022	68 lower peninsula Michigan counties	Region 1	2	281034	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)384-1695		(616)464-8850		(888)389-6648		(616)464-8820		(888)384-1695		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2320	022	2	1	02	01	H2320_022_2	9	1					1	08/05/2021	2022.01	08/05/2021 08:18:42 AM Eastern Daylight Time	08/03/2021 11:37:10 PM Eastern Daylight Time	07/30/2021 02:24:14 PM Eastern Daylight Time			08/05/2021 11:58:59 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Key (HMO-POS)	01	02		1			H2320	022	2	2022	68 lower peninsula Michigan counties	Region 2	2	229655	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)384-1695		(616)464-8850		(888)389-6648		(616)464-8820		(888)384-1695		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2320	022	3	1	02	01	H2320_022_3	9	1					1	08/05/2021	2022.01	08/05/2021 08:19:12 AM Eastern Daylight Time	08/03/2021 11:37:46 PM Eastern Daylight Time	07/30/2021 02:24:30 PM Eastern Daylight Time			08/05/2021 11:58:59 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Key (HMO-POS)	01	02		1			H2320	022	3	2022	68 lower peninsula Michigan counties	Region 3	2	119812	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)384-1695		(616)464-8850		(888)389-6648		(616)464-8820		(888)384-1695		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2320	022	4	1	02	01	H2320_022_4	9	1					1	08/05/2021	2022.01	08/05/2021 11:13:37 AM Eastern Daylight Time	08/03/2021 11:38:22 PM Eastern Daylight Time	07/30/2021 02:24:46 PM Eastern Daylight Time			08/05/2021 11:58:59 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Key (HMO-POS)	01	02		1			H2320	022	4	2022	68 lower peninsula Michigan counties	Region 4	2	86123	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)384-1695		(616)464-8850		(888)389-6648		(616)464-8820		(888)384-1695		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2320	022	5	1	02	01	H2320_022_5	9	1					1	08/05/2021	2022.01	08/05/2021 11:13:17 AM Eastern Daylight Time	08/03/2021 11:38:58 PM Eastern Daylight Time	07/30/2021 02:25:04 PM Eastern Daylight Time			08/05/2021 11:58:59 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Key (HMO-POS)	01	02		1			H2320	022	5	2022	68 lower peninsula Michigan counties	Region 5	2	82461	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)384-1695		(616)464-8850		(888)389-6648		(616)464-8820		(888)384-1695		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2320	028	1	1	02	01	H2320_028_1	9	1					0	07/19/2021	2022.01	07/19/2021 02:48:46 PM Eastern Daylight Time	08/03/2021 11:39:32 PM Eastern Daylight Time	07/30/2021 02:25:20 PM Eastern Daylight Time			08/05/2021 11:58:59 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare (HMO-POS)	01	02		1			H2320	028	1	2022	68 lower peninsula Michigan counties	Region 1	2	82573	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)384-1695		(616)464-8850		(888)389-6648		(616)464-8820		(888)384-1695		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2320	028	2	1	02	01	H2320_028_2	9	1					0	07/19/2021	2022.01	07/19/2021 03:28:33 PM Eastern Daylight Time	08/03/2021 11:40:08 PM Eastern Daylight Time	07/30/2021 02:25:36 PM Eastern Daylight Time			08/05/2021 11:58:59 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare (HMO-POS)	01	02		1			H2320	028	2	2022	68 lower peninsula Michigan counties	Region 2	2	25176	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)384-1695		(616)464-8850		(888)389-6648		(616)464-8820		(888)384-1695		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2320	028	3	1	02	01	H2320_028_3	9	1					0	07/19/2021	2022.01	07/19/2021 02:50:37 PM Eastern Daylight Time	08/03/2021 11:40:46 PM Eastern Daylight Time	07/30/2021 02:25:52 PM Eastern Daylight Time			08/05/2021 11:58:59 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare (HMO-POS)	01	02		1			H2320	028	3	2022	68 lower peninsula Michigan counties	Region 3	2	7336	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)384-1695		(616)464-8850		(888)389-6648		(616)464-8820		(888)384-1695		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2320	028	4	1	02	01	H2320_028_4	9	1					0	07/19/2021	2022.01	07/19/2021 03:12:14 PM Eastern Daylight Time	08/03/2021 11:41:22 PM Eastern Daylight Time	07/30/2021 02:26:08 PM Eastern Daylight Time			08/05/2021 11:58:59 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare (HMO-POS)	01	02		1			H2320	028	4	2022	68 lower peninsula Michigan counties	Region 4	2	2750	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)384-1695		(616)464-8850		(888)389-6648		(616)464-8820		(888)384-1695		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2320	028	5	1	02	01	H2320_028_5	9	1					0	07/19/2021	2022.01	07/19/2021 03:29:31 PM Eastern Daylight Time	08/03/2021 11:41:58 PM Eastern Daylight Time	07/30/2021 02:26:24 PM Eastern Daylight Time			08/05/2021 11:58:59 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare (HMO-POS)	01	02		1			H2320	028	5	2022	68 lower peninsula Michigan counties	Region 5	2	6820	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)384-1695		(616)464-8850		(888)389-6648		(616)464-8820		(888)384-1695		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2320	029	1	1	02	01	H2320_029_1	11	1					1	07/19/2021	2022.01	07/19/2021 02:51:18 PM Eastern Daylight Time	08/03/2021 11:42:32 PM Eastern Daylight Time	07/30/2021 02:26:40 PM Eastern Daylight Time			08/05/2021 11:58:59 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Value (HMO-POS)	01	02		1			H2320	029	1	2022	68 lower peninsula Michigan counties	Region 1	2	297037	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)384-1695		(616)464-8850		(888)389-6648		(616)464-8820		(888)384-1695		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2320	029	2	1	02	01	H2320_029_2	11	1					1	07/19/2021	2022.01	07/19/2021 02:51:43 PM Eastern Daylight Time	08/03/2021 11:43:06 PM Eastern Daylight Time	07/30/2021 02:26:54 PM Eastern Daylight Time			08/05/2021 11:58:59 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Value (HMO-POS)	01	02		1			H2320	029	2	2022	68 lower peninsula Michigan counties	Region 2	2	74885	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)384-1695		(616)464-8850		(888)389-6648		(616)464-8820		(888)384-1695		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2320	029	3	1	02	01	H2320_029_3	11	1					1	07/19/2021	2022.01	07/19/2021 03:29:13 PM Eastern Daylight Time	08/03/2021 11:43:42 PM Eastern Daylight Time	07/30/2021 02:27:10 PM Eastern Daylight Time			08/05/2021 11:58:59 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Value (HMO-POS)	01	02		1			H2320	029	3	2022	68 lower peninsula Michigan counties	Region 3	2	12614	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)384-1695		(616)464-8850		(888)389-6648		(616)464-8820		(888)384-1695		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2320	029	4	1	02	01	H2320_029_4	11	1					1	07/19/2021	2022.01	07/19/2021 02:51:43 PM Eastern Daylight Time	08/03/2021 11:44:20 PM Eastern Daylight Time	07/30/2021 02:27:28 PM Eastern Daylight Time			08/05/2021 11:58:59 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Value (HMO-POS)	01	02		1			H2320	029	4	2022	68 lower peninsula Michigan counties	Region 4	2	8717	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)384-1695		(616)464-8850		(888)389-6648		(616)464-8820		(888)384-1695		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2320	029	5	1	02	01	H2320_029_5	11	1					1	07/19/2021	2022.01	07/19/2021 02:51:59 PM Eastern Daylight Time	08/03/2021 11:44:56 PM Eastern Daylight Time	07/30/2021 02:27:42 PM Eastern Daylight Time			08/05/2021 11:58:59 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Value (HMO-POS)	01	02		1			H2320	029	5	2022	68 lower peninsula Michigan counties	Region 5	2	21604	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)384-1695		(616)464-8850		(888)389-6648		(616)464-8820		(888)384-1695		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2320	802	0	1	02	01	H2320_802_0	7	1						06/07/2021	2022.01	06/07/2021 03:18:53 AM Eastern Daylight Time					06/07/2021 11:18:26 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	2022	National		1	4104	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2320	803	0	1	02	01	H2320_803_0	8	1						06/18/2021	2022.01	06/18/2021 02:14:49 PM Eastern Daylight Time					06/18/2021 02:24:10 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare EG Calendar Year (HMO-POS)	01	02		1			H2320	803	0	2022	National		1	270694	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2320	804	0	1	01	01	H2320_804_0	7	1						06/07/2021	2022.01	06/07/2021 03:19:31 AM Eastern Daylight Time					06/07/2021 11:18:26 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	2022	State of Michigan		1	468	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2320	805	0	1	01	01	H2320_805_0	7	1						06/07/2021	2022.01	06/07/2021 03:20:00 AM Eastern Daylight Time					06/07/2021 11:18:26 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	2022	State of Michigan		1	8652	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2320	810	0	1	01	01	H2320_810_0	7	1				0	0	06/07/2021	2022.01	06/07/2021 03:20:31 AM Eastern Daylight Time					06/07/2021 11:18:26 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare EG HMO Cal Year (HMO)	01	01		1			H2320	810	0	2022	State of Michigan		1	20	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2320	811	0	1	01	01	H2320_811_0	8	1				0	0	06/18/2021	2022.01	06/18/2021 02:15:01 PM Eastern Daylight Time					06/18/2021 02:24:10 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare EG HMO Non-Cal Year (HMO)	01	01		1			H2320	811	0	2022	State of Michigan		1	20	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2320	812	0	1	02	01	H2320_812_0	7	1				0	0	06/07/2021	2022.01	06/07/2021 03:40:57 AM Eastern Daylight Time					06/07/2021 11:18:26 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	2022	National		1	20	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2320	813	0	1	02	01	H2320_813_0	8	1				0	0	06/18/2021	2022.01	06/18/2021 02:15:14 PM Eastern Daylight Time					06/18/2021 02:24:10 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	2022	National		1	20	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2322	004	0	1	04	01	H2322_004_0	7	1					1	08/02/2021	2022.01	08/02/2021 05:25:01 PM Eastern Daylight Time	08/05/2021 01:01:07 PM Eastern Daylight Time	08/05/2021 01:01:40 PM Eastern Daylight Time			08/05/2021 01:43:39 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	2022	Mid and Southeast Michigan Counties		2		2			2						www.hap.org/medicare	www.hap.org/medicare	www.hap.org/medicare	(888)658-2536		(313)664-7015		(833)923-1630		(833)923-1630		(877)797-9697		(877)797-9697		(833)923-1630		(833)923-1630		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2322	008	0	1	04	01	H2322_008_0	7	1					1	08/02/2021	2022.01	08/02/2021 05:23:21 PM Eastern Daylight Time	08/05/2021 01:01:07 PM Eastern Daylight Time	08/05/2021 01:01:40 PM Eastern Daylight Time			08/05/2021 01:43:39 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	2022	Mid and Southeast Michigan Counties		2		2			2						www.hap.org/medicare	www.hap.org/medicare	www.hap.org/medicare	(888)658-2536		(313)664-7015		(833)923-1630		(833)923-1630		(877)797-9697		(877)797-9697		(833)923-1630		(833)923-1630		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2322	011	0	1	04	01	H2322_011_0	7	1					1	08/02/2021	2022.01	08/02/2021 05:21:42 PM Eastern Daylight Time	08/05/2021 01:01:07 PM Eastern Daylight Time	08/05/2021 01:01:40 PM Eastern Daylight Time			08/05/2021 01:43:39 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	2022	Mid and Southeast Michigan Counties		2		2			2						www.hap.org/medicare	www.hap.org/medicare	www.hap.org/medicare	(888)658-2536		(313)664-7015		(833)923-1630		(833)923-1630		(877)797-9697		(877)797-9697		(833)923-1630		(833)923-1630		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2322	012	0	1	04	01	H2322_012_0	7	1					1	08/02/2021	2022.01	08/02/2021 05:22:27 PM Eastern Daylight Time	08/05/2021 01:01:07 PM Eastern Daylight Time	08/05/2021 01:01:40 PM Eastern Daylight Time			08/05/2021 01:43:39 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	2022	Mid and Southeast Michigan Counties		2		2			2						www.hap.org/medicare	www.hap.org/medicare	www.hap.org/medicare	(888)658-2536		(313)664-7015		(833)923-1630		(833)923-1630		(877)797-9697		(877)797-9697		(833)923-1630		(833)923-1630		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2322	801	0	1	04	01	H2322_801_0	4	1				0	0	04/13/2021	2022.01	04/13/2021 12:46:44 PM Eastern Daylight Time					06/05/2021 02:58:06 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	2022	United States EG Area		1	0	2			2						www.hap.org/medicare	www.hap.org/medicare	www.hap.org/medicare	(888)658-2536		(313)664-7015		(833)923-1630		(833)923-1630										(711)-		(711)-		(711)-		(711)-										2					2						2			
H2322	803	0	1	04	01	H2322_803_0	4	1						04/13/2021	2022.01	04/13/2021 12:51:58 PM Eastern Daylight Time					06/05/2021 02:58:06 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	2022	United States EG Area		1	183	2			2						www.hap.org/medicare	www.hap.org/medicare	www.hap.org/medicare	(888)658-2536		(313)664-7015		(833)923-1630		(833)923-1630		(877)797-9697		(877)797-9697		(833)923-1630		(833)923-1630		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2334	003	0	1	04	01	H2334_003_0	7	1					1	08/09/2021	2022.01	08/09/2021 03:50:55 PM Central Daylight Time	08/11/2021 01:34:14 PM Central Daylight Time	08/05/2021 02:07:10 PM Central Daylight Time			08/11/2021 07:24:20 PM Central Daylight Time	EON HEALTH, INC. (SC)	Clear Spring Health	www.eonhealthplan.com	Clear Spring Health Choice Plan (PPO)	01	04		1			H2334	003	0	2022	Select South Carolina Counties		2		2			2						https://www.eonhp.com/	https://www.eonhp.com/	www.eonhealthplan.com	(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2334	005	0	1	04	01	H2334_005_0	7	1					1	08/09/2021	2022.01	08/09/2021 03:54:55 PM Central Daylight Time	08/11/2021 01:34:25 PM Central Daylight Time	08/05/2021 02:07:15 PM Central Daylight Time			08/11/2021 07:24:20 PM Central Daylight Time	EON HEALTH, INC. (SC)	Clear Spring Health	www.eonhealthplan.com	Clear Spring Health Gold Plus (PPO)	01	04		1			H2334	005	0	2022	Select South Carolina Counties		2		2			2						https://www.eonhp.com/	https://www.eonhp.com/	www.eonhealthplan.com	(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2354	015	0	1	01	01	H2354_015_0	7	1					1	08/02/2021	2022.01	08/02/2021 05:13:36 PM Eastern Daylight Time	08/05/2021 01:01:07 PM Eastern Daylight Time	08/05/2021 01:01:40 PM Eastern Daylight Time			08/05/2021 01:43:39 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	2022	Mid, Southwest 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		(833)923-1630		(833)923-1630		(877)797-9697		(877)797-9697		(833)923-1630		(833)923-1630		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2354	018	0	1	01	01	H2354_018_0	7	1					1	08/02/2021	2022.01	08/02/2021 05:18:25 PM Eastern Daylight Time	08/05/2021 01:01:07 PM Eastern Daylight Time	08/05/2021 01:01:40 PM Eastern Daylight Time			08/05/2021 01:43:39 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	2022	Wayne, Oakland and Macomb counties		2	136200	2			2						www.hap.org/medicare	www.hap.org/medicare	www.hap.org/medicare	(800)801-1770		(313)664-7015		(833)923-1630		(833)923-1630		(877)797-9697		(877)797-9697		(833)923-1630		(833)923-1630		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	3-1;3-2;5;7a;7c;7d;7e1;7e2;7f;7g;7h1;7h2;7i;8a1;8b1;8b2;8b3;9a1;9a2;9b;9c;11a;11b1;11b2;11c1;11c2;16b;17a;18a;	
H2354	019	0	1	01	01	H2354_019_0	6	1				0	0	07/20/2021	2022.01	07/20/2021 09:51:58 AM Eastern Daylight Time	06/05/2021 02:49:06 PM Eastern Daylight Time				07/21/2021 10:39:20 AM 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	2022	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		(833)923-1630		(833)923-1630										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2354	021	0	1	02	01	H2354_021_0	7	1					1	08/02/2021	2022.01	08/02/2021 05:20:05 PM Eastern Daylight Time	08/05/2021 01:01:07 PM Eastern Daylight Time	08/05/2021 01:01:39 PM Eastern Daylight Time			08/05/2021 01:43:39 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	021	0	2022	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		(833)923-1630		(833)923-1630		(877)797-9697		(877)797-9697		(833)923-1630		(833)923-1630		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2354	022	0	1	02	01	H2354_022_0	7	1					1	08/02/2021	2022.01	08/02/2021 05:20:52 PM Eastern Daylight Time	08/05/2021 01:01:07 PM Eastern Daylight Time	08/05/2021 01:01:39 PM Eastern Daylight Time			08/05/2021 01:43:39 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	022	0	2022	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		(833)923-1630		(833)923-1630		(877)797-9697		(877)797-9697		(833)923-1630		(833)923-1630		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2354	024	0	1	01	01	H2354_024_0	7	1					1	08/02/2021	2022.01	08/02/2021 05:17:16 PM Eastern Daylight Time	08/05/2021 01:01:07 PM Eastern Daylight Time	08/05/2021 01:01:40 PM Eastern Daylight Time			08/05/2021 01:43:39 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	2022	Counties: HIL, JAC, LIV, MAC, OAK, WAS, WAY		2		2			2						www.hap.org/medicare	www.hap.org/medicare	www.hap.org/medicare	(866)766-4714		(313)664-0444		(833)923-1630		(833)923-1630		(877)797-9697		(877)797-9697		(833)923-1630		(833)923-1630		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2354	025	0	1	01	01	H2354_025_0	9	1	2	1			0	08/02/2021	2022.01	08/02/2021 05:19:05 PM Eastern Daylight Time	08/05/2021 01:01:07 PM Eastern Daylight Time	08/05/2021 01:01:40 PM Eastern Daylight Time			08/05/2021 01:43:39 PM Eastern Daylight Time	HEALTH ALLIANCE PLAN OF MICHIGAN	HAP Senior Plus	www.hap.org/medicare	HAP Empowered Duals (HMO D-SNP)	01	01		1			H2354	025	0	2022	Genesee, Wayne, Oakland and Macomb Counties		2		2			1	3		1		1	www.hap.org/medicare	www.hap.org/medicare	www.hap.org/medicare	(800)848-4844		(810)230-2046		(833)923-1630		(833)923-1630		(844)818-9036		(844)818-9036		(833)923-1630		(833)923-1630		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2354	026	0	1	01	01	H2354_026_0	7	1					1	08/02/2021	2022.01	08/02/2021 05:14:26 PM Eastern Daylight Time	08/05/2021 01:01:07 PM Eastern Daylight Time	08/05/2021 01:01:40 PM Eastern Daylight Time			08/05/2021 01:43:39 PM Eastern Daylight Time	HEALTH ALLIANCE PLAN OF MICHIGAN	HAP Senior Plus	www.hap.org/medicare	HAP Choice Medicare - West Michigan Option 1 (HMO)	01	01		1			H2354	026	0	2022	Counties:  KEN, MUS, OCE, OTT		2		2			2						www.hap.org/medicare	www.hap.org/medicare	www.hap.org/medicare	(800)801-1770		(313)664-7015		(833)923-1630		(833)923-1630		(877)797-9697		(877)797-9697		(833)923-1630		(833)923-1630		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2354	027	0	1	01	01	H2354_027_0	7	1					1	08/02/2021	2022.01	08/02/2021 05:15:22 PM Eastern Daylight Time	08/05/2021 01:01:07 PM Eastern Daylight Time	08/05/2021 01:01:40 PM Eastern Daylight Time			08/05/2021 01:43:39 PM Eastern Daylight Time	HEALTH ALLIANCE PLAN OF MICHIGAN	HAP Senior Plus	www.hap.org/medicare	HAP Choice Medicare - West Michigan Option 2 (HMO)	01	01		1			H2354	027	0	2022	Counties:  KEN, MUS, OCE, OTT		2		2			2						www.hap.org/medicare	www.hap.org/medicare	www.hap.org/medicare	(800)801-1770		(313)664-7015		(833)923-1630		(833)923-1630		(877)797-9697		(877)797-9697		(833)923-1630		(833)923-1630		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2354	801	0	1	01	01	H2354_801_0	4	1				0	0	04/13/2021	2022.01	04/13/2021 03:56:14 PM Eastern Daylight Time					06/05/2021 02:58:06 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	2022	United States EG Area		1	319380	2			2						www.hap.org/medicare	www.hap.org/medicare	www.hap.org/medicare	(800)801-1770		(313)664-7015		(833)923-1630		(833)923-1630										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2354	802	0	1	02	01	H2354_802_0	4	1						04/14/2021	2022.01	04/14/2021 12:11:00 PM Eastern Daylight Time					06/05/2021 02:58:06 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	2022	United States EG Area		1	27384	2			2						www.hap.org/medicare	www.hap.org/medicare	www.hap.org/medicare	(800)801-1770		(313)664-7015		(833)923-1630		(833)923-1630		(877)797-9697		(877)797-9697		(833)923-1630		(833)923-1630		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2368	001	0	1	20	08	H2368_001_0	1	1						05/27/2021	2022.01	05/27/2021 09:15:14 AM Mountain Daylight Time		05/27/2021 08:41:43 AM Mountain Daylight Time			05/27/2021 09:22:18 AM Mountain Daylight Time	INNOVAGE CALIFORNIA PACE-SACRAMENTO, LLC	InnovAge California PACE - Sacramento	www.myinnovage.com	InnovAge California PACE Sacramento Dual Eligibles (PACE)	08	20		1			H2368	001	0	2022	InnovAge California PACE Sacramento Dual Eligibles		2		2			2						www.granerx.com	www.myinnovage.com												(844)704-9613				(844)704-9613												(711)-				(711)-																
H2368	002	0	1	20	08	H2368_002_0	1	1						05/27/2021	2022.01	05/27/2021 09:15:28 AM Mountain Daylight Time		05/27/2021 08:41:43 AM Mountain Daylight Time			05/27/2021 09:22:18 AM Mountain Daylight Time	INNOVAGE CALIFORNIA PACE-SACRAMENTO, LLC	InnovAge California PACE - Sacramento	www.myinnovage.com	InnovAge California PACE Sacramento Medicare Only (PACE)	08	20		1			H2368	002	0	2022	InnovAge California PACE Sacramento Medicare Only		2		2			2						www.granerx.com	www.myinnovage.com												(844)704-9613				(844)704-9613												(711)-				(711)-																
H2384	001	0	1	20	08	H2384_001_0	1	1						06/01/2021	2022.01	06/01/2021 03:55:05 PM Mountain Daylight Time		06/01/2021 10:05:21 AM Mountain Daylight Time			06/01/2021 03:55:51 PM Mountain Daylight Time	SEQUOIA PACE, LLC	WelbeHealth Sequoia PACE	https://welbehealth.com/sequoia/	WelbeHealth Sequoia PACE (PACE)	08	20		1			H2384	001	0	2022	Parts of Fresno, Kings, Madera and Tulare Counties		2		2			2						https://www.omnicare.com/	NA												(800)637-3187				(800)637-3187												(800)735-2922				(800)735-2922																
H2384	002	0	1	20	08	H2384_002_0	1	1						06/01/2021	2022.01	06/01/2021 03:55:15 PM Mountain Daylight Time		06/01/2021 10:05:22 AM Mountain Daylight Time			06/01/2021 03:55:51 PM Mountain Daylight Time	SEQUOIA PACE, LLC	WelbeHealth Sequoia PACE	https://welbehealth.com/sequoia/	WelbeHealth Sequoia PACE (PACE)	08	20		1			H2384	002	0	2022	Parts of Fresno, Kings, Madera and Tulare Counties		2		2			2						https://www.omnicare.com/	NA												(800)637-3187				(800)637-3187												(800)735-2922				(800)735-2922																
H2386	001	0	1	20	08	H2386_001_0	1	1						06/02/2021	2022.01	06/02/2021 01:08:53 PM Eastern Daylight Time		05/27/2021 09:55:35 AM Eastern Daylight Time			06/02/2021 01:12:21 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	2022	Counties:  Buchanan, Dickenson, Russell, Tazewell		2		2			2						www.optum.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						06/02/2021	2022.01	06/02/2021 01:10:03 PM Eastern Daylight Time		05/27/2021 09:56:03 AM Eastern Daylight Time			06/02/2021 01:12:21 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	2022	Counties:  Buchanan, Dickenson, Russell, Tazewell		2		2			2						www.optum.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	5	1		1			0	07/09/2021	2022.01	07/09/2021 02:37:58 PM Central Daylight Time	08/05/2021 08:08:02 AM Central Daylight Time	08/05/2021 08:08:21 AM Central Daylight Time			08/05/2021 08:34:34 AM Central Daylight Time	KANSAS SUPERIOR SELECT, INC.	Kansas Health Advantage	KansasHealthAdvantage.com	Kansas Health Advantage (HMO I-SNP)	01	01		1			H2392	001	0	2022	Central and East Kansas		2	7420	2			1	1	3				KansasHealthAdvantage.com	KansasHealthAdvantage.com	KansasHealthAdvantage.com	(800)399-7524		(800)399-7524		(800)399-7524		(800)399-7524		(800)399-7524		(800)399-7524		(800)399-7524		(800)399-7524		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					1					2	2			
H2392	002	0	1	01	01	H2392_002_0	5	1		1			0	08/03/2021	2022.01	08/03/2021 11:08:34 AM Central Daylight Time	08/05/2021 08:08:02 AM Central Daylight Time	08/05/2021 08:08:21 AM Central Daylight Time			08/05/2021 08:34:34 AM Central Daylight Time	KANSAS SUPERIOR SELECT, INC.	Kansas Health Advantage	KansasHealthAdvantage.com	Kansas Health Advantage Gold (HMO I-SNP)	01	01		1			H2392	002	0	2022	Central and East Kansas		2	888	2			1	1	3				KansasHealthAdvantage.com	KansasHealthAdvantage.com	KansasHealthAdvantage.com	(800)399-7524		(800)399-7524		(800)399-7524		(800)399-7524		(800)399-7524		(800)399-7524		(800)399-7524		(800)399-7524		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2392	003	0	1	01	01	H2392_003_0	5	1		1			0	06/07/2021	2022.01	06/07/2021 02:07:08 PM Central Daylight Time	08/05/2021 08:08:02 AM Central Daylight Time	08/05/2021 08:08:21 AM Central Daylight Time			08/05/2021 08:34:34 AM Central Daylight Time	KANSAS SUPERIOR SELECT, INC.	Kansas Health Advantage	KansasHealthAdvantage.com	Kansas Health Advantage Silver (HMO I-SNP)	01	01		1			H2392	003	0	2022	Central and East Kansas		2	888	2			1	1	3				KansasHealthAdvantage.com	KansasHealthAdvantage.com	KansasHealthAdvantage.com	(800)399-7524		(800)399-7524		(800)399-7524		(800)399-7524		(800)399-7524		(800)399-7524		(800)399-7524		(800)399-7524		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2400	001	0	1	01	01	H2400_001_0	5	1		1			0	07/01/2021	2022.01	07/01/2021 09:37:06 AM Eastern Daylight Time	07/30/2021 03:14:00 PM Eastern Daylight Time	07/30/2021 09:42:32 AM Eastern Daylight Time			08/02/2021 02:04:44 PM Eastern Daylight Time	SIGNATURE ADVANTAGE, LLC	Signature Advantage (HMO SNP)	www.signatureadvantageplan.com	Signature Advantage Plan (HMO I-SNP)	01	01		1			H2400	001	0	2022	KY (partial)		2		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			
H2400	002	0	1	01	01	H2400_002_0	4	1		1			0	06/02/2021	2022.01	06/02/2021 11:20:17 AM Eastern Daylight Time	07/30/2021 03:15:35 PM Eastern Daylight Time	07/30/2021 09:46:18 AM Eastern Daylight Time			08/02/2021 02:04:44 PM Eastern Daylight Time	SIGNATURE ADVANTAGE, LLC	Signature Advantage (HMO SNP)	www.signatureadvantageplan.com	Signature Advantage Community (HMO I-SNP)	01	01		1			H2400	002	0	2022	KY (partial)		2		2			1	1	2				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	3	1		1			0	08/04/2021	2022.01	08/04/2021 11:08:01 AM Central Daylight Time	08/04/2021 02:23:54 PM Central Daylight Time	07/29/2021 08:05:28 PM Central Daylight Time			08/04/2021 02:50:48 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan 1 (PPO I-SNP)	01	04		1			H2406	001	0	2022	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	4	1					1	08/04/2021	2022.01	08/04/2021 12:37:08 PM Central Daylight Time	08/03/2021 12:24:08 PM Central Daylight Time	07/29/2021 08:05:43 PM Central Daylight Time			08/04/2021 07:39:56 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H2406	008	0	2022	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					1	08/04/2021	2022.01	08/04/2021 12:37:22 PM Central Daylight Time	08/03/2021 12:24:42 PM Central Daylight Time	07/29/2021 08:05:58 PM Central Daylight Time			08/04/2021 07:39:56 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H2406	009	0	2022	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					1	08/04/2021	2022.01	08/04/2021 12:37:35 PM Central Daylight Time	08/03/2021 12:25:17 PM Central Daylight Time	07/29/2021 08:06:13 PM Central Daylight Time			08/04/2021 07:39:56 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H2406	010	0	2022	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					1	08/04/2021	2022.01	08/04/2021 12:37:46 PM Central Daylight Time	08/03/2021 12:25:56 PM Central Daylight Time	07/29/2021 08:06:28 PM Central Daylight Time			08/04/2021 07:39:56 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H2406	011	0	2022	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					1	08/04/2021	2022.01	08/04/2021 12:38:00 PM Central Daylight Time	08/03/2021 12:26:34 PM Central Daylight Time	07/29/2021 08:06:42 PM Central Daylight Time			08/04/2021 07:39:56 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H2406	012	0	2022	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					1	08/04/2021	2022.01	08/04/2021 12:38:12 PM Central Daylight Time	08/03/2021 12:27:11 PM Central Daylight Time	07/29/2021 08:06:56 PM Central Daylight Time			08/04/2021 07:39:56 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H2406	013	0	2022	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					1	08/04/2021	2022.01	08/04/2021 12:38:40 PM Central Daylight Time	08/03/2021 12:27:50 PM Central Daylight Time	07/29/2021 08:07:11 PM Central Daylight Time			08/04/2021 07:39:56 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H2406	014	0	2022	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					1	08/04/2021	2022.01	08/04/2021 12:38:52 PM Central Daylight Time	08/03/2021 12:28:24 PM Central Daylight Time	07/29/2021 08:07:27 PM Central Daylight Time			08/04/2021 07:39:56 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H2406	015	0	2022	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					1	08/04/2021	2022.01	08/04/2021 12:39:03 PM Central Daylight Time	08/03/2021 12:29:02 PM Central Daylight Time	07/29/2021 08:07:43 PM Central Daylight Time			08/04/2021 07:39:56 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H2406	016	0	2022	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					1	08/04/2021	2022.01	08/04/2021 12:39:15 PM Central Daylight Time	08/03/2021 12:29:34 PM Central Daylight Time	07/29/2021 08:07:58 PM Central Daylight Time			08/04/2021 07:39:56 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H2406	017	0	2022	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	3	1					1	08/04/2021	2022.01	08/04/2021 12:39:26 PM Central Daylight Time	08/03/2021 12:30:12 PM Central Daylight Time	07/29/2021 08:08:14 PM Central Daylight Time			08/04/2021 07:39:56 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H2406	018	0	2022	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					1	08/04/2021	2022.01	08/04/2021 12:39:37 PM Central Daylight Time	08/03/2021 12:30:48 PM Central Daylight Time	07/29/2021 08:08:30 PM Central Daylight Time			08/04/2021 07:39:56 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H2406	019	0	2022	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	805	0	1	04	01	H2406_805_0	1	1						05/24/2021	2022.01	05/24/2021 01:48:07 PM Central Daylight Time					06/02/2021 09:37:42 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2406	805	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;17a;18a;	2		1									
H2406	806	0	1	04	01	H2406_806_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 08:39:14 AM Central Daylight Time					06/02/2021 09:37:42 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2406	806	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;17a;18a;	2		1									
H2406	807	0	1	04	01	H2406_807_0	1	1						05/24/2021	2022.01	05/24/2021 01:48:41 PM Central Daylight Time					06/02/2021 09:37:42 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2406	807	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;17a;18a;	2		1									
H2406	808	0	2	04	01	H2406_808_0	1	1						05/24/2021	2022.01	05/24/2021 01:48:57 PM Central Daylight Time					06/02/2021 09:37:42 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H2406	808	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;17a;18a;	2		1									
H2406	809	0	2	04	01	H2406_809_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 08:41:03 AM Central Daylight Time					06/02/2021 09:37:42 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H2406	809	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;17a;18a;	2		1									
H2406	810	0	2	04	01	H2406_810_0	1	1						05/24/2021	2022.01	05/24/2021 01:59:49 PM Central Daylight Time					06/02/2021 09:37:42 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H2406	810	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;17a;18a;	2		1									
H2406	811	0	1	04	01	H2406_811_0	1	1						05/24/2021	2022.01	05/24/2021 02:00:08 PM Central Daylight Time					06/02/2021 09:37:42 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2406	811	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;17a;18a;	2		1									
H2406	812	0	1	04	01	H2406_812_0	1	1						05/24/2021	2022.01	05/24/2021 02:00:55 PM Central Daylight Time					06/02/2021 09:37:42 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2406	812	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;17a;18a;	2		1									
H2406	813	0	1	04	01	H2406_813_0	1	1						05/24/2021	2022.01	05/24/2021 02:01:28 PM Central Daylight Time					06/02/2021 09:37:42 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2406	813	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;17a;18a;	2		1									
H2406	814	0	1	04	01	H2406_814_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 08:41:39 AM Central Daylight Time					06/02/2021 09:37:42 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2406	814	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;17a;18a;	2		1									
H2406	815	0	1	04	01	H2406_815_0	1	1						05/24/2021	2022.01	05/24/2021 02:02:01 PM Central Daylight Time					06/02/2021 09:37:42 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2406	815	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;17a;18a;	2		1									
H2406	816	0	2	04	01	H2406_816_0	1	1						05/24/2021	2022.01	05/24/2021 02:02:19 PM Central Daylight Time					06/02/2021 09:37:42 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H2406	816	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;17a;18a;	2		1									
H2406	817	0	2	04	01	H2406_817_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 08:48:58 AM Central Daylight Time					06/02/2021 09:37:42 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H2406	817	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;17a;18a;	2		1									
H2406	818	0	2	04	01	H2406_818_0	1	1						05/24/2021	2022.01	05/24/2021 02:02:56 PM Central Daylight Time					06/02/2021 09:37:42 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H2406	818	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;17a;18a;	2		1									
H2406	819	0	1	04	01	H2406_819_0	1	1						05/24/2021	2022.01	05/24/2021 02:03:14 PM Central Daylight Time					06/02/2021 09:37:42 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2406	819	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;17a;18a;	2		1									
H2406	820	0	1	04	01	H2406_820_0	1	1						05/24/2021	2022.01	05/24/2021 02:03:36 PM Central Daylight Time					06/02/2021 09:37:42 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2406	820	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;17a;18a;	2		1									
H2406	821	0	1	04	01	H2406_821_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 08:49:27 AM Central Daylight Time					06/02/2021 09:37:42 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2406	821	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;17a;18a;	2		1									
H2406	822	0	1	04	01	H2406_822_0	1	1						05/24/2021	2022.01	05/24/2021 02:04:17 PM Central Daylight Time					06/02/2021 09:37:42 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2406	822	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;17a;18a;	2		1									
H2406	823	0	1	04	01	H2406_823_0	1	1						05/24/2021	2022.01	05/24/2021 02:04:41 PM Central Daylight Time					06/02/2021 09:37:42 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2406	823	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;17a;18a;	2		1									
H2406	824	0	1	04	01	H2406_824_0	1	1						05/24/2021	2022.01	05/24/2021 02:06:18 PM Central Daylight Time					06/02/2021 09:37:42 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2406	824	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;17a;18a;	2		1									
H2406	825	0	1	04	01	H2406_825_0	1	1						05/24/2021	2022.01	05/24/2021 02:06:38 PM Central Daylight Time					06/02/2021 09:37:42 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2406	825	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;17a;18a;	2		1									
H2406	826	0	1	04	01	H2406_826_0	1	1						05/24/2021	2022.01	05/24/2021 02:06:58 PM Central Daylight Time					06/02/2021 09:37:42 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2406	826	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;17a;18a;	2		1									
H2406	827	0	1	04	01	H2406_827_0	1	1						05/24/2021	2022.01	05/24/2021 02:07:19 PM Central Daylight Time					06/02/2021 09:37:42 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2406	827	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;17a;18a;	2		1									
H2406	828	0	2	04	01	H2406_828_0	1	1						05/24/2021	2022.01	05/24/2021 02:07:39 PM Central Daylight Time					06/02/2021 09:37:42 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H2406	828	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;17a;18a;	2		1									
H2406	829	0	1	04	01	H2406_829_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 08:49:46 AM Central Daylight Time					06/02/2021 09:37:42 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2406	829	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;17a;18a;	2		1									
H2406	830	0	1	04	01	H2406_830_0	1	1						05/24/2021	2022.01	05/24/2021 02:10:11 PM Central Daylight Time					06/02/2021 09:37:42 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2406	830	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;17a;18a;	2		1									
H2406	831	0	1	04	01	H2406_831_0	1	1						05/24/2021	2022.01	05/24/2021 02:10:28 PM Central Daylight Time					06/02/2021 09:37:42 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2406	831	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;17a;18a;	2		1									
H2406	832	0	1	04	01	H2406_832_0	1	1						05/24/2021	2022.01	05/24/2021 02:10:46 PM Central Daylight Time					06/02/2021 09:37:42 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2406	832	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;17a;18a;	2		1									
H2406	833	0	1	04	01	H2406_833_0	1	1						05/24/2021	2022.01	05/24/2021 02:11:02 PM Central Daylight Time					06/02/2021 09:37:42 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2406	833	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;17a;18a;	2		1									
H2406	834	0	1	04	01	H2406_834_0	1	1						05/24/2021	2022.01	05/24/2021 02:11:19 PM Central Daylight Time					06/02/2021 09:37:42 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2406	834	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;17a;18a;	2		1									
H2406	835	0	1	04	01	H2406_835_0	1	1						05/24/2021	2022.01	05/24/2021 02:11:35 PM Central Daylight Time					06/02/2021 09:37:42 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2406	835	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;17a;18a;	2		1									
H2416	001	0	1	01	01	H2416_001_0	7	1	2	1			0	07/08/2021	2022.01	07/08/2021 06:41:49 PM Central Daylight Time	07/29/2021 03:56:00 PM Central Daylight Time	07/29/2021 04:14:12 PM Central Daylight Time			07/30/2021 11:05:54 AM Central Daylight Time	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	PrimeWest Health	www.primewest.org/pwshc	PrimeWest Senior Health Complete (HMO D-SNP)	01	01		1			H2416	001	0	2022	Northern, west central, and southwestern Minnesota		2	22752	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					1					1	2			
H2417	001	0	1	01	01	H2417_001_0	6	1	2	1			0	07/14/2021	2022.01	07/14/2021 02:38:25 PM Central Daylight Time	07/30/2021 05:34:04 PM Central Daylight Time	07/30/2021 05:21:18 PM Central Daylight Time			08/03/2021 09:20:16 AM Central Daylight Time	ITASCA MEDICAL CARE	Itasca Medical Care/IMCare Classic	www.imcare.org	IMCare Classic (HMO D-SNP)	01	01		1			H2417	001	0	2022	Itasca County		2	4344	2			1	3		1		1	http://www.caremark.com/wps/portal	http://www.imcare.org	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		2					1					1	2			
H2419	001	0	1	01	01	H2419_001_0	8	1	2	1			0	07/13/2021	2022.01	07/13/2021 11:48:55 AM Central Daylight Time	08/02/2021 03:29:09 PM Central Daylight Time	08/02/2021 03:22:27 PM Central Daylight Time			08/02/2021 03:59:12 PM Central Daylight Time	SOUTH COUNTRY HEALTH ALLIANCE	South Country Health Alliance	www.mnscha.org	SeniorCare Complete (HMO D-SNP)	01	01		1			H2419	001	0	2022	Select Counties in Minnesota		2		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	7	1	2	1			0	07/16/2021	2022.01	07/16/2021 12:51:29 PM Central Daylight Time	08/04/2021 09:50:50 AM Central Daylight Time	08/02/2021 12:16:04 PM Central Daylight Time			08/05/2021 09:20:42 AM Central Daylight Time	HEALTHPARTNERS, INC.	HealthPartners	healthpartners.com/msho	HealthPartners Minnesota Senior Health Options (HMO D-SNP)	01	01		1			H2422	002	0	2022	Minneapolis/St. Paul Metro Area		2	59610	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			0	08/03/2021	2022.01	08/03/2021 12:52:24 PM Central Daylight Time	08/03/2021 12:06:18 PM Central Daylight Time	07/30/2021 09:03:40 AM Central Daylight Time			08/04/2021 05:20:10 PM Central Daylight Time	BLUE PLUS	Blue Plus	www.bluecrossmn.com/secureblue	SecureBlue (HMO D-SNP)	01	01		1			H2425	001	0	2022	62 Counties within the State of Minnesota		2	104039	2			1	3		1		1	www.myprime.com	www.myprime.com	www.bluecrossmn.com/secureblue	(888)740-6013		(651)662-6013		(866)477-1584		(866)477-1584		(888)877-6424		(888)877-6424		(866)477-1584		(866)477-1584		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2450	001	0	1	18	06	H2450_001_0	4	1						07/14/2021	2022.01	07/14/2021 12:46:52 PM Central Daylight Time		08/03/2021 02:52:32 PM Central Daylight Time			08/03/2021 04:27:49 PM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica	medica.com	Medica Prime Solution Basic w/Rx 2 (Cost)	06	18		1			H2450	001	0	2022	Select Counties in MN		2	22464	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						07/14/2021	2022.01	07/14/2021 12:51:11 PM Central Daylight Time		08/03/2021 02:52:29 PM Central Daylight Time			08/03/2021 04:27:49 PM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica	medica.com	Medica Prime Solution Enhanced w/Rx 2 (Cost)	06	18		1			H2450	002	0	2022	Select Counties in MN		2	14604	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	3	1						05/21/2021	2022.01	05/21/2021 03:25:56 PM Central Daylight Time		08/03/2021 02:52:29 PM Central Daylight Time			08/03/2021 04:27:49 PM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica	medica.com	Medica Prime Solution Thrift w/Rx (Cost)	06	18		1			H2450	007	0	2022	All of SD, select MN, ND, and WI counties		2	4554	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						07/14/2021	2022.01	07/14/2021 12:55:00 PM Central Daylight Time		08/03/2021 02:52:30 PM Central Daylight Time			08/03/2021 04:27:49 PM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica	medica.com	Medica Prime Solution Basic w/Rx (Cost)	06	18		1			H2450	016	0	2022	Select Counties in MN		2	46248	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						07/14/2021	2022.01	07/14/2021 12:57:04 PM Central Daylight Time		08/03/2021 02:52:30 PM Central Daylight Time			08/03/2021 04:27:49 PM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica	medica.com	Medica Prime Solution Enhanced w/Rx (Cost)	06	18		1			H2450	017	0	2022	Select Counties in MN		2	8370	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	1	1				0	0	05/20/2021	2022.01	05/20/2021 09:24:09 AM Central Daylight Time					06/02/2021 08:14:13 AM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica	medica.com	Medica Prime Solution Thrift (Cost)	06	18		1			H2450	030	0	2022	All SD plus counties in IA KS MN MO ND NE OK WI WY		2	6120	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	2	1				0	0	07/14/2021	2022.01	07/14/2021 12:59:51 PM Central Daylight Time					07/14/2021 04:27:45 PM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica	medica.com	Medica Prime Solution Basic (Cost)	06	18		1			H2450	032	0	2022	Select Counties in MN		2	55662	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	2	1				0	0	07/14/2021	2022.01	07/14/2021 02:33:47 PM Central Daylight Time					07/14/2021 04:27:45 PM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica	medica.com	Medica Prime Solution Enhanced (Cost)	06	18		1			H2450	033	0	2022	Select Counties in MN		2	18012	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	2	1				0	0	07/14/2021	2022.01	07/14/2021 02:36:25 PM Central Daylight Time					07/14/2021 04:27:45 PM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica	medica.com	Medica Prime Solution Core (Cost)	06	18		1			H2450	034	0	2022	All of SD, plus select counties in ND and WY		2	333018	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						07/14/2021	2022.01	07/14/2021 02:38:04 PM Central Daylight Time		08/03/2021 02:52:30 PM Central Daylight Time			08/03/2021 04:27:49 PM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica	medica.com	Medica Prime Solution Core w/Rx (Cost)	06	18		1			H2450	035	0	2022	All of SD, plus select counties in ND		2	44130	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	2	1				0	0	07/14/2021	2022.01	07/14/2021 02:45:22 PM Central Daylight Time					07/14/2021 04:27:45 PM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica	medica.com	Medica Prime Solution Premier (Cost)	06	18		1			H2450	036	0	2022	All of SD, plus select counties in ND and WY		2	135281	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						07/14/2021	2022.01	07/14/2021 02:47:32 PM Central Daylight Time		08/03/2021 02:52:31 PM Central Daylight Time			08/03/2021 04:27:49 PM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica	medica.com	Medica Prime Solution Premier w/Rx (Cost)	06	18		1			H2450	037	0	2022	All of SD, plus select counties in ND		2	12138	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	2	1				0	0	07/14/2021	2022.01	07/14/2021 02:50:08 PM Central Daylight Time					07/14/2021 04:27:45 PM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica	medica.com	Medica Prime Solution Focus (Cost)	06	18		1			H2450	038	0	2022	Select counties in WI		2	177666	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						07/14/2021	2022.01	07/14/2021 02:52:28 PM Central Daylight Time		08/03/2021 02:52:31 PM Central Daylight Time			08/03/2021 04:27:49 PM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica	medica.com	Medica Prime Solution Focus w/Rx (Cost)	06	18		1			H2450	039	0	2022	Select counties in WI		2	92784	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	2	1				0	0	07/14/2021	2022.01	07/14/2021 02:55:19 PM Central Daylight Time					07/14/2021 04:27:45 PM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica	medica.com	Medica Prime Solution Total (Cost)	06	18		1			H2450	040	0	2022	Select counties in WI		2	26244	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	4	1						07/14/2021	2022.01	07/14/2021 02:57:17 PM Central Daylight Time		08/03/2021 02:52:32 PM Central Daylight Time			08/03/2021 04:27:49 PM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica	medica.com	Medica Prime Solution Total w/Rx (Cost)	06	18		1			H2450	041	0	2022	Select counties in WI		2	20262	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	2	1				0	0	07/14/2021	2022.01	07/14/2021 03:00:27 PM Central Daylight Time					07/14/2021 04:27:45 PM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica	medica.com	Medica Prime Solution Premier (Cost)	06	18		1			H2450	042	0	2022	Select counties in Iowa		2	2220	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	2	1				0	0	07/14/2021	2022.01	07/14/2021 03:03:02 PM Central Daylight Time					07/14/2021 04:27:45 PM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica	medica.com	Medica Prime Solution Premier (Cost)	06	18		1			H2450	043	0	2022	Select counties in Nebraska		2	44454	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	2	1				0	0	07/14/2021	2022.01	07/14/2021 03:05:47 PM Central Daylight Time					07/14/2021 04:27:45 PM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica	medica.com	Medica Prime Solution Standard (Cost)	06	18		1			H2450	044	0	2022	All of SD, select MN, ND, and NE counties		2	121899	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	045	0	1	18	06	H2450_045_0	2	1				0	0	07/14/2021	2022.01	07/14/2021 03:07:48 PM Central Daylight Time					07/14/2021 04:27:45 PM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica	medica.com	Medica Prime Solution Core (Cost)	06	18		1			H2450	045	0	2022	Select counties in IA		2	1218	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	046	0	1	18	06	H2450_046_0	2	1				0	0	07/14/2021	2022.01	07/14/2021 03:09:25 PM Central Daylight Time					07/14/2021 04:27:45 PM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica	medica.com	Medica Prime Solution Core (Cost)	06	18		1			H2450	046	0	2022	Select counties in NE		2	6552	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	047	0	1	18	06	H2450_047_0	2	1				0	0	07/14/2021	2022.01	07/14/2021 03:11:07 PM Central Daylight Time					07/14/2021 04:27:45 PM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica	medica.com	Medica Prime Solution Core (Cost)	06	18		1			H2450	047	0	2022	Select counties in KS, MO, and OK		2	199	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	048	0	1	18	06	H2450_048_0	2	1				0	0	07/14/2021	2022.01	07/14/2021 03:13:27 PM Central Daylight Time					07/14/2021 04:27:45 PM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica	medica.com	Medica Prime Solution Premier (Cost)	06	18		1			H2450	048	0	2022	Select counties in KS, MO, and OK		2	2176	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	049	0	1	18	06	H2450_049_0	4	1						07/14/2021	2022.01	07/14/2021 03:15:25 PM Central Daylight Time		08/03/2021 02:52:32 PM Central Daylight Time			08/03/2021 04:27:49 PM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica	medica.com	Medica Prime Solution Standard w/Rx (Cost)	06	18		1			H2450	049	0	2022	SD and select counties in MN		2	5274	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	050	0	1	18	06	H2450_050_0	2	1				0	0	07/14/2021	2022.01	07/14/2021 03:17:11 PM Central Daylight Time					07/14/2021 04:27:45 PM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica	medica.com	Medica Prime Solution Standard (Cost)	06	18		1			H2450	050	0	2022	Select counties in WI		2	22626	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	1	1						05/20/2021	2022.01	05/20/2021 09:10:06 AM Central Daylight Time					06/02/2021 08:14:13 AM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica	medica.com	Medica Group Prime Solution w/Rx (Cost)	06	18		1			H2450	801	0	2022	All SD plus counties in IA KS MN MO ND NE OK WI WY		1	25200	2			2						medica.com/Members	medica.com/Members	medica.com/Members	(800)575-2330		(952)992-2330		(800)906-5432		(952)992-2345		(800)575-2330		(952)992-2330		(800)906-5432		(952)992-2345		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H2456	002	0	1	01	01	H2456_002_0	6	1	2	1			0	08/04/2021	2022.01	08/04/2021 01:51:46 PM Central Daylight Time	08/04/2021 11:19:41 PM Central Daylight Time	08/04/2021 02:24:11 PM Central Daylight Time			08/05/2021 01:27:48 PM Central Daylight Time	UCARE MINNESOTA	UCare's MSHO	https://home.ucare.org	UCare's Minnesota Senior Health Options (HMO D-SNP)	01	01		1			H2456	002	0	2022	Twin Cities Metropolitan area and Greater MN		2		2			1	3		1		1	https://home.ucare.org	https://home.ucare.org/en-us/search-network/formulary	https://search.ucare.org	(866)280-7202		(612)676-6868		(877)671-1065		(612)676-6652		(866)280-7202		(612)676-6868		(877)671-1065		(612)676-6652		(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	8	1	2	1			0	08/05/2021	2022.01	08/05/2021 08:32:15 AM Central Daylight Time	08/05/2021 12:29:35 PM Central Daylight Time	08/05/2021 12:28:46 PM Central Daylight Time			08/05/2021 01:20:46 PM Central Daylight Time	MEDICA HEALTH PLANS	Medica	medica.com	Medica DUAL Solution (HMO D-SNP)	01	01		1			H2458	002	0	2022	Specific Minnesota counties		2		2			1	3		1		1	medica.com/DUAL	medica.com/DUAL	medica.com/DUAL	(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				0	0	06/04/2021	2022.01	06/04/2021 08:38:19 AM Central Daylight Time	06/06/2021 04:04:19 PM Central Daylight Time				07/21/2021 04:48:50 PM Central Daylight Time	UCARE MINNESOTA	UCare	https://home.ucare.org	UCare Value (HMO-POS)	01	02		1			H2459	001	0	2022	State of Minnesota		2		2			2						www.ucare.org	https://home.ucare.org/en-us/search-network/formulary	https://search.ucare.org	(877)523-1515		(612)676-3600		(877)671-1058		(612)676-6616										(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					1	08/05/2021	2022.01	08/05/2021 03:01:51 PM Central Daylight Time	08/05/2021 02:53:27 PM Central Daylight Time	07/29/2021 06:24:05 PM Central Daylight Time			08/05/2021 03:44:10 PM Central Daylight Time	UCARE MINNESOTA	UCare	https://home.ucare.org	UCare Prime (HMO-POS)	01	02		1			H2459	020	0	2022	45 counties		2		2			2						https://home.ucare.org	https://home.ucare.org/en-us/search-network/formulary/	https://search.ucare.org	(877)523-1515		(612)676-3600		(877)671-1058		(612)676-6616		(877)523-1515		(612)676-3600		(877)671-1058		(612)676-6616		(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	5	1					1	08/05/2021	2022.01	08/05/2021 02:44:03 PM Central Daylight Time	08/05/2021 12:25:51 PM Central Daylight Time	07/29/2021 06:36:55 PM Central Daylight Time			08/05/2021 03:44:10 PM Central Daylight Time	UCARE MINNESOTA	UCare	https://home.ucare.org	UCare Classic (HMO-POS)	01	02		1			H2459	021	1	2022	44 Counties	Twin Cities Metropolitan Area	2		2			2						https://home.ucare.org	https://home.ucare.org/en-us/search-network/formulary	https://search.ucare.org	(877)523-1515		(612)676-3600		(877)671-1058		(612)676-6616		(877)523-1515		(612)676-3600		(877)671-1058		(612)676-6616		(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	5	1					1	08/05/2021	2022.01	08/05/2021 02:50:37 PM Central Daylight Time	08/05/2021 11:23:38 AM Central Daylight Time	07/29/2021 06:45:09 PM Central Daylight Time			08/05/2021 03:44:10 PM Central Daylight Time	UCARE MINNESOTA	UCare	https://home.ucare.org	UCare Classic (HMO-POS)	01	02		1			H2459	021	2	2022	44 Counties	Northern Minnesota	2		2			2						https://home.ucare.org	https://home.ucare.org/en-us/search-network/formulary	https://search.ucare.org	(877)523-1515		(612)676-3600		(877)671-1058		(612)676-6616		(877)523-1515		(612)676-3600		(877)671-1058		(612)676-6616		(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	5	1					1	08/05/2021	2022.01	08/05/2021 02:56:00 PM Central Daylight Time	08/04/2021 10:53:16 PM Central Daylight Time	07/29/2021 06:52:48 PM Central Daylight Time			08/05/2021 03:44:10 PM Central Daylight Time	UCARE MINNESOTA	UCare	https://home.ucare.org	UCare Classic (HMO-POS)	01	02		1			H2459	021	3	2022	44 Counties	Southern Minnesota	2		2			2						https://home.ucare.org	https://home.ucare.org/en-us/search-network/formulary	https://search.ucare.org	(877)523-1515		(612)676-3600		(877)671-1058		(612)676-6616		(877)523-1515		(612)676-3600		(877)671-1058		(612)676-6616		(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	7	1					1	07/06/2021	2022.01	07/06/2021 03:36:59 PM Central Daylight Time	08/04/2021 10:16:59 AM Central Daylight Time	07/29/2021 07:00:25 PM Central Daylight Time			08/05/2021 01:27:48 PM Central Daylight Time	UCARE MINNESOTA	UCare	https://home.ucare.org	UCare Essentials Rx (HMO-POS)	01	02		1			H2459	023	1	2022	46 Counties	Twin Cities Metropolitan Area	2		2			2						https://home.ucare.org	https://home.ucare.org/en-us/search-network/formulary/	https://search.ucare.org	(877)523-1515		(612)676-3600		(877)671-1058		(612)676-6616		(877)523-1515		(612)676-3600		(877)671-1058		(612)676-6616		(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	5	1					1	07/06/2021	2022.01	07/06/2021 03:37:33 PM Central Daylight Time	08/04/2021 10:14:13 AM Central Daylight Time	07/29/2021 07:09:11 PM Central Daylight Time			08/05/2021 01:27:48 PM Central Daylight Time	UCARE MINNESOTA	UCare	https://home.ucare.org	UCare Essentials Rx (HMO-POS)	01	02		1			H2459	023	2	2022	46 Counties	Northern Minnesota	2		2			2						https://home.ucare.org	https://home.ucare.org/en-us/search-network/formulary/	https://search.ucare.org	(877)523-1515		(612)676-3600		(877)671-1058		(612)676-6616		(877)523-1515		(612)676-3600		(877)671-1058		(612)676-6616		(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	5	1					1	07/21/2021	2022.01	07/21/2021 03:25:33 PM Central Daylight Time	08/04/2021 10:11:18 AM Central Daylight Time	07/29/2021 07:16:29 PM Central Daylight Time			08/05/2021 01:27:48 PM Central Daylight Time	UCARE MINNESOTA	UCare	https://home.ucare.org	UCare Standard (HMO-POS)	01	02		1			H2459	024	0	2022	Southern Minnesota		2		2			2						https://home.ucare.org	https://home.ucare.org/en-us/search-network/formulary	https://search.ucare.org	(877)523-1515		(612)676-3600		(877)671-1058		(612)676-6616		(877)523-1515		(612)676-3600		(877)671-1058		(612)676-6616		(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	5	1					1	08/05/2021	2022.01	08/05/2021 04:03:11 PM Central Daylight Time	08/05/2021 10:41:53 AM Central Daylight Time	07/29/2021 07:25:14 PM Central Daylight Time			08/05/2021 04:34:25 PM Central Daylight Time	UCARE MINNESOTA	UCare	https://home.ucare.org	UCare Complete (HMO-POS)	01	02		1			H2459	026	1	2022	State of Minnesota	Twin Cities Metropolitan Area	2		2			2						https://home.ucare.org	https://home.ucare.org/en-us/search-network/formulary	https://search.ucare.org	(877)523-1515		(612)676-3600		(877)671-1058		(612)676-6616		(877)523-1515		(612)676-3600		(877)671-1058		(612)676-6616		(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					1	08/05/2021	2022.01	08/05/2021 04:09:01 PM Central Daylight Time	08/05/2021 10:51:54 AM Central Daylight Time	07/29/2021 07:31:35 PM Central Daylight Time			08/05/2021 04:34:25 PM Central Daylight Time	UCARE MINNESOTA	UCare	https://home.ucare.org	UCare Complete (HMO-POS)	01	02		1			H2459	026	3	2022	State of Minnesota	Northern Minnesota	2		2			2						https://home.ucare.org	https://home.ucare.org/en-us/search-network/formulary	https://search.ucare.org	(877)523-1515		(612)676-3600		(877)671-1058		(612)676-6616		(877)523-1515		(612)676-3600		(877)671-1058		(612)676-6616		(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	4	1	02	01	H2459_026_4	5	1					1	08/05/2021	2022.01	08/05/2021 04:26:40 PM Central Daylight Time	08/04/2021 10:22:51 PM Central Daylight Time	07/29/2021 07:38:38 PM Central Daylight Time			08/05/2021 04:34:25 PM Central Daylight Time	UCARE MINNESOTA	UCare	https://home.ucare.org	UCare Complete (HMO-POS)	01	02		1			H2459	026	4	2022	State of Minnesota	Southern Minnesota	2		2			2						https://home.ucare.org	https://home.ucare.org/en-us/search-network/formulary	https://search.ucare.org	(877)523-1515		(612)676-3600		(877)671-1058		(612)676-6616		(877)523-1515		(612)676-3600		(877)671-1058		(612)676-6616		(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	028	0	1	02	01	H2459_028_0	8	1					1	09/23/2021	2022.01	09/23/2021 01:54:10 PM Central Daylight Time	08/09/2021 10:05:03 AM Central Daylight Time	07/29/2021 07:44:50 PM Central Daylight Time			09/23/2021 02:40:10 PM Central Daylight Time	UCARE MINNESOTA	UCare	https://home.ucare.org	UCare Prime (HMO-POS)	01	02		1			H2459	028	0	2022	Southern Minnesota		2		2			2						https://home.ucare.org	https://home.ucare.org/en-us/search-network/formulary	https://search.ucare.org	(877)523-1515		(612)676-3600		(877)671-1058		(612)676-6616		(877)523-1515		(612)676-3600		(877)671-1058		(612)676-6616		(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	029	0	1	02	01	H2459_029_0	8	1					1	08/05/2021	2022.01	08/05/2021 05:41:19 PM Central Daylight Time	08/05/2021 02:40:15 PM Central Daylight Time	07/29/2021 07:52:22 PM Central Daylight Time			08/05/2021 07:14:41 PM Central Daylight Time	UCARE MINNESOTA	UCare	https://home.ucare.org	UCare Aware (HMO-POS)	01	02		1			H2459	029	0	2022	46 counties		2		2			2						https://home.ucare.org	https://home.ucare.org/en-us/search-network/formulary	https://search.ucare.org	(877)523-1515		(612)676-3600		(877)671-1058		(612)676-6616		(877)523-1515		(612)676-3600		(877)671-1058		(612)676-6616		(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	030	0	1	02	01	H2459_030_0	4	1				0	0	06/01/2021	2022.01	06/01/2021 01:10:36 PM Central Daylight Time	06/07/2021 05:36:05 PM Central Daylight Time				07/21/2021 04:48:50 PM Central Daylight Time	UCARE MINNESOTA	UCare	https://home.ucare.org	UCare Value Plus (HMO-POS)	01	02		1			H2459	030	0	2022	State of Minnesota		2		2			2						https://home.ucare.org	https://home.ucare.org/en-us/search-network/formulary	https://search.ucare.org	(877)523-1515		(612)676-3600		(877)671-1058		(612)676-6616										(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810										2					2					2	2			
H2459	031	0	1	01	01	H2459_031_0	8	1		1			1	07/21/2021	2022.01	07/21/2021 03:40:32 PM Central Daylight Time	08/04/2021 08:49:53 AM Central Daylight Time	08/04/2021 08:49:57 AM Central Daylight Time			08/05/2021 01:27:48 PM Central Daylight Time	UCARE MINNESOTA	UCare	https://home.ucare.org	UCare Advocate Choice (HMO I-SNP)	01	01		1			H2459	031	0	2022	Twin Cities and Greater MN 17 counties		2		2			1	1	3				https://home.ucare.org	https://home.ucare.org/en-us/search-network/formulary	https://search.ucare.org	(855)931-4854		(612)676-6772		(877)671-1065		(612)676-6652		(855)931-4854		(612)676-6772		(877)671-1065		(612)676-6652		(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	032	0	1	01	01	H2459_032_0	8	1		1			1	07/21/2021	2022.01	07/21/2021 03:45:47 PM Central Daylight Time	08/04/2021 08:50:01 AM Central Daylight Time	08/04/2021 08:50:03 AM Central Daylight Time			08/05/2021 01:27:48 PM Central Daylight Time	UCARE MINNESOTA	UCare	https://home.ucare.org	UCare Advocate Plus (HMO I-SNP)	01	01		1			H2459	032	0	2022	Twin Cities and Greater MN 17 counties		2		2			1	1	3				https://home.ucare.org	https://home.ucare.org/en-us/search-network/formulary	https://search.ucare	(855)931-4854		(612)676-6772		(877)671-1065		(612)676-6652		(855)931-4854		(612)676-6772		(877)671-1065		(612)676-6652		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		(800)688-2538		(612)676-6810		2					2					2	2			
H2459	801	0	1	02	01	H2459_801_0	3	1						05/27/2021	2022.01	05/27/2021 09:09:05 AM Central Daylight Time					06/07/2021 10:42:13 PM Central Daylight Time	UCARE MINNESOTA	UCare	https://home.ucare.org	Group UCare (HMO-POS)	01	02		1			H2459	801	0	2022	Minnesota and 26 Wisconsin Counties		1	71704	2			2						https://home.ucare.org	https://home.ucare.org/en-us/search-network/formulary	https://search.ucare.org	(877)447-4385		(612)676-6840		(877)671-1058		(612)676-6616		(877)447-4385		(612)676-6840		(877)671-1058		(612)676-6616		(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			
H2461	005	0	1	18	06	H2461_005_0	3	1				0	0	08/03/2021	2022.01	08/03/2021 05:56:05 PM Central Daylight Time					08/04/2021 12:45:31 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	2022	21 County region		2	40172	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	3	1				0	0	08/03/2021	2022.01	08/03/2021 05:56:56 PM Central Daylight Time					08/04/2021 12:45:31 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	2022	21 County Region		2	145924	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	3	1				0	0	08/03/2021	2022.01	08/03/2021 05:57:53 PM Central Daylight Time					08/04/2021 12:45:31 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	2022	21 County region		2	197816	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	3	1						08/03/2021	2022.01	08/03/2021 06:00:36 PM Central Daylight Time		08/03/2021 03:16:28 PM Central Daylight Time			08/03/2021 07:47:27 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	2022	21 County Region		2	7873	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	3	1						08/03/2021	2022.01	08/03/2021 06:10:16 PM Central Daylight Time		07/29/2021 06:25:28 PM Central Daylight Time			08/03/2021 07:47:27 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	2022	21 County Region		2	98531	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	3	1						08/03/2021	2022.01	08/03/2021 06:12:57 PM Central Daylight Time		07/29/2021 06:36:24 PM Central Daylight Time			08/03/2021 07:47:27 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	2022	21 County Region		2	55483	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	2	1				0	0	06/04/2021	2022.01	06/04/2021 03:05:11 PM Central Daylight Time					06/04/2021 03:07:44 PM Central Daylight Time	GROUP HEALTH PLAN, INC. (MN)	HealthPartners	healthpartners.com/medicare	HealthPartners Freedom Basic (Cost)	06	18		1			H2462	004	0	2022	Duluth Area and Select MN Counties		2	33	2			2						healthpartners.com/partdpharmacy	healthpartners.com/medicarerx	healthpartners.com/medicarenetworks	(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	1	1				0	0	06/03/2021	2022.01	06/03/2021 03:44:40 PM Central Daylight Time					06/03/2021 04:05:39 PM Central Daylight Time	GROUP HEALTH PLAN, INC. (MN)	HealthPartners	healthpartners.com/medicare	HealthPartners Freedom Ultimate (Cost)	06	18		1			H2462	010	0	2022	Duluth Area and Select MN Counties		2	1121	2			2						healthpartners.com/partdpharmacy	healthpartners.com/medicarerx	healthpartners.com/medicarenetworks	(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	2	1				0	0	07/16/2021	2022.01	07/16/2021 12:01:03 PM Central Daylight Time					07/16/2021 12:39:49 PM Central Daylight Time	GROUP HEALTH PLAN, INC. (MN)	HealthPartners	healthpartners.com/medicare	HealthPartners Freedom Balance (Cost)	06	18		1			H2462	016	0	2022	Duluth Area and Select MN Counties		2	4817	2			2						healthpartners.com/partdpharmacy	healthpartners.com/medicarerx	healthpartners.com/medicarenetworks	(800)233-9645		(952)883-7979		(800)247-7015		(952)883-5601										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2462	018	0	1	18	06	H2462_018_0	1	1				0	0	06/03/2021	2022.01	06/03/2021 03:46:00 PM Central Daylight Time					06/03/2021 04:05:39 PM Central Daylight Time	GROUP HEALTH PLAN, INC. (MN)	HealthPartners	healthpartners.com/medicare	HealthPartners Freedom Vital (Cost)	06	18		1			H2462	018	0	2022	Duluth Area and Select MN Counties		2	5463	2			2						healthpartners.com/partdpharmacy	healthpartners.com/medicarerx	healthpartners.com/medicarenetworks	(800)233-9645		(952)883-7979		(800)247-7015		(952)883-5601										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2462	022	0	1	18	06	H2462_022_0	2	1				0	0	06/04/2021	2022.01	06/04/2021 03:05:59 PM Central Daylight Time					06/04/2021 03:07:44 PM Central Daylight Time	GROUP HEALTH PLAN, INC. (MN)	HealthPartners	healthpartners.com/medicare	HealthPartners Freedom Base (Cost)	06	18		1			H2462	022	0	2022	Sioux Falls, Watertown, Fargo, Jamestown, Bismarck		2	48	2			2						healthpartners.com/partdpharmacy	healthpartners.com/medicarerx	healthpartners.com/medicarenetworks	(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	1	1				0	0	06/03/2021	2022.01	06/03/2021 03:53:13 PM Central Daylight Time					06/03/2021 04:05:39 PM Central Daylight Time	GROUP HEALTH PLAN, INC. (MN)	HealthPartners	healthpartners.com/medicare	HealthPartners Freedom Plains (Cost)	06	18		1			H2462	023	0	2022	Sioux Falls, Watertown, Fargo, Jamestown, Bismarck		2	6564	2			2						healthpartners.com/partdpharmacy	healthpartners.com/medicarerx	healthpartners.com/medicarenetworks	(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	2	1				0	0	07/16/2021	2022.01	07/16/2021 12:04:32 PM Central Daylight Time					07/16/2021 12:39:49 PM Central Daylight Time	GROUP HEALTH PLAN, INC. (MN)	HealthPartners	healthpartners.com/medicare	HealthPartners Freedom Prairie (Cost)	06	18		1			H2462	024	0	2022	Sioux Falls, Watertown, Fargo, Jamestown, Bismarck		2	864	2			2						healthpartners.com/partdpharmacy	healthpartners.com/medicarerx	healthpartners.com/medicarenetworks	(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	1	1				0	0	06/03/2021	2022.01	06/03/2021 03:56:10 PM Central Daylight Time					06/03/2021 04:05:39 PM Central Daylight Time	GROUP HEALTH PLAN, INC. (MN)	HealthPartners	healthpartners.com/medicare	HealthPartners Freedom Crest (Cost)	06	18		1			H2462	025	0	2022	Sioux Falls, Watertown, Fargo, Jamestown, Bismarck		2	2190	2			2						healthpartners.com/partdpharmacy	healthpartners.com/medicarerx	healthpartners.com/medicarenetworks	(800)233-9645		(800)233-9645		(800)247-7015		(800)247-7015										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2462	026	0	1	18	06	H2462_026_0	2	1				0	0	06/06/2021	2022.01	06/06/2021 02:44:29 PM Central Daylight Time					06/06/2021 03:53:44 PM Central Daylight Time	GROUP HEALTH PLAN, INC. (MN)	HealthPartners	healthpartners.com/medicare	HealthPartners Freedom Basic WI (Cost)	06	18		1			H2462	026	0	2022	Select Counties in Western WI		2	570	2			2						healthpartners.com/partdpharmacy	healthpartners.com/medicarerx	healthpartners.com/medicarenetworks	(800)233-9645		(952)883-7979		(800)247-7015		(952)883-5601										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2462	027	0	1	18	06	H2462_027_0	1	1				0	0	06/03/2021	2022.01	06/03/2021 03:47:39 PM Central Daylight Time					06/03/2021 04:05:39 PM Central Daylight Time	GROUP HEALTH PLAN, INC. (MN)	HealthPartners	healthpartners.com/medicare	HealthPartners Freedom Vital WI (Cost)	06	18		1			H2462	027	0	2022	Select Counties in Western WI		2	8214	2			2						healthpartners.com/partdpharmacy	healthpartners.com/medicarerx	healthpartners.com/medicarenetworks	(800)233-9645		(952)883-7979		(800)247-7015		(952)883-5601										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2462	028	0	1	18	06	H2462_028_0	1	1				0	0	06/03/2021	2022.01	06/03/2021 03:49:16 PM Central Daylight Time					06/03/2021 04:05:39 PM Central Daylight Time	GROUP HEALTH PLAN, INC. (MN)	HealthPartners	healthpartners.com/medicare	HealthPartners Freedom Balance WI (Cost)	06	18		1			H2462	028	0	2022	Select Counties in Western WI		2	14753	2			2						healthpartners.com/partdpharmacy	healthpartners.com/medicarerx	healthpartners.com/medicarenetworks	(800)233-9645		(952)883-7979		(800)247-7015		(952)883-5601										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2462	801	0	1	18	06	H2462_801_0	1	1						06/03/2021	2022.01	06/03/2021 03:49:54 PM Central Daylight Time					06/03/2021 04:05:39 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	2022	Select Counties in MN, WI, ND, and SD		1	636	2			2						healthpartners.com/partdpharmacy	healthpartners.com/medicarerx	healthpartners.com/medicarenetworks	(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						06/03/2021	2022.01	06/03/2021 03:50:19 PM Central Daylight Time					06/03/2021 04:05:39 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	2022	Select Counties in MN, WI, ND, and SD		1	0	2			2						healthpartners.com/partdpharmacy	healthpartners.com/medicarerx	healthpartners.com/medicarenetworks	(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			1		1	07/31/2021	2022.01	07/31/2021 02:18:11 PM Eastern Daylight Time	08/03/2021 07:24:52 PM Eastern Daylight Time	07/30/2021 10:36:02 AM Eastern Daylight Time			08/04/2021 01:27:12 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	2022	Pinal and Yuma Counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	8	1			1		1	08/02/2021	2022.01	08/02/2021 12:29:07 PM Eastern Daylight Time	08/03/2021 06:15:39 PM Eastern Daylight Time	07/30/2021 10:36:14 AM Eastern Daylight Time			08/04/2021 02:25:33 PM 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	2022	Davis, Salt Lake, Utah and Weber counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	005	0	1	01	01	H2486_005_0	5	1			1		1	08/01/2021	2022.01	08/01/2021 09:42:10 AM Eastern Daylight Time	08/03/2021 07:13:22 PM Eastern Daylight Time	07/30/2021 10:36:26 AM Eastern Daylight Time			08/04/2021 02:48:19 PM Eastern Daylight Time	HUMANA MEDICAL PLAN OF UTAH, INC.	Humana	www.humana.com/medicare	Humana Community (HMO)	01	01		1			H2486	005	0	2022	Ada, Canyon, and Payette counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	006	0	1	01	01	H2486_006_0	7	1			1		1	08/02/2021	2022.01	08/02/2021 02:27:41 PM Eastern Daylight Time	08/03/2021 07:07:38 PM Eastern Daylight Time	07/30/2021 10:36:38 AM Eastern Daylight Time			08/04/2021 03:07:42 PM Eastern Daylight Time	HUMANA MEDICAL PLAN OF UTAH, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H2486-006 (HMO)	01	01		1			H2486	006	0	2022	Snohomish County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	007	0	1	01	01	H2486_007_0	8	1			1		1	08/02/2021	2022.01	08/02/2021 02:31:47 PM Eastern Daylight Time	08/03/2021 07:10:25 PM Eastern Daylight Time	07/30/2021 10:36:50 AM Eastern Daylight Time			08/04/2021 03:07:42 PM Eastern Daylight Time	HUMANA MEDICAL PLAN OF UTAH, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H2486-007 (HMO)	01	01		1			H2486	007	0	2022	Clark County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	008	0	1	01	01	H2486_008_0	7	1			1		1	08/04/2021	2022.01	08/04/2021 02:39:52 PM Eastern Daylight Time	08/03/2021 07:14:43 PM Eastern Daylight Time	07/30/2021 10:37:04 AM Eastern Daylight Time			08/04/2021 02:48:19 PM Eastern Daylight Time	HUMANA MEDICAL PLAN OF UTAH, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H2486-008 (HMO)	01	01		1			H2486	008	0	2022	Select Counties in Idaho		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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						05/25/2021	2022.01	05/25/2021 02:16:07 PM Eastern Daylight Time					06/04/2021 08:33:40 AM Eastern Daylight Time	HUMANA MEDICAL PLAN OF UTAH, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H2486	801	0	2022	Select counties in Utah		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242		(866)396-8810		(866)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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H2486	802	0	1	01	01	H2486_802_0	1	1				0	0	05/25/2021	2022.01	05/25/2021 02:18:25 PM Eastern Daylight Time					06/04/2021 08:33:40 AM Eastern Daylight Time	HUMANA MEDICAL PLAN OF UTAH, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H2486	802	0	2022	Select counties in Utah		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H2486	805	0	1	01	01	H2486_805_0	1	1						05/27/2021	2022.01	05/27/2021 03:29:15 PM Eastern Daylight Time					06/04/2021 08:33:40 AM Eastern Daylight Time	HUMANA MEDICAL PLAN OF UTAH, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H2486	805	0	2022	Select counties in Utah		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242		(866)396-8810		(866)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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					2				
H2486	806	0	1	01	01	H2486_806_0	1	1				0	0	05/27/2021	2022.01	05/27/2021 03:31:39 PM Eastern Daylight Time					06/04/2021 08:33:40 AM Eastern Daylight Time	HUMANA MEDICAL PLAN OF UTAH, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H2486	806	0	2022	Select counties in Utah		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					2				
H2491	004	0	1	01	01	H2491_004_0	3	1	2	1			0	08/03/2021	2022.01	08/03/2021 02:23:03 PM Central Daylight Time	08/03/2021 11:50:04 PM Eastern Daylight Time	07/30/2021 11:00:36 AM Eastern Daylight Time			08/04/2021 10:40:50 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Wellcare	www.wellcare.com/ohana	Wellcare 'Ohana Dual Liberty (HMO D-SNP)	01	01		1			H2491	004	0	2022	Select counties in HI		2	49797	2			1	3		1		1	www.wellcare.com/ohana	www.wellcare.com/ohana	www.wellcare.com/ohana	(877)457-7621		(877)457-7621		(844)917-0175		(844)917-0175		(877)457-7621		(877)457-7621		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2491	006	0	1	01	01	H2491_006_0	5	1	2	1			0	07/06/2021	2022.01	07/06/2021 12:34:20 PM Eastern Daylight Time	08/03/2021 11:50:30 PM Eastern Daylight Time	07/30/2021 11:00:54 AM Eastern Daylight Time			08/04/2021 10:52:49 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Access (HMO D-SNP)	01	01		1			H2491	006	0	2022	Select counties in LA		2	26332	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2491	007	0	1	01	01	H2491_007_0	4	1					0	08/01/2021	2022.01	08/01/2021 12:14:01 PM Pacific Daylight Time	08/03/2021 11:50:59 PM Eastern Daylight Time	07/30/2021 11:01:30 AM Eastern Daylight Time			08/04/2021 10:52:49 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO)	01	01		1			H2491	007	0	2022	Select counties in LA		2	44152	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2491	008	0	1	01	01	H2491_008_0	5	1	2	1			0	07/06/2021	2022.01	07/06/2021 12:36:24 PM Eastern Daylight Time	08/03/2021 11:51:27 PM Eastern Daylight Time	07/30/2021 11:01:50 AM Eastern Daylight Time			08/04/2021 10:52:49 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Liberty (HMO D-SNP)	01	01		1			H2491	008	0	2022	Select counties in LA		2	12909	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2491	009	0	1	01	01	H2491_009_0	4	1					0	08/03/2021	2022.01	08/03/2021 02:16:19 PM Central Daylight Time	08/03/2021 11:51:58 PM Eastern Daylight Time	07/30/2021 11:02:20 AM Eastern Daylight Time			08/04/2021 10:40:50 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Wellcare	www.wellcare.com/ohana	Wellcare 'Ohana No Premium (HMO)	01	01		1			H2491	009	0	2022	Select counties in HI		2	33616	2			2						www.wellcare.com/ohana	www.wellcare.com/ohana	www.wellcare.com/ohana	(877)457-7621		(877)457-7621		(844)917-0175		(844)917-0175		(877)457-7621		(877)457-7621		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	7a;7c;7d;7f;7g;7i;7j;7k;16b;17a;18a;	
H2491	010	0	1	01	01	H2491_010_0	4	1					0	06/03/2021	2022.01	06/03/2021 12:39:43 PM Pacific Daylight Time	08/04/2021 03:22:28 PM Eastern Daylight Time	07/30/2021 11:02:40 AM Eastern Daylight Time			08/04/2021 10:52:49 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Assist (HMO)	01	01		1			H2491	010	0	2022	Select counties in LA		2	30447	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2491	011	0	1	01	01	H2491_011_0	4	1	2	1			0	06/03/2021	2022.01	06/03/2021 10:46:03 AM Pacific Daylight Time	08/03/2021 11:52:51 PM Eastern Daylight Time	07/30/2021 11:03:00 AM Eastern Daylight Time			08/04/2021 10:52:49 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Freedom (HMO D-SNP)	01	01		1			H2491	011	0	2022	Select counties in LA		2	17231	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2491	012	0	1	01	01	H2491_012_0	4	1	2	1			0	06/03/2021	2022.01	06/03/2021 10:50:56 AM Pacific Daylight Time	08/03/2021 11:53:20 PM Eastern Daylight Time	07/30/2021 11:03:32 AM Eastern Daylight Time			08/04/2021 10:52:49 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Pinnacle (HMO D-SNP)	01	01		1			H2491	012	0	2022	Select counties in LA		2	47487	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2491	013	0	1	01	01	H2491_013_0	4	1					0	05/30/2021	2022.01	05/30/2021 11:14:20 AM Eastern Daylight Time	08/03/2021 11:53:48 PM Eastern Daylight Time	07/30/2021 11:04:16 AM Eastern Daylight Time			08/04/2021 10:40:50 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Wellcare	www.wellcare.com/ohana	Wellcare 'Ohana Plus (HMO)	01	01		1			H2491	013	0	2022	Select counties in HI		2	6073	2			2						www.wellcare.com/ohana	www.wellcare.com/ohana	www.wellcare.com/ohana	(877)457-7621		(877)457-7621		(844)917-0175		(844)917-0175		(877)457-7621		(877)457-7621		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2491	014	0	1	01	01	H2491_014_0	4	1					0	08/01/2021	2022.01	08/01/2021 12:16:00 PM Pacific Daylight Time	08/03/2021 11:54:16 PM Eastern Daylight Time	07/30/2021 11:04:58 AM Eastern Daylight Time			08/04/2021 10:52:49 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium Baton Rouge General (HMO)	01	01		1			H2491	014	0	2022	Select counties in LA		2	4198	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	7a;7c;7d;7f;7g;7i;7j;7k;8a1;8b1;9a1;9a2;9b;14e5;16b;17a;18a;	
H2491	015	0	1	01	01	H2491_015_0	4	1					0	08/03/2021	2022.01	08/03/2021 02:18:28 PM Central Daylight Time	08/03/2021 11:54:46 PM Eastern Daylight Time	07/30/2021 11:05:52 AM Eastern Daylight Time			08/04/2021 10:40:50 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Wellcare	www.wellcare.com/ohana	Wellcare 'Ohana No Premium (HMO)	01	01		1			H2491	015	0	2022	Select counties in HI		2	30051	2			2						www.wellcare.com/ohana	www.wellcare.com/ohana	www.wellcare.com/ohana	(877)457-7621		(877)457-7621		(844)917-0175		(844)917-0175		(877)457-7621		(877)457-7621		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2491	016	0	1	01	01	H2491_016_0	4	1					0	08/01/2021	2022.01	08/01/2021 12:17:23 PM Pacific Daylight Time	08/03/2021 11:55:14 PM Eastern Daylight Time	07/30/2021 11:06:12 AM Eastern Daylight Time			08/04/2021 10:52:49 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Endurance (HMO)	01	01		1			H2491	016	0	2022	Select counties in LA		2	10343	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2491	017	0	1	01	01	H2491_017_0	4	1					0	08/01/2021	2022.01	08/01/2021 12:19:05 PM Pacific Daylight Time	08/03/2021 11:55:45 PM Eastern Daylight Time	07/30/2021 11:06:32 AM Eastern Daylight Time			08/04/2021 10:52:49 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO)	01	01		1			H2491	017	0	2022	Select counties in LA		2	3446	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2491	018	0	1	01	01	H2491_018_0	3	1				0	0	06/03/2021	2022.01	06/03/2021 12:48:22 PM Pacific Daylight Time	06/04/2021 12:54:53 PM Eastern Daylight Time				07/19/2021 05:55:30 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Patriot No Premium (HMO)	01	01		1			H2491	018	0	2022	Select counties in LA		2	2241	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2506	001	0	1	48	05	H2506_001_0	2	1						07/15/2021	2022.01	07/15/2021 10:13:18 AM Eastern Daylight Time					07/15/2021 10:19:19 AM Eastern Daylight Time	Aetna Better Health Premier Plan MMAI Inc.	Aetna Better Health Premier Plan	www.aetnabetterhealth.com/illinois	Aetna Better Health Premier Plan (Medicare-Medicaid Plan)	05	48		1			H2506	001	0	2022	Illinois statewide		2	144264	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						07/14/2021	2022.01	07/14/2021 02:19:02 PM Mountain Daylight Time					07/14/2021 03:40:52 PM Mountain 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	2022	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	3	1						06/30/2021	2022.01	06/30/2021 09:37:03 AM Pacific Daylight Time					07/02/2021 10:20:54 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	2022	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	3	1						06/02/2021	2022.01	06/02/2021 02:05:09 PM Eastern Daylight Time		06/02/2021 01:59:30 PM Eastern Daylight Time			06/02/2021 02:10:08 PM Eastern Daylight Time	SPIRITRUST LUTHERAN LIFE	SpiriTrust Lutheran LIFE	www.spiritrustlutheranlife.org	SpiriTrust Lutheran LIFE - Dual (PACE)	08	20		1			H2537	001	0	2022	Franklin, Cumberland, Perry Counties		2		2			2						carekinesis.com	spiritrustlutheranlife.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	3	1						06/02/2021	2022.01	06/02/2021 01:52:18 PM Eastern Daylight Time		06/02/2021 01:59:30 PM Eastern Daylight Time			06/02/2021 02:10:08 PM Eastern Daylight Time	SPIRITRUST LUTHERAN LIFE	SpiriTrust Lutheran LIFE	www.spiritrustlutheranlife.org	SpiriTrust Lutheran LIFE  - Medicare Only (PACE)	08	20		1			H2537	002	0	2022	Franklin, Cumberland, Perry Counties		2		2			2						carekinesis.com	spiritrustlutheranlife.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	004	0	1	01	01	H2563_004_0	10	1	2	1	1		0	07/23/2021	2022.01	07/23/2021 04:02:57 PM Eastern Daylight Time	08/05/2021 09:20:12 AM Eastern Daylight Time	08/05/2021 09:20:12 AM Eastern Daylight Time			08/05/2021 12:25:26 PM Eastern Daylight Time	OPTIMA HEALTH PLAN	Optima Medicare	www.optimahealth.com/medicare	Optima Community Complete (HMO D-SNP)	01	01		1			H2563	004	0	2022	Virginia		2	213894	2			1	3		1		1	www.optimahealth.com	www.optimahealth.com/medicare	www.optimahealth.com/medicare	(800)927-6048		(800)927-6048		(844)563-4201		(844)563-4201		(800)927-6048		(800)927-6048		(844)563-4201		(844)563-4201		(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	11	1			1		0	07/29/2021	2022.01	07/29/2021 12:36:44 PM Eastern Daylight Time	08/05/2021 09:20:12 AM Eastern Daylight Time	08/05/2021 09:20:12 AM Eastern Daylight Time			08/05/2021 12:25:26 PM Eastern Daylight Time	OPTIMA HEALTH PLAN	Optima Medicare	www.optimahealth.com/medicare	Optima Medicare Prime (HMO)	01	01		1			H2563	005	1	2022	Greater Hampton Roads, Virginia	Greater Hampton Roads, VA - Southside	2	14283	2			2						www.optimahealth.com	www.optimahealth.com/medicare	www.optimahealth.com/medicare	(800)927-6048		(800)927-6048		(844)563-4201		(844)563-4201		(800)927-6048		(800)927-6048		(844)563-4201		(844)563-4201		(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	11	1			1		0	07/16/2021	2022.01	07/16/2021 08:27:17 PM Eastern Daylight Time	08/05/2021 09:20:12 AM Eastern Daylight Time	08/05/2021 09:20:12 AM Eastern Daylight Time			08/05/2021 12:25:26 PM Eastern Daylight Time	OPTIMA HEALTH PLAN	Optima Medicare	www.optimahealth.com/medicare	Optima Medicare Prime (HMO)	01	01		1			H2563	005	2	2022	Greater Hampton Roads, Virginia	Greater Hampton Roads, VA - Peninsula	2	2113	2			2						www.optimahealth.com	www.optimahealth.com/medicare	www.optimahealth.com/medicare	(800)927-6048		(800)927-6048		(844)563-4201		(844)563-4201		(800)927-6048		(800)927-6048		(844)563-4201		(844)563-4201		(800)828-1140		(711)-		(800)828-1140		(711)-		(800)828-1140		(711)-		(800)828-1140		(711)-		2					2					2	2			
H2563	008	0	1	01	01	H2563_008_0	11	1			1		1	08/04/2021	2022.01	08/04/2021 02:46:26 PM Eastern Daylight Time	08/05/2021 09:20:12 AM Eastern Daylight Time	08/05/2021 09:20:12 AM Eastern Daylight Time			08/05/2021 12:25:26 PM Eastern Daylight Time	OPTIMA HEALTH PLAN	Optima Medicare	www.optimahealth.com/medicare	Optima Medicare Value (HMO)	01	01		1			H2563	008	0	2022	Northern Virginia		2	11840	2			2						www.optimahealth.com	www.optimahealth.com/medicare	www.optimahealth.com/medicare	(800)927-6048		(800)927-6048		(844)563-4201		(844)563-4201		(800)927-6048		(800)927-6048		(844)563-4201		(844)563-4201		(800)828-1140		(711)-		(800)828-1140		(711)-		(800)828-1140		(711)-		(800)828-1140		(711)-		2					2					2	2			
H2563	009	0	1	01	01	H2563_009_0	11	1			1		1	08/04/2021	2022.01	08/04/2021 02:50:28 PM Eastern Daylight Time	08/05/2021 09:20:12 AM Eastern Daylight Time	08/05/2021 09:20:12 AM Eastern Daylight Time			08/05/2021 12:25:26 PM Eastern Daylight Time	OPTIMA HEALTH PLAN	Optima Medicare	www.optimahealth.com/medicare	Optima Medicare Value (HMO)	01	01		1			H2563	009	0	2022	Central Virginia		2	33723	2			2						www.optimahealth.com	www.optimahealth.com/medicare	www.optimahealth.com/medicare	(800)927-6048		(800)927-6048		(844)563-4201		(844)563-4201		(800)927-6048		(800)927-6048		(844)563-4201		(844)563-4201		(800)828-1140		(711)-		(800)828-1140		(711)-		(800)828-1140		(711)-		(800)828-1140		(711)-		2					2					2	2			
H2563	012	0	1	01	01	H2563_012_0	10	1			1		0	07/16/2021	2022.01	07/16/2021 08:27:45 PM Eastern Daylight Time	08/05/2021 09:20:12 AM Eastern Daylight Time	08/05/2021 09:20:12 AM Eastern Daylight Time			08/05/2021 12:25:26 PM Eastern Daylight Time	OPTIMA HEALTH PLAN	Optima Medicare	www.optimahealth.com/medicare	Optima Medicare Prime (HMO)	01	01		1			H2563	012	0	2022	Northern Virginia		2	450	2			2						www.optimahealth.com	www.optimahealth.com/medicare	www.optimahealth.com/medicare	(800)927-6048		(800)927-6048		(844)563-4201		(844)563-4201		(800)927-6048		(800)927-6048		(844)563-4201		(844)563-4201		(800)828-1140		(711)-		(800)828-1140		(711)-		(800)828-1140		(711)-		(800)828-1140		(711)-		2					2					2	2			
H2563	013	0	1	01	01	H2563_013_0	10	1			1		0	07/16/2021	2022.01	07/16/2021 08:27:57 PM Eastern Daylight Time	08/05/2021 09:20:12 AM Eastern Daylight Time	08/05/2021 09:20:12 AM Eastern Daylight Time			08/05/2021 12:25:26 PM Eastern Daylight Time	OPTIMA HEALTH PLAN	Optima Medicare	www.optimahealth.com/medicare	Optima Medicare Prime (HMO)	01	01		1			H2563	013	0	2022	Central Virginia		2	1231	2			2						www.optimahealth.com	www.optimahealth.com/medicare	www.optimahealth.com/medicare	(800)927-6048		(800)927-6048		(844)563-4201		(844)563-4201		(800)927-6048		(800)927-6048		(844)563-4201		(844)563-4201		(800)828-1140		(711)-		(800)828-1140		(711)-		(800)828-1140		(711)-		(800)828-1140		(711)-		2					2					2	2			
H2563	014	0	1	01	01	H2563_014_0	7	1			2	0	0	07/16/2021	2022.01	07/16/2021 08:30:21 PM Eastern Daylight Time	06/04/2021 07:29:33 PM Eastern Daylight Time				07/22/2021 03:41:53 PM Eastern Daylight Time	OPTIMA HEALTH PLAN	Optima Medicare	www.optimahealth.com/medicare	Optima Medicare Salute (HMO)	01	01		1			H2563	014	0	2022	Virginia		2	6143	2			2						www.optimahealth.com	www.optimahealth.com/medicare	www.optimahealth.com/medicare	(800)927-6048		(800)927-6048		(844)563-4201		(844)563-4201										(800)828-1140		(711)-		(800)828-1140		(711)-										2					2					2	2			
H2563	015	0	1	01	01	H2563_015_0	11	1			1		1	08/04/2021	2022.01	08/04/2021 02:52:48 PM Eastern Daylight Time	08/05/2021 09:20:12 AM Eastern Daylight Time	08/05/2021 09:20:12 AM Eastern Daylight Time			08/05/2021 12:25:26 PM Eastern Daylight Time	OPTIMA HEALTH PLAN	Optima Medicare	www.optimhealth.com/medicare	Optima Medicare Value (HMO)	01	01		1			H2563	015	0	2022	Southwest Virginia		2	2144	2			2						www.optimahealth.com	www.optimhealth.com/medicare	www.optimahealth.com/medicare	(800)927-6048		(800)927-6048		(844)563-4201		(844)563-4201		(800)927-6048		(800)927-6048		(844)563-4201		(844)563-4201		(800)828-1140		(711)-		(800)828-1140		(711)-		(800)828-1140		(711)-		(800)828-1140		(711)-		2					2					2	2			
H2563	016	0	1	01	01	H2563_016_0	11	1			1		1	08/04/2021	2022.01	08/04/2021 02:54:41 PM Eastern Daylight Time	08/05/2021 09:20:12 AM Eastern Daylight Time	08/05/2021 09:20:12 AM Eastern Daylight Time			08/05/2021 12:25:26 PM Eastern Daylight Time	OPTIMA HEALTH PLAN	Optima Medicare	www.optimahealth.com/medicare	Optima Medicare Value (HMO)	01	01		1			H2563	016	0	2022	Roanoke/ Alleghany and surrounding counties		2	16674	2			2						www.optimahealth.com	www.optimahealth.com/medicare	www.optimahealth.com/medicare	(800)927-6048		(800)927-6048		(844)563-4201		(844)563-4201		(800)927-6048		(800)927-6048		(844)563-4201		(844)563-4201		(800)828-1140		(711)-		(800)828-1140		(711)-		(800)828-1140		(711)-		(800)828-1140		(711)-		2					2					2	2			
H2563	017	1	1	01	01	H2563_017_1	11	1			1		1	08/05/2021	2022.01	08/05/2021 12:24:11 PM Eastern Daylight Time	08/05/2021 09:20:12 AM Eastern Daylight Time	08/05/2021 09:20:12 AM Eastern Daylight Time			08/05/2021 12:25:26 PM Eastern Daylight Time	OPTIMA HEALTH PLAN	Optima Medicare	www.optimahealth.com/medicare	Optima Medicare Value (HMO)	01	01		1			H2563	017	1	2022	Greater Hampton Roads, Virginia	Greater Hampton Roads, VA - Southside	2	95955	2			2						www.optimahealth.com	www.optimahealth.com/medicare	www.optimahealth.com/medicare	(800)927-6048		(800)927-6048		(844)563-4201		(844)563-4201		(800)927-6048		(800)927-6048		(844)563-4201		(844)563-4201		(800)828-1140		(711)-		(800)828-1140		(711)-		(800)828-1140		(711)-		(800)828-1140		(711)-		2					2					2	2			
H2563	017	2	1	01	01	H2563_017_2	11	1			1		1	08/05/2021	2022.01	08/05/2021 12:24:20 PM Eastern Daylight Time	08/05/2021 09:20:12 AM Eastern Daylight Time	08/05/2021 09:20:12 AM Eastern Daylight Time			08/05/2021 12:25:26 PM Eastern Daylight Time	OPTIMA HEALTH PLAN	Optima Medicare	www.optimahealth.com/medicare	Optima Medicare Value (HMO)	01	01		1			H2563	017	2	2022	Greater Hampton Roads, Virginia	Greater Hampton Roads, VA - Peninsula	2	21695	2			2						www.optimahealth.com	www.optimahealth.com/medicare	www.optimahealth.com/medicare	(800)927-6048		(800)927-6048		(844)563-4201		(844)563-4201		(800)927-6048		(800)927-6048		(844)563-4201		(844)563-4201		(800)828-1140		(711)-		(800)828-1140		(711)-		(800)828-1140		(711)-		(800)828-1140		(711)-		2					2					2	2			
H2563	801	0	1	01	01	H2563_801_0	2	1						06/04/2021	2022.01	06/04/2021 09:13:37 AM Eastern Daylight Time					06/04/2021 07:35:25 PM Eastern Daylight Time	OPTIMA HEALTH PLAN	Optima Medicare	www.optimahealth.com/medicare	Optima Medicare - MAPD Calendar Year (HMO)	01	01		1			H2563	801	0	2022	Virginia		1	100	2			2						www.optimahealth.com	www.optimahealth.com/medicare	www.optimahealth.com/medicare	(800)927-6048		(800)927-6048		(844)563-4201		(844)563-4201		(800)927-6048		(800)927-6048		(844)563-4201		(844)563-4201		(800)828-1140		(711)-		(800)828-1140		(711)-		(800)828-1140		(711)-		(800)828-1140		(711)-		2					2					2	2			
H2563	802	0	1	01	01	H2563_802_0	2	1						04/16/2021	2022.01	04/16/2021 03:19:59 PM Eastern Daylight Time					06/04/2021 07:35:25 PM Eastern Daylight Time	OPTIMA HEALTH PLAN	Optima Medicare	www.optimahealth.com/medicare	Optima Medicare - MAPD Non-Calendar Year (HMO)	01	01		1			H2563	802	0	2022	Virginia		1	100	2			2						www.optimahealth.com	www.optimahealth.com/medicare	www.optimahealth.com/medicare	(800)927-6048		(800)927-6048		(844)563-4201		(844)563-4201		(800)927-6048		(800)927-6048		(844)563-4201		(844)563-4201		(800)828-1140		(711)-		(800)828-1140		(711)-		(800)828-1140		(711)-		(800)828-1140		(711)-		2					2					2	2			
H2563	803	0	1	01	01	H2563_803_0	2	1				0	0	04/16/2021	2022.01	04/16/2021 03:23:14 PM Eastern Daylight Time					06/04/2021 07:35:25 PM Eastern Daylight Time	OPTIMA HEALTH PLAN	Optima Medicare	www.optimahealth.com/medicare	Optima Medicare - MA Only Calendar Year (HMO)	01	01		1			H2563	803	0	2022	Virginia		1	100	2			2						www.optimahealth.com	www.optimahealth.com/medicare	www.optimahealth.com/medicare	(800)927-6048		(800)927-6048		(844)563-4201		(844)563-4201										(800)828-1140		(711)-		(800)828-1140		(711)-										2					2					2	2			
H2563	804	0	1	01	01	H2563_804_0	2	1				0	0	04/16/2021	2022.01	04/16/2021 03:26:45 PM Eastern Daylight Time					06/04/2021 07:35:25 PM Eastern Daylight Time	OPTIMA HEALTH PLAN	Optima Medicare	www.optimahealth.com/medicare	Optima Medicare - MA Only Non-Calendar Year (HMO)	01	01		1			H2563	804	0	2022	Virginia		1	100	2			2						www.optimahealth.com	www.optimahealth.com/medicare	www.optimahealth.com/medicare	(800)927-6048		(800)927-6048		(844)563-4201		(844)563-4201										(800)828-1140		(711)-		(800)828-1140		(711)-										2					2					2	2			
H2577	001	1	1	04	01	H2577_001_1	3	1					1	08/04/2021	2022.01	08/04/2021 10:44:57 AM Central Daylight Time	08/03/2021 12:36:06 PM Central Daylight Time	07/29/2021 08:08:46 PM Central Daylight Time			08/04/2021 08:05:11 PM Central Daylight Time	CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 1 (PPO)	01	04		1			H2577	001	1	2022	Select counties in Colorado	Larimer and Weld 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			
H2577	001	2	1	04	01	H2577_001_2	3	1					1	08/04/2021	2022.01	08/04/2021 10:46:17 AM Central Daylight Time	08/03/2021 12:36:47 PM Central Daylight Time	07/29/2021 08:09:00 PM Central Daylight Time			08/04/2021 08:05:11 PM Central Daylight Time	CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 1 (PPO)	01	04		1			H2577	001	2	2022	Select counties in Colorado	El Paso, Fremont, Pueblo, and Teller 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			
H2577	002	0	1	04	01	H2577_002_0	3	1					1	08/04/2021	2022.01	08/04/2021 10:47:24 AM Central Daylight Time	08/03/2021 12:37:26 PM Central Daylight Time	07/29/2021 08:09:16 PM Central Daylight Time			08/04/2021 08:05:11 PM Central Daylight Time	CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Walgreens (PPO)	01	04		1			H2577	002	0	2022	Select counties in Denver		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			
H2577	003	1	1	04	01	H2577_003_1	3	1					1	08/04/2021	2022.01	08/04/2021 10:48:38 AM Central Daylight Time	08/03/2021 12:38:09 PM Central Daylight Time	07/29/2021 08:09:31 PM Central Daylight Time			08/04/2021 08:05:11 PM Central Daylight Time	CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 2 (PPO)	01	04		1			H2577	003	1	2022	Select counties in Colorado	Larimer and Weld 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			
H2577	003	2	1	04	01	H2577_003_2	3	1					1	08/04/2021	2022.01	08/04/2021 10:49:40 AM Central Daylight Time	08/03/2021 12:38:54 PM Central Daylight Time	07/29/2021 08:09:47 PM Central Daylight Time			08/04/2021 08:05:11 PM Central Daylight Time	CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 2 (PPO)	01	04		1			H2577	003	2	2022	Select counties in Colorado	El Paso, Fremont, Pueblo, and Teller 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			
H2577	004	0	1	04	01	H2577_004_0	3	1					1	08/04/2021	2022.01	08/04/2021 09:41:24 AM Central Daylight Time	08/03/2021 12:39:35 PM Central Daylight Time	07/29/2021 08:10:03 PM Central Daylight Time			08/04/2021 04:21:31 PM Central Daylight Time	CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H2577	004	0	2022	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			
H2577	005	0	1	04	01	H2577_005_0	3	1					1	08/04/2021	2022.01	08/04/2021 09:39:31 AM Central Daylight Time	08/03/2021 07:44:39 PM Central Daylight Time	07/29/2021 08:10:19 PM Central Daylight Time			08/04/2021 04:21:31 PM Central Daylight Time	CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Walgreens (PPO)	01	04		1			H2577	005	0	2022	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		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2577	006	0	1	04	01	H2577_006_0	3	1					1	08/04/2021	2022.01	08/04/2021 09:37:47 AM Central Daylight Time	08/03/2021 07:45:10 PM Central Daylight Time	07/29/2021 08:10:35 PM Central Daylight Time			08/04/2021 04:21:31 PM Central Daylight Time	CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 1 (PPO)	01	04		1			H2577	006	0	2022	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		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2577	007	0	1	04	01	H2577_007_0	3	1					1	08/04/2021	2022.01	08/04/2021 10:40:42 AM Central Daylight Time	08/03/2021 12:41:33 PM Central Daylight Time	07/29/2021 08:10:50 PM Central Daylight Time			08/04/2021 01:59:15 PM Central Daylight Time	CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Walgreens (PPO)	01	04		1			H2577	007	0	2022	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			
H2577	008	0	1	04	01	H2577_008_0	3	1					1	08/04/2021	2022.01	08/04/2021 10:38:40 AM Central Daylight Time	08/03/2021 12:42:12 PM Central Daylight Time	07/29/2021 08:11:06 PM Central Daylight Time			08/04/2021 01:59:15 PM Central Daylight Time	CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Walgreens (PPO)	01	04		1			H2577	008	0	2022	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			
H2577	009	0	1	04	01	H2577_009_0	3	1					1	08/04/2021	2022.01	08/04/2021 09:36:08 AM Central Daylight Time	08/03/2021 12:42:53 PM Central Daylight Time	07/29/2021 08:11:21 PM Central Daylight Time			08/04/2021 04:21:31 PM Central Daylight Time	CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Walgreens (PPO)	01	04		1			H2577	009	0	2022	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			
H2577	011	0	1	04	01	H2577_011_0	3	1					1	08/04/2021	2022.01	08/04/2021 09:34:16 AM Central Daylight Time	08/03/2021 12:43:31 PM Central Daylight Time	07/29/2021 08:11:36 PM Central Daylight Time			08/04/2021 04:21:31 PM Central Daylight Time	CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H2577	011	0	2022	Tidewater 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			
H2577	013	0	1	04	01	H2577_013_0	3	1					1	08/04/2021	2022.01	08/04/2021 09:26:37 AM Central Daylight Time	08/03/2021 12:44:11 PM Central Daylight Time	07/29/2021 08:11:51 PM Central Daylight Time			08/04/2021 04:21:31 PM Central Daylight Time	CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H2577	013	0	2022	Richmond 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			
H2577	014	0	1	04	01	H2577_014_0	3	1					1	08/04/2021	2022.01	08/04/2021 09:23:27 AM Central Daylight Time	08/03/2021 12:44:51 PM Central Daylight Time	07/29/2021 08:12:08 PM Central Daylight Time			08/04/2021 04:21:31 PM Central Daylight Time	CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H2577	014	0	2022	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			
H2577	015	0	1	04	01	H2577_015_0	2	1				0	0	07/15/2021	2022.01	07/15/2021 03:57:27 PM Central Daylight Time	06/03/2021 03:01:45 PM Central Daylight Time				07/16/2021 12:36:20 PM Central Daylight Time	CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (PPO)	01	04		1			H2577	015	0	2022	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										(711)-		(711)-		(711)-		(711)-										2					2						2			
H2577	016	0	1	04	01	H2577_016_0	3	1					1	08/04/2021	2022.01	08/04/2021 09:17:41 AM Central Daylight Time	08/03/2021 12:45:30 PM Central Daylight Time	07/29/2021 08:12:23 PM Central Daylight Time			08/04/2021 04:21:31 PM Central Daylight Time	CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H2577	016	0	2022	Asheville 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			
H2577	017	0	1	04	01	H2577_017_0	3	1					1	08/04/2021	2022.01	08/04/2021 09:13:55 AM Central Daylight Time	08/03/2021 12:46:10 PM Central Daylight Time	07/29/2021 08:12:39 PM Central Daylight Time			08/04/2021 04:21:31 PM Central Daylight Time	CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H2577	017	0	2022	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			
H2577	018	0	1	04	01	H2577_018_0	3	1					1	08/04/2021	2022.01	08/04/2021 09:10:22 AM Central Daylight Time	08/03/2021 12:46:50 PM Central Daylight Time	07/29/2021 08:12:52 PM Central Daylight Time			08/04/2021 04:21:31 PM Central Daylight Time	CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 2 (PPO)	01	04		1			H2577	018	0	2022	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			
H2577	019	0	1	04	01	H2577_019_0	2	1				0	0	07/15/2021	2022.01	07/15/2021 03:57:17 PM Central Daylight Time	06/03/2021 03:04:03 PM Central Daylight Time				07/16/2021 12:36:20 PM Central Daylight Time	CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (PPO)	01	04		1			H2577	019	0	2022	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			
H2577	020	0	1	04	01	H2577_020_0	3	1					1	08/04/2021	2022.01	08/04/2021 10:37:14 AM Central Daylight Time	08/03/2021 12:47:29 PM Central Daylight Time	07/29/2021 08:13:07 PM Central Daylight Time			08/04/2021 01:59:15 PM Central Daylight Time	CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANY	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Medicare Advantage Choice (PPO)	01	04		1			H2577	020	0	2022	Select Counties for Tennessee & Virginia		2		2			2						www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.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			
H2577	021	0	1	04	01	H2577_021_0	4	1					1	08/17/2021	2022.01	08/17/2021 10:58:00 AM Central Daylight Time	08/03/2021 07:45:43 PM Central Daylight Time	07/29/2021 08:13:22 PM Central Daylight Time			08/17/2021 11:01:29 AM Central Daylight Time	CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 1 (PPO)	01	04		1			H2577	021	0	2022	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			
H2577	022	0	1	04	01	H2577_022_0	4	1					1	08/04/2021	2022.01	08/04/2021 10:51:14 AM Central Daylight Time	08/03/2021 08:47:35 PM Central Daylight Time	07/29/2021 08:13:37 PM Central Daylight Time			08/04/2021 08:05:11 PM Central Daylight Time	CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage ChoicePlan 3 (PPO)	01	04		1			H2577	022	0	2022	Select Counties in Colorado		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			
H2577	023	0	1	04	01	H2577_023_0	4	1					1	08/04/2021	2022.01	08/04/2021 10:52:31 AM Central Daylight Time	08/03/2021 08:48:06 PM Central Daylight Time	07/29/2021 08:13:52 PM Central Daylight Time			08/04/2021 08:05:11 PM Central Daylight Time	CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage ChoicePlan 3 (PPO)	01	04		1			H2577	023	0	2022	Select Counties in Colorado		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			
H2577	026	0	1	04	01	H2577_026_0	3	1					1	08/04/2021	2022.01	08/04/2021 09:03:23 AM Central Daylight Time	08/03/2021 07:46:15 PM Central Daylight Time	07/29/2021 08:14:07 PM Central Daylight Time			08/04/2021 04:21:31 PM Central Daylight Time	CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 2 (PPO)	01	04		1			H2577	026	0	2022	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		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2577	027	0	1	04	01	H2577_027_0	3	1					1	08/04/2021	2022.01	08/04/2021 09:01:22 AM Central Daylight Time	08/03/2021 12:50:58 PM Central Daylight Time	07/29/2021 08:14:22 PM Central Daylight Time			08/04/2021 04:21:31 PM Central Daylight Time	CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H2577	027	0	2022	Roanoke 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			
H2577	028	0	1	04	01	H2577_028_0	3	1					1	08/04/2021	2022.01	08/04/2021 02:38:58 PM Central Daylight Time	08/03/2021 07:46:46 PM Central Daylight Time	07/29/2021 08:14:37 PM Central Daylight Time			08/05/2021 03:47:40 PM Central Daylight Time	CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H2577	028	0	2022	Central 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			
H2577	029	0	1	04	01	H2577_029_0	4	1					1	08/17/2021	2022.01	08/17/2021 10:59:02 AM Central Daylight Time	08/03/2021 07:47:18 PM Central Daylight Time	07/29/2021 08:14:52 PM Central Daylight Time			08/17/2021 11:01:29 AM Central Daylight Time	CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 2 (PPO)	01	04		1			H2577	029	0	2022	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			
H2582	002	0	1	01	01	H2582_002_0	4	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 11:43:33 AM Central Daylight Time	08/03/2021 12:46:34 PM Central Daylight Time	07/29/2021 08:15:07 PM Central Daylight Time			08/04/2021 08:05:11 PM Central Daylight Time	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	UnitedHealthcare	www.rmhpdualcare.org	Rocky Mountain Health Plans DualCare Plus (HMO D-SNP)	01	01		1			H2582	002	0	2022	Select Counties in Western Colorado		2		2			1	3		1		1	www.rmhpdualcare.org	www.rmhpdualcare.org	www.rmhpdualcare.org	(800)346-4643		(800)346-4643		(888)834-3721		(888)834-3721		(800)346-4643		(800)346-4643		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2582	004	0	1	01	01	H2582_004_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 11:44:38 AM Central Daylight Time	08/03/2021 12:47:11 PM Central Daylight Time	07/29/2021 08:15:23 PM Central Daylight Time			08/04/2021 08:05:11 PM Central Daylight Time	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	UnitedHealthcare	www.rmhpMedicare.org	Rocky Mountain Health Plans CareAdvantage Value (HMO)	01	01		1			H2582	004	0	2022	Select Counties in Western Colorado		2		2			2						www.rmhpMedicare.org	www.rmhpMedicare.org	www.rmhpMedicare.org	(800)346-4643		(800)346-4643		(800)555-5757		(800)555-5757		(800)346-4643		(800)346-4643		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2582	005	0	1	01	01	H2582_005_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 11:45:41 AM Central Daylight Time	08/03/2021 12:47:46 PM Central Daylight Time	07/29/2021 08:15:39 PM Central Daylight Time			08/04/2021 08:05:11 PM Central Daylight Time	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	UnitedHealthcare	www.rmhpMedicare.org	Rocky Mountain Health Plans CareAdvantage Enhanced (HMO)	01	01		1			H2582	005	0	2022	Select Counties in Western Colorado		2		2			2						www.rmhpMedicare.org	www.rmhpMedicare.org	www.rmhpMedicare.org	(800)346-4643		(800)346-4643		(800)555-5757		(800)555-5757		(800)346-4643		(800)346-4643		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2591	801	0	1	04	01	H2591_801_0	4	1				0	0	04/20/2021	2022.01	04/20/2021 04:44:51 PM US Eastern Daylight Time					06/06/2021 01:28:52 PM Eastern Daylight Time	HEALTH ALLIANCE - MIDWEST, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Medicare Employer PPO (PPO)	01	04		1			H2591	801	0	2022	Health Alliance Medicare		1	0	1	1		2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)917-8550		(877)917-8550		(877)933-8454		(877)933-8454										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;7b;7c;7i;8a;8b1;8b2;9a1;9a2;9b;10a;11a;11b;15;	1	2;	1									
H2591	802	0	1	04	01	H2591_802_0	4	1						04/20/2021	2022.01	04/20/2021 04:44:02 PM US Eastern Daylight Time					06/06/2021 01:28:52 PM Eastern Daylight Time	HEALTH ALLIANCE - MIDWEST, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Health Alliance Medicare (PPO)	01	04		1			H2591	802	0	2022	Health Alliance Medicare		1	4796	1	1		2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.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	1	1a;1b;2;5;7b;7c;7i;8a;8b1;8b2;9a1;9a2;9b;10a;11a;11b;15;	1	2;	1									
H2591	803	0	1	04	01	H2591_803_0	4	1						04/20/2021	2022.01	04/20/2021 04:47:55 PM US Eastern Daylight Time					06/06/2021 01:28:52 PM Eastern Daylight Time	HEALTH ALLIANCE - MIDWEST, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Health Alliance Medicare (non calendar) (PPO)	01	04		1			H2591	803	0	2022	Health Alliance Medicare  (non calendar)		1	0	1	1		2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.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	1	1a;1b;2;5;7b;7c;7i;8a;8b1;8b2;9a1;9a2;9b;10a;11a;11b;15;	1	2;	1									
H2593	001	0	1	01	01	H2593_001_0	7	1			2		0	07/18/2021	2022.01	07/18/2021 01:48:36 PM Pacific Daylight Time	08/03/2021 06:04:08 PM Eastern Daylight Time	08/03/2021 06:04:08 PM Eastern Daylight Time			08/04/2021 01:51:40 PM Eastern Daylight Time	AMERIGROUP TEXAS, INC.	Amerigroup	shop.amerigroup.com/medicare	Amerivantage Classic (HMO)	01	01		1			H2593	001	0	2022	Pima County		2		2			2						www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare	(888)816-2790		(888)816-2790		(855)593-0913		(855)593-0913		(833)337-1266		(833)337-1266		(855)485-0934		(855)485-0934		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	003	0	1	01	01	H2593_003_0	6	1		1	2		0	06/04/2021	2022.01	06/04/2021 03:29:56 PM Eastern Daylight Time	08/03/2021 06:04:08 PM Eastern Daylight Time	08/03/2021 06:04:08 PM Eastern Daylight Time			08/04/2021 01:51:40 PM Eastern Daylight Time	AMERIGROUP TEXAS, INC.	Amerigroup	shop.amerigroup.com/medicare	Amerivantage Comfort (HMO I-SNP)	01	01		1			H2593	003	0	2022	Pima County		2		2			1	1	3				www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare	(888)816-2790		(888)816-2790		(855)593-0914		(855)593-0914		(833)337-1266		(833)337-1266		(855)485-0935		(855)485-0935		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	005	0	1	01	01	H2593_005_0	6	1		1	2		0	07/18/2021	2022.01	07/18/2021 01:49:45 PM Pacific Daylight Time	08/03/2021 06:04:08 PM Eastern Daylight Time	08/03/2021 06:04:08 PM Eastern Daylight Time			08/04/2021 01:51:40 PM Eastern Daylight Time	AMERIGROUP TEXAS, INC.	Amerigroup	//shop.amerigroup.com/medicare	Amerivantage Lung Care (HMO C-SNP)	01	01		1			H2593	005	0	2022	Pima County		2		2			1	4			00000000000100000000		www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare	(888)816-2790		(888)816-2790		(855)593-0915		(855)593-0915		(833)337-1266		(833)337-1266		(855)485-0936		(855)485-0936		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	006	0	1	01	01	H2593_006_0	6	1		1	2		0	07/18/2021	2022.01	07/18/2021 01:49:54 PM Pacific Daylight Time	08/03/2021 06:04:08 PM Eastern Daylight Time	08/03/2021 06:04:08 PM Eastern Daylight Time			08/04/2021 01:51:40 PM Eastern Daylight Time	AMERIGROUP TEXAS, INC.	Amerigroup	shop.amerigroup.com/medicare	Amerivantage Diabetes Care (HMO C-SNP)	01	01		1			H2593	006	0	2022	Pima County		2		2			1	4			00000010000000000000		www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare	(888)816-2790		(888)816-2790		(855)593-0915		(855)593-0915		(833)337-1266		(833)337-1266		(855)485-0936		(855)485-0936		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	013	0	1	01	01	H2593_013_0	6	1		1	2		0	07/18/2021	2022.01	07/18/2021 01:50:04 PM Pacific Daylight Time	08/03/2021 06:04:08 PM Eastern Daylight Time	08/03/2021 06:04:08 PM Eastern Daylight Time			08/04/2021 01:51:40 PM Eastern Daylight Time	AMERIGROUP TEXAS, INC.	Amerigroup	shop.amerigroup.com/medicare	Amerivantage Heart Care (HMO C-SNP)	01	01		1			H2593	013	0	2022	Pima County		2		2			1	4			00000000000000010000		www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare	(888)816-2790		(888)816-2790		(855)593-0915		(855)593-0915		(833)337-1266		(833)337-1266		(855)485-0936		(855)485-0936		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	018	0	1	01	01	H2593_018_0	6	1			2		0	07/18/2021	2022.01	07/18/2021 01:51:15 PM Pacific Daylight Time	08/03/2021 06:04:08 PM Eastern Daylight Time	08/03/2021 06:04:08 PM Eastern Daylight Time			08/04/2021 01:51:40 PM Eastern Daylight Time	AMERIGROUP TEXAS, INC.	Amerigroup	shop.amerigroup.com/medicare	Amerivantage Smart Value (HMO)	01	01		1			H2593	018	0	2022	Pima County		2		2			2						www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare	(888)816-2790		(888)816-2790		(855)593-0913		(855)593-0913		(833)337-1266		(833)337-1266		(855)485-0934		(855)485-0934		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	019	0	1	01	01	H2593_019_0	6	1		1	2		0	07/18/2021	2022.01	07/18/2021 01:51:26 PM Pacific Daylight Time	08/03/2021 06:04:08 PM Eastern Daylight Time	08/03/2021 06:04:08 PM Eastern Daylight Time			08/04/2021 01:51:40 PM Eastern Daylight Time	AMERIGROUP TEXAS, INC.	Amerigroup	shop.amerigroup.com/medicare	Amerivantage Comfort (HMO I-SNP)	01	01		1			H2593	019	0	2022	Maricopa County		2		2			1	1	3				www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare	(888)816-2790		(888)816-2790		(855)593-0914		(855)593-0914		(833)337-1266		(833)337-1266		(855)485-0935		(855)485-0935		(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	1		0	08/02/2021	2022.01	08/02/2021 12:31:17 PM Eastern Daylight Time	08/03/2021 06:03:59 PM Eastern Daylight Time	08/03/2021 06:03:59 PM Eastern Daylight Time			08/04/2021 02:00:52 PM Eastern Daylight Time	AMERIGROUP TEXAS, INC.	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Dual Coordination (HMO D-SNP)	01	01		1			H2593	021	0	2022	Select Counties in Tennessee		2		2			1	3		1		1	www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare	(877)411-0929		(877)411-0929		(855)593-0916		(855)593-0916		(833)337-1265		(833)337-1265		(855)485-0937		(855)485-0937		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	022	0	1	01	01	H2593_022_0	7	1			2		0	08/04/2021	2022.01	08/04/2021 10:10:27 AM Eastern Daylight Time	08/04/2021 02:07:51 PM Eastern Daylight Time	08/03/2021 06:03:59 PM Eastern Daylight Time			08/04/2021 06:33:23 PM Eastern Daylight Time	AMERIGROUP TEXAS, INC.	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Classic (HMO)	01	01		1			H2593	022	0	2022	Select Counties in Tennessee		2		2			2						www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare	(866)805-4589		(866)805-4589		(855)593-0913		(855)593-0913		(833)293-5476		(833)293-5476		(855)485-0934		(855)485-0934		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	023	0	1	01	01	H2593_023_0	9	1			2		0	08/02/2021	2022.01	08/02/2021 12:31:50 PM Eastern Daylight Time	08/03/2021 06:03:59 PM Eastern Daylight Time	08/03/2021 06:03:59 PM Eastern Daylight Time			08/04/2021 02:00:52 PM Eastern Daylight Time	AMERIGROUP TEXAS, INC.	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Classic (HMO)	01	01		1			H2593	023	0	2022	Select Counties in Tennessee		2		2			2						www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare	(866)805-4589		(866)805-4589		(855)593-0913		(855)593-0913		(833)293-5476		(833)293-5476		(855)485-0934		(855)485-0934		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	025	0	1	01	01	H2593_025_0	9	1			2		0	08/02/2021	2022.01	08/02/2021 08:48:00 AM Eastern Daylight Time	08/03/2021 06:03:59 PM Eastern Daylight Time	08/03/2021 06:03:59 PM Eastern Daylight Time			08/04/2021 02:00:52 PM Eastern Daylight Time	AMERIGROUP TEXAS, INC.	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Balance (HMO)	01	01		1			H2593	025	0	2022	Select Counties in Tennessee		2		2			2						www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare	(866)805-4589		(866)805-4589		(855)593-0913		(855)593-0913		(833)293-5476		(833)293-5476		(855)485-0934		(855)485-0934		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	029	0	1	01	01	H2593_029_0	8	1			2		0	08/04/2021	2022.01	08/04/2021 09:16:09 AM Pacific Daylight Time	08/04/2021 11:08:49 AM Pacific Daylight Time	08/03/2021 03:04:03 PM Pacific Daylight Time			08/04/2021 01:36:04 PM Pacific Daylight Time	AMERIGROUP TEXAS, INC.	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Classic (HMO)	01	01		1			H2593	029	0	2022	Select Counties in TX		2		2			2						www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare	(866)805-4589		(866)805-4589		(855)593-0913		(855)593-0913		(833)293-5476		(833)293-5476		(855)485-0934		(855)485-0934		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	031	0	1	02	01	H2593_031_0	9	1		1	2		0	07/18/2021	2022.01	07/18/2021 03:01:05 PM Pacific Daylight Time		08/03/2021 03:04:03 PM Pacific Daylight Time		08/03/2021 03:04:03 PM Pacific Daylight Time	08/04/2021 12:07:42 PM Pacific Daylight Time	AMERIGROUP TEXAS, INC.	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage ESRD Care (HMO-POS C-SNP)	01	02		1			H2593	031	0	2022	Select Counties in Texas		2		2			1	4			00000000100000000000		www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare	(877)269-5660		(877)269-5660		(855)593-0917		(855)593-0917		(833)337-1264		(833)337-1264		(855)485-0938		(855)485-0938		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	032	0	1	01	01	H2593_032_0	8	1	2	1	1		0	08/02/2021	2022.01	08/02/2021 10:40:57 AM Eastern Daylight Time	08/03/2021 06:03:58 PM Eastern Daylight Time	08/03/2021 06:03:58 PM Eastern Daylight Time			08/04/2021 03:50:55 PM Eastern Daylight Time	AMERIGROUP TEXAS, INC.	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Dual Coordination (HMO D-SNP)	01	01		1			H2593	032	0	2022	Select Counties in Texas		2		2			1	3		2		2	www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare	(844)765-5165		(844)765-5165		(855)593-0916		(855)593-0916		(833)293-5475		(833)293-5475		(855)485-0937		(855)485-0937		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	037	0	1	01	01	H2593_037_0	8	1		1	2		0	06/04/2021	2022.01	06/04/2021 07:56:18 AM Pacific Daylight Time	08/03/2021 03:04:03 PM Pacific Daylight Time	08/03/2021 03:04:03 PM Pacific Daylight Time			08/04/2021 12:07:42 PM Pacific Daylight Time	AMERIGROUP TEXAS, INC.	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Diabetes Care (HMO C-SNP)	01	01		1			H2593	037	0	2022	Harris County		2		2			1	4			00000010000000000000		www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare	(844)469-6823		(844)469-6823		(855)593-0915		(855)593-0915		(833)370-7464		(833)370-7464		(855)485-0936		(855)485-0936		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	038	0	1	01	01	H2593_038_0	8	1		1	2		0	06/04/2021	2022.01	06/04/2021 07:56:38 AM Pacific Daylight Time	08/03/2021 03:04:03 PM Pacific Daylight Time	08/03/2021 03:04:03 PM Pacific Daylight Time			08/04/2021 12:07:42 PM Pacific Daylight Time	AMERIGROUP TEXAS, INC.	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Heart Care (HMO C-SNP)	01	01		1			H2593	038	0	2022	Harris County		2		2			1	4			00000000000000010000		www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare	(844)469-6823		(844)469-6823		(855)593-0915		(855)593-0915		(833)370-7464		(833)370-7464		(855)485-0936		(855)485-0936		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	039	0	1	01	01	H2593_039_0	8	1		1	2		0	06/04/2021	2022.01	06/04/2021 07:56:58 AM Pacific Daylight Time	08/03/2021 03:04:03 PM Pacific Daylight Time	08/03/2021 03:04:03 PM Pacific Daylight Time			08/04/2021 12:07:42 PM Pacific Daylight Time	AMERIGROUP TEXAS, INC.	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Lung Care (HMO C-SNP)	01	01		1			H2593	039	0	2022	Harris County		2		2			1	4			00000000000100000000		www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare	(844)469-6823		(844)469-6823		(855)593-0915		(855)593-0915		(833)370-7464		(833)370-7464		(855)485-0936		(855)485-0936		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	040	0	1	01	01	H2593_040_0	6	1		1	2		0	07/18/2021	2022.01	07/18/2021 01:51:35 PM Pacific Daylight Time		08/03/2021 06:04:08 PM Eastern Daylight Time		08/03/2021 06:04:08 PM Eastern Daylight Time	08/04/2021 01:51:40 PM Eastern Daylight Time	AMERIGROUP TEXAS, INC.	Amerigroup	shop.amerigroup.com/medicare	Amerivantage ESRD Care (HMO C-SNP)	01	01		1			H2593	040	0	2022	Pima County		2		2			1	4			00000000100000000000		www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare	(888)816-2790		(888)816-2790		(855)593-0915		(855)593-0915		(833)337-1266		(833)337-1266		(855)485-0936		(855)485-0936		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	041	0	1	01	01	H2593_041_0	8	1		1	2		0	07/16/2021	2022.01	07/16/2021 09:35:01 AM Pacific Daylight Time	08/03/2021 03:04:03 PM Pacific Daylight Time	08/03/2021 03:04:03 PM Pacific Daylight Time			08/04/2021 12:07:42 PM Pacific Daylight Time	AMERIGROUP TEXAS, INC.	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Diabetes Care (HMO C-SNP)	01	01		1			H2593	041	0	2022	Tarrant County		2		2			1	4			00000010000000000000		www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare	(844)469-6823		(844)469-6823		(855)593-0915		(855)593-0915		(833)370-7464		(833)370-7464		(855)485-0936		(855)485-0936		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	042	0	1	01	01	H2593_042_0	8	1		1	2		0	06/04/2021	2022.01	06/04/2021 07:57:37 AM Pacific Daylight Time	08/03/2021 03:04:03 PM Pacific Daylight Time	08/03/2021 03:04:03 PM Pacific Daylight Time			08/04/2021 12:07:42 PM Pacific Daylight Time	AMERIGROUP TEXAS, INC.	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Comfort (HMO I-SNP)	01	01		1			H2593	042	0	2022	Harris and Tarrant Counties		2		2			1	1	3				www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare	(844)286-1378		(844)286-1378		(855)593-0914		(855)593-0914		(833)293-5476		(833)293-5476		(855)485-0935		(855)485-0935		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	043	0	1	01	01	H2593_043_0	10	1		1	2		0	07/18/2021	2022.01	07/18/2021 03:12:35 PM Pacific Daylight Time		08/03/2021 03:04:03 PM Pacific Daylight Time		08/03/2021 03:04:03 PM Pacific Daylight Time	08/04/2021 12:07:42 PM Pacific Daylight Time	AMERIGROUP TEXAS, INC.	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage ESRD Care Plus (HMO C-SNP)	01	01		1			H2593	043	0	2022	Select Counties in TX		2		2			1	4			00000000100000000000		www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare	(866)805-4589		(866)805-4589		(855)593-0913		(855)593-0913		(833)293-5476		(833)293-5476		(855)485-0934		(855)485-0934		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2610	005	0	1	01	01	H2610_005_0	5	1					0	08/02/2021	2022.01	08/02/2021 11:09:09 AM Central Daylight Time	08/02/2021 09:21:37 AM Central Daylight Time	08/02/2021 09:25:51 AM Central Daylight Time			08/02/2021 01:15:22 PM Central Daylight Time	ESSENCE HEALTHCARE, INC.	Essence Healthcare	www.essencehealthcare.com	Essence Advantage (HMO)	01	01		1			H2610	005	0	2022	St. Louis Metropolitan Area		2		2			2						https://www.essencehealthcare.com/	https://www.everythingessence.com/s/Essence_Formulary	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	6	1					0	08/02/2021	2022.01	08/02/2021 11:10:26 AM Central Daylight Time	08/02/2021 10:14:01 AM Central Daylight Time	08/02/2021 10:17:41 AM Central Daylight Time			08/02/2021 01:15:22 PM Central Daylight Time	ESSENCE HEALTHCARE, INC.	Essence Healthcare	www.essencehealthcare.com	Essence Advantage Plus (HMO)	01	01		1			H2610	006	0	2022	St. Louis Metropolitan Area		2		2			2						https://www.essencehealthcare.com/	https://www.everythingessence.com/s/Essence_Formulary	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					0	08/03/2021	2022.01	08/03/2021 08:23:15 AM Central Daylight Time	08/02/2021 10:26:34 AM Central Daylight Time	08/02/2021 10:41:03 AM Central Daylight Time			08/03/2021 08:26:32 AM Central Daylight Time	ESSENCE HEALTHCARE, INC.	Essence Healthcare	www.essencehealthcare.com	Essence Advantage (HMO)	01	01		1			H2610	011	0	2022	Columbia Metropolitan Area		2		2			2						https://www.essencehealthcare.com/	https://www.everythingessence.com/s/Essence_Formulary	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	4	1					0	08/02/2021	2022.01	08/02/2021 11:11:37 AM Central Daylight Time	08/02/2021 10:59:50 AM Central Daylight Time	08/02/2021 10:58:15 AM Central Daylight Time			08/02/2021 01:15:22 PM Central Daylight Time	ESSENCE HEALTHCARE, INC.	Essence Healthcare	www.essencehealthcare.com	CoxHealth MedicarePlus (HMO)	01	01		1			H2610	015	0	2022	Southwest Missouri		2		2			2						https://www.essencehealthcare.com/	https://www.everythingessence.com/s/Essence_Formulary	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	4	1					0	08/02/2021	2022.01	08/02/2021 11:12:05 AM Central Daylight Time	08/02/2021 11:10:21 AM Central Daylight Time	08/02/2021 11:08:56 AM Central Daylight Time			08/02/2021 01:15:22 PM Central Daylight Time	ESSENCE HEALTHCARE, INC.	Essence Healthcare	www.essencehealthcare.com	Essence Advantage Select (HMO)	01	01		1			H2610	016	0	2022	St. Louis Metropolitan Area		2		2			2						https://www.essencehealthcare.com/	https://www.everythingessence.com/s/Essence_Formulary	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	017	0	1	01	01	H2610_017_0	10	1	2	1			0	08/10/2021	2022.01	08/10/2021 09:37:06 AM Central Daylight Time	08/02/2021 11:26:27 AM Central Daylight Time	08/02/2021 11:33:41 AM Central Daylight Time			08/10/2021 09:50:37 AM Central Daylight Time	ESSENCE HEALTHCARE, INC.	Essence Healthcare	www.essencehealthcare.com	Essence Dual Advantage (HMO D-SNP)	01	01		1			H2610	017	0	2022	St. Louis Metropolitan Area, MO only		2		2			1	3		1		1	https://www.essencehealthcare.com/	https://www.everythingessence.com/s/Essence_Formulary	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	1	1						05/27/2021	2022.01	05/27/2021 10:38:36 AM Central Daylight Time					05/28/2021 08:39:37 AM Central Daylight Time	ESSENCE HEALTHCARE, INC.	Essence Healthcare	www.essencehealthcare.com	Essence Advantage EGWP MAPD calendar (HMO)	01	01		1			H2610	803	0	2022	MO and IL Service Area		1	300	2			2						https://www.essencehealthcare.com/	https://www.everythingessence.com/s/Essence_Formulary	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;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H2610	804	0	1	01	01	H2610_804_0	1	1						05/27/2021	2022.01	05/27/2021 10:38:17 AM Central Daylight Time					05/28/2021 08:39:37 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	2022	MO and IL Service Area		1	300	2			2						https://www.essencehealthcare.com/	https://www.everythingessence.com/s/Essence_Formulary	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;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H2610	805	0	1	01	01	H2610_805_0	1	1				0	0	05/27/2021	2022.01	05/27/2021 10:38:03 AM Central Daylight Time					05/28/2021 08:39:37 AM Central Daylight Time	ESSENCE HEALTHCARE, INC.	Essence Healthcare	www.essencehealthcare.com	Essence Advantage EGWP MA Only Calendar Year (HMO)	01	01		1			H2610	805	0	2022	MO and IL Service Area		1	300	2			2						https://www.essencehealthcare.com/	https://www.everythingessence.com/s/Essence_Formulary	www.essencehealthcare.com	(866)597-9560		(314)209-2700		(866)509-5399		(314)209-3930										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H2610	806	0	1	01	01	H2610_806_0	1	1				0	0	05/27/2021	2022.01	05/27/2021 10:37:37 AM Central Daylight Time					05/28/2021 08:39:37 AM Central Daylight Time	ESSENCE HEALTHCARE, INC.	Essence Healthcare	www.essencehealthcare.com	Essence Advantage EGWP MA Only non-Calendar Year (HMO)	01	01		1			H2610	806	0	2022	MO and IL Service Area		1	300	2			2						https://www.essencehealthcare.com/	https://www.everythingessence.com/s/Essence_Formulary	www.essencehealthcare.com	(866)597-9560		(314)209-2700		(866)509-5399		(314)209-3930										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H2610	807	0	1	02	01	H2610_807_0	2	1						05/27/2021	2022.01	05/27/2021 10:37:21 AM Central Daylight Time					06/21/2021 02:32:49 PM Central Daylight Time	ESSENCE HEALTHCARE, INC.	Essence Healthcare	www.essencehealthcare.com	Essence Advantage EGWP MAPD Calendar Year (HMO-POS)	01	02		1			H2610	807	0	2022	MO and IL Service Area		1	300	2			2						https://www.essencehealthcare.com/	https://www.everythingessence.com/s/Essence_Formulary	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;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1				
H2610	808	0	1	02	01	H2610_808_0	2	1						05/27/2021	2022.01	05/27/2021 10:37:07 AM Central Daylight Time					06/21/2021 02:32:49 PM Central Daylight Time	ESSENCE HEALTHCARE, INC.	Essence Healthcare	www.essencehealthcare.com	Essence Advantage EGWP MAPD non-Calendar Year (HMO-POS)	01	02		1			H2610	808	0	2022	MO and IL Service Area		1	300	2			2						https://www.essencehealthcare.com/	https://www.everythingessence.com/s/Essence_Formulary	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;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1				
H2610	809	0	1	02	01	H2610_809_0	2	1				0	0	05/27/2021	2022.01	05/27/2021 10:36:52 AM Central Daylight Time					06/21/2021 02:32:49 PM Central Daylight Time	ESSENCE HEALTHCARE, INC.	Essence Healthcare	www.essencehealthcare.com	Essence Advantage EGWP MA Only Calendar Year (HMO-POS)	01	02		1			H2610	809	0	2022	MO and IL Service Area		1	300	2			2						https://www.essencehealthcare.com/	https://www.everythingessence.com/s/Essence_Formulary	www.essencehealthcare.com	(866)597-9560		(314)209-2700		(866)509-5399		(314)209-3930										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1				
H2610	810	0	1	02	01	H2610_810_0	2	1				0	0	05/27/2021	2022.01	05/27/2021 10:36:36 AM Central Daylight Time					06/21/2021 02:32:49 PM Central Daylight Time	ESSENCE HEALTHCARE, INC.	Essence Healthcare	www.essencehealthcare.com	Essence Advantage EGWP MA Only non-Calendar Year (HMO-POS)	01	02		1			H2610	810	0	2022	MO and IL Service Area		1	300	2			2						https://www.essencehealthcare.com/	https://www.everythingessence.com/s/Essence_Formulary	www.essencehealthcare.com	(866)597-9560		(314)209-2700		(866)509-5399		(314)209-3930										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1				
H2624	001	0	1	01	01	H2624_001_0	15	1		1			1	08/04/2021	2022.01	08/04/2021 07:13:56 PM India Standard Time	08/03/2021 03:34:06 PM Central Daylight Time	07/29/2021 05:54:13 PM Central Daylight Time			08/04/2021 03:50:46 PM Central Daylight Time	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	www.healthteamadvantage.com	HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)	01	01		1			H2624	001	0	2022	Greensboro (Guilford County)		2	10388	2			1	4			00000000000000000100		www.healthteamadvantage.com	www.healthteamadvantage.com	www.healthteamadvantage.com	(833)324-3242		(833)324-3242		(877)905-9216		(877)905-9216		(833)324-3242		(833)324-3242		(877)905-9216		(877)905-9216		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2663	002	0	1	01	01	H2663_002_0	4	1					0	08/02/2021	2022.01	08/02/2021 03:03:33 PM Central Daylight Time	08/03/2021 10:45:49 AM Central Daylight Time	08/02/2021 08:28:33 AM Central Daylight Time			08/04/2021 12:29:03 PM Central Daylight Time	COVENTRY HEALTH CARE OF MISSOURI, INC	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Option 2 (HMO)	01	01		1			H2663	002	0	2022	St Louis Missouri Metro Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2663	005	0	1	01	01	H2663_005_0	2	1					0	08/02/2021	2022.01	08/02/2021 09:34:10 PM Central Daylight Time	08/03/2021 10:46:49 AM Central Daylight Time	08/02/2021 08:28:38 AM Central Daylight Time			08/04/2021 12:29:03 PM Central Daylight Time	COVENTRY HEALTH CARE OF MISSOURI, INC	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Gold Advantage Prime (HMO)	01	01		1			H2663	005	0	2022	St Louis Missouri Metro Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2663	006	0	1	02	01	H2663_006_0	2	1					0	08/02/2021	2022.01	08/02/2021 09:37:05 PM Central Daylight Time	08/03/2021 10:47:55 AM Central Daylight Time	08/02/2021 08:28:42 AM Central Daylight Time			08/04/2021 12:29:03 PM Central Daylight Time	COVENTRY HEALTH CARE OF MISSOURI, INC	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Option 1 (HMO-POS)	01	02		1			H2663	006	0	2022	St Louis Missouri Metro Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2663	017	0	1	01	01	H2663_017_0	2	1					0	08/02/2021	2022.01	08/02/2021 02:44:14 PM Central Daylight Time	08/03/2021 10:50:07 AM Central Daylight Time	08/02/2021 08:28:46 AM Central Daylight Time			08/04/2021 12:29:03 PM Central Daylight Time	COVENTRY HEALTH CARE OF MISSOURI, INC	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare UnityPoint Health Prime (HMO)	01	01		1			H2663	017	0	2022	Peoria and Tazewell Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2663	021	0	1	02	01	H2663_021_0	2	1					0	08/02/2021	2022.01	08/02/2021 03:38:02 PM Central Daylight Time	08/04/2021 10:01:42 AM Central Daylight Time	08/02/2021 08:28:50 AM Central Daylight Time			08/04/2021 03:51:37 PM Central Daylight Time	COVENTRY HEALTH CARE OF MISSOURI, INC	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (HMO-POS)	01	02		1			H2663	021	0	2022	Southwest Missouri		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2663	022	0	1	02	01	H2663_022_0	1	1				0	0	06/01/2021	2022.01	06/01/2021 04:28:41 PM Eastern Daylight Time	06/01/2021 04:14:52 PM Central Daylight Time				06/03/2021 12:00:10 PM Central Daylight Time	COVENTRY HEALTH CARE OF MISSOURI, INC	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Eagle (HMO-POS)	01	02		1			H2663	022	0	2022	Southwest Missouri		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2663	023	0	1	02	01	H2663_023_0	2	1					0	08/02/2021	2022.01	08/02/2021 03:39:00 PM Central Daylight Time	08/04/2021 10:06:56 AM Central Daylight Time	08/02/2021 08:28:54 AM Central Daylight Time			08/04/2021 03:51:37 PM Central Daylight Time	COVENTRY HEALTH CARE OF MISSOURI, INC	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plus (HMO-POS)	01	02		1			H2663	023	0	2022	Southwest Missouri		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2663	025	0	1	02	01	H2663_025_0	1	1				0	0	06/01/2021	2022.01	06/01/2021 06:01:45 PM Eastern Daylight Time	06/01/2021 04:16:12 PM Central Daylight Time				06/03/2021 12:00:10 PM Central Daylight Time	COVENTRY HEALTH CARE OF MISSOURI, INC	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Eagle (HMO-POS)	01	02		1			H2663	025	0	2022	Limited counties Missouri and Kansas		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2663	026	0	1	01	01	H2663_026_0	2	1					0	08/02/2021	2022.01	08/02/2021 03:39:20 PM Central Daylight Time	08/04/2021 10:10:08 AM Central Daylight Time	08/02/2021 08:28:58 AM Central Daylight Time			08/04/2021 03:51:37 PM Central Daylight Time	COVENTRY HEALTH CARE OF MISSOURI, INC	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (HMO)	01	01		1			H2663	026	0	2022	Kansas City Metro Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2663	028	0	1	02	01	H2663_028_0	2	1					0	08/02/2021	2022.01	08/02/2021 03:39:40 PM Central Daylight Time	08/04/2021 10:07:11 AM Central Daylight Time	08/02/2021 08:29:03 AM Central Daylight Time			08/04/2021 03:51:37 PM Central Daylight Time	COVENTRY HEALTH CARE OF MISSOURI, INC	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (HMO-POS)	01	02		1			H2663	028	0	2022	Wichita Kansas Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2663	029	0	1	02	01	H2663_029_0	2	1					0	08/02/2021	2022.01	08/02/2021 03:40:12 PM Central Daylight Time	08/04/2021 10:00:32 AM Central Daylight Time	08/02/2021 08:29:07 AM Central Daylight Time			08/04/2021 03:51:37 PM Central Daylight Time	COVENTRY HEALTH CARE OF MISSOURI, INC	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (HMO-POS)	01	02		1			H2663	029	0	2022	Northwest Arkansas		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2663	032	0	1	01	01	H2663_032_0	2	1					0	08/02/2021	2022.01	08/02/2021 02:44:42 PM Central Daylight Time	08/03/2021 10:50:15 AM Central Daylight Time	08/02/2021 08:29:11 AM Central Daylight Time			08/04/2021 12:29:03 PM Central Daylight Time	COVENTRY HEALTH CARE OF MISSOURI, INC	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Gold Advantage Value Prime (HMO)	01	01		1			H2663	032	0	2022	St Louis and surrounding counties IL-MO		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2663	034	0	1	01	01	H2663_034_0	3	1					0	08/02/2021	2022.01	08/02/2021 02:42:29 PM Eastern Daylight Time	08/02/2021 02:49:13 PM Eastern Daylight Time	08/02/2021 09:29:15 AM Eastern Daylight Time			08/05/2021 02:55:16 PM Eastern Daylight Time	COVENTRY HEALTH CARE OF MISSOURI, INC	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (HMO)	01	01		1			H2663	034	0	2022	Oklahoma City and Surrounding Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2663	038	0	1	01	01	H2663_038_0	2	1					0	08/02/2021	2022.01	08/02/2021 03:40:40 PM Central Daylight Time	08/04/2021 09:58:41 AM Central Daylight Time	08/02/2021 08:29:19 AM Central Daylight Time			08/04/2021 03:51:37 PM Central Daylight Time	COVENTRY HEALTH CARE OF MISSOURI, INC	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (HMO)	01	01		1			H2663	038	0	2022	Topeka and surrounding areas		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		2					2					2	2			
H2663	039	0	1	01	01	H2663_039_0	2	1					0	08/02/2021	2022.01	08/02/2021 03:41:24 PM Central Daylight Time	08/04/2021 10:03:20 AM Central Daylight Time	08/02/2021 08:29:23 AM Central Daylight Time			08/04/2021 03:51:37 PM Central Daylight Time	COVENTRY HEALTH CARE OF MISSOURI, INC	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (HMO)	01	01		1			H2663	039	0	2022	Little Rock Arkansas		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		2					2					2	2			
H2663	040	0	1	01	01	H2663_040_0	2	1					0	08/02/2021	2022.01	08/02/2021 03:42:50 PM Central Daylight Time	08/04/2021 10:04:34 AM Central Daylight Time	08/02/2021 08:29:28 AM Central Daylight Time			08/04/2021 03:51:37 PM Central Daylight Time	COVENTRY HEALTH CARE OF MISSOURI, INC	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (HMO)	01	01		1			H2663	040	0	2022	Western KS: Saline and surrounding counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		2					2					2	2			
H2663	041	0	1	01	01	H2663_041_0	2	1					0	08/02/2021	2022.01	08/02/2021 02:45:08 PM Central Daylight Time	08/03/2021 10:48:37 AM Central Daylight Time	08/02/2021 08:29:32 AM Central Daylight Time			08/04/2021 12:29:03 PM Central Daylight Time	COVENTRY HEALTH CARE OF MISSOURI, INC	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Preferred (HMO)	01	01		1			H2663	041	0	2022	Cape Girardeau MO		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		2					2					2	2			
H2663	042	0	1	01	01	H2663_042_0	2	1					0	08/02/2021	2022.01	08/02/2021 03:43:10 PM Central Daylight Time	08/04/2021 10:05:40 AM Central Daylight Time	08/02/2021 08:29:36 AM Central Daylight Time			08/04/2021 03:51:37 PM Central Daylight Time	COVENTRY HEALTH CARE OF MISSOURI, INC	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (HMO)	01	01		1			H2663	042	0	2022	St. Joe and surrounding areas		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		2					2					2	2			
H2663	043	0	1	01	01	H2663_043_0	3	1					0	08/02/2021	2022.01	08/02/2021 03:43:54 PM Central Daylight Time	08/04/2021 10:07:16 AM Central Daylight Time	08/02/2021 08:29:40 AM Central Daylight Time			08/04/2021 03:51:37 PM Central Daylight Time	COVENTRY HEALTH CARE OF MISSOURI, INC	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value (HMO)	01	01		1			H2663	043	0	2022	Springfield and surrounding areas		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		2					2					2	2			
H2663	805	0	1	01	01	H2663_805_0	1	1				0	0	05/27/2021	2022.01	05/27/2021 11:11:54 PM Eastern Daylight Time					06/03/2021 12:46:31 PM Eastern Daylight Time	COVENTRY HEALTH CARE OF MISSOURI, INC	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (HMO)	01	01		1			H2663	805	0	2022	Missouri and Illinois		1	310	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H2663	810	0	1	01	01	H2663_810_0	1	1						05/27/2021	2022.01	05/27/2021 11:12:27 PM Eastern Daylight Time					06/03/2021 12:46:31 PM Eastern Daylight Time	COVENTRY HEALTH CARE OF MISSOURI, INC	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan w/Rx (HMO)	01	01		1			H2663	810	0	2022	Kansas, Missouri, Illinois		1	35440	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H2678	001	0	1	01	01	H2678_001_0	5	1					1	08/04/2021	2022.01	08/04/2021 04:11:33 PM Central Daylight Time	08/04/2021 09:58:37 AM Central Daylight Time	07/29/2021 05:47:24 PM Central Daylight Time			08/04/2021 05:48:31 PM Central Daylight Time	MoreCare, Inc.	MoreCare	www.mymorecare.com	MoreCare For You (HMO)	01	01		1			H2678	001	0	2022	Cook County		2		2			2						www.mymorecare.com	www.mymorecare.com	www.mymorecare.com	(844)480-8528		(844)480-8528		(877)770-2636		(877)770-2636		(844)480-8528		(844)480-8528		(877)770-2636		(877)770-2636		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2678	002	0	1	01	01	H2678_002_0	4	1		1			0	08/04/2021	2022.01	08/04/2021 04:11:52 PM Central Daylight Time	08/04/2021 10:00:00 AM Central Daylight Time	07/29/2021 05:51:55 PM Central Daylight Time			08/04/2021 05:48:31 PM Central Daylight Time	MoreCare, Inc.	MoreCare	www.mymorecare.com	MoreCare + (HMO C-SNP)	01	01		1			H2678	002	0	2022	Cook County		2		2			1	4			00000000001000000000		www.mymorecare.com	www.mymorecare.com	www.mymorecare.com	(844)480-8528		(844)480-8528		(877)770-2636		(877)770-2636		(844)480-8528		(844)480-8528		(877)770-2636		(877)770-2636		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2678	003	0	1	01	01	H2678_003_0	4	1		1			0	08/04/2021	2022.01	08/04/2021 04:12:15 PM Central Daylight Time	08/04/2021 10:03:11 AM Central Daylight Time	07/29/2021 05:53:19 PM Central Daylight Time			08/04/2021 05:48:31 PM Central Daylight Time	MoreCare, Inc.	MoreCare	www.mymorecare.com	MoreCare Home (HMO I-SNP)	01	01		1			H2678	003	0	2022	Cook County		2		2			1	1	3				www.mymorecare.com	www.mymorecare.com	www.mymorecare.com	(844)480-8528		(844)480-8528		(877)770-2636		(877)770-2636		(844)480-8528		(844)480-8528		(877)770-2636		(877)770-2636		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2678	004	0	1	01	01	H2678_004_0	4	1		1			0	08/04/2021	2022.01	08/04/2021 04:13:15 PM Central Daylight Time	08/04/2021 10:05:06 AM Central Daylight Time	07/29/2021 05:55:33 PM Central Daylight Time			08/04/2021 05:48:31 PM Central Daylight Time	MoreCare, Inc.	MoreCare	www.mymorecare.com	MoreCare At Home (HMO I-SNP)	01	01		1			H2678	004	0	2022	Cook County		2		2			1	1	3				www.mymorecare.com	www.mymorecare.com	www.mymorecare.com	(844)480-8528		(844)480-8528		(877)770-2636		(877)770-2636		(844)480-8528		(844)480-8528		(877)770-2636		(877)770-2636		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2694	001	0	1	04	01	H2694_001_0	20	1					0	08/05/2021	2022.01	08/05/2021 06:41:51 PM Central Daylight Time						ETERNALHEALTH, INC.	eternalHealth	www.eternalHealth.com	eternalHealth PPO (PPO)	01	04		1			H2694	001	0	2022	Middlesex, Suffolk and Worcester Counties		2	18600	2			2						www.eternalHealth.com	www.eternalHealth.com	www.eternalHealth.com	(800)680-4568		(617)684-2348		(800)464-7198		(617)546-5733		(866)443-1095		(520)918-1254		(866)443-1095		(520)918-1254		(711)-		(711)-		(711)-		(711)-		(800)498-5428		(711)-		(800)498-5428		(711)-		2					2						2			
H2697	001	0	1	01	01	H2697_001_0	8	1					1	07/15/2021	2022.01	07/15/2021 10:27:33 PM US Eastern Daylight Time	08/04/2021 03:34:22 PM Eastern Daylight Time	07/30/2021 10:21:47 AM Eastern Daylight Time			08/05/2021 09:29:00 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF OHIO, INC.	Devoted Health	www.Devoted.com	Devoted Health Core (HMO)	01	01		1			H2697	001	0	2022	Northern Ohio		2		2			2						www.Devoted.com	www.Devoted.com	www.Devoted.com	(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2697	002	0	1	01	01	H2697_002_0	9	1					1	07/15/2021	2022.01	07/15/2021 10:27:55 PM US Eastern Daylight Time	08/09/2021 01:11:00 PM Eastern Daylight Time	07/30/2021 10:22:07 AM Eastern Daylight Time			08/09/2021 02:29:35 PM Eastern Daylight Time	DEVOTED HEALTH PLAN OF OHIO, INC.	Devoted Health	www.Devoted.com	Devoted Health Prime (HMO)	01	01		1			H2697	002	0	2022	Northern Ohio		2		2			2						www.Devoted.com	www.Devoted.com	www.Devoted.com	(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2697	003	0	1	01	01	H2697_003_0	9	1					1	08/05/2021	2022.01	08/05/2021 10:59:41 AM Eastern Daylight Time	08/04/2021 03:35:19 PM Eastern Daylight Time	07/30/2021 10:22:27 AM Eastern Daylight Time			08/05/2021 11:01:02 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF OHIO, INC.	Devoted Health	www.Devoted.com	Devoted Health Saver (HMO)	01	01		1			H2697	003	0	2022	Northern Ohio		2		2			2						www.Devoted.com	www.Devoted.com	www.Devoted.com	(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2722	002	0	1	02	01	H2722_002_0	12	1					1	08/01/2021	2022.01	08/01/2021 07:01:19 PM Central Daylight Time	07/30/2021 05:07:38 PM Central Daylight Time	07/29/2021 08:18:54 PM Central Daylight Time			08/04/2021 10:51:39 AM Central Daylight Time	VANTAGE HEALTH PLAN OF ARKANSAS, INC.	Vantage Health Plan	www.VantageMedicare.com	Vantage BASIC (HMO-POS)	01	02		1			H2722	002	0	2022	South Arkansas		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			
H2722	003	0	1	02	01	H2722_003_0	14	1	2	1			0	08/01/2021	2022.01	08/01/2021 07:10:45 PM Central Daylight Time	07/30/2021 05:09:02 PM Central Daylight Time	07/29/2021 08:19:26 PM Central Daylight Time			08/04/2021 10:51:39 AM Central Daylight Time	VANTAGE HEALTH PLAN OF ARKANSAS, INC.	Vantage Health Plan	www.VantageMedicare.com	Vantage DUAL PLUS (HMO-POS D-SNP)	01	02		1			H2722	003	0	2022	South Arkansas		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			
H2722	004	0	1	02	01	H2722_004_0	12	1					1	08/01/2021	2022.01	08/01/2021 07:16:52 PM Central Daylight Time	07/30/2021 05:10:52 PM Central Daylight Time	07/29/2021 08:20:02 PM Central Daylight Time			08/04/2021 10:51:39 AM Central Daylight Time	VANTAGE HEALTH PLAN OF ARKANSAS, INC.	Vantage Health Plan	www.VantageMedicare.com	Vantage STANDARD (HMO-POS)	01	02		1			H2722	004	0	2022	South Arkansas		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			
H2722	801	0	1	02	01	H2722_801_0	7	1						05/12/2021	2022.01	05/12/2021 07:33:38 PM Central Daylight Time					06/06/2021 07:04:41 PM Central Daylight Time	VANTAGE HEALTH PLAN OF ARKANSAS, INC.	Vantage Health Plan	www.VantageMedicare.com	Vantage - MAPD EGWP CY (HMO-POS)	01	02		1			H2722	801	0	2022	Arkansas		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			
H2737	001	0	1	04	01	H2737_001_0	7	1					0	08/05/2021	2022.01	08/05/2021 03:27:30 PM Eastern Daylight Time	08/04/2021 03:22:28 PM Eastern Daylight Time	07/30/2021 10:57:34 AM Eastern Daylight Time			08/05/2021 03:28:31 PM Eastern Daylight Time	HEALTH NEW ENGLAND, INC.	Health New England Medicare Advantage Plans	www.healthnewengland.org/medicare	Health New England Medicare Compass (PPO)	01	04		1			H2737	001	0	2022	Hampden, Hampshire, Franklin, Berkshire Counties		2	5000	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)393-0395		(800)393-0395		(800)393-0395		(800)393-0395		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2737	002	0	1	04	01	H2737_002_0	7	1					0	08/05/2021	2022.01	08/05/2021 03:27:37 PM Eastern Daylight Time	08/04/2021 03:28:04 PM Eastern Daylight Time	07/30/2021 10:59:02 AM Eastern Daylight Time			08/05/2021 03:28:31 PM Eastern Daylight Time	HEALTH NEW ENGLAND, INC.	Health New England Medicare Advantage Plans	www.healthnewengland.org/medicare	Health New England Medicare Compass Premier (PPO)	01	04		1			H2737	002	0	2022	Hampden, Hampshire, Franklin, Berkshire Counties		2	1000	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)393-0395		(800)393-0395		(800)393-0395		(800)393-0395		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2737	801	0	1	04	01	H2737_801_0	3	1						06/04/2021	2022.01	06/04/2021 02:42:48 PM Eastern Daylight Time					06/06/2021 09:00:43 PM Eastern Daylight Time	HEALTH NEW ENGLAND, INC.	Health New England Medicare Advantage Plans	www.healthnewengland.org/medicare	Health New England Compass Group Rx (PPO)	01	04		1			H2737	801	0	2022	United States		1	5978	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)393-0395		(800)393-0395		(800)393-0395		(800)393-0395		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	2;5;6;7c;7i;8a;8b1;9a1;9a2;9b;10a;11a;11b;11c;14a;15;	2		1									
H2737	802	0	1	04	01	H2737_802_0	3	1				0	0	06/04/2021	2022.01	06/04/2021 02:45:18 PM Eastern Daylight Time					06/06/2021 09:00:43 PM Eastern Daylight Time	HEALTH NEW ENGLAND, INC.	Health New England Medicare Advantage Plans	www.healthnewengland.org/medicare	Health New England Compass Group Calendar (PPO)	01	04		1			H2737	802	0	2022	United States		1	61	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;14a;15;	2		1									
H2737	803	0	1	04	01	H2737_803_0	3	1						06/04/2021	2022.01	06/04/2021 03:02:24 PM Eastern Daylight Time					06/06/2021 09:00:43 PM Eastern Daylight Time	HEALTH NEW ENGLAND, INC.	Health New England Medicare Advantage Plans	www.healthnewengland.org/medicare	Health New England Compass Group Non-Calendar (PPO)	01	04		1			H2737	803	0	2022	United States		1	61	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)393-0395		(800)393-0395		(800)393-0395		(800)393-0395		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	2;5;6;7c;7i;8a;8b1;9a1;9a2;9b;10a;11a;11b;11c;14a;15;	2		1									
H2752	001	0	1	01	01	H2752_001_0	4	1			2		1	08/02/2021	2022.01	08/02/2021 04:39:52 PM Central Daylight Time	08/03/2021 08:38:54 AM Central Daylight Time	07/30/2021 11:32:39 AM Central Daylight Time			08/04/2021 10:27:29 AM Central Daylight Time	CIGNA HEALTHCARE OF CONNECTICUT INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H2752	001	0	2022	Connecticut		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101		(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2752	002	0	1	01	01	H2752_002_0	4	1	2	1	1		0	05/23/2021	2022.01	05/23/2021 03:40:08 PM Central Daylight Time	08/03/2021 08:39:56 AM Central Daylight Time	07/30/2021 11:33:04 AM Central Daylight Time			08/04/2021 10:27:29 AM Central Daylight Time	CIGNA HEALTHCARE OF CONNECTICUT INC.	Cigna	www.cignamedicare.com	Cigna TotalCare Plus (HMO D-SNP)	01	01		1			H2752	002	0	2022	Connecticut		2		2			1	3		1		2	www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101		(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2765	001	0	1	02	01	H2765_001_0	6	1				0	0	07/02/2021	2022.01	07/02/2021 08:45:19 AM Pacific Daylight Time	06/04/2021 04:24:46 PM Pacific Daylight Time				07/02/2021 10:51:24 AM Pacific Daylight Time	SUMMIT HEALTH PLAN, INC.	Summit Health Plan, Inc.	yoursummithealth.com	Summit Health Core (HMO-POS)	01	02		1			H2765	001	0	2022	Eastern Oregon		2		2			2						yoursummithealth.com	yoursummithealth.com	yoursummithealth.com	(844)827-2355		(541)663-2721		(844)931-1781		(844)931-1781										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2765	002	0	1	01	01	H2765_002_0	7	1					0	08/03/2021	2022.01	08/03/2021 11:40:01 AM Pacific Daylight Time	08/04/2021 11:01:46 AM Pacific Daylight Time	08/04/2021 11:01:48 AM Pacific Daylight Time			08/04/2021 11:35:36 AM Pacific Daylight Time	SUMMIT HEALTH PLAN, INC.	Summit Health Plan, Inc.	yoursummithealth.com	Summit Health Value + Rx (HMO)	01	01		1			H2765	002	0	2022	Eastern Oregon		2		2			2						yoursummithealth.com	yoursummithealth.com	yoursummithealth.com	(844)827-2355		(541)663-2721		(844)931-1781		(844)931-1781		(844)827-2355		(541)663-2721		(844)931-1781		(844)931-1781		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2765	003	0	1	02	01	H2765_003_0	7	1					0	08/03/2021	2022.01	08/03/2021 11:40:39 AM Pacific Daylight Time	08/04/2021 11:01:52 AM Pacific Daylight Time	08/04/2021 11:01:57 AM Pacific Daylight Time			08/04/2021 11:35:36 AM Pacific Daylight Time	SUMMIT HEALTH PLAN, INC.	Summit Health Plan, Inc.	yoursummithealth.com	Summit Health Standard + Rx (HMO-POS)	01	02		1			H2765	003	0	2022	Eastern Oregon		2		2			2						yoursummithealth.com	yoursummithealth.com	yoursummithealth.com	(844)827-2355		(541)663-2721		(844)931-1781		(844)931-1781		(844)827-2355		(541)663-2721		(844)931-1781		(844)931-1781		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2765	004	0	1	02	01	H2765_004_0	7	1					0	07/02/2021	2022.01	07/02/2021 09:38:40 AM Pacific Daylight Time	08/04/2021 11:01:59 AM Pacific Daylight Time	08/04/2021 11:02:01 AM Pacific Daylight Time			08/04/2021 11:35:36 AM Pacific Daylight Time	SUMMIT HEALTH PLAN, INC.	Summit Health Plan, Inc.	yoursummithealth.com	Summit Health Premier + Rx (HMO-POS)	01	02		1			H2765	004	0	2022	Eastern Oregon		2		2			2						yoursummithealth.com	yoursummithealth.com	yoursummithealth.com	(844)827-2355		(541)663-2721		(844)931-1781		(844)931-1781		(844)827-2355		(541)663-2721		(844)931-1781		(844)931-1781		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2775	105	0	1	04	01	H2775_105_0	5	1					0	08/03/2021	2022.01	08/03/2021 11:09:55 AM Eastern Daylight Time	08/03/2021 11:56:44 PM Eastern Daylight Time	07/30/2021 11:06:54 AM Eastern Daylight Time			08/04/2021 11:02:27 PM Eastern Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Wellcare	www.wellcare.com/medicare	Wellcare Premium Ultra Open (PPO)	01	04		1			H2775	105	0	2022	Select counties in NY		2	25892	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2775	106	0	1	04	01	H2775_106_0	5	1					0	08/03/2021	2022.01	08/03/2021 04:11:27 PM Eastern Daylight Time	08/03/2021 11:57:12 PM Eastern Daylight Time	07/30/2021 11:07:14 AM Eastern Daylight Time			08/04/2021 11:02:27 PM Eastern Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Wellcare	www.wellcare.com/medicare	Wellcare No Premium Open (PPO)	01	04		1			H2775	106	0	2022	Select counties in NY		2	325620	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2775	108	0	1	04	01	H2775_108_0	7	1				0	0	07/06/2021	2022.01	07/06/2021 01:10:16 PM Eastern Daylight Time	07/02/2021 01:06:32 PM Eastern Daylight Time				07/19/2021 04:15:23 PM Eastern Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Wellcare	www.wellcare.com/medicare	Wellcare Patriot No Premium Open (PPO)	01	04		1			H2775	108	0	2022	Select counties in NY		2	1222	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175										(711)-		(711)-		(711)-		(711)-										2					2						2			
H2775	109	0	1	04	01	H2775_109_0	5	1					0	08/03/2021	2022.01	08/03/2021 10:14:37 AM Eastern Daylight Time	08/03/2021 11:58:08 PM Eastern Daylight Time	07/30/2021 11:07:44 AM Eastern Daylight Time			08/04/2021 11:21:47 PM Eastern Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Wellcare	www.wellcare.com/medicare	Wellcare No Premium Open (PPO)	01	04		1			H2775	109	0	2022	All counties in ME		2	156030	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2775	111	0	1	04	01	H2775_111_0	5	1					0	06/01/2021	2022.01	06/01/2021 03:03:24 PM Eastern Daylight Time	08/03/2021 11:58:36 PM Eastern Daylight Time	07/30/2021 11:08:34 AM Eastern Daylight Time			08/04/2021 11:02:27 PM Eastern Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Wellcare	www.wellcare.com/medicare	Wellcare Giveback Open (PPO)	01	04		1			H2775	111	0	2022	Select counties in NY		2	411357	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2775	112	0	1	04	01	H2775_112_0	5	1	2	1			0	07/18/2021	2022.01	07/18/2021 05:14:45 PM Eastern Daylight Time	08/03/2021 11:59:04 PM Eastern Daylight Time	07/30/2021 11:09:02 AM Eastern Daylight Time			08/04/2021 11:02:27 PM Eastern Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Wellcare	www.wellcare.com/medicare	Wellcare Dual Access Open (PPO D-SNP)	01	04		1			H2775	112	0	2022	Select counties in NY		2	97038	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2775	113	0	1	04	01	H2775_113_0	5	1					0	06/04/2021	2022.01	06/04/2021 01:49:38 PM Eastern Daylight Time	08/03/2021 11:59:33 PM Eastern Daylight Time	07/30/2021 11:09:42 AM Eastern Daylight Time			08/04/2021 11:02:27 PM Eastern Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Wellcare	www.wellcare.com/medicare	Wellcare Assist Open (PPO)	01	04		1			H2775	113	0	2022	Select counties in NY		2	80913	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2775	114	0	1	04	01	H2775_114_0	6	1					0	06/06/2021	2022.01	06/06/2021 11:36:36 PM Eastern Daylight Time	08/04/2021 12:00:03 AM Eastern Daylight Time	07/30/2021 11:10:06 AM Eastern Daylight Time			08/04/2021 11:21:47 PM Eastern Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Wellcare	www.wellcare.com/medicare	Wellcare Assist Open (PPO)	01	04		1			H2775	114	0	2022	All counties in ME		2	1924	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2775	115	0	1	04	01	H2775_115_0	6	1	2	1			0	08/03/2021	2022.01	08/03/2021 10:17:02 AM Eastern Daylight Time	08/04/2021 12:00:34 AM Eastern Daylight Time	07/30/2021 11:10:30 AM Eastern Daylight Time			08/04/2021 11:21:47 PM Eastern Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Wellcare	www.wellcare.com/medicare	Wellcare Dual Liberty Open (PPO D-SNP)	01	04		1			H2775	115	0	2022	All counties in ME		2	3366	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2775	801	0	1	04	01	H2775_801_0	2	1				0	0	05/03/2021	2022.01	05/03/2021 03:08:33 PM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Wellcare	www.wellcare.com/medicare	Today's Options PPO - MA Group Plan (PPO)	01	04		1			H2775	801	0	2022	National		1	100	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H2775	802	0	1	04	01	H2775_802_0	2	1						05/04/2021	2022.01	05/04/2021 08:41:02 AM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Wellcare	www.wellcare.com/medicare	Today's Options PPO - MAPD Group Plan (PPO)	01	04		1			H2775	802	0	2022	National		1	100	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H2775	803	0	1	04	01	H2775_803_0	2	1						05/04/2021	2022.01	05/04/2021 08:41:26 AM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Wellcare	www.wellcare.com/medicare	Today's Options PPO - MAPD Group Plan - NCY (PPO)	01	04		1			H2775	803	0	2022	National		1	100	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H2782	002	0	1	01	01	H2782_002_0	5	1					1	08/04/2021	2022.01	08/04/2021 10:00:58 AM Pacific Daylight Time	08/04/2021 08:59:04 AM Pacific Daylight Time	08/04/2021 08:59:24 AM Pacific Daylight Time			08/04/2021 12:08:44 PM Pacific Daylight Time	WESTERN HEALTH ADVANTAGE	Western Health Advantage	medicare.westernhealth.com	Western Health Advantage MyCare (HMO)	01	01		1			H2782	002	0	2022	Northern California		2		2			2						medicare.westernhealth.com	medicare.westernhealth.com	mywha.org/MyCareDoctors	(888)563-2250		(916)563-2250		(888)992-7494		(916)246-7494		(888)563-2250		(916)563-2250		(888)992-7494		(916)246-7494		(888)877-5378		(711)-		(888)877-5378		(711)-		(888)877-5378		(711)-		(888)877-5378		(711)-		2					2					2	2			
H2782	003	0	1	01	01	H2782_003_0	5	1					1	07/30/2021	2022.01	07/30/2021 01:48:17 PM Pacific Daylight Time	08/04/2021 08:59:58 AM Pacific Daylight Time	08/04/2021 09:00:21 AM Pacific Daylight Time			08/04/2021 12:08:44 PM Pacific Daylight Time	WESTERN HEALTH ADVANTAGE	Western Health Advantage	medicare.westernhealth.com	Western Health Advantage MyCare Plus (HMO)	01	01		1			H2782	003	0	2022	Northern California		2		2			2						medicare.westernhealth.com	medicare.westernhealth.com	mywha.org/MyCareDoctors	(888)563-2250		(916)563-2250		(888)992-7494		(916)246-7494		(888)563-2250		(916)563-2250		(888)992-7494		(916)246-7494		(888)877-5378		(711)-		(888)877-5378		(711)-		(888)877-5378		(711)-		(888)877-5378		(711)-		2					2					2	2			
H2782	801	0	1	01	01	H2782_801_0	1	1				0	0	05/13/2021	2022.01	05/13/2021 01:15:37 PM Pacific Daylight Time					06/01/2021 08:12:37 AM Pacific Daylight Time	WESTERN HEALTH ADVANTAGE	Western Health Advantage	medicare.westernhealth.com	Western Health Advantage MyCare EGWP (HMO)	01	01		1			H2782	801	0	2022	Northern California		1	0	2			2						medicare.westernhealth.com	medicare.westernhealth.com	mywha.org/MyCareDoctors	(888)563-2250		(916)563-2250		(888)992-7494		(916)246-7494										(888)877-5378		(711)-		(888)877-5378		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7c;7d;7f;7i;7k;8a;8b1;8b2;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;6;7c;7d;7f;7i;7k;8a;8b1;8b2;8b3;18a;	1					1				
H2782	802	0	1	01	01	H2782_802_0	1	1						05/13/2021	2022.01	05/13/2021 01:26:20 PM Pacific Daylight Time					06/01/2021 08:12:37 AM Pacific Daylight Time	WESTERN HEALTH ADVANTAGE	Western Health Advantage	medicare.westernhealth.com	Western Health Advantage MyCare EGWP MAPD (HMO)	01	01		1			H2782	802	0	2022	Northern California		1	1200	2			2						medicare.westernhealth.com	medicare.westernhealth.com	mywha.org/MyCareDoctors	(888)563-2250		(916)563-2250		(888)992-7494		(916)246-7494		(888)563-2250		(916)563-2250		(888)992-7494		(916)246-7494		(888)877-5378		(711)-		(888)877-5378		(711)-		(888)877-5378		(711)-		(888)877-5378		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7c;7d;7f;7i;7k;8a;8b1;8b2;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;6;7c;7d;7f;7i;7k;8a;8b1;8b2;8b3;18a;	1					1				
H2782	803	0	1	01	01	H2782_803_0	1	1				0	0	05/13/2021	2022.01	05/13/2021 01:26:40 PM Pacific Daylight Time					06/01/2021 08:12:37 AM Pacific Daylight Time	WESTERN HEALTH ADVANTAGE	Western Health Advantage	medicare.westernhealth.com	Western Health Advantage MyCare EGWP MA Fiscal (HMO)	01	01		1			H2782	803	0	2022	Northern California		1	0	2			2						medicare.westernhealth.com	medicare.westernhealth.com	mywha.org/MyCareDoctors	(888)563-2250		(916)563-2250		(888)992-7494		(916)246-7494										(888)877-5378		(711)-		(888)877-5378		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7c;7d;7f;7i;7k;8a;8b1;8b2;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;6;7c;7d;7f;7i;7k;8a;8b1;8b2;8b3;18a;	1					1				
H2782	804	0	1	01	01	H2782_804_0	1	1						05/13/2021	2022.01	05/13/2021 01:26:56 PM Pacific Daylight Time					06/01/2021 08:12:37 AM Pacific Daylight Time	WESTERN HEALTH ADVANTAGE	Western Health Advantage	medicare.westernhealth.com	Western Health Advantage MyCare EGWP MAPD Fiscal (HMO)	01	01		1			H2782	804	0	2022	Northern California		1	600	2			2						medicare.westernhealth.com	medicare.westernhealth.com	mywha.org/MyCareDoctors	(888)563-2250		(916)563-2250		(888)992-7494		(916)246-7494		(888)563-2250		(916)563-2250		(888)992-7494		(916)246-7494		(888)877-5378		(711)-		(888)877-5378		(711)-		(888)877-5378		(711)-		(888)877-5378		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7c;7d;7f;7i;7k;8a;8b1;8b2;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;6;7c;7d;7f;7i;7k;8a;8b1;8b2;8b3;18a;	1					1				
H2793	003	0	1	01	01	H2793_003_0	8	1					1	08/04/2021	2022.01	08/04/2021 03:18:15 PM Pacific Daylight Time	08/04/2021 08:31:05 AM Mountain Daylight Time	08/05/2021 02:02:21 PM Mountain Daylight Time			08/05/2021 08:43:54 PM Mountain Daylight Time	IMPERIAL INSURANCE COMPANIES INC.	Imperial Insurance Companies, Inc	www.imperialhealthplan.com	Imperial Insurance Company Traditional (HMO)	01	01		1			H2793	003	0	2022	AZ,TX,NM,NV,UT		2	26400	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			
H2793	004	0	1	01	01	H2793_004_0	9	1	2	1			0	07/19/2021	2022.01	07/19/2021 10:12:20 AM Pacific Daylight Time	08/04/2021 08:31:52 AM Mountain Daylight Time	08/05/2021 02:03:06 PM Mountain Daylight Time			08/05/2021 08:43:54 PM Mountain Daylight Time	IMPERIAL INSURANCE COMPANIES INC.	Imperial Insurance Companies, Inc	www.imperialhealthplan.com	Imperial Insurance Company Dual (HMO D-SNP)	01	01		1			H2793	004	0	2022	TX		2	900	2			1	3		1		1	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			
H2793	005	0	1	01	01	H2793_005_0	9	1		1			1	08/04/2021	2022.01	08/04/2021 03:18:44 PM Pacific Daylight Time	08/04/2021 08:32:34 AM Mountain Daylight Time	08/05/2021 02:04:36 PM Mountain Daylight Time			08/05/2021 08:43:54 PM Mountain Daylight Time	IMPERIAL INSURANCE COMPANIES INC.	Imperial Insurance Companies, Inc	www.imperialhealthplan.com	Imperial Insurance Value (HMO C-SNP)	01	01		1			H2793	005	0	2022	AZ,TX,NM,NV,UT		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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2793	007	0	1	01	01	H2793_007_0	9	1					0	08/04/2021	2022.01	08/04/2021 03:20:32 PM Pacific Daylight Time	08/05/2021 08:23:48 PM Mountain Daylight Time	08/05/2021 03:11:33 PM Mountain Daylight Time			08/05/2021 08:43:54 PM Mountain Daylight Time	IMPERIAL INSURANCE COMPANIES INC.	Imperial Insurance Companies, Inc	www.imperialhealthplan.com	Imperial Insurance Traditional Plus (HMO)	01	01		1			H2793	007	0	2022	AZ, UT, NV, NM		2	240	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					1					1	2			
H2802	001	0	1	02	01	H2802_001_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 03:00:32 PM Central Daylight Time	08/03/2021 01:46:27 PM Central Daylight Time	07/29/2021 08:15:54 PM Central Daylight Time			08/05/2021 10:00:31 AM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	01	02		1			H2802	001	0	2022	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	02	01	H2802_007_0	5	1			2		1	08/17/2021	2022.01	08/17/2021 11:02:43 AM Central Daylight Time	08/03/2021 01:32:34 PM Central Daylight Time	07/29/2021 08:16:09 PM Central Daylight Time			08/17/2021 11:13:16 AM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Profile (HMO-POS)	01	02		1			H2802	007	0	2022	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	02	01	H2802_008_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 09:54:51 AM Central Daylight Time	08/03/2021 01:32:59 PM Central Daylight Time	07/29/2021 08:16:24 PM Central Daylight Time			08/05/2021 01:19:01 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	01	02		1			H2802	008	0	2022	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	02	01	H2802_010_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 09:56:45 AM Central Daylight Time	08/03/2021 01:33:22 PM Central Daylight Time	07/29/2021 08:16:40 PM Central Daylight Time			08/05/2021 01:19:01 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	01	02		1			H2802	010	0	2022	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	02	01	H2802_012_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 09:58:23 AM Central Daylight Time	08/03/2021 01:33:46 PM Central Daylight Time	07/29/2021 08:16:56 PM Central Daylight Time			08/05/2021 01:19:01 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	01	02		1			H2802	012	0	2022	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	016	0	1	02	01	H2802_016_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 10:00:30 AM Central Daylight Time	08/03/2021 01:34:10 PM Central Daylight Time	07/29/2021 08:17:11 PM Central Daylight Time			08/05/2021 01:19:01 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	01	02		1			H2802	016	0	2022	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	02	01	H2802_018_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 10:02:18 AM Central Daylight Time	08/03/2021 01:34:34 PM Central Daylight Time	07/29/2021 08:17:27 PM Central Daylight Time			08/05/2021 01:19:01 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	01	02		1			H2802	018	0	2022	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	02	01	H2802_020_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 10:05:33 AM Central Daylight Time	08/03/2021 01:34:58 PM Central Daylight Time	07/29/2021 08:17:43 PM Central Daylight Time			08/05/2021 01:19:01 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	01	02		1			H2802	020	0	2022	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	024	0	1	01	01	H2802_024_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 10:05:09 AM Central Daylight Time	08/03/2021 01:35:23 PM Central Daylight Time	07/29/2021 08:17:58 PM Central Daylight Time			08/04/2021 04:16:56 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Access (HMO)	01	01		1			H2802	024	0	2022	Select counties in the 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			2		1	08/04/2021	2022.01	08/04/2021 10:06:40 AM Central Daylight Time	08/03/2021 01:35:47 PM Central Daylight Time	07/29/2021 08:18:19 PM Central Daylight Time			08/04/2021 04:16:56 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO)	01	01		1			H2802	025	0	2022	Select counties in the 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	3	1		1	2		0	08/04/2021	2022.01	08/04/2021 09:58:12 AM Central Daylight Time	08/03/2021 01:36:12 PM Central Daylight Time	07/29/2021 08:18:35 PM Central Daylight Time			08/04/2021 02:42:22 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan 1 (HMO-POS I-SNP)	01	02		1			H2802	027	0	2022	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	02	01	H2802_028_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 10:52:45 AM Central Daylight Time	08/03/2021 01:46:51 PM Central Daylight Time	07/29/2021 08:18:51 PM Central Daylight Time			08/05/2021 12:36:30 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO-POS)	01	02		1			H2802	028	0	2022	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	02	01	H2802_029_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 10:53:51 AM Central Daylight Time	08/03/2021 01:36:54 PM Central Daylight Time	07/29/2021 08:19:06 PM Central Daylight Time			08/05/2021 12:36:30 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO-POS)	01	02		1			H2802	029	0	2022	Central Missouri 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	030	0	1	02	01	H2802_030_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 10:54:59 AM Central Daylight Time	08/03/2021 01:37:19 PM Central Daylight Time	07/29/2021 08:19:21 PM Central Daylight Time			08/05/2021 12:36:30 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO-POS)	01	02		1			H2802	030	0	2022	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	02	01	H2802_031_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 10:56:11 AM Central Daylight Time	08/03/2021 01:37:44 PM Central Daylight Time	07/29/2021 08:19:37 PM Central Daylight Time			08/05/2021 12:36:30 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO-POS)	01	02		1			H2802	031	0	2022	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	02	01	H2802_032_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 10:57:23 AM Central Daylight Time	08/03/2021 01:38:08 PM Central Daylight Time	07/29/2021 08:19:52 PM Central Daylight Time			08/05/2021 12:36:30 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO-POS)	01	02		1			H2802	032	0	2022	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	02	01	H2802_033_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 10:58:41 AM Central Daylight Time	08/03/2021 01:38:34 PM Central Daylight Time	07/29/2021 08:20:09 PM Central Daylight Time			08/05/2021 12:36:30 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO-POS)	01	02		1			H2802	033	0	2022	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	02	01	H2802_034_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 10:59:55 AM Central Daylight Time	08/03/2021 01:39:00 PM Central Daylight Time	07/29/2021 08:20:24 PM Central Daylight Time			08/05/2021 12:36:30 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO-POS)	01	02		1			H2802	034	0	2022	Wichita 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	035	0	1	02	01	H2802_035_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 11:01:22 AM Central Daylight Time	08/03/2021 01:39:26 PM Central Daylight Time	07/29/2021 08:20:39 PM Central Daylight Time			08/05/2021 12:36:30 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO-POS)	01	02		1			H2802	035	0	2022	Wichita 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	041	0	1	01	01	H2802_041_0	5	1			1		1	08/04/2021	2022.01	08/04/2021 10:34:59 AM Central Daylight Time	08/03/2021 01:39:51 PM Central Daylight Time	07/29/2021 08:20:54 PM Central Daylight Time			08/04/2021 01:59:15 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 3 (HMO)	01	01		1			H2802	041	0	2022	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	4	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 10:33:27 AM Central Daylight Time	08/03/2021 01:40:16 PM Central Daylight Time	07/29/2021 08:21:11 PM Central Daylight Time			08/04/2021 01:59:15 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Dual Complete Plan 2 (HMO D-SNP)	01	01		1			H2802	044	0	2022	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	048	0	1	01	01	H2802_048_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 11:02:49 AM Central Daylight Time	08/03/2021 01:40:41 PM Central Daylight Time	07/29/2021 08:21:27 PM Central Daylight Time			08/05/2021 12:36:30 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO)	01	01		1			H2802	048	0	2022	Central Missouri 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	049	0	1	02	01	H2802_049_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 11:04:16 AM Central Daylight Time	08/03/2021 01:41:05 PM Central Daylight Time	07/29/2021 08:21:41 PM Central Daylight Time			08/05/2021 12:36:30 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	01	02		1			H2802	049	0	2022	Southeast Missouri 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	050	0	1	02	01	H2802_050_0	2	1			2	0	0	07/15/2021	2022.01	07/15/2021 03:52:59 PM Central Daylight Time	06/03/2021 03:06:52 PM Central Daylight Time				07/15/2021 05:33:52 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (HMO-POS)	01	02		1			H2802	050	0	2022	Select Counties in Missouri 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										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2802	052	0	1	02	01	H2802_052_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 11:08:00 AM Central Daylight Time	08/03/2021 01:41:30 PM Central Daylight Time	07/29/2021 08:21:56 PM Central Daylight Time			08/05/2021 12:36:30 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO-POS)	01	02		1			H2802	052	0	2022	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	053	0	1	01	01	H2802_053_0	4	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 02:59:14 PM Central Daylight Time	08/03/2021 01:41:54 PM Central Daylight Time	07/29/2021 08:22:11 PM Central Daylight Time			08/05/2021 10:00:31 AM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Plan 2 (HMO D-SNP)	01	01		1			H2802	053	0	2022	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			
H2802	801	0	1	01	01	H2802_801_0	1	1						05/24/2021	2022.01	05/24/2021 12:11:53 PM Central Daylight Time					06/02/2021 12:12:47 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H2802	801	0	2022	Select Counties in Alabama		1	144	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1					1				
H2802	802	0	1	01	01	H2802_802_0	1	1						06/02/2021	2022.01	06/02/2021 09:09:11 AM Central Daylight Time					06/02/2021 12:12:47 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H2802	802	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1					1				
H2802	803	0	1	01	01	H2802_803_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 09:09:40 AM Central Daylight Time					06/02/2021 12:12:47 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H2802	803	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1					1				
H2802	804	0	1	01	01	H2802_804_0	1	1						05/24/2021	2022.01	05/24/2021 12:14:08 PM Central Daylight Time					06/02/2021 12:12:47 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H2802	804	0	2022	St Louis Area		1	20508	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1					1				
H2802	805	0	1	01	01	H2802_805_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 09:07:56 AM Central Daylight Time					06/02/2021 12:12:47 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H2802	805	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1					1				
H2802	806	0	1	01	01	H2802_806_0	1	1						05/24/2021	2022.01	05/24/2021 12:14:48 PM Central Daylight Time					06/02/2021 12:12:47 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H2802	806	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1					1				
H2802	807	0	1	01	01	H2802_807_0	1	1						05/24/2021	2022.01	05/24/2021 12:15:47 PM Central Daylight Time					06/02/2021 12:12:47 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H2802	807	0	2022	Springfield Area		1	108	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1					1				
H2802	808	0	1	01	01	H2802_808_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 09:07:19 AM Central Daylight Time					06/02/2021 12:12:47 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H2802	808	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1					1				
H2802	809	0	1	01	01	H2802_809_0	1	1						05/24/2021	2022.01	05/24/2021 12:16:40 PM Central Daylight Time					06/02/2021 12:12:47 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H2802	809	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1					1				
H2815	001	0	1	20	08	H2815_001_0	1	1						06/03/2021	2022.01	06/03/2021 03:08:12 PM Mountain Daylight Time		06/03/2021 02:18:19 PM Mountain Daylight Time			06/03/2021 03:11:57 PM 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	2022	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	1	1						06/03/2021	2022.01	06/03/2021 03:08:27 PM Mountain Daylight Time		06/03/2021 02:18:19 PM Mountain Daylight Time			06/03/2021 03:11:57 PM 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	2022	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	5	1						08/03/2021	2022.01	08/03/2021 11:14:45 AM Eastern Daylight Time	08/04/2021 12:01:05 AM Eastern Daylight Time	07/30/2021 11:10:52 AM Eastern Daylight Time			08/04/2021 11:02:27 PM Eastern Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Wellcare	www.wellcare.com/medicare	Wellcare Premium Ultra (PFFS)	04	09	1	1			H2816	013	0	2022	Select counties in NY		2	4798	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2816	019	0	1	09	04	H2816_019_0	5	1						08/03/2021	2022.01	08/03/2021 09:42:53 AM Eastern Daylight Time	08/04/2021 12:01:33 AM Eastern Daylight Time	07/30/2021 11:11:12 AM Eastern Daylight Time			08/04/2021 11:02:27 PM Eastern Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Wellcare	www.wellcare.com/medicare	Wellcare Premium Enhanced (PFFS)	04	09	1	1			H2816	019	0	2022	Select counties in NY		2	4829	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2816	037	0	1	09	04	H2816_037_0	6	1				0	0	06/02/2021	2022.01	06/02/2021 03:34:04 PM Eastern Daylight Time	06/06/2021 12:43:41 PM Eastern Daylight Time				07/19/2021 04:15:23 PM Eastern Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Wellcare	www.wellcare.com/medicare	Wellcare Advantage Premium Enhanced (PFFS)	04	09	1	1			H2816	037	0	2022	Select counties in NY		2	3760	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2816	038	0	1	09	04	H2816_038_0	6	1				0	0	06/02/2021	2022.01	06/02/2021 03:35:48 PM Eastern Daylight Time	06/06/2021 12:45:28 PM Eastern Daylight Time				07/19/2021 04:15:23 PM Eastern Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Wellcare	www.wellcare.com/medicare	Wellcare Advantage No Premium (PFFS)	04	09	1	1			H2816	038	0	2022	Select counties in NY		2	23805	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2816	040	0	1	09	04	H2816_040_0	5	1				0	0	06/02/2021	2022.01	06/02/2021 02:34:16 PM Eastern Daylight Time	06/06/2021 12:46:57 PM Eastern Daylight Time				07/19/2021 04:18:34 PM Eastern Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Wellcare	www.wellcare.com/medicare	Wellcare Advantage No Premium (PFFS)	04	09	1	1			H2816	040	0	2022	Select counties in ME		2	5600	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2816	801	0	1	09	04	H2816_801_0	2	1				0	0	05/03/2021	2022.01	05/03/2021 01:35:24 PM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Wellcare	www.wellcare.com/medicare	Today's Options PFFS - MA Group Plan (PFFS)	04	09	1	1			H2816	801	0	2022	National		1	100	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056										(711)-		(711)-		(711)-		(711)-										1					1					1				
H2816	802	0	1	09	04	H2816_802_0	2	1						05/03/2021	2022.01	05/03/2021 01:35:13 PM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Wellcare	www.wellcare.com/medicare	Today's Options PFFS - MAPD Group Plan (PFFS)	04	09	1	1			H2816	802	0	2022	National		1	100	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1					1					1				
H2816	803	0	1	09	04	H2816_803_0	2	1						05/03/2021	2022.01	05/03/2021 01:35:04 PM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Wellcare	www.wellcare.com/medicare	Today's Options PFFS - MAPD Group Plan - NCY (PFFS)	04	09	1	1			H2816	803	0	2022	National		1	100	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1					1					1				
H2825	001	0	1	01	01	H2825_001_0	8	1					1	08/02/2021	2022.01	08/02/2021 09:34:35 AM Central Daylight Time	07/30/2021 02:52:55 PM Central Daylight Time	07/30/2021 02:56:06 PM Central Daylight Time			08/03/2021 11:36:14 AM Central Daylight Time	MARY WASHINGTON HEALTH PLAN	Mary Washington Medicare Advantage	www.mwmaplan.com	Mary Washington Medicare Advantage Complete (HMO)	01	01		1			H2825	001	0	2022	Greater Fredericksburg Region		2		2			2						www.mwmaplan.com	www.mwmaplan.com	www.mwmaplan.com	(844)529-3760		(844)529-3760		(844)529-3827		(844)529-3827		(844)529-3760		(844)529-3760		(844)529-3827		(844)529-3827		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2825	002	0	1	01	01	H2825_002_0	7	1					0	07/14/2021	2022.01	07/14/2021 02:49:11 PM Central Daylight Time	07/30/2021 03:02:40 PM Central Daylight Time	07/30/2021 03:08:10 PM Central Daylight Time			08/03/2021 11:36:14 AM Central Daylight Time	MARY WASHINGTON HEALTH PLAN	Mary Washington Medicare Advantage	www.mwmaplan.com	Mary Washington Medicare Advantage Rewards (HMO)	01	01		1			H2825	002	0	2022	Greater Fredericksburg Region		2		2			2						www.mwmaplan.com	www.mwmaplan.com	www.mwmaplan.com	(844)529-3760		(844)529-3760		(844)529-3827		(844)529-3827		(844)529-3760		(844)529-3760		(844)529-3827		(844)529-3827		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2825	003	0	1	01	01	H2825_003_0	9	1					1	08/10/2021	2022.01	08/10/2021 09:36:28 AM Central Daylight Time	07/30/2021 03:16:38 PM Central Daylight Time	07/30/2021 03:19:59 PM Central Daylight Time			08/10/2021 09:54:51 AM Central Daylight Time	MARY WASHINGTON HEALTH PLAN	Mary Washington Medicare Advantage	www.mwmaplan.com	Riverside Medicare Advantage Complete (HMO)	01	01		1			H2825	003	0	2022	VA Peninsula, Williamsburg, Gloucester		2		2			2						www.mwmaplan.com	www.mwmaplan.com	www.mwmaplan.com	(844)529-3760		(844)529-3760		(844)529-3827		(844)529-3827		(844)529-3760		(844)529-3760		(844)529-3827		(844)529-3827		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2825	801	0	1	01	01	H2825_801_0	1	1						05/26/2021	2022.01	05/26/2021 02:19:43 PM Central Daylight Time					05/28/2021 10:26:05 AM Central Daylight Time	MARY WASHINGTON HEALTH PLAN	Mary Washington Medicare Advantage	www.mwmaplan.com	EGWP MAPD Calendar year (HMO)	01	01		1			H2825	801	0	2022	Certain Counties in Virginia		1	300	2			2						www.mwmaplan.com	www.mwmaplan.com	www.mwmaplan.com	(844)529-3760		(844)529-3760		(844)529-3827		(844)529-3827		(844)529-3760		(844)529-3760		(844)529-3827		(844)529-3827		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H2825	802	0	1	01	01	H2825_802_0	1	1						05/26/2021	2022.01	05/26/2021 02:20:05 PM Central Daylight Time					05/28/2021 10:26:05 AM Central Daylight Time	MARY WASHINGTON HEALTH PLAN	Mary Washington Medicare Advantage	www.mwmaplan.com	EGWP MAPD Non-Calendar year (HMO)	01	01		1			H2825	802	0	2022	Certain Counties in Virginia		1	300	2			2						www.mwmaplan.com	www.mwmaplan.com	www.mwmaplan.com	(844)529-3760		(844)529-3760		(844)529-3827		(844)529-3827		(844)529-3760		(844)529-3760		(844)529-3827		(844)529-3827		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H2825	803	0	1	01	01	H2825_803_0	1	1				0	0	05/26/2021	2022.01	05/26/2021 02:20:28 PM Central Daylight Time					05/28/2021 10:26:05 AM Central Daylight Time	MARY WASHINGTON HEALTH PLAN	Mary Washington Medicare Advantage	www.mwmaplan.com	EGWP MA Only Calendar Year (HMO)	01	01		1			H2825	803	0	2022	Certain Counties in Virginia		1	300	2			2						www.mwmaplan.com	www.mwmaplan.com	www.mwmaplan.com	(844)529-3760		(844)529-3760		(844)529-3827		(844)529-3827										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H2825	804	0	1	01	01	H2825_804_0	1	1				0	0	05/26/2021	2022.01	05/26/2021 02:20:52 PM Central Daylight Time					05/28/2021 10:26:05 AM Central Daylight Time	MARY WASHINGTON HEALTH PLAN	Mary Washington Medicare Advantage	www.mwmaplan.com	EGWP MA Only non-Calendar Year (HMO)	01	01		1			H2825	804	0	2022	Certain Counties in Virginia		1	300	2			2						www.mwmaplan.com	www.mwmaplan.com	www.mwmaplan.com	(844)529-3760		(844)529-3760		(844)529-3827		(844)529-3827										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H2835	001	0	1	20	08	H2835_001_0	1	1						06/02/2021	2022.01	06/02/2021 09:36:33 AM Eastern Daylight Time		06/02/2021 09:33:33 AM Eastern Daylight Time			06/02/2021 09:38:33 AM Eastern Daylight Time	THE CASCADE PACE, INC.	Thome PACE	www.thomepace.org	Thome PACE (PACE)	08	20		1			H2835	001	0	2022	Jackson, Lenawee, and Hillsdale Counties		2		2			2						www.hometownpharmacy.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						06/02/2021	2022.01	06/02/2021 09:37:04 AM Eastern Daylight Time		06/02/2021 09:33:33 AM Eastern Daylight Time			06/02/2021 09:38:33 AM Eastern Daylight Time	THE CASCADE PACE, INC.	Thome PACE	www.thomepace.org	Thome PACE Medicare Only (PACE)	08	20		1			H2835	002	0	2022	Jackson, Lenawee, and Hillsdale County		2		2			2						www.hometownpharmacy.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	005	0	1	04	01	H2836_005_0	6	1			2		0	08/02/2021	2022.01	08/02/2021 11:25:11 AM Eastern Daylight Time	08/03/2021 06:04:04 PM Eastern Daylight Time	08/03/2021 06:04:04 PM Eastern Daylight Time			08/04/2021 02:27:41 PM Eastern Daylight Time	ANTHEM HEALTH PLANS, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/shop	Anthem MediBlue Access Select (PPO)	01	04		1			H2836	005	0	2022	State of Connecticut		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com/medicare	(833)713-1076		(833)713-1076		(855)593-0918		(855)593-0918		(833)498-1586		(833)498-1586		(855)485-0939		(855)485-0939		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2836	006	0	1	04	01	H2836_006_0	7	1	2	1	1		0	07/15/2021	2022.01	07/15/2021 11:08:22 AM Eastern Daylight Time	08/03/2021 06:04:04 PM Eastern Daylight Time	08/03/2021 06:04:04 PM Eastern Daylight Time			08/04/2021 02:27:41 PM Eastern Daylight Time	ANTHEM HEALTH PLANS, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem MediBlue Dual Access (PPO D-SNP)	01	04		1			H2836	006	0	2022	Select counties in Connecticut		2		2			1	3		1		1	shop.anthem.com/medicare	shop.anthem.com/medicare	www.anthem.com/medicare	(833)713-1076		(833)713-1076		(855)593-0918		(855)593-0918		(833)498-1586		(833)498-1586		(855)485-0939		(855)485-0939		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2836	801	0	1	04	01	H2836_801_0	4	1						06/02/2021	2022.01	06/02/2021 04:09:45 PM Pacific Daylight Time					06/04/2021 08:35:52 AM Pacific Daylight Time	ANTHEM HEALTH PLANS, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem MediBlue Preferred (PPO)	01	04		1			H2836	801	0	2022	National		1	600	2			2						www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1									
H2853	001	0	1	01	01	H2853_001_0	4	1					0	08/02/2021	2022.01	08/02/2021 04:05:00 PM Central Daylight Time	08/03/2021 11:03:30 PM Central Daylight Time	07/30/2021 10:11:30 AM Central Daylight Time			08/04/2021 10:17:29 PM Central Daylight Time	CENTENE VENTURE COMPANY TENNESSEE	Ascension Complete	www.ascensioncomplete.com	Ascension Complete Saint Thomas Reward (HMO)	01	01		1			H2853	001	0	2022	10 counties in central Tennessee		2	859	2			2						ascensioncomplete.com/findadoctor	ascensioncomplete.com/formulary	ascensioncomplete.com/findadoctor	(833)906-2876		(833)906-2876		(844)578-1927		(844)578-1927		(833)906-2876		(833)906-2876		(844)578-1927		(844)578-1927		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2853	002	0	1	01	01	H2853_002_0	4	1					0	08/02/2021	2022.01	08/02/2021 04:05:35 PM Central Daylight Time	08/03/2021 11:04:00 PM Central Daylight Time	07/30/2021 10:12:06 AM Central Daylight Time			08/04/2021 10:17:29 PM Central Daylight Time	CENTENE VENTURE COMPANY TENNESSEE	Ascension Complete	ascensioncomplete.com	Ascension Complete Saint Thomas Secure (HMO)	01	01		1			H2853	002	0	2022	10 counties in central Tennessee		2	5955	2			2						ascensioncomplete.com/findadoctor	ascensioncomplete.com/formulary	ascensioncomplete.com/findadoctor	(833)906-2876		(833)906-2876		(844)578-1927		(844)578-1927		(833)906-2876		(833)906-2876		(844)578-1927		(844)578-1927		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2853	801	0	1	01	01	H2853_801_0	2	1						05/03/2021	2022.01	05/03/2021 01:35:35 PM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	CENTENE VENTURE COMPANY TENNESSEE	Ascension Complete	ascensioncomplete.com	Ascension Complete Group Medicare Advantage (HMO)	01	01		1			H2853	801	0	2022	10 Counties in Central Tennessee		1	100	2			2						https://www.ascensioncomplete.com/drug-pharmacy/coverage-determinations-redeterminations.html	https://www.ascensioncomplete.com/drug-pharmacy/formulary.html	ascensioncomplete.com/tn-findadoctor	(855)848-6940		(855)848-6940		(844)942-0039		(844)942-0039		(855)848-6940		(855)848-6940		(844)942-0039		(844)942-0039		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H2853	802	0	1	01	01	H2853_802_0	2	1				0	0	05/03/2021	2022.01	05/03/2021 01:35:52 PM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	CENTENE VENTURE COMPANY TENNESSEE	Ascension Complete	ascensioncomplete.com	Ascension Complete Group Medicare Advantage (HMO)	01	01		1			H2853	802	0	2022	10 Counties in Central Tennessee		1	100	2			2						https://www.ascensioncomplete.com/drug-pharmacy/coverage-determinations-redeterminations.html	https://www.ascensioncomplete.com/drug-pharmacy/formulary.html	ascensioncomplete.com/tn-findadoctor	(855)848-6940		(855)848-6940		(844)942-0039		(844)942-0039										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H2853	803	0	1	01	01	H2853_803_0	2	1						05/03/2021	2022.01	05/03/2021 01:36:13 PM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	CENTENE VENTURE COMPANY TENNESSEE	Ascension Complete	ascensioncomplete.com	Ascension Complete Group Medicare Advantage (HMO)	01	01		1			H2853	803	0	2022	10 Counties in Central Tennessee		1	100	2			2						https://www.ascensioncomplete.com/drug-pharmacy/coverage-determinations-redeterminations.html	https://www.ascensioncomplete.com/drug-pharmacy/formulary.html	ascensioncomplete.com/tn-findadoctor	(855)848-6940		(855)848-6940		(844)942-0039		(844)942-0039		(855)848-6940		(855)848-6940		(844)942-0039		(844)942-0039		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H2879	001	0	1	01	01	H2879_001_0	5	1	2	1			0	08/05/2021	2022.01	08/05/2021 10:24:53 AM Pacific Daylight Time	08/04/2021 05:29:22 PM Pacific Daylight Time	08/04/2021 04:35:28 PM Pacific Daylight Time			08/05/2021 03:02:36 PM Pacific Daylight Time	MOLINA HEALTHCARE OF WISCONSIN, INC.	Molina Healthcare of Wisconsin and Massachusetts	www.molinahealthcare.com/medicare	Molina Medicare Complete Care (HMO D-SNP)	01	01		1			H2879	001	0	2022	Select Counties in Wisconsin		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			
H2879	002	0	1	01	01	H2879_002_0	5	1					1	08/05/2021	2022.01	08/05/2021 10:26:09 AM Pacific Daylight Time	08/04/2021 05:29:54 PM Pacific Daylight Time	08/04/2021 04:35:54 PM Pacific Daylight Time			08/05/2021 03:02:36 PM Pacific Daylight Time	MOLINA HEALTHCARE OF WISCONSIN, INC.	Molina Healthcare of Wisconsin and Massachusetts	www.molinahealthcare.com	Senior Whole Health Medicare Choice Care (HMO)	01	01		1			H2879	002	0	2022	Select counties in Massachusetts		2		2			2						www.molinahealthcare.com	www.molinahealthcare.com	www.molinahealthcare.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			
H2879	003	0	1	01	01	H2879_003_0	5	1					1	08/05/2021	2022.01	08/05/2021 10:26:28 AM Pacific Daylight Time	08/04/2021 05:30:28 PM Pacific Daylight Time	08/04/2021 04:36:24 PM Pacific Daylight Time			08/05/2021 03:02:36 PM Pacific Daylight Time	MOLINA HEALTHCARE OF WISCONSIN, INC.	Molina Healthcare of Wisconsin and Massachusetts	www.molinahealthcare.com/medicare	Molina Medicare Choice Care (HMO)	01	01		1			H2879	003	0	2022	Select counties in Wisconsin		2		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			
H2882	003	0	1	20	08	H2882_003_0	1	1						06/01/2021	2022.01	06/01/2021 09:36:47 AM Eastern Daylight Time		06/01/2021 09:43:31 AM Eastern Daylight Time			06/01/2021 10:04:31 AM Eastern Daylight Time	PACE CENTRAL MICHIGAN, INC.	PACE Central Michigan	www.pacecmi.org	PACE Central Michigan (PACE)	08	20		1			H2882	003	0	2022	Central Michigan		2		2			2						https://hometownpharmacy.com/	N/A												(989)953-5800				(989)953-5800												(771)-				(771)-																
H2882	004	0	1	20	08	H2882_004_0	1	1						06/01/2021	2022.01	06/01/2021 09:37:51 AM Eastern Daylight Time		06/01/2021 09:43:58 AM Eastern Daylight Time			06/01/2021 10:04:31 AM Eastern Daylight Time	PACE CENTRAL MICHIGAN, INC.	PACE Central Michigan	www.pacecmi.org	PACE Central Michigan (PACE)	08	20		1			H2882	004	0	2022	Central Michigan		2		2			2						https://hometownpharmacy.com/	N/A												(989)953-5800				(989)953-5800												(771)-				(771)-																
H2915	002	0	1	01	01	H2915_002_0	4	1	2	1			0	08/03/2021	2022.01	08/03/2021 11:20:10 AM Eastern Daylight Time	08/04/2021 08:16:54 AM Eastern Daylight Time	07/30/2021 11:12:38 AM Eastern Daylight Time			08/04/2021 09:45:33 PM Eastern Daylight Time	PENNSYLVANIA HEALTH & WELLNESS, INC.	Wellcare by Allwell	www.wellcare.com/allwellPA	Wellcare Dual Access (HMO D-SNP)	01	01		1			H2915	002	0	2022	Select counties in PA		2	74386	2			1	3		1		1	www.wellcare.com/allwellPA	www.wellcare.com/allwellPA	www.wellcare.com/allwellPA	(866)330-9368		(866)330-9368		(866)277-6583		(866)277-6583		(866)330-9368		(866)330-9368		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2915	003	0	1	01	01	H2915_003_0	4	1					0	08/03/2021	2022.01	08/03/2021 11:36:06 AM Eastern Daylight Time	08/04/2021 08:26:37 AM Eastern Daylight Time	07/30/2021 11:13:14 AM Eastern Daylight Time			08/04/2021 09:45:33 PM Eastern Daylight Time	PENNSYLVANIA HEALTH & WELLNESS, INC.	Wellcare by Allwell	www.wellcare.com/allwellPA	Wellcare No Premium (HMO)	01	01		1			H2915	003	0	2022	Select counties in PA		2	27742	2			2						www.wellcare.com/allwellPA	www.wellcare.com/allwellPA	www.wellcare.com/allwellPA	(855)766-1456		(855)766-1456		(866)277-6583		(866)277-6583		(855)766-1456		(855)766-1456		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2915	007	0	1	01	01	H2915_007_0	5	1	2	1			0	08/03/2021	2022.01	08/03/2021 02:51:41 PM Eastern Daylight Time	08/04/2021 08:08:30 AM Eastern Daylight Time	07/30/2021 11:13:34 AM Eastern Daylight Time			08/04/2021 09:45:33 PM Eastern Daylight Time	PENNSYLVANIA HEALTH & WELLNESS, INC.	Wellcare by Allwell	www.wellcare.com/allwellPA	Wellcare Dual Access (HMO D-SNP)	01	01		1			H2915	007	0	2022	Select counties in PA		2	29902	2			1	3		1		1	www.wellcare.com/allwellPA	www.wellcare.com/allwellPA	www.wellcare.com/allwellPA	(866)330-9368		(866)330-9368		(866)277-6583		(866)277-6583		(866)330-9368		(866)330-9368		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2915	011	0	1	01	01	H2915_011_0	4	1					0	06/04/2021	2022.01	06/04/2021 01:11:19 PM Eastern Daylight Time	08/04/2021 08:14:00 AM Eastern Daylight Time	07/30/2021 11:13:54 AM Eastern Daylight Time			08/04/2021 09:45:33 PM Eastern Daylight Time	PENNSYLVANIA HEALTH & WELLNESS, INC.	Wellcare by Allwell	www.wellcare.com/allwellPA	Wellcare Assist (HMO)	01	01		1			H2915	011	0	2022	Select counties in PA		2	776	2			2						www.wellcare.com/allwellPA	www.wellcare.com/allwellPA	www.wellcare.com/allwellPA	(855)766-1456		(855)766-1456		(866)277-6583		(866)277-6583		(855)766-1456		(855)766-1456		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2915	012	0	1	01	01	H2915_012_0	4	1					0	05/31/2021	2022.01	05/31/2021 08:56:41 AM Eastern Daylight Time	08/04/2021 08:04:26 AM Eastern Daylight Time	07/30/2021 11:14:16 AM Eastern Daylight Time			08/04/2021 09:45:33 PM Eastern Daylight Time	PENNSYLVANIA HEALTH & WELLNESS, INC.	Wellcare by Allwell	www.wellcare.com/allwellPA	Wellcare Giveback (HMO)	01	01		1			H2915	012	0	2022	Select counties in PA		2	5978	2			2						www.wellcare.com/allwellPA	www.wellcare.com/allwellPA	www.wellcare.com/allwellPA	(855)766-1456		(855)766-1456		(866)277-6583		(866)277-6583		(855)766-1456		(855)766-1456		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2915	013	0	1	01	01	H2915_013_0	3	1				0	0	05/31/2021	2022.01	05/31/2021 08:55:13 AM Eastern Daylight Time	06/04/2021 08:10:14 PM Eastern Daylight Time				07/19/2021 05:05:07 PM Eastern Daylight Time	PENNSYLVANIA HEALTH & WELLNESS, INC.	Wellcare by Allwell	www.wellcare.com/allwellPA	Wellcare Patriot Giveback (HMO)	01	01		1			H2915	013	0	2022	Select counties in PA		2	1117	2			2						www.wellcare.com/allwellPA	www.wellcare.com/allwellPA	www.wellcare.com/allwellPA	(855)766-1456		(855)766-1456		(866)277-6583		(866)277-6583										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2915	016	0	1	01	01	H2915_016_0	4	1					0	08/03/2021	2022.01	08/03/2021 11:24:23 AM Eastern Daylight Time	08/04/2021 08:27:28 AM Eastern Daylight Time	07/30/2021 11:14:36 AM Eastern Daylight Time			08/04/2021 09:45:33 PM Eastern Daylight Time	PENNSYLVANIA HEALTH & WELLNESS, INC.	Wellcare by Allwell	www.wellcare.com/allwellPA	Wellcare No Premium (HMO)	01	01		1			H2915	016	0	2022	Select Counties in PA		2	23371	2			2						www.wellcare.com/allwellPA	www.wellcare.com/allwellPA	www.wellcare.com/allwellPA	(855)766-1456		(855)766-1456		(866)277-6583		(866)277-6583		(855)766-1456		(855)766-1456		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2915	801	0	1	01	01	H2915_801_0	2	1						06/02/2021	2022.01	06/02/2021 08:07:44 AM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	PENNSYLVANIA HEALTH & WELLNESS, INC.	Wellcare by Allwell	allwell.pahealthwellness.com	Allwell Group (HMO)	01	01		1			H2915	801	0	2022	Pennsylvania		1	100	2			2						allwell.pahealthwellness.com/findadoctor	allwell.pahealthwellness.com/formulary	allwell.pahealthwellness.com/findadoctor	(855)766-1456		(855)766-1456		(844)942-0039		(844)942-0039		(855)766-1456		(855)766-1456		(844)942-0039		(844)942-0039		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H2915	802	0	1	01	01	H2915_802_0	2	1				0	0	05/03/2021	2022.01	05/03/2021 01:36:41 PM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	PENNSYLVANIA HEALTH & WELLNESS, INC.	Wellcare by Allwell	allwell.pahealthwellness.com	Allwell Group (HMO)	01	01		1			H2915	802	0	2022	Pennsylvania		1	100	2			2						allwell.pahealthwellness.com/findadoctor	allwell.pahealthwellness.com/formulary	allwell.pahealthwellness.com/findadoctor	(855)766-1456		(855)766-1456		(844)942-0039		(844)942-0039										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H2915	803	0	1	01	01	H2915_803_0	2	1						05/03/2021	2022.01	05/03/2021 01:36:54 PM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	PENNSYLVANIA HEALTH & WELLNESS, INC.	Wellcare by Allwell	allwell.pahealthwellness.com	Allwell Group (HMO)	01	01		1			H2915	803	0	2022	Pennsylvania		1	100	2			2						allwell.pahealthwellness.com/findadoctor	allwell.pahealthwellness.com/formulary	allwell.pahealthwellness.com/findadoctor	(855)766-1456		(855)766-1456		(844)942-0039		(844)942-0039		(855)766-1456		(855)766-1456		(844)942-0039		(844)942-0039		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H2926	001	0	1	01	01	H2926_001_0	10	1	2	1			0	07/08/2021	2022.01	07/08/2021 06:52:04 PM Central Daylight Time	07/29/2021 04:04:07 PM Central Daylight Time	07/29/2021 04:19:33 PM Central Daylight Time			07/30/2021 11:10:31 AM Central Daylight Time	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	PrimeWest Health	www.primewest.org/phc	Prime Health Complete (HMO D-SNP)	01	01		1			H2926	001	0	2022	Northern, west central, and southwestern Minnesota		2	1638	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					1					1	2			
H2936	001	0	1	20	08	H2936_001_0	1	1						05/24/2021	2022.01	05/24/2021 12:26:36 PM Eastern Daylight Time		05/24/2021 12:08:59 PM Eastern Daylight Time			05/24/2021 12:44:04 PM Eastern Daylight Time	LIFECIRCLES	LIFECIRCLES	www.lifecircles-pace.org	LifeCircles (PACE)	08	20		1			H2936	001	0	2022	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						05/24/2021	2022.01	05/24/2021 12:27:00 PM Eastern Daylight Time		05/24/2021 12:08:59 PM Eastern Daylight Time			05/24/2021 12:44:04 PM Eastern Daylight Time	LIFECIRCLES	LIFECIRCLES	www.lifecircles-pace.org	002 - Medicare Only (PACE)	08	20		1			H2936	002	0	2022	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	2	1						04/28/2021	2022.01	04/28/2021 04:00:57 PM Eastern Daylight Time		07/27/2021 02:04:57 PM Eastern Daylight Time			07/27/2021 02:39:58 PM Eastern Daylight Time	SENIOR LIFE GREENSBURG, INC.	Senior LIFE Greensburg, Inc.	www.seniorlifepa.com	Senior LIFE Greensburg Dual Eligible (PACE)	08	20		1			H2937	001	0	2022	Westmoreland County		2		2			2						http://granerx.com/	NA										(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000										(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000																
H2937	002	0	1	20	08	H2937_002_0	2	1						04/28/2021	2022.01	04/28/2021 04:01:11 PM Eastern Daylight Time		07/27/2021 02:05:22 PM Eastern Daylight Time			07/27/2021 02:39:58 PM Eastern Daylight Time	SENIOR LIFE GREENSBURG, INC.	Senior LIFE Greensburg, Inc.	www.Seniorlifegreensburg.com	Senior LIFE Greensburg Medicare Only (PACE)	08	20		1			H2937	002	0	2022	Westmoreland County		2		2			2						http://granerx.com/	NA										(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000										(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000																
H2941	001	0	1	20	08	H2941_001_0	1	1						06/02/2021	2022.01	06/02/2021 01:08:47 PM Eastern Daylight Time		05/28/2021 09:14:03 AM Eastern Daylight Time			06/02/2021 01:12:21 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	2022	South Hampton Roads Area		2		2			2						www.sentara.com	www.sentara.com										(800)736-8272		(757)553-3105		(800)736-8272		(757)553-3105										(844)359-0862		(757)390-4049		(844)359-0862		(757)390-4049																
H2941	002	0	1	20	08	H2941_002_0	1	1						06/02/2021	2022.01	06/02/2021 01:10:18 PM Eastern Daylight Time		05/28/2021 09:28:30 AM Eastern Daylight Time			06/02/2021 01:12:21 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	2022	South Hampton Roads area		2		2			2						www.sentara.com	www.sentara.com										(800)736-8272		(757)553-3105		(800)736-8272		(757)553-3105										(800)225-7784		(757)552-7120		(800)225-7784		(757)552-7120																
H2944	013	0	1	09	04	H2944_013_0	3	1						07/15/2021	2022.01	07/15/2021 02:32:09 PM Eastern Daylight Time	08/03/2021 05:35:34 PM Eastern Daylight Time	07/30/2021 10:37:16 AM Eastern Daylight Time			08/04/2021 01:40:20 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H2944-013 (PFFS)	04	09	3	1			H2944	013	0	2022	Select Counties in KS, MO and OK		2		2			2						https://www.humana.com/pharmacy/	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	4	1						07/31/2021	2022.01	07/31/2021 03:04:17 PM Eastern Daylight Time	08/03/2021 05:28:49 PM Eastern Daylight Time	07/30/2021 10:37:28 AM Eastern Daylight Time			08/04/2021 02:06:50 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H2944-114 (PFFS)	04	09	3	1			H2944	114	0	2022	Lowndes County		2		2			2						https://www.humana.com/pharmacy/	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				0	0	06/03/2021	2022.01	06/03/2021 07:41:36 PM Eastern Daylight Time	07/22/2021 09:19:48 AM Eastern Daylight Time				07/22/2021 01:31:00 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	2022	Select Counties in KS, MO and OK		2		2			2						https://www.humana.com/pharmacy/	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	009	0	1	01	01	H2960_009_0	4	1				0	0	07/21/2021	2022.01	07/21/2021 02:23:27 PM Pacific Daylight Time	07/20/2021 12:49:00 PM Pacific Daylight Time				07/21/2021 02:37:45 PM Pacific Daylight Time	HOMETOWN HEALTH PLAN, INC.	Senior Care Plus	www.SeniorCarePlus.com	Senior Care Plus Patriot Plan (HMO)	01	01		1			H2960	009	0	2022	Washoe, Carson City Counties, NV		2	5723	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;7a;9a1;9a2;9b;	
H2960	012	0	1	01	01	H2960_012_0	8	1					1	08/10/2021	2022.01	08/10/2021 08:50:18 AM Pacific Daylight Time	08/05/2021 07:03:14 PM Pacific Daylight Time	08/05/2021 07:03:49 PM Pacific Daylight Time			08/10/2021 09:11:06 AM Pacific Daylight Time	HOMETOWN HEALTH PLAN, INC.	Senior Care Plus	www.SeniorCarePlus.com	Senior Care Plus Essential plan (HMO)	01	01		1			H2960	012	0	2022	Washoe, Carson City Counties, NV		2	130458	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;7a;9a1;9a2;9b;	
H2960	018	0	1	01	01	H2960_018_0	7	1					1	08/10/2021	2022.01	08/10/2021 08:50:35 AM Pacific Daylight Time	08/05/2021 07:03:14 PM Pacific Daylight Time	08/05/2021 07:03:49 PM Pacific Daylight Time			08/10/2021 09:14:56 AM Pacific Daylight Time	HOMETOWN HEALTH PLAN, INC.	Senior Care Plus	www.SeniorCarePlus.com	Senior Care Plus Select Plan (HMO)	01	01		1			H2960	018	0	2022	Washoe, Carson City Counties, NV		2	8973	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;7a;9a1;9a2;9b;	
H2960	019	0	1	01	01	H2960_019_0	5	1					1	08/05/2021	2022.01	08/05/2021 06:18:03 PM Pacific Daylight Time	08/05/2021 06:07:51 PM Pacific Daylight Time	08/05/2021 06:08:27 PM Pacific Daylight Time			08/06/2021 11:39:21 AM Pacific Daylight Time	HOMETOWN HEALTH PLAN, INC.	Senior Care Plus	www.SeniorCarePlus.com	Senior Care Plus Complete Plan (HMO)	01	01		1			H2960	019	0	2022	Clark and Nye Counties		2	7305	2			2						www.SeniorCarePlus.com	www.SeniorCarePlus.com	www.SeniorCarePlus.com	(888)775-7003		(702)914-0863		(888)775-7003		(702)914-0863		(800)681-9585		(800)681-9585		(888)775-7003		(702)914-0863		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	4b;	
H2960	021	0	1	01	01	H2960_021_0	5	1					1	08/05/2021	2022.01	08/05/2021 01:49:23 PM Pacific Daylight Time	08/05/2021 06:07:51 PM Pacific Daylight Time	08/05/2021 06:08:27 PM Pacific Daylight Time			08/06/2021 11:41:10 AM Pacific Daylight Time	HOMETOWN HEALTH PLAN, INC.	Senior Care Plus	www.SeniorCarePlus.com	Senior Care Plus Comprehensive plan (HMO)	01	01		1			H2960	021	0	2022	Clark County Nv		2	1955	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	022	0	1	01	01	H2960_022_0	5	1		1			1	08/05/2021	2022.01	08/05/2021 01:55:15 PM Pacific Daylight Time	08/05/2021 06:07:50 PM Pacific Daylight Time	08/05/2021 06:08:26 PM Pacific Daylight Time			08/06/2021 11:42:48 AM Pacific Daylight Time	HOMETOWN HEALTH PLAN, INC.	Senior Care Plus	www.SeniorCarePlus.com	Senior Care Plus Encompass Plan (HMO C-SNP)	01	01		1			H2960	022	0	2022	Clark, NV County		2	1184	2			1	4			00000000000000000010		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;7d;7g;	
H2960	023	0	1	01	01	H2960_023_0	6	1					1	08/10/2021	2022.01	08/10/2021 09:16:53 AM Pacific Daylight Time	08/05/2021 07:03:14 PM Pacific Daylight Time	08/05/2021 07:03:49 PM Pacific Daylight Time			08/10/2021 09:17:11 AM Pacific Daylight Time	HOMETOWN HEALTH PLAN, INC.	Senior Care Plus	www.SeniorCarePlus.com	Renown Preferred Plan by Senior Care Plus (HMO)	01	01		1			H2960	023	0	2022	Washoe, Carson City Counties, NV		2	75662	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;9a1;9a2;9b;	
H2960	024	0	1	01	01	H2960_024_0	4	1	2	1			0	08/05/2021	2022.01	08/05/2021 07:19:09 PM Pacific Daylight Time	08/05/2021 06:07:51 PM Pacific Daylight Time	08/06/2021 12:49:53 PM Pacific Daylight Time			08/06/2021 12:51:25 PM Pacific Daylight Time	HOMETOWN HEALTH PLAN, INC.	Senior Care Plus	www.SeniorCarePlus.com	Senior Care Plus Extensive Duals Plan (HMO D-SNP)	01	01		1			H2960	024	0	2022	Washoe, Carson City Counties, NV		2	5400	2			1	3		1		1	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					1					2	2			
H2960	803	0	1	01	01	H2960_803_0	2	1						06/07/2021	2022.01	06/07/2021 11:42:24 AM Pacific Daylight Time					06/07/2021 07:53:01 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	2022	State of Nevada		1	3336	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	7	1			2		1	07/13/2021	2022.01	07/13/2021 03:55:03 PM Eastern Daylight Time	07/30/2021 04:52:10 PM Eastern Daylight Time	07/30/2021 05:36:57 PM Eastern Daylight Time			08/04/2021 09:45:13 AM Eastern Daylight Time	ULTIMATE HEALTH PLANS, INC.	Ultimate Health Plans	www.chooseultimate.com	Premier by Ultimate (HMO)	01	01		1			H2962	001	0	2022	Hernando County		2	28480	2			2						www.chooseultimate.com	www.chooseultimate.com	www.chooseultimate.com	(888)657-4170		(224)399-4282		(855)858-7526		(352)277-5427		(800)311-7517		(800)311-7517		(855)858-7526		(352)277-5427		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2962	013	3	1	01	01	H2962_013_3	7	1			2		1	07/13/2021	2022.01	07/13/2021 03:55:22 PM Eastern Daylight Time	07/30/2021 04:52:37 PM Eastern Daylight Time	07/30/2021 05:37:18 PM Eastern Daylight Time			08/04/2021 09:45:13 AM Eastern Daylight Time	ULTIMATE HEALTH PLANS, INC.	Ultimate Health Plans	www.chooseultimate.com	Premier by Ultimate (HMO)	01	01		1			H2962	013	3	2022	Citrus and Pasco Counties, FL	Pasco County	2	11060	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		(800)311-7517		(855)858-7526		(352)277-5370		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2962	013	4	1	01	01	H2962_013_4	7	1			2		1	07/13/2021	2022.01	07/13/2021 03:55:42 PM Eastern Daylight Time	07/30/2021 04:53:05 PM Eastern Daylight Time	07/30/2021 05:37:38 PM Eastern Daylight Time			08/04/2021 09:45:13 AM Eastern Daylight Time	ULTIMATE HEALTH PLANS, INC.	Ultimate Health Plans	www.chooseultimate.com	Premier by Ultimate (HMO)	01	01		1			H2962	013	4	2022	Citrus and Pasco Counties, FL	Citrus County	2	19992	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		(800)311-7517		(855)858-7526		(352)277-5370		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2962	014	1	1	01	01	H2962_014_1	7	1			2		1	07/13/2021	2022.01	07/13/2021 03:56:07 PM Eastern Daylight Time	07/30/2021 04:53:33 PM Eastern Daylight Time	07/30/2021 05:37:58 PM Eastern Daylight Time			08/04/2021 09:45:13 AM Eastern Daylight Time	ULTIMATE HEALTH PLANS, INC.	Ultimate Health Plans	www.chooseultimate.com	Premier Plus by Ultimate (HMO)	01	01		1			H2962	014	1	2022	Citrus, Hernando and Pasco Counties, FL	Hernando and Pasco Counties	2	6374	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		(800)311-7517		(855)858-7526		(352)277-5370		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2962	014	2	1	01	01	H2962_014_2	7	1			2		1	07/13/2021	2022.01	07/13/2021 03:56:59 PM Eastern Daylight Time	07/30/2021 04:54:01 PM Eastern Daylight Time	07/30/2021 05:38:19 PM Eastern Daylight Time			08/04/2021 09:45:13 AM Eastern Daylight Time	ULTIMATE HEALTH PLANS, INC.	Ultimate Health Plans	www.chooseultimate.com	Premier Plus by Ultimate (HMO)	01	01		1			H2962	014	2	2022	Citrus, Hernando and Pasco Counties, FL	Citrus County	2	2682	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		(800)311-7517		(855)858-7526		(352)277-5370		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2962	016	0	1	01	01	H2962_016_0	7	1			2		1	07/13/2021	2022.01	07/13/2021 04:00:50 PM Eastern Daylight Time	07/30/2021 04:54:30 PM Eastern Daylight Time	07/30/2021 05:38:39 PM Eastern Daylight Time			08/04/2021 09:45:13 AM Eastern Daylight Time	ULTIMATE HEALTH PLANS, INC.	Ultimate Health Plans	www.chooseultimate.com	Premier Plus by Ultimate (HMO)	01	01		1			H2962	016	0	2022	Marion, Lake and Sumter Counties, FL		2	180	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		(800)311-7517		(855)858-7526		(352)277-5370		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2962	019	1	1	01	01	H2962_019_1	7	1		1	2		1	07/13/2021	2022.01	07/13/2021 04:01:04 PM Eastern Daylight Time	07/30/2021 04:54:58 PM Eastern Daylight Time	07/30/2021 05:38:59 PM Eastern Daylight Time			08/04/2021 09:45:13 AM Eastern Daylight Time	ULTIMATE HEALTH PLANS, INC.	Ultimate Health Plans	www.chooseultimate.com	Advantage Care by Ultimate (HMO C-SNP)	01	01		1			H2962	019	1	2022	Hernando and Pasco Counties in Florida	Hernando County, FL	2	15830	2			1	4			00000000000000001000		www.chooseultimate.com	www.chooseultimate.com	www.chooseultimate.com	(888)657-4170		(224)399-4282		(855)858-7526		(352)277-5370		(800)311-7517		(800)311-7517		(855)858-7526		(352)277-5370		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2962	019	2	1	01	01	H2962_019_2	7	1		1	2		1	07/13/2021	2022.01	07/13/2021 04:02:38 PM Eastern Daylight Time	07/30/2021 04:55:26 PM Eastern Daylight Time	07/30/2021 05:39:20 PM Eastern Daylight Time			08/04/2021 09:45:13 AM Eastern Daylight Time	ULTIMATE HEALTH PLANS, INC.	Ultimate Health Plans	www.chooseultimate.com	Advantage Care by Ultimate (HMO C-SNP)	01	01		1			H2962	019	2	2022	Hernando and Pasco Counties in Florida	Pasco County, FL	2	5088	2			1	4			00000000000000001000		www.chooseultimate.com	www.chooseultimate.com	www.chooseultimate.com	(888)657-4170		(224)399-4282		(855)858-7526		(352)277-5370		(800)311-7517		(800)311-7517		(855)858-7526		(352)277-5370		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2962	021	0	1	01	01	H2962_021_0	7	1		1	2		1	07/13/2021	2022.01	07/13/2021 04:03:11 PM Eastern Daylight Time	07/30/2021 04:55:54 PM Eastern Daylight Time	07/30/2021 05:39:40 PM Eastern Daylight Time			08/04/2021 09:45:13 AM Eastern Daylight Time	ULTIMATE HEALTH PLANS, INC.	Ultimate Health Plans	www.chooseultimate.com	Advantage Care by Ultimate (HMO C-SNP)	01	01		1			H2962	021	0	2022	Citrus County, FL		2	11821	2			1	4			00000000000000001000		www.chooseultimate.com	www.chooseultimate.com	www.chooseultimate.com	(888)657-4170		(224)399-4282		(855)858-7526		(352)277-5370		(800)311-7517		(800)311-7517		(855)858-7526		(352)277-5370		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2962	022	0	1	01	01	H2962_022_0	7	1		1	2		1	07/13/2021	2022.01	07/13/2021 04:03:57 PM Eastern Daylight Time	07/30/2021 04:56:21 PM Eastern Daylight Time	07/30/2021 05:40:01 PM Eastern Daylight Time			08/04/2021 09:45:13 AM Eastern Daylight Time	ULTIMATE HEALTH PLANS, INC.	Ultimate Health Plans	www.chooseultimate.com	Advantage Care CHF by Ultimate (HMO C-SNP)	01	01		1			H2962	022	0	2022	Citrus County, FL		2	198	2			1	4			00001000000000000000		www.chooseultimate.com	www.chooseultimate.com	www.chooseultimate.com	(888)657-4170		(224)399-4282		(855)858-7526		(352)277-5370		(800)311-7517		(800)311-7517		(855)858-7526		(352)277-5370		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2962	023	0	1	01	01	H2962_023_0	7	1		1	2		1	07/13/2021	2022.01	07/13/2021 04:04:33 PM Eastern Daylight Time	07/30/2021 04:56:47 PM Eastern Daylight Time	07/30/2021 05:40:24 PM Eastern Daylight Time			08/04/2021 09:45:13 AM Eastern Daylight Time	ULTIMATE HEALTH PLANS, INC.	Ultimate Health Plans	www.chooseultimate.com	Advantage Care COPD by Ultimate (HMO C-SNP)	01	01		1			H2962	023	0	2022	Citrus County, FL		2	132	2			1	4			00000000000100000000		www.chooseultimate.com	www.chooseultimate.com	www.chooseultimate.com	(888)657-4170		(224)399-4282		(855)858-7526		(352)277-5370		(800)311-7517		(800)311-7517		(855)858-7526		(352)277-5370		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2962	024	0	1	01	01	H2962_024_0	7	1		1	2		1	07/13/2021	2022.01	07/13/2021 04:04:47 PM Eastern Daylight Time	07/30/2021 04:57:14 PM Eastern Daylight Time	07/30/2021 05:40:43 PM Eastern Daylight Time			08/04/2021 09:45:13 AM Eastern Daylight Time	ULTIMATE HEALTH PLANS, INC.	Ultimate Health Plans	www.chooseultimate.com	Advantage Care CHF by Ultimate (HMO C-SNP)	01	01		1			H2962	024	0	2022	Hernando and Pasco Counties, FL		2	148	2			1	4			00001000000000000000		www.chooseultimate.com	www.chooseultimate.com	www.chooseultimate.com	(888)657-4170		(224)399-4282		(855)858-7526		(352)277-5370		(800)311-7517		(800)311-7517		(855)858-7526		(352)277-5370		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2962	025	0	1	01	01	H2962_025_0	7	1		1	2		1	07/13/2021	2022.01	07/13/2021 04:05:35 PM Eastern Daylight Time	07/30/2021 04:57:42 PM Eastern Daylight Time	07/30/2021 05:41:04 PM Eastern Daylight Time			08/04/2021 09:45:13 AM Eastern Daylight Time	ULTIMATE HEALTH PLANS, INC.	Ultimate Health Plans	www.chooseultimate.com	Advantage Care COPD by Ultimate (HMO C-SNP)	01	01		1			H2962	025	0	2022	Hernando and Pasco Counties, FL		2	132	2			1	4			00000000000100000000		www.chooseultimate.com	www.chooseultimate.com	www.chooseultimate.com	(888)657-4170		(224)399-4282		(855)858-7526		(352)277-5370		(800)311-7517		(800)311-7517		(855)858-7526		(352)277-5370		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2962	026	0	1	01	01	H2962_026_0	7	1		1	2		1	07/13/2021	2022.01	07/13/2021 04:05:47 PM Eastern Daylight Time	07/30/2021 04:58:09 PM Eastern Daylight Time	07/30/2021 05:41:24 PM Eastern Daylight Time			08/04/2021 09:45:13 AM Eastern Daylight Time	ULTIMATE HEALTH PLANS, INC.	Ultimate Health Plans	www.chooseultimate.com	Advantage Care by Ultimate (HMO C-SNP)	01	01		1			H2962	026	0	2022	Hillsborough and Pinellas Counties, FL		2	2013	2			1	4			00000000000000000010		www.chooseultimate.com	www.chooseultimate.com	www.chooseultimate.com	(888)657-4170		(224)399-4282		(855)858-7526		(352)277-5370		(800)311-7517		(800)311-7517		(855)858-7526		(352)277-5370		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2962	027	0	1	01	01	H2962_027_0	7	1		1	2		1	07/13/2021	2022.01	07/13/2021 04:06:05 PM Eastern Daylight Time	07/30/2021 04:58:36 PM Eastern Daylight Time	07/30/2021 05:41:44 PM Eastern Daylight Time			08/04/2021 09:45:13 AM Eastern Daylight Time	ULTIMATE HEALTH PLANS, INC.	Ultimate Health Plans	www.chooseultimate.com	Advantage Care COPD by Ultimate (HMO C-SNP)	01	01		1			H2962	027	0	2022	Hillsborough County, Pinellas County, FL		2	16	2			1	4			00000000000100000000		www.chooseultimate.com	www.chooseultimate.com	www.chooseultimate.com	(888)657-4170		(224)399-4282		(855)858-7526		(352)277-5370		(800)311-7517		(800)311-7517		(855)858-7526		(352)277-5370		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2962	028	0	1	01	01	H2962_028_0	7	1			2		1	07/13/2021	2022.01	07/13/2021 04:06:18 PM Eastern Daylight Time	07/30/2021 04:59:10 PM Eastern Daylight Time	07/30/2021 05:42:04 PM Eastern Daylight Time			08/04/2021 09:45:13 AM Eastern Daylight Time	ULTIMATE HEALTH PLANS, INC.	Ultimate Health Plans	www.chooseultimate.com	Premier by Ultimate (HMO)	01	01		1			H2962	028	0	2022	Marion, Lake and Sumter Counties, FL		2	2921	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		(800)311-7517		(855)858-7526		(352)277-5370		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2962	029	0	1	01	01	H2962_029_0	7	1		1	2		1	07/13/2021	2022.01	07/13/2021 04:06:34 PM Eastern Daylight Time	07/30/2021 04:59:44 PM Eastern Daylight Time	07/30/2021 05:42:24 PM Eastern Daylight Time			08/04/2021 09:45:13 AM Eastern Daylight Time	ULTIMATE HEALTH PLANS, INC.	Ultimate Health Plans	www.chooseultimate.com	Advantage Care by Ultimate (HMO C-SNP)	01	01		1			H2962	029	0	2022	Marion, Lake and Sumter Counties, FL		2	4784	2			1	4			00000000000000000010		www.chooseultimate.com	www.chooseultimate.com	www.chooseultimate.com	(888)657-4170		(224)399-4282		(855)858-7526		(352)277-5370		(800)311-7517		(800)311-7517		(855)858-7526		(352)277-5370		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2962	030	0	1	01	01	H2962_030_0	7	1		1	2		1	07/13/2021	2022.01	07/13/2021 04:06:49 PM Eastern Daylight Time	07/30/2021 05:00:12 PM Eastern Daylight Time	07/30/2021 05:42:44 PM Eastern Daylight Time			08/04/2021 09:45:13 AM Eastern Daylight Time	ULTIMATE HEALTH PLANS, INC.	Ultimate Health Plans	www.chooseultimate.com	Advantage Care COPD by Ultimate (HMO C-SNP)	01	01		1			H2962	030	0	2022	Marion, Lake, and Sumter Counties, FL		2	296	2			1	4			00000000000100000000		www.chooseultimate.com	www.chooseultimate.com	www.chooseultimate.com	(888)657-4170		(224)399-4282		(855)858-7526		(352)277-5370		(800)311-7517		(800)311-7517		(855)858-7526		(352)277-5370		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2962	031	0	1	01	01	H2962_031_0	7	1			2		1	07/13/2021	2022.01	07/13/2021 04:07:05 PM Eastern Daylight Time	07/30/2021 05:00:43 PM Eastern Daylight Time	07/30/2021 05:43:04 PM Eastern Daylight Time			08/04/2021 09:45:13 AM Eastern Daylight Time	ULTIMATE HEALTH PLANS, INC.	Ultimate Health Plans	www.chooseultimate.com	Premier by Ultimate (HMO)	01	01		1			H2962	031	0	2022	Indian River and St. Lucie Counties, FL		2	3101	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		(800)311-7517		(855)858-7526		(352)277-5370		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2962	032	0	1	01	01	H2962_032_0	7	1			2		1	07/13/2021	2022.01	07/13/2021 07:53:35 PM Eastern Daylight Time	07/30/2021 05:01:11 PM Eastern Daylight Time	07/30/2021 05:43:24 PM Eastern Daylight Time			08/04/2021 09:45:13 AM Eastern Daylight Time	ULTIMATE HEALTH PLANS, INC.	Ultimate Health Plans	www.chooseultimate.com	Premier Plus by Ultimate (HMO)	01	01		1			H2962	032	0	2022	Indian River and St. Lucie Counties, FL		2	693	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		(800)311-7517		(855)858-7526		(352)277-5370		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2962	033	0	1	01	01	H2962_033_0	7	1		1	2		1	07/13/2021	2022.01	07/13/2021 04:07:32 PM Eastern Daylight Time	07/30/2021 05:01:41 PM Eastern Daylight Time	07/30/2021 05:43:45 PM Eastern Daylight Time			08/04/2021 09:45:13 AM Eastern Daylight Time	ULTIMATE HEALTH PLANS, INC.	Ultimate Health Plans	www.chooseultimate.com	Advantage Care by Ultimate (HMO C-SNP)	01	01		1			H2962	033	0	2022	Indian River and St. Lucie Counties, FL		2	330	2			1	4			00000000000000000010		www.chooseultimate.com	www.chooseultimate.com	www.chooseultimate.com	(888)657-4170		(224)399-4282		(855)858-7526		(352)277-5370		(800)311-7517		(800)311-7517		(855)858-7526		(352)277-5370		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2962	034	0	1	01	01	H2962_034_0	7	1		1	2		1	07/13/2021	2022.01	07/13/2021 04:07:46 PM Eastern Daylight Time	07/30/2021 05:02:07 PM Eastern Daylight Time	07/30/2021 05:44:05 PM Eastern Daylight Time			08/04/2021 09:45:13 AM Eastern Daylight Time	ULTIMATE HEALTH PLANS, INC.	Ultimate Health Plans	www.chooseultimate.com	Advantage Care COPD by Ultimate (HMO C-SNP)	01	01		1			H2962	034	0	2022	Indian River and St. Lucie Counties, FL		2	49	2			1	4			00000000000100000000		www.chooseultimate.com	www.chooseultimate.com	www.chooseultimate.com	(888)657-4170		(224)399-4282		(855)858-7526		(352)277-5370		(800)311-7517		(800)311-7517		(855)858-7526		(352)277-5370		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2962	035	0	1	01	01	H2962_035_0	10	1	2	1	1		0	09/27/2021	2022.01	09/27/2021 12:46:30 PM Eastern Daylight Time	08/12/2021 10:57:24 AM Eastern Daylight Time	07/30/2021 05:44:26 PM Eastern Daylight Time			09/27/2021 01:55:08 PM Eastern Daylight Time	ULTIMATE HEALTH PLANS, INC.	Ultimate Health Plans	www.chooseultimate.com	Advantage Plus by Ultimate (Full) (HMO D-SNP)	01	01		1			H2962	035	0	2022	Citrus County		2	360	2			1	3		2		2	www.chooseultimate.com	www.chooseultimate.com	www.chooseultimate.com	(888)657-4170		(224)399-4282		(855)858-7526		(352)277-5427		(800)311-7517		(800)311-7517		(855)858-7526		(352)277-5427		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2962	036	0	1	01	01	H2962_036_0	10	1	2	1	1		0	09/27/2021	2022.01	09/27/2021 12:52:31 PM Eastern Daylight Time	08/12/2021 10:58:05 AM Eastern Daylight Time	07/30/2021 05:44:47 PM Eastern Daylight Time			09/27/2021 01:55:08 PM Eastern Daylight Time	ULTIMATE HEALTH PLANS, INC.	Ultimate Health Plans	www.chooseultimate.com	Advantage Plus by Ultimate (Partial) (HMO D-SNP)	01	01		1			H2962	036	0	2022	Citrus County		2	360	2			1	3		2		2	www.chooseultimate.com	www.chooseultimate.com	www.chooseultimate.com	(888)657-4170		(224)399-4282		(855)858-7526		(352)277-5427		(800)311-7517		(800)311-7517		(855)858-7526		(352)277-5427		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2962	037	0	1	01	01	H2962_037_0	10	1	2	1	1		0	09/27/2021	2022.01	09/27/2021 12:53:23 PM Eastern Daylight Time	08/12/2021 10:58:41 AM Eastern Daylight Time	07/30/2021 05:45:09 PM Eastern Daylight Time			09/27/2021 01:55:08 PM Eastern Daylight Time	ULTIMATE HEALTH PLANS, INC.	Ultimate Health Plans	www.chooseultimate.com	Advantage Plus by Ultimate (Full) (HMO D-SNP)	01	01		1			H2962	037	0	2022	Hernando and Pasco Counties		2	360	2			1	3		2		2	www.chooseultimate.com	www.chooseultimate.com	www.chooseultimate.com	(888)657-4170		(224)399-4282		(855)858-7526		(352)277-5427		(800)311-7517		(800)311-7517		(855)858-7526		(352)277-5427		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2962	038	0	1	01	01	H2962_038_0	10	1	2	1	1		0	09/27/2021	2022.01	09/27/2021 12:54:11 PM Eastern Daylight Time	08/12/2021 10:59:17 AM Eastern Daylight Time	07/30/2021 05:45:30 PM Eastern Daylight Time			09/27/2021 01:55:08 PM Eastern Daylight Time	ULTIMATE HEALTH PLANS, INC.	Ultimate Health Plans	www.chooseultimate.com	Advantage Plus by Ultimate (Partial) (HMO D-SNP)	01	01		1			H2962	038	0	2022	Hernando and Pasco Counties		2	360	2			1	3		2		2	www.chooseultimate.com	www.chooseultimate.com	www.chooseultimate.com	(888)657-4170		(224)399-4282		(855)858-7526		(352)277-5427		(800)311-7517		(800)311-7517		(855)858-7526		(352)277-5427		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2962	039	0	1	01	01	H2962_039_0	10	1	2	1	1		0	09/27/2021	2022.01	09/27/2021 12:53:24 PM Eastern Daylight Time	08/12/2021 11:18:14 AM Eastern Daylight Time	07/30/2021 05:45:50 PM Eastern Daylight Time			09/27/2021 01:55:08 PM Eastern Daylight Time	ULTIMATE HEALTH PLANS, INC.	Ultimate Health Plans	www.chooseultimate.com	Advantage Plus by Ultimate (Full) (HMO D-SNP)	01	01		1			H2962	039	0	2022	Hillsborough and Pinellas Counties		2	360	2			1	3		2		2	www.chooseultimate.com	www.chooseultimate.com	www.chooseultimate.com	(888)657-4170		(224)399-4282		(855)858-7526		(352)277-5427		(800)311-7517		(800)311-7517		(855)858-7526		(352)277-5427		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2962	040	0	1	01	01	H2962_040_0	10	1	2	1	1		0	09/27/2021	2022.01	09/27/2021 12:54:11 PM Eastern Daylight Time	08/12/2021 11:16:40 AM Eastern Daylight Time	07/30/2021 05:46:10 PM Eastern Daylight Time			09/27/2021 01:55:08 PM Eastern Daylight Time	ULTIMATE HEALTH PLANS, INC.	Ultimate Health Plans	www.chooseultimate.com	Advantage Plus by Ultimate (Partial) (HMO D-SNP)	01	01		1			H2962	040	0	2022	Hillsborough and Pinellas Counties		2	360	2			1	3		2		2	www.chooseultimate.com	www.chooseultimate.com	www.chooseultimate.com	(888)657-4170		(224)399-4282		(855)858-7526		(352)277-5427		(800)311-7517		(800)311-7517		(855)858-7526		(352)277-5427		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2962	041	0	1	01	01	H2962_041_0	10	1	2	1	1		0	09/27/2021	2022.01	09/27/2021 12:54:38 PM Eastern Daylight Time	08/12/2021 11:19:41 AM Eastern Daylight Time	07/30/2021 05:46:30 PM Eastern Daylight Time			09/27/2021 01:55:08 PM Eastern Daylight Time	ULTIMATE HEALTH PLANS, INC.	Ultimate Health Plans	www.chooseultimate.com	Advantage Plus by Ultimate (Full) (HMO D-SNP)	01	01		1			H2962	041	0	2022	Marion, Lake and Sumter Counties		2	360	2			1	3		2		2	www.chooseultimate.com	www.chooseultimate.com	www.chooseultimate.com	(888)657-4170		(224)399-4282		(855)858-7526		(352)277-5427		(800)311-7517		(800)311-7517		(855)858-7526		(352)277-5427		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2962	042	0	1	01	01	H2962_042_0	10	1	2	1	1		0	09/27/2021	2022.01	09/27/2021 12:54:11 PM Eastern Daylight Time	08/12/2021 11:21:24 AM Eastern Daylight Time	07/30/2021 05:46:50 PM Eastern Daylight Time			09/27/2021 01:55:08 PM Eastern Daylight Time	ULTIMATE HEALTH PLANS, INC.	Ultimate Health Plans	www.chooseultimate.com	Advantage Plus by Ultimate (Partial) (HMO D-SNP)	01	01		1			H2962	042	0	2022	Marion, Lake and Sumter Counties		2	360	2			1	3		2		2	www.chooseultimate.com	www.chooseultimate.com	www.chooseultimate.com	(888)657-4170		(224)399-4282		(855)858-7526		(352)277-5427		(800)311-7517		(800)311-7517		(855)858-7526		(352)277-5427		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2962	043	0	1	01	01	H2962_043_0	10	1	2	1	1		0	09/27/2021	2022.01	09/27/2021 12:53:24 PM Eastern Daylight Time	08/12/2021 11:26:24 AM Eastern Daylight Time	07/30/2021 05:47:10 PM Eastern Daylight Time			09/27/2021 01:55:08 PM Eastern Daylight Time	ULTIMATE HEALTH PLANS, INC.	Ultimate Health Plans	www.chooseultimate.com	Advantage Plus by Ultimate (Full) (HMO D-SNP)	01	01		1			H2962	043	0	2022	Indian River and St. Lucie Counties		2	360	2			1	3		2		2	www.chooseultimate.com	www.chooseultimate.com	www.chooseultimate.com	(888)657-4170		(224)399-4282		(855)858-7526		(352)277-5427		(800)311-7517		(800)311-7517		(855)858-7526		(352)277-5427		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2962	044	0	1	01	01	H2962_044_0	10	1	2	1	1		0	09/27/2021	2022.01	09/27/2021 12:55:22 PM Eastern Daylight Time	08/12/2021 11:28:37 AM Eastern Daylight Time	07/30/2021 05:47:30 PM Eastern Daylight Time			09/27/2021 01:55:08 PM Eastern Daylight Time	ULTIMATE HEALTH PLANS, INC.	Ultimate Health Plans	www.chooseultimate.com	Advantage Plus by Ultimate (Partial) (HMO D-SNP)	01	01		1			H2962	044	0	2022	Indian River and St. Lucie Counties		2	360	2			1	3		2		2	www.chooseultimate.com	www.chooseultimate.com	www.chooseultimate.com	(888)657-4170		(224)399-4282		(855)858-7526		(352)277-5427		(800)311-7517		(800)311-7517		(855)858-7526		(352)277-5427		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2962	045	0	1	01	01	H2962_045_0	7	1			2		1	07/13/2021	2022.01	07/13/2021 05:24:34 PM Eastern Daylight Time	07/30/2021 05:07:25 PM Eastern Daylight Time	07/30/2021 05:47:49 PM Eastern Daylight Time			08/04/2021 09:45:13 AM Eastern Daylight Time	ULTIMATE HEALTH PLANS, INC.	Ultimate Health Plans	www.chooseultimate.com	Premier by Ultimate (HMO)	01	01		1			H2962	045	0	2022	Hillsborough and Pinellas Counties		2	4218	2			2						www.chooseultimate.com	www.chooseultimate.com	www.chooseultimate.com	(888)657-4170		(224)399-4282		(855)858-7526		(352)277-5427		(800)311-7517		(800)311-7517		(855)858-7526		(352)277-5427		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2986	001	0	1	01	01	H2986_001_0	13	1					1	07/16/2021	2022.01	07/16/2021 03:33:09 PM Central Daylight Time	07/30/2021 09:45:07 AM Central Daylight Time	07/30/2021 09:46:18 AM Central Daylight Time			08/02/2021 02:10:25 PM Central Daylight Time	STANFORD HEALTHCARE ADVANTAGE	Stanford Health Care Advantage	www.StanfordHealthCareAdvantage.org	Stanford Health Care Advantage - Platinum (HMO)	01	01		1			H2986	001	0	2022	Santa Clara County		2		2			2						www.StanfordHealthCareAdvantage.org	www.StanfordHealthCareAdvantage.org	www.StanfordHealthCareAdvantage.org	(855)996-8422		(855)996-8422		(855)200-0109		(855)200-0109		(800)243-2051		(800)243-2051		(855)200-0109		(855)200-0109		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2986	002	0	1	01	01	H2986_002_0	12	1					1	07/16/2021	2022.01	07/16/2021 03:34:17 PM Central Daylight Time	07/30/2021 10:38:41 AM Central Daylight Time	07/30/2021 10:46:50 AM Central Daylight Time			08/02/2021 02:10:25 PM Central Daylight Time	STANFORD HEALTHCARE ADVANTAGE	Stanford Health Care Advantage	www.StanfordHealthCareAdvantage.org	Stanford Health Care Advantage - Gold (HMO)	01	01		1			H2986	002	0	2022	Santa Clara County		2		2			2						www.StanfordHealthCareAdvantage.org	www.StanfordHealthCareAdvantage.org	www.StanfordHealthCareAdvantage.org	(855)996-8422		(855)996-8422		(855)200-0109		(855)200-0109		(800)243-2051		(800)243-2051		(855)200-0109		(855)200-0109		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2986	004	0	1	01	01	H2986_004_0	12	1					1	07/16/2021	2022.01	07/16/2021 03:35:27 PM Central Daylight Time	07/30/2021 10:56:13 AM Central Daylight Time	07/30/2021 11:00:23 AM Central Daylight Time			08/02/2021 02:10:25 PM Central Daylight Time	STANFORD HEALTHCARE ADVANTAGE	Stanford Health Care Advantage	www.StanfordHealthCareAdvantage.org	Stanford Health Care Advantage - Platinum (HMO)	01	01		1			H2986	004	0	2022	Alameda and San Mateo Counties		2		2			2						www.StanfordHealthCareAdvantage.org	www.StanfordHealthCareAdvantage.org	www.StanfordHealthCareAdvantage.org	(855)996-8422		(855)996-8422		(855)200-0109		(855)200-0109		(800)243-2051		(800)243-2051		(855)200-0109		(855)200-0109		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2986	007	0	1	01	01	H2986_007_0	13	1					1	07/16/2021	2022.01	07/16/2021 03:36:11 PM Central Daylight Time	07/30/2021 11:31:18 AM Central Daylight Time	07/30/2021 11:52:32 AM Central Daylight Time			08/02/2021 02:10:25 PM Central Daylight Time	STANFORD HEALTHCARE ADVANTAGE	Stanford Health Care Advantage	www.StanfordHealthCareAdvantage.org	Stanford Health Care Advantage - Gold (HMO)	01	01		1			H2986	007	0	2022	Alameda and San Mateo Counties		2		2			2						www.StanfordHealthCareAdvantage.org	www.StanfordHealthCareAdvantage.org	www.StanfordHealthCareAdvantage.org	(855)996-8422		(855)996-8422		(855)200-0109		(855)200-0109		(800)243-2051		(800)243-2051		(855)200-0109		(855)200-0109		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2986	801	0	1	01	01	H2986_801_0	2	1						05/10/2021	2022.01	05/10/2021 11:11:09 AM Central Daylight Time					05/28/2021 03:11:22 PM Central Daylight Time	STANFORD HEALTHCARE ADVANTAGE	Stanford Health Care Advantage	www.StanfordHealthCareAdvantage.org	Stanford Health Care Advantage EGWP MAPD calendar (HMO)	01	01		1			H2986	801	0	2022	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		(855)200-0109		(855)200-0109		(800)243-2051		(800)243-2051		(855)200-0109		(855)200-0109		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H2986	802	0	1	01	01	H2986_802_0	2	1						05/10/2021	2022.01	05/10/2021 11:11:26 AM Central Daylight Time					05/28/2021 03:11:22 PM Central Daylight Time	STANFORD HEALTHCARE ADVANTAGE	Stanford Health Care Advantage	www.StanfordHealthCareAdvantage.org	Stanford Health Care Advantage EGWP MAPD non-CY (HMO)	01	01		1			H2986	802	0	2022	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		(855)200-0109		(855)200-0109		(800)243-2051		(800)243-2051		(855)200-0109		(855)200-0109		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H2986	803	0	1	01	01	H2986_803_0	2	1				0	0	05/10/2021	2022.01	05/10/2021 11:11:43 AM Central Daylight Time					05/28/2021 03:11:22 PM Central Daylight Time	STANFORD HEALTHCARE ADVANTAGE	Stanford Health Care Advantage	www.StanfordHealthCareAdvantage.org	Stanford Health Care Advantage EGWP MA only CY (HMO)	01	01		1			H2986	803	0	2022	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		(855)200-0109		(855)200-0109										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H2986	804	0	1	01	01	H2986_804_0	2	1				0	0	05/10/2021	2022.01	05/10/2021 11:12:00 AM Central Daylight Time					05/28/2021 03:11:22 PM Central Daylight Time	STANFORD HEALTHCARE ADVANTAGE	Stanford Health Care Advantage	www.StanfordHealthCareAdvantage.org	Stanford Health Care Advantage EGWP MA Only non-CY (HMO)	01	01		1			H2986	804	0	2022	Alameda, Santa Clara, San Mateo counties		1	300	2			2						http://StanfordHealthCareAdvantage.org	http://StanfordHealthCareAdvantage.org	www.StanfordHealthCareAdvantage.org	(855)996-8422		(855)996-8422		(855)200-0109		(855)200-0109										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H2992	001	0	1	20	08	H2992_001_0	4	1						04/28/2021	2022.01	04/28/2021 04:01:26 PM Eastern Daylight Time		08/09/2021 05:10:51 PM Eastern Daylight Time			08/09/2021 07:15:48 PM Eastern Daylight Time	SENIORLIFE WASHINGTON, INC.	Senior LIFE Washington / Uniontown / Greene	www.seniorlifepa.com	Senior LIFE Washington Dual Eligible (PACE)	08	20		1			H2992	001	0	2022	Washington and Greene Counties		2		2			2						http://granerx.com/	None										(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000										(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000																
H2992	002	0	1	20	08	H2992_002_0	4	1						04/28/2021	2022.01	04/28/2021 04:01:36 PM Eastern Daylight Time		08/09/2021 05:18:48 PM Eastern Daylight Time			08/09/2021 07:15:48 PM Eastern Daylight Time	SENIORLIFE WASHINGTON, INC.	Senior LIFE Washington / Uniontown / Greene	www.seniorlifewashington.com	Senior LIFE Washington Medicare Only (PACE)	08	20		1			H2992	002	0	2022	Washington and Greene Counties		2		2			2						http://granerx.com/	None										(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000										(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000																
H2992	003	0	1	20	08	H2992_003_0	4	1						04/28/2021	2022.01	04/28/2021 04:01:46 PM Eastern Daylight Time		08/09/2021 05:26:52 PM Eastern Daylight Time			08/09/2021 07:15:48 PM Eastern Daylight Time	SENIORLIFE WASHINGTON, INC.	Senior LIFE Washington / Uniontown / Greene	www.seniorlifeuniontown.com	Senior LIFE Uniontown Dual Eligible (PACE)	08	20		1			H2992	003	0	2022	Fayette County		2		2			2						http://granerx.com/	None										(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000										(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000																
H2992	004	0	1	20	08	H2992_004_0	4	1						04/28/2021	2022.01	04/28/2021 04:01:56 PM Eastern Daylight Time		08/09/2021 05:35:14 PM Eastern Daylight Time			08/09/2021 07:15:48 PM Eastern Daylight Time	SENIORLIFE WASHINGTON, INC.	Senior LIFE Washington / Uniontown / Greene	www.seniorlifeuniontown.com	Senior LIFE Uniontown Medicare Only (PACE)	08	20		1			H2992	004	0	2022	Fayette County		2		2			2						http://granerx.com/	None										(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000										(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000																
H3015	001	0	1	01	01	H3015_001_0	6	1	2	1			0	08/05/2021	2022.01	08/05/2021 08:45:49 PM Eastern Daylight Time	08/04/2021 10:36:28 AM Eastern Daylight Time	08/04/2021 10:31:19 AM Eastern Daylight Time			08/06/2021 07:21:08 AM Eastern Daylight Time	SHARED HEALTH MISSISSIPPI, INC.	Shared Health Dual Plus	www.sharedhealthms.com	Shared Health Dual Plus (HMO D-SNP)	01	01		1			H3015	001	0	2022	Mississippi		2		2			1	3		1		1	www.sharedhealthms.com	www.sharedhealthms.com	www.sharedhealthms.com	(844)474-6477		(769)572-3875		(855)890-1234		(769)572-3900		(844)474-6477		(769)572-3875		(855)890-1234		(769)572-3900		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3047	001	0	1	04	01	H3047_001_0	4	1					0	08/01/2021	2022.01	08/01/2021 12:35:49 PM Pacific Daylight Time	08/04/2021 12:06:15 AM Eastern Daylight Time	07/30/2021 11:15:32 AM Eastern Daylight Time			08/04/2021 10:52:49 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Wellcare	www.wellcare.com/medicare	Wellcare No Premium Open (PPO)	01	04		1			H3047	001	0	2022	Select counties in LA		2	3748	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3047	002	0	1	04	01	H3047_002_0	4	1					0	08/01/2021	2022.01	08/01/2021 12:34:15 PM Pacific Daylight Time	08/04/2021 12:06:45 AM Eastern Daylight Time	07/30/2021 11:15:58 AM Eastern Daylight Time			08/04/2021 10:52:49 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Wellcare	www.wellcare.com/medicare	Wellcare Giveback Open (PPO)	01	04		1			H3047	002	0	2022	Select counties in LA		2	37499	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3047	004	0	1	04	01	H3047_004_0	4	1					0	07/16/2021	2022.01	07/16/2021 02:29:58 PM Pacific Daylight Time	08/04/2021 12:07:14 AM Eastern Daylight Time	07/30/2021 11:16:16 AM Eastern Daylight Time			08/04/2021 10:52:49 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Wellcare	www.wellcare.com/medicare	Wellcare Community Assist (PPO)	01	04		1			H3047	004	0	2022	Select counties in LA		2	0	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3060	001	0	1	20	08	H3060_001_0	1	1						06/02/2021	2022.01	06/02/2021 02:40:28 PM Eastern Daylight Time		06/01/2021 06:35:22 PM Eastern Daylight Time			06/02/2021 02:49:43 PM 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	2022	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						06/02/2021	2022.01	06/02/2021 02:40:43 PM Eastern Daylight Time		06/01/2021 06:36:26 PM Eastern Daylight Time			06/02/2021 02:49:43 PM 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	2022	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					1	08/05/2021	2022.01	08/05/2021 08:29:36 AM Central Daylight Time	08/05/2021 02:09:18 PM Central Daylight Time	08/05/2021 02:07:19 PM Central Daylight Time			08/05/2021 06:05:28 PM Central Daylight Time	COMMUNITY CARE ALLIANCE OF ILLINOIS, INC.	Clear Spring Health	www.ccaillinois.com/medicare	Clear Spring Health Community Advantage Plan (HMO)	01	01		1			H3071	002	0	2022	Rockford Area, Chicago Area		2	41274	2			2						www.ccaillinois.com/medicare	www.ccaillinois.com/medicare	www.ccaillinois.com/medicare	(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3071	003	0	1	02	01	H3071_003_0	6	1					0	08/05/2021	2022.01	08/05/2021 08:33:01 AM Central Daylight Time	08/05/2021 02:09:19 PM Central Daylight Time	08/05/2021 02:07:24 PM Central Daylight Time			08/05/2021 06:05:28 PM Central Daylight Time	COMMUNITY CARE ALLIANCE OF ILLINOIS, INC.	Clear Spring Health	www.ccaillinois.com/medicare	Clear Spring Health Community Flex Plan (HMO-POS)	01	02		1			H3071	003	0	2022	Rockford Area, Chicago Area		2	32548	2			2						www.ccaillinois.com/medicare	www.ccaillinois.com/medicare	www.ccaillinois.com/medicare	(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3084	001	0	1	20	08	H3084_001_0	1	1						06/02/2021	2022.01	06/02/2021 03:20:37 PM Pacific Daylight Time		06/02/2021 03:16:12 PM Pacific Daylight Time			06/02/2021 03:22:19 PM Pacific Daylight Time	INTERNATIONAL COMMUNITY HEALTH SERVICES	International Community Health Services	www.ichsPACE.org	ICHS PACE - Dual Eligible (PACE)	08	20		1			H3084	001	0	2022	Parts of King County		2		2			2						NA	NA												(206)462-7100				(206)462-7100												(206)788-3774				(206)788-3774																
H3084	002	0	1	20	08	H3084_002_0	1	1						06/02/2021	2022.01	06/02/2021 03:21:07 PM Pacific Daylight Time		06/02/2021 03:16:12 PM Pacific Daylight Time			06/02/2021 03:22:19 PM Pacific Daylight Time	INTERNATIONAL COMMUNITY HEALTH SERVICES	International Community Health Services	www.ichsPACE.org	ICHS PACE - Medicare Only (PACE)	08	20		1			H3084	002	0	2022	Parts of King County		2		2			2						NA	NA												(206)462-7100				(206)462-7100												(206)788-3774				(206)788-3774																
H3113	001	0	1	01	01	H3113_001_0	3	1		1	2		0	08/04/2021	2022.01	08/04/2021 10:30:31 AM Central Daylight Time	08/03/2021 11:44:09 AM Central Daylight Time	07/29/2021 08:22:27 PM Central Daylight Time			08/04/2021 02:53:53 PM Central Daylight Time	OXFORD HEALTH PLANS (NJ), INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (HMO I-SNP)	01	01		1			H3113	001	0	2022	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	1		0	08/05/2021	2022.01	08/05/2021 10:09:37 AM Central Daylight Time	08/03/2021 11:44:41 AM Central Daylight Time	07/29/2021 08:22:42 PM Central Daylight Time			08/05/2021 01:30:34 PM Central Daylight Time	OXFORD HEALTH PLANS (NJ), INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete ONE (HMO D-SNP)	01	01		1			H3113	005	0	2022	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	02	01	H3113_008_0	4	1		1	2		1	08/04/2021	2022.01	08/04/2021 10:28:42 AM Central Daylight Time	08/03/2021 11:45:13 AM Central Daylight Time	07/29/2021 08:22:57 PM Central Daylight Time			08/04/2021 02:53:53 PM Central Daylight Time	OXFORD HEALTH PLANS (NJ), INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Assisted Living Plan (HMO-POS I-SNP)	01	02		1			H3113	008	0	2022	Lane County of 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	2			
H3113	009	0	1	01	01	H3113_009_0	4	1	2	1	1		0	08/05/2021	2022.01	08/05/2021 11:02:04 AM Central Daylight Time	08/03/2021 07:47:50 PM Central Daylight Time	07/29/2021 08:23:13 PM Central Daylight Time			08/05/2021 04:00:19 PM Central Daylight Time	OXFORD HEALTH PLANS (NJ), INC.	UnitedHealthcare	www.UHC.com/PADual	UnitedHealthcare Dual Complete (HMO D-SNP)	01	01		1			H3113	009	0	2022	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	5	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 02:45:12 PM Central Daylight Time	08/03/2021 11:46:22 AM Central Daylight Time	07/29/2021 08:23:28 PM Central Daylight Time			08/05/2021 04:00:19 PM Central Daylight Time	OXFORD HEALTH PLANS (NJ), INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO D-SNP)	01	01		1			H3113	010	0	2022	State of 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	5	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 02:48:20 PM Central Daylight Time	08/03/2021 11:46:57 AM Central Daylight Time	07/29/2021 08:23:44 PM Central Daylight Time			08/05/2021 04:00:19 PM Central Daylight Time	OXFORD HEALTH PLANS (NJ), INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO D-SNP)	01	01		1			H3113	011	0	2022	State of Delaware		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	013	0	1	01	01	H3113_013_0	4	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 03:31:36 PM Central Daylight Time	08/03/2021 11:47:33 AM Central Daylight Time	07/29/2021 08:24:01 PM Central Daylight Time			08/05/2021 04:00:19 PM Central Daylight Time	OXFORD HEALTH PLANS (NJ), INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Select (HMO D-SNP)	01	01		1			H3113	013	0	2022	State of Delaware		2		2			1	3		2		2	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	014	0	1	01	01	H3113_014_0	4	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 03:33:04 PM Central Daylight Time	08/03/2021 07:48:22 PM Central Daylight Time	07/29/2021 08:24:17 PM Central Daylight Time			08/05/2021 04:00:19 PM Central Daylight Time	OXFORD HEALTH PLANS (NJ), INC.	UnitedHealthcare	www.UHC.com/PADual	UnitedHealthcare Dual Complete Select (HMO D-SNP)	01	01		1			H3113	014	0	2022	Select Counties in Pennsylvania		2		2			1	3		2		2	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			
H3132	001	0	1	01	01	H3132_001_0	4	1		1			0	08/05/2021	2022.01	08/05/2021 03:45:31 PM Pacific Daylight Time	08/05/2021 03:48:46 PM Pacific Daylight Time	08/05/2021 03:51:15 PM Pacific Daylight Time			08/05/2021 03:52:56 PM Pacific Daylight Time	AHF MCO OF FLORIDA, INC.	AHF	www.php-fl.org	PHP (HMO C-SNP)	01	01		1			H3132	001	0	2022	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			
H3146	001	0	1	02	01	H3146_001_0	3	1			2		0	08/02/2021	2022.01	08/02/2021 09:42:38 AM Eastern Daylight Time	08/03/2021 02:26:03 AM Eastern Daylight Time	08/02/2021 09:29:44 AM Eastern Daylight Time			08/04/2021 02:51:20 PM Eastern Daylight Time	AETNA BETTER HEALTH INC. (GA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO-POS)	01	02		1			H3146	001	0	2022	Charlotte NC and Surrounding Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3146	002	0	1	01	01	H3146_002_0	4	1	2	1	1		0	07/08/2021	2022.01	07/08/2021 10:24:09 AM Eastern Daylight Time	08/03/2021 02:33:58 AM Eastern Daylight Time	08/02/2021 09:29:49 AM Eastern Daylight Time			08/04/2021 02:51:20 PM Eastern Daylight Time	AETNA BETTER HEALTH INC. (GA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Assure Plan (HMO D-SNP)	01	01		1			H3146	002	0	2022	Triangle & Eastern North Carolina Area		2		2			1	3		1		1	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3146	003	0	1	01	01	H3146_003_0	4	1	2	1	1		0	07/08/2021	2022.01	07/08/2021 10:24:28 AM Eastern Daylight Time	08/03/2021 02:37:43 AM Eastern Daylight Time	08/02/2021 09:29:53 AM Eastern Daylight Time			08/04/2021 02:51:20 PM Eastern Daylight Time	AETNA BETTER HEALTH INC. (GA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Assure Plan (HMO D-SNP)	01	01		1			H3146	003	0	2022	Triad North Carolina Area		2		2			1	3		1		1	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3146	004	0	1	02	01	H3146_004_0	3	1			2		0	08/02/2021	2022.01	08/02/2021 09:43:19 AM Eastern Daylight Time	08/03/2021 02:38:40 AM Eastern Daylight Time	08/02/2021 09:29:57 AM Eastern Daylight Time			08/04/2021 02:51:20 PM Eastern Daylight Time	AETNA BETTER HEALTH INC. (GA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO-POS)	01	02		1			H3146	004	0	2022	Triangle North Carolina Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3146	005	0	1	01	01	H3146_005_0	3	1			2		0	08/02/2021	2022.01	08/02/2021 09:43:47 AM Eastern Daylight Time	08/03/2021 02:40:04 AM Eastern Daylight Time	08/02/2021 09:30:01 AM Eastern Daylight Time			08/04/2021 02:51:20 PM Eastern Daylight Time	AETNA BETTER HEALTH INC. (GA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plus Plan (HMO)	01	01		1			H3146	005	0	2022	Western North Carolina		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3146	006	0	1	01	01	H3146_006_0	3	1			2		0	08/02/2021	2022.01	08/02/2021 09:44:18 AM Eastern Daylight Time	08/03/2021 02:42:01 AM Eastern Daylight Time	08/02/2021 09:30:05 AM Eastern Daylight Time			08/04/2021 02:51:20 PM Eastern Daylight Time	AETNA BETTER HEALTH INC. (GA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plus Plan (HMO)	01	01		1			H3146	006	0	2022	Greensboro, Winston-Salem NC and Surrounding Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3146	007	0	1	02	01	H3146_007_0	3	1			2		1	08/02/2021	2022.01	08/02/2021 09:44:48 AM Eastern Daylight Time	08/03/2021 02:42:27 AM Eastern Daylight Time	08/02/2021 09:30:09 AM Eastern Daylight Time			08/04/2021 02:51:20 PM Eastern Daylight Time	AETNA BETTER HEALTH INC. (GA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime (HMO-POS)	01	02		1			H3146	007	0	2022	Triad and Piedmont Area NC		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3146	008	0	1	01	01	H3146_008_0	4	1	2	1	1		0	07/08/2021	2022.01	07/08/2021 10:24:49 AM Eastern Daylight Time	08/03/2021 02:44:12 AM Eastern Daylight Time	08/02/2021 09:30:13 AM Eastern Daylight Time			08/04/2021 02:51:20 PM Eastern Daylight Time	AETNA BETTER HEALTH INC. (GA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Assure Plan (HMO D-SNP)	01	01		1			H3146	008	0	2022	Charlotte Metro North Carolina		2		2			1	3		1		1	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3146	009	0	1	01	01	H3146_009_0	4	1	2	1	1		0	07/08/2021	2022.01	07/08/2021 10:25:18 AM Eastern Daylight Time	08/03/2021 02:44:11 AM Eastern Daylight Time	08/02/2021 09:30:18 AM Eastern Daylight Time			08/04/2021 02:51:20 PM Eastern Daylight Time	AETNA BETTER HEALTH INC. (GA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Assure Plan (HMO D-SNP)	01	01		1			H3146	009	0	2022	Western North Carolina		2		2			1	3		1		1	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3146	010	0	1	01	01	H3146_010_0	3	1			2		0	08/02/2021	2022.01	08/02/2021 09:45:17 AM Eastern Daylight Time	08/03/2021 02:47:21 AM Eastern Daylight Time	08/02/2021 09:30:22 AM Eastern Daylight Time			08/04/2021 02:51:20 PM Eastern Daylight Time	AETNA BETTER HEALTH INC. (GA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plus Plan (HMO)	01	01		1			H3146	010	0	2022	Charlotte Metro & Piedmont North Carolina		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3146	011	0	1	01	01	H3146_011_0	3	1			2		0	08/02/2021	2022.01	08/02/2021 09:46:06 AM Eastern Daylight Time	08/03/2021 02:47:32 AM Eastern Daylight Time	08/02/2021 09:30:26 AM Eastern Daylight Time			08/04/2021 02:51:20 PM Eastern Daylight Time	AETNA BETTER HEALTH INC. (GA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plus Plan (HMO)	01	01		1			H3146	011	0	2022	South Carolina		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3146	012	0	1	01	01	H3146_012_0	3	1			2		0	08/02/2021	2022.01	08/02/2021 09:46:35 AM Eastern Daylight Time	08/03/2021 02:49:40 AM Eastern Daylight Time	08/02/2021 09:30:30 AM Eastern Daylight Time			08/04/2021 02:51:20 PM Eastern Daylight Time	AETNA BETTER HEALTH INC. (GA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plus Plan (HMO)	01	01		1			H3146	012	0	2022	Middle Tennessee		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3146	013	0	1	01	01	H3146_013_0	3	1			2		0	08/02/2021	2022.01	08/02/2021 09:47:02 AM Eastern Daylight Time	08/03/2021 02:49:25 AM Eastern Daylight Time	08/02/2021 09:30:34 AM Eastern Daylight Time			08/04/2021 02:51:20 PM Eastern Daylight Time	AETNA BETTER HEALTH INC. (GA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plus Plan (HMO)	01	01		1			H3146	013	0	2022	Memphis TN and Surrounding Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3146	014	0	1	02	01	H3146_014_0	4	1			2		0	08/02/2021	2022.01	08/02/2021 09:47:36 AM Eastern Daylight Time	08/03/2021 02:51:46 AM Eastern Daylight Time	08/02/2021 09:30:38 AM Eastern Daylight Time			08/04/2021 02:51:20 PM Eastern Daylight Time	AETNA BETTER HEALTH INC. (GA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime Plan (HMO-POS)	01	02		1			H3146	014	0	2022	Upstate and Midlands South Carolina		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3146	801	0	1	01	01	H3146_801_0	1	1				0	0	05/27/2021	2022.01	05/27/2021 11:13:10 PM Eastern Daylight Time					06/03/2021 12:55:17 PM Eastern Daylight Time	AETNA BETTER HEALTH INC. (GA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (HMO)	01	01		1			H3146	801	0	2022	North Carolina		1	120	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H3146	802	0	1	01	01	H3146_802_0	1	1						05/27/2021	2022.01	05/27/2021 11:13:52 PM Eastern Daylight Time					06/03/2021 12:55:17 PM Eastern Daylight Time	AETNA BETTER HEALTH INC. (GA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan w/Rx (HMO)	01	01		1			H3146	802	0	2022	North Carolina		1	120	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H3152	022	0	1	02	01	H3152_022_0	2	1					0	05/27/2021	2022.01	05/27/2021 08:44:22 AM Eastern Daylight Time	08/04/2021 02:48:38 PM Eastern Daylight Time	08/02/2021 09:30:43 AM Eastern Daylight Time			08/04/2021 03:24:59 PM Eastern Daylight Time	AETNA HEALTH INC. (NJ)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Explorer Premier (HMO-POS)	01	02		1			H3152	022	0	2022	SNJ Counties: AL, BR, CM, CP, CU, GL, ON, SM		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3152	045	0	1	01	01	H3152_045_0	1	1				0	0	05/26/2021	2022.01	05/26/2021 03:52:18 PM Eastern Daylight Time	06/02/2021 02:54:14 PM Eastern Daylight Time				06/03/2021 01:03:11 PM Eastern Daylight Time	AETNA HEALTH INC. (NJ)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Eagle (HMO)	01	01		1			H3152	045	0	2022	New Jersey Counties: All		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3152	048	0	1	02	01	H3152_048_0	2	1					0	08/02/2021	2022.01	08/02/2021 03:14:10 PM Eastern Daylight Time	08/02/2021 04:04:05 PM Eastern Daylight Time	08/02/2021 09:30:47 AM Eastern Daylight Time			08/04/2021 03:24:59 PM Eastern Daylight Time	AETNA HEALTH INC. (NJ)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Explorer Premier Plus (HMO-POS)	01	02		1			H3152	048	0	2022	Northern New Jersey		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3152	080	0	1	02	01	H3152_080_0	2	1					0	08/02/2021	2022.01	08/02/2021 03:05:47 PM Eastern Daylight Time	08/02/2021 04:04:56 PM Eastern Daylight Time	08/02/2021 09:30:51 AM Eastern Daylight Time			08/04/2021 03:24:59 PM Eastern Daylight Time	AETNA HEALTH INC. (NJ)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime Value (HMO-POS)	01	02		1			H3152	080	0	2022	Counties: BR, HT, MR, MN, MO, PS, SM, SX, UN, WR		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3152	082	0	1	01	01	H3152_082_0	2	1					0	08/02/2021	2022.01	08/02/2021 03:15:18 PM Eastern Daylight Time	08/02/2021 04:05:48 PM Eastern Daylight Time	08/02/2021 09:30:55 AM Eastern Daylight Time			08/04/2021 03:24:59 PM Eastern Daylight Time	AETNA HEALTH INC. (NJ)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Explorer Value (HMO)	01	01		1			H3152	082	0	2022	Southern NJ, Middlesex and Monmouth Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3152	084	0	1	01	01	H3152_084_0	2	1					0	08/02/2021	2022.01	08/02/2021 03:16:05 PM Eastern Daylight Time	08/02/2021 04:06:41 PM Eastern Daylight Time	08/02/2021 09:31:00 AM Eastern Daylight Time			08/04/2021 03:24:59 PM Eastern Daylight Time	AETNA HEALTH INC. (NJ)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Explorer Elite (HMO)	01	01		1			H3152	084	0	2022	Northern and Southern NJ		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3152	088	0	1	01	01	H3152_088_0	2	1					0	08/02/2021	2022.01	08/02/2021 03:06:49 PM Eastern Daylight Time	08/02/2021 04:07:33 PM Eastern Daylight Time	08/02/2021 09:31:04 AM Eastern Daylight Time			08/04/2021 03:24:59 PM Eastern Daylight Time	AETNA HEALTH INC. (NJ)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite 3 (HMO)	01	01		1			H3152	088	0	2022	New Jersey Counties: All		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3152	092	0	1	01	01	H3152_092_0	3	1					0	08/02/2021	2022.01	08/02/2021 03:17:17 PM Eastern Daylight Time	08/02/2021 04:08:25 PM Eastern Daylight Time	08/02/2021 09:31:08 AM Eastern Daylight Time			08/04/2021 03:24:59 PM Eastern Daylight Time	AETNA HEALTH INC. (NJ)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Explorer Elite 2 (HMO)	01	01		1			H3152	092	0	2022	NNJ Counties: BR, ES, HD, MR, MX, MN, MO, PS, UN		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3152	801	0	1	01	01	H3152_801_0	1	1				0	0	05/27/2021	2022.01	05/27/2021 11:14:21 PM Eastern Daylight Time					06/03/2021 12:55:17 PM Eastern Daylight Time	AETNA HEALTH INC. (NJ)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (HMO)	01	01		1			H3152	801	0	2022	New Jersey		1	162730	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H3152	804	0	1	01	01	H3152_804_0	1	1						05/27/2021	2022.01	05/27/2021 11:15:08 PM Eastern Daylight Time					06/03/2021 12:55:17 PM Eastern Daylight Time	AETNA HEALTH INC. (NJ)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan w/Rx (HMO)	01	01		1			H3152	804	0	2022	New Jersey		1	8070	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H3154	004	0	1	01	01	H3154_004_0	7	1					0	06/03/2021	2022.01	06/03/2021 08:01:29 AM Eastern Daylight Time	08/02/2021 03:40:31 PM Eastern Daylight Time	08/02/2021 03:39:31 PM Eastern Daylight Time			08/02/2021 04:07:25 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	2022	Cape May, Salem, Warren		2	19336	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	3	1				0	0	06/03/2021	2022.01	06/03/2021 08:04:09 AM Eastern Daylight Time	06/04/2021 02:26:17 PM Eastern Daylight Time				06/04/2021 02:31:36 PM 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	2022	Cape May, Salem, Warren		2	1480	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	7	1					0	06/03/2021	2022.01	06/03/2021 08:05:50 AM Eastern Daylight Time	08/02/2021 03:38:50 PM Eastern Daylight Time	08/02/2021 03:37:39 PM Eastern Daylight Time			08/02/2021 04:07:25 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	2022	10 Counties Throughout New Jersey		2	46092	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					0	06/03/2021	2022.01	06/03/2021 08:07:35 AM Eastern Daylight Time	08/02/2021 03:35:24 PM Eastern Daylight Time	08/02/2021 03:34:14 PM Eastern Daylight Time			08/02/2021 04:07:25 PM 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	2022	Mercer County		2	7466	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	7	1					0	07/08/2021	2022.01	07/08/2021 01:44:54 PM Eastern Daylight Time	08/02/2021 03:32:53 PM Eastern Daylight Time	08/02/2021 03:31:31 PM Eastern Daylight Time			08/02/2021 04:07:25 PM 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	2022	Hunterdon, Somerset, Sussex, Warren		2	17868	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	8	1					0	07/14/2021	2022.01	07/14/2021 07:37:54 AM Eastern Daylight Time	08/02/2021 03:30:19 PM Eastern Daylight Time	08/02/2021 03:29:05 PM Eastern Daylight Time			08/02/2021 04:07:25 PM 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	2022	Atlantic, Cumberland, Morris		2	10787	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	2	1				0	0	06/03/2021	2022.01	06/03/2021 12:54:37 PM Eastern Daylight Time					06/03/2021 07:40:56 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	2022	New Jersey		1	119	2			2						www.horizonblue.com/ma-pharmacy-search	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;7i;8a;8b1;8b2;9a1;9b;9c;10a;11a;11b;11c;15;	2		1	1	1a;1b;2;5;6;7c;7d;7i;8a;8b1;8b2;9a1;9b;9c;10a;11a;11b;11c;15;	2		1				
H3154	802	0	1	02	01	H3154_802_0	2	1						06/03/2021	2022.01	06/03/2021 12:56:13 PM Eastern Daylight Time					06/03/2021 07:40:56 PM Eastern Daylight Time	HORIZON INSURANCE COMPANY	Horizon Blue Cross Blue Shield of New Jersey	www.HorizonBlue.com	Horizon Medicare Blue Access Group w/Rx (HMO-POS)	01	02		1			H3154	802	0	2022	New Jersey		1	3938	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;7i;8a;8b1;8b2;9a1;9b;9c;10a;11a;11b;11c;15;	2		1	1	1a;1b;2;5;6;7c;7d;7i;8a;8b1;8b2;9a1;9b;9c;10a;11a;11b;11c;15;	2		1				
H3154	811	0	1	01	01	H3154_811_0	2	1				0	0	06/03/2021	2022.01	06/03/2021 12:58:12 PM Eastern Daylight Time					06/03/2021 07:40:56 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	2022	New Jersey		1	134	2			2						www.horizonblue.com/ma-pharmacy-search	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;7i;8a;8b1;8b2;9a1;9b;9c;10a;11a;11b;11c;15;	2		1					1				
H3154	812	0	1	02	01	H3154_812_0	2	1						06/03/2021	2022.01	06/03/2021 01:00:18 PM Eastern Daylight Time					06/03/2021 07:40:56 PM Eastern Daylight Time	HORIZON INSURANCE COMPANY	Horizon Blue Cross Blue Shield of New Jersey	www.HorizonBlue.com	Horizon Medicare Blue Access Group w/Rx Value (HMO-POS)	01	02		1			H3154	812	0	2022	New Jersey		1	118	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;7i;8a;8b1;8b2;9a1;9b;9c;10a;11a;11b;11c;15;	2		1	1	1a;1b;2;5;6;7c;7d;7i;8a;8b1;8b2;9a1;9b;9c;10a;11a;11b;11c;15;	2		1				
H3170	003	1	1	01	01	H3170_003_1	5	1					0	07/09/2021	2022.01	07/09/2021 10:39:47 AM Eastern Daylight Time	08/03/2021 10:03:48 AM Eastern Daylight Time	08/03/2021 10:03:48 AM Eastern Daylight Time			08/03/2021 10:06:49 AM Eastern Daylight Time	SAPPHIRE EDGE, INC.	Blue Cross and Blue Shield of Nebraska	https://Medicare.NebraskaBlue.com	Blue Cross Blue Shield Nebraska MA Core (HMO)	01	01		1			H3170	003	1	2022	Omaha/Lincoln Metro Area and Central Nebraska	Metro Area	2	10545	2			2						https://Medicare.NebraskaBlue.com/MedicareAdvantage/FindAPharmacy	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			
H3170	003	2	1	01	01	H3170_003_2	5	1					0	07/09/2021	2022.01	07/09/2021 10:41:10 AM Eastern Daylight Time	08/03/2021 10:03:48 AM Eastern Daylight Time	08/03/2021 10:03:48 AM Eastern Daylight Time			08/03/2021 10:06:49 AM Eastern Daylight Time	SAPPHIRE EDGE, INC.	Blue Cross and Blue Shield of Nebraska	https://Medicare.NebraskaBlue.com	Blue Cross Blue Shield Nebraska MA Core (HMO)	01	01		1			H3170	003	2	2022	Omaha/Lincoln Metro Area and Central Nebraska	Central Nebraska	2	3829	2			2						https://Medicare.NebraskaBlue.com/MedicareAdvantage/FindAPharmacy	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			
H3186	001	0	1	04	01	H3186_001_0	12	1					1	08/04/2021	2022.01	08/04/2021 12:05:16 PM Central Daylight Time	08/04/2021 11:29:49 AM Central Daylight Time	08/02/2021 12:30:23 PM Central Daylight Time			08/05/2021 11:18:13 AM Central Daylight Time	SANFORD HEALTH PLAN OF MINNESOTA	Sanford Health Plan of Minnesota	www.sanfordhealthplan.com	Align ChoiceElite (PPO)	01	04		1			H3186	001	0	2022	Minnesota		2		2			2						www.sanfordhealthplan.com	www.sanfordhealthplan.com	www.sanfordhealthplan.com	(888)279-1549		(423)427-3977		(888)279-1549		(423)427-3977		(800)498-5428		(520)918-1254		(800)498-5428		(520)918-1254		(888)279-1549		(423)427-3993		(888)279-1549		(423)427-3993		(800)498-5428		(711)-		(800)498-5428		(711)-		2					2						2			
H3186	002	0	1	04	01	H3186_002_0	12	1					1	08/04/2021	2022.01	08/04/2021 12:05:56 PM Central Daylight Time	08/04/2021 11:32:26 AM Central Daylight Time	08/02/2021 12:32:10 PM Central Daylight Time			08/05/2021 11:18:13 AM Central Daylight Time	SANFORD HEALTH PLAN OF MINNESOTA	Sanford Health Plan of Minnesota	www.sanfordhealthplan.com	Align ChoicePlus (PPO)	01	04		1			H3186	002	0	2022	Minnesota		2		2			2						www.sanfordhealthplan.com	www.sanfordhealthplan.com	www.sanfordhealthplan.com	(888)279-1549		(423)427-3977		(888)279-1549		(423)427-3977		(800)498-5428		(520)918-1254		(800)498-5428		(520)918-1254		(888)279-1549		(423)427-3993		(888)279-1549		(423)427-3993		(800)498-5428		(711)-		(800)498-5428		(711)-		2					2						2			
H3192	001	0	1	02	01	H3192_001_0	6	1			2		1	08/02/2021	2022.01	08/02/2021 04:11:42 PM Eastern Daylight Time	08/03/2021 12:44:00 PM Eastern Daylight Time	08/02/2021 09:31:12 AM Eastern Daylight Time			08/04/2021 04:49:40 PM Eastern Daylight Time	AETNA HEALTH OF MICHIGAN INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime (HMO-POS)	01	02		1			H3192	001	0	2022	Chicagoland		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3192	002	0	1	02	01	H3192_002_0	6	1			2		0	08/02/2021	2022.01	08/02/2021 04:12:55 PM Eastern Daylight Time	08/03/2021 12:45:18 PM Eastern Daylight Time	08/02/2021 09:31:16 AM Eastern Daylight Time			08/04/2021 04:49:40 PM Eastern Daylight Time	AETNA HEALTH OF MICHIGAN INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (HMO-POS)	01	02		1			H3192	002	0	2022	Midland area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3192	003	0	1	02	01	H3192_003_0	6	1			2		0	08/02/2021	2022.01	08/02/2021 04:13:22 PM Eastern Daylight Time	08/03/2021 12:46:30 PM Eastern Daylight Time	08/02/2021 09:31:21 AM Eastern Daylight Time			08/04/2021 04:49:40 PM Eastern Daylight Time	AETNA HEALTH OF MICHIGAN INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (HMO-POS)	01	02		1			H3192	003	0	2022	Southeast Michigan		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3192	004	0	1	02	01	H3192_004_0	6	1			2		1	08/02/2021	2022.01	08/02/2021 04:14:18 PM Eastern Daylight Time	08/03/2021 12:47:46 PM Eastern Daylight Time	08/02/2021 09:31:25 AM Eastern Daylight Time			08/04/2021 04:49:40 PM Eastern Daylight Time	AETNA HEALTH OF MICHIGAN INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime (HMO-POS)	01	02		1			H3192	004	0	2022	Northeast Indiana		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3192	005	0	1	02	01	H3192_005_0	6	1			2		1	08/02/2021	2022.01	08/02/2021 04:14:42 PM Eastern Daylight Time	08/03/2021 12:48:57 PM Eastern Daylight Time	08/02/2021 09:31:29 AM Eastern Daylight Time			08/04/2021 04:49:40 PM Eastern Daylight Time	AETNA HEALTH OF MICHIGAN INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime (HMO-POS)	01	02		1			H3192	005	0	2022	Northwest Indiana		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3192	006	0	1	02	01	H3192_006_0	5	1			2		1	08/02/2021	2022.01	08/02/2021 04:15:12 PM Eastern Daylight Time	08/03/2021 12:50:19 PM Eastern Daylight Time	08/02/2021 09:31:33 AM Eastern Daylight Time			08/04/2021 04:49:40 PM Eastern Daylight Time	AETNA HEALTH OF MICHIGAN INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime (HMO-POS)	01	02		1			H3192	006	0	2022	Central Indiana		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3192	007	0	1	01	01	H3192_007_0	5	1	2	1	1		0	07/08/2021	2022.01	07/08/2021 10:11:44 AM Eastern Daylight Time	08/03/2021 01:27:08 PM Eastern Daylight Time	08/02/2021 09:31:37 AM Eastern Daylight Time			08/04/2021 04:49:40 PM Eastern Daylight Time	AETNA HEALTH OF MICHIGAN INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Assure Premier (HMO D-SNP)	01	01		1			H3192	007	0	2022	Southeast Michigan		2		2			1	3		1		1	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3192	008	0	1	01	01	H3192_008_0	5	1	2	1	1		0	07/08/2021	2022.01	07/08/2021 10:12:02 AM Eastern Daylight Time	08/03/2021 01:29:19 PM Eastern Daylight Time	08/02/2021 09:31:42 AM Eastern Daylight Time			08/04/2021 04:49:40 PM Eastern Daylight Time	AETNA HEALTH OF MICHIGAN INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Assure Premier (HMO D-SNP)	01	01		1			H3192	008	0	2022	Northwest Indiana		2		2			1	3		1		1	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3192	009	0	1	01	01	H3192_009_0	6	1	2	1	1		0	07/08/2021	2022.01	07/08/2021 10:12:20 AM Eastern Daylight Time	08/03/2021 01:31:43 PM Eastern Daylight Time	08/02/2021 09:31:46 AM Eastern Daylight Time			08/04/2021 04:49:40 PM Eastern Daylight Time	AETNA HEALTH OF MICHIGAN INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Assure Premier (HMO D-SNP)	01	01		1			H3192	009	0	2022	Central Indiana		2		2			1	3		1		1	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3192	801	0	1	01	01	H3192_801_0	1	1				0	0	05/27/2021	2022.01	05/27/2021 11:15:53 PM Eastern Daylight Time					06/03/2021 01:02:15 PM Eastern Daylight Time	AETNA HEALTH OF MICHIGAN INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (HMO)	01	01		1			H3192	801	0	2022	Illinois and Michigan		1	120	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H3192	802	0	1	01	01	H3192_802_0	1	1						05/27/2021	2022.01	05/27/2021 11:16:15 PM Eastern Daylight Time					06/03/2021 01:02:15 PM Eastern Daylight Time	AETNA HEALTH OF MICHIGAN INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan w/Rx (HMO)	01	01		1			H3192	802	0	2022	Illinois and Michigan		1	120	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H3204	001	0	1	01	01	H3204_001_0	8	1			1		1	08/03/2021	2022.01	08/03/2021 02:17:24 PM Mountain Daylight Time	08/03/2021 12:19:20 PM Mountain Daylight Time	08/03/2021 12:35:51 PM Mountain Daylight Time			08/03/2021 02:23:06 PM Mountain Daylight Time	PRESBYTERIAN HEALTH PLAN	Presbyterian Health Plan	www.phs.org/Medicare	Presbyterian Senior Care Plan 2 with Rx (HMO)	01	01		1			H3204	001	0	2022	Greater Albuquerque Area, Rio Arriba and Santa Fe		2	312481	2			2						www.phs.org/Medicare	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	8	1			1		1	07/07/2021	2022.01	07/07/2021 09:26:33 AM Mountain Daylight Time	08/03/2021 12:19:20 PM Mountain Daylight Time	08/03/2021 12:35:51 PM Mountain Daylight Time			08/03/2021 02:23:06 PM Mountain Daylight Time	PRESBYTERIAN HEALTH PLAN	Presbyterian Health Plan	www.phs.org/Medicare	Presbyterian Senior Care Plan 3 with Rx (HMO)	01	01		1			H3204	007	0	2022	Greater Albuquerque Area, Rio Arriba and Santa Fe		2	36107	2			2						www.phs.org/Medicare	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	4	1			1	0	0	07/07/2021	2022.01	07/07/2021 09:27:13 AM Mountain Daylight Time	07/01/2021 07:13:10 PM Mountain Daylight Time				07/07/2021 04:11:10 PM Mountain Daylight Time	PRESBYTERIAN HEALTH PLAN	Presbyterian Health Plan	www.phs.org/Medicare	Presbyterian Senior Care Plan 1 (HMO)	01	01		1			H3204	008	0	2022	Greater Albuquerque Area, Rio Arriba and Santa Fe		2	26136	2			2						www.phs.org/Medicare	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	013	4	1	01	01	H3204_013_4	6	1	2	1	2		0	08/01/2021	2022.01	08/01/2021 07:06:16 PM Mountain Daylight Time	08/03/2021 12:19:20 PM Mountain Daylight Time	08/03/2021 12:35:51 PM Mountain Daylight Time			08/03/2021 02:23:06 PM Mountain Daylight Time	PRESBYTERIAN HEALTH PLAN	Presbyterian Health Plan	www.phs.org/Medicare	Presbyterian Dual Plus (HMO D-SNP)	01	01		1			H3204	013	4	2022	State of New Mexico	Central New Mexico	2	165808	2			1	3		2		2	www.phs.org/Medicare	www.phs.org/Medicare	https://www.phs.org/doctors-services/Pages/find-a-doctor.aspx	(855)465-7737		(505)923-7675		(866)757-5264		(505)923-5264		(855)465-7737		(505)923-7675		(866)757-5264		(505)923-5264		(800)659-8331		(711)-		(800)659-8331		(711)-		(800)659-8331		(711)-		(800)659-8331		(711)-		2					2					2	2			
H3204	013	5	1	01	01	H3204_013_5	5	1	2	1	2		0	07/07/2021	2022.01	07/07/2021 01:13:12 PM Mountain Daylight Time	08/03/2021 12:19:20 PM Mountain Daylight Time	08/03/2021 12:35:51 PM Mountain Daylight Time			08/03/2021 02:23:06 PM Mountain Daylight Time	PRESBYTERIAN HEALTH PLAN	Presbyterian Health Plan	www.phs.org/Medicare	Presbyterian Dual Plus (HMO D-SNP)	01	01		1			H3204	013	5	2022	State of New Mexico	Rural New Mexico	2	849	2			1	3		2		2	www.phs.org/Medicare	www.phs.org/Medicare	https://www.phs.org/doctors-services/Pages/find-a-doctor.aspx	(855)465-7737		(505)923-7675		(866)757-5264		(505)923-5264		(855)465-7737		(505)923-7675		(866)757-5264		(505)923-5264		(800)659-8331		(711)-		(800)659-8331		(711)-		(800)659-8331		(711)-		(800)659-8331		(711)-		2					2					2	2			
H3204	801	0	1	02	01	H3204_801_0	1	1						05/31/2021	2022.01	05/31/2021 03:47:16 PM Mountain Daylight Time					06/06/2021 09:40:38 AM Mountain Daylight Time	PRESBYTERIAN HEALTH PLAN	Presbyterian Health Plan	www.phs.org/Medicare	Pres Senior Care Emp Group Plan 2 with Rx (HMO-POS)	01	02		1			H3204	801	0	2022	Greater Albuquerque Area, Rio Arriba and Santa Fe		1	2040	2			2						www.phs.org/Medicare	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;5;6;8b1;8b2;9a1;9a2;9b;11a;11b;	2		1	1	1a;1b;5;6;8b1;8b2;9a1;9a2;11a;11b;	2		1				
H3204	802	0	1	02	01	H3204_802_0	1	1				0	0	05/31/2021	2022.01	05/31/2021 03:47:39 PM Mountain Daylight Time					06/06/2021 09:40:38 AM Mountain Daylight Time	PRESBYTERIAN HEALTH PLAN	Presbyterian Health Plan	www.phs.org/Medicare	Pres Senior Care Emp Group Plan 1 (HMO-POS)	01	02		1			H3204	802	0	2022	Greater Albuquerque Area, Rio Arriba and Santa Fe		1	12	2			2						www.phs.org/Medicare	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;5;6;8b1;8b2;9a1;9a2;9b;11a;11b;	2		1	1	1a;1b;5;6;8b1;8b2;9a1;9a2;9b;11a;11b;	2		1				
H3204	803	0	1	02	01	H3204_803_0	1	1						05/31/2021	2022.01	05/31/2021 03:47:53 PM Mountain Daylight Time					06/06/2021 09:40:38 AM Mountain Daylight Time	PRESBYTERIAN HEALTH PLAN	Presbyterian Health Plan	www.phs.org/Medicare	Pres Senior Care Emp Group Plan 2 w/ Rx NC (HMO-POS)	01	02		1			H3204	803	0	2022	Greater Albuquerque Area, Rio Arriba and Santa Fe		1	12	2			2						www.phs.org/Medicare	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;5;6;8a;8b1;9a1;9a2;9b;11a;11b;	2		1	1	1a;1b;5;6;8a;8b1;9a1;9a2;9b;11a;11b;	2		1				
H3204	808	0	1	02	01	H3204_808_0	1	1						05/31/2021	2022.01	05/31/2021 03:48:20 PM Mountain Daylight Time					06/06/2021 09:40:38 AM Mountain Daylight Time	PRESBYTERIAN HEALTH PLAN	Presbyterian Health Plan	www.phs.org/Medicare	Presbyterian Senior Care Emp Group Plan 5 (HMO-POS)	01	02		1			H3204	808	0	2022	State of New Mexico		1	121050	2			2						www.phs.org/Medicare	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;5;6;8b1;8b2;9a1;9a2;9b;11a;11b;	2		1	2		2		1				
H3204	809	0	1	02	01	H3204_809_0	1	1				0	0	05/31/2021	2022.01	05/31/2021 03:58:15 PM Mountain Daylight Time					06/06/2021 09:40:38 AM Mountain Daylight Time	PRESBYTERIAN HEALTH PLAN	Presbyterian Health Plan	www.phs.org/Medicare	Presbyterian Senior Care Emp Group Plan 6 (HMO-POS)	01	02		1			H3204	809	0	2022	State of New Mexico		1	12	2			2						www.phs.org/Medicare	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;5;6;8b1;8b2;9a1;9a2;9b;11a;11b;	2		1	2		2		2				
H3204	810	0	1	02	01	H3204_810_0	1	1						05/31/2021	2022.01	05/31/2021 03:53:12 PM Mountain Daylight Time					06/06/2021 09:40:38 AM Mountain Daylight Time	PRESBYTERIAN HEALTH PLAN	Presbyterian Health Plan	www.phs.org/Medicare	Presbyterian Senior Care Emp Group Plan 5 NC (HMO-POS)	01	02		1			H3204	810	0	2022	State of New Mexico		1	12	2			2						www.phs.org/Medicare	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	1b;5;6;8b1;8b2;9a1;9a2;9b;11a;11b;	2		1	2		2		2				
H3206	001	0	1	04	01	H3206_001_0	3	1					0	07/07/2021	2022.01	07/07/2021 09:35:07 AM Mountain Daylight Time	08/03/2021 12:19:19 PM Mountain Daylight Time	08/03/2021 12:35:51 PM Mountain Daylight Time			08/03/2021 02:23:06 PM Mountain Daylight Time	PRESBYTERIAN INSURANCE COMPANY, INC.	Presbyterian Insurance Company, Inc.	www.phs.org/Medicare	Presbyterian MediCare PPO Plan 2 with Rx (PPO)	01	04		1			H3206	001	0	2022	State of New Mexico		2	20606	2			2						www.phs.org/Medicare	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	2	1				0	0	07/07/2021	2022.01	07/07/2021 09:37:32 AM Mountain Daylight Time	07/01/2021 07:13:09 PM Mountain Daylight Time				07/07/2021 04:11:10 PM Mountain Daylight Time	PRESBYTERIAN INSURANCE COMPANY, INC.	Presbyterian Insurance Company, Inc.	www.phs.org/Medicare	Presbyterian MediCare PPO Plan 1 (PPO)	01	04		1			H3206	003	0	2022	State of New Mexico		2	1748	2			2						www.phs.org/Medicare	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	1	1						06/04/2021	2022.01	06/04/2021 11:36:10 AM Mountain Daylight Time					06/06/2021 09:40:38 AM Mountain Daylight Time	PRESBYTERIAN INSURANCE COMPANY, INC.	Presbyterian Insurance Company, Inc.	www.phs.org/Medicare	Pres MediCare PPO Emp Group Plan 2 with Rx (PPO)	01	04		1			H3206	801	0	2022	State of New Mexico		1	12	2			2						www.phs.org/Medicare	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;5;6;8b1;8b2;9a1;9a2;9b;11a;11b;	2		1									
H3206	802	0	1	04	01	H3206_802_0	1	1				0	0	06/04/2021	2022.01	06/04/2021 11:41:58 AM Mountain Daylight Time					06/06/2021 09:40:38 AM Mountain Daylight Time	PRESBYTERIAN INSURANCE COMPANY, INC.	Presbyterian Insurance Company, Inc.	www.phs.org/Medicare	Pres Medicare PPO Employer Group Plan 1 (PPO)	01	04		1			H3206	802	0	2022	State of New Mexico		1	12	2			2						www.phs.org/Medicare	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;5;6;8b1;8b2;9a1;9a2;11a;11b;	2		1									
H3206	803	0	1	04	01	H3206_803_0	1	1						06/04/2021	2022.01	06/04/2021 12:07:29 PM Mountain Daylight Time					06/06/2021 09:40:38 AM Mountain Daylight Time	PRESBYTERIAN INSURANCE COMPANY, INC.	Presbyterian Insurance Company, Inc.	www.phs.org/Medicare	Pres MediCare PPO Empl Group Plan 2 +Rx NC (PPO)	01	04		1			H3206	803	0	2022	State of New Mexico		1	12	2			2						www.phs.org/Medicare	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			
H3213	015	0	1	01	01	H3213_015_0	5	1	2	1			0	08/03/2021	2022.01	08/03/2021 02:34:03 PM Eastern Daylight Time	08/03/2021 01:14:56 PM Eastern Daylight Time	07/30/2021 03:23:18 PM Eastern Daylight Time			08/05/2021 03:41:11 PM Eastern Daylight Time	CARESOURCE KENTUCKY CO.	CareSource	http://www.caresource.com/ky/plans/dsnp/	CareSource Dual Advantage (HMO D-SNP)	01	01		1			H3213	015	0	2022	Region 1		2		2			1	3		1		1	www.caresource.com	www.caresource.com/ky/plans/dsnp/pharmacy/drug-formulary/	www.caresource.com/providers	(833)230-2020		(833)230-2020		(844)607-2830		(844)607-2830		(833)230-2020		(833)230-2020		(844)607-2830		(844)607-2830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3213	016	0	1	01	01	H3213_016_0	5	1	2	1			0	08/03/2021	2022.01	08/03/2021 11:45:32 AM Eastern Daylight Time	08/03/2021 01:17:20 PM Eastern Daylight Time	07/30/2021 03:24:38 PM Eastern Daylight Time			08/05/2021 04:07:05 PM Eastern Daylight Time	CARESOURCE KENTUCKY CO.	CareSource	http://www.caresource.com/ky/plans/dsnp/	CareSource Dual Advantage (HMO D-SNP)	01	01		1			H3213	016	0	2022	Region 2		2		2			1	3		1		1	www.caresource.com	www.caresource.com/ky/plans/dsnp/pharmacy/drug-formulary/	www.caresource.com/providers	(833)230-2020		(833)230-2020		(844)607-2830		(844)607-2830		(833)230-2020		(833)230-2020		(844)607-2830		(844)607-2830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3219	001	0	1	04	01	H3219_001_0	4	1					0	08/05/2021	2022.01	08/05/2021 06:13:31 PM Eastern Daylight Time	08/02/2021 04:21:30 PM Eastern Daylight Time	08/02/2021 09:31:50 AM Eastern Daylight Time			08/05/2021 06:19:03 PM Eastern Daylight Time	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Allina Health Aetna Medicare	www.AllinaHealthAetnaMedicare.com	Allina Health Aetna Medicare Plus (PPO)	01	04		1			H3219	001	0	2022	Twin Cities Metro and Select MN Counties		2		2			2						www.AllinaHealthAetnaMedicare.com/findpharmacy	www.AllinaHealthAetnaMedicare.com/formulary	www.AllinaHealthAetnaMedicare.com/findprovider	(833)570-6671		(833)570-6671		(833)206-8764		(833)206-8764		(833)570-6671		(833)570-6671		(833)206-8764		(833)206-8764		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3219	002	0	1	04	01	H3219_002_0	2	1					0	07/28/2021	2022.01	07/28/2021 03:30:04 PM Eastern Daylight Time	08/02/2021 04:22:57 PM Eastern Daylight Time	08/02/2021 09:31:54 AM Eastern Daylight Time			08/04/2021 02:06:41 PM Eastern Daylight Time	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Allina Health Aetna Medicare	www.AllinaHealthAetnaMedicare.com	Allina Health Aetna Medicare Premier (PPO)	01	04		1			H3219	002	0	2022	Twin Cities Metro and Select MN Counties		2		2			2						www.AllinaHealthAetnaMedicare.com/findprovider	www.AllinaHealthAetnaMedicare.com/formulary	www.AllinaHealthAetnaMedicare.com/findprovider	(833)570-6671		(833)570-6671		(833)206-8764		(833)206-8764		(833)570-6671		(833)570-6671		(833)206-8764		(833)206-8764		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3219	003	0	1	04	01	H3219_003_0	2	1					0	08/02/2021	2022.01	08/02/2021 03:32:01 PM Eastern Daylight Time	08/02/2021 04:24:09 PM Eastern Daylight Time	08/02/2021 09:31:58 AM Eastern Daylight Time			08/04/2021 02:06:41 PM Eastern Daylight Time	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Allina Health Aetna Medicare	www.AllinaHealthAetnaMedicare.com	Allina Health Aetna Medicare Grand (PPO)	01	04		1			H3219	003	0	2022	Twin Cities Metro and Select MN Counties		2		2			2						www.AllinaHealthAetnaMedicare.com/findpharmacy	www.AllinaHealthAetnaMedicare.com/formulary	www.AllinaHealthAetnaMedicare.com/findprovider	(833)570-6671		(833)570-6671		(833)206-8764		(833)206-8764		(833)570-6671		(833)570-6671		(833)206-8764		(833)206-8764		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3219	004	0	1	04	01	H3219_004_0	3	1					1	06/01/2021	2022.01	06/01/2021 07:03:28 PM Eastern Daylight Time	08/02/2021 04:25:05 PM Eastern Daylight Time	08/02/2021 09:32:03 AM Eastern Daylight Time			08/04/2021 02:06:41 PM Eastern Daylight Time	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Allina Health Aetna Medicare	www.AllinaHealthAetnaMedicare.com	Allina Health Aetna Medicare Elite (PPO)	01	04		1			H3219	004	0	2022	Twin Cities Metro and Select MN Counties		2		2			2						www.AllinaHealthAetnaMedicare.com/findpharmacy	www.AllinaHealthAetnaMedicare.com/formulary	www.AllinaHealthAetnaMedicare.com/findprovider	(833)570-6671		(833)570-6671		(833)206-8764		(833)206-8764		(833)570-6671		(833)570-6671		(833)206-8764		(833)206-8764		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3219	005	0	1	04	01	H3219_005_0	1	1				0	0	05/25/2021	2022.01	05/25/2021 07:54:17 PM Eastern Daylight Time	06/01/2021 04:47:14 PM Eastern Daylight Time				06/03/2021 01:43:28 PM Eastern Daylight Time	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Allina Health Aetna Medicare	www.AllinaHealthAetnaMedicare.com	Allina Health Aetna Medicare Eagle (PPO)	01	04		1			H3219	005	0	2022	Twin Cities Metro and Select MN Counties		2		2			2						www.AllinaHealthAetnaMedicare.com/findpharmacy	www.AllinaHealthAetnaMedicare.com/formulary	www.AllinaHealthAetnaMedicare.com/findprovider	(833)570-6671		(833)570-6671		(833)206-8764		(833)206-8764										(711)-		(711)-		(711)-		(711)-										2					2						2			
H3219	801	0	1	04	01	H3219_801_0	1	1				0	0	05/27/2021	2022.01	05/27/2021 11:16:58 PM Eastern Daylight Time					06/03/2021 01:02:15 PM Eastern Daylight Time	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Allina Health Aetna Medicare	www.aetnamedicare.com	Allina Health Aetna Medicare Plan (PPO)	01	04		1			H3219	801	0	2022	Minnesota		1	120	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H3219	802	0	1	04	01	H3219_802_0	1	1						05/27/2021	2022.01	05/27/2021 11:18:53 PM Eastern Daylight Time					06/03/2021 01:02:15 PM Eastern Daylight Time	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Allina Health Aetna Medicare	www.aetnamedicare.com	Allina Health Aetna Medicare w/Rx Plan (PPO)	01	04		1			H3219	802	0	2022	Minnesota		1	120	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H3237	001	0	1	48	05	H3237_001_0	4	1						07/14/2021	2022.01	07/14/2021 05:16:05 PM Eastern Daylight Time					07/15/2021 11:24:29 AM Eastern 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	2022	Los Angeles County		2	68332	2			2						mmp.healthnetcalifornia.com/mmp/find-a-doctor.html	mmp.healthnetcalifornia.com/mmp/prescription-drug-part-d/formulary.html	mmp.healthnetcalifornia.com/mmp/find-a-doctor.html	(855)464-3571		(855)464-3571		(855)464-3571		(855)464-3571		(855)464-3571		(855)464-3571		(855)464-3571		(855)464-3571		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H3237	002	0	1	48	05	H3237_002_0	4	1						07/14/2021	2022.01	07/14/2021 05:17:46 PM Eastern Daylight Time					07/15/2021 11:24:29 AM Eastern 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	2022	San Diego County		2	12058	2			2						mmp.healthnetcalifornia.com/mmp/find-a-doctor.html	mmp.healthnetcalifornia.com/mmp/prescription-drug-part-d/formulary.html	mmp.healthnetcalifornia.com/mmp/find-a-doctor.html	(855)464-3572		(855)464-3572		(855)464-3572		(855)464-3572		(855)464-3572		(855)464-3572		(855)464-3572		(855)464-3572		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H3239	001	0	1	01	01	H3239_001_0	5	1	2	1	1		0	08/02/2021	2022.01	08/02/2021 04:08:13 PM Eastern Daylight Time	08/03/2021 10:35:48 AM Eastern Daylight Time	08/02/2021 09:32:07 AM Eastern Daylight Time			08/04/2021 04:53:41 PM Eastern Daylight Time	AETNA BETTER HEALTH, INC. (LA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Dual Preferred Plan (HMO D-SNP)	01	01		1			H3239	001	0	2022	New Orleans and Surrounding Parishes		2		2			1	3		1		1	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3239	002	0	1	01	01	H3239_002_0	5	1	2	1	1		0	07/08/2021	2022.01	07/08/2021 10:12:58 AM Eastern Daylight Time	08/03/2021 10:36:43 AM Eastern Daylight Time	08/02/2021 09:32:11 AM Eastern Daylight Time			08/04/2021 04:53:41 PM Eastern Daylight Time	AETNA BETTER HEALTH, INC. (LA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Dual Preferred Plan (HMO D-SNP)	01	01		1			H3239	002	0	2022	Select Birmingham and Northern AL counties		2		2			1	3		2		2	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3239	003	0	1	01	01	H3239_003_0	5	1	2	1	1		0	07/08/2021	2022.01	07/08/2021 10:13:17 AM Eastern Daylight Time	08/03/2021 10:37:42 AM Eastern Daylight Time	08/02/2021 09:32:15 AM Eastern Daylight Time			08/04/2021 04:53:41 PM Eastern Daylight Time	AETNA BETTER HEALTH, INC. (LA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Dual Preferred Plan (HMO D-SNP)	01	01		1			H3239	003	0	2022	Select Counties in Montgomery and Mobile AL area		2		2			1	3		2		2	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3239	005	0	1	01	01	H3239_005_0	5	1	2	1	1		0	07/08/2021	2022.01	07/08/2021 10:13:33 AM Eastern Daylight Time	08/03/2021 10:38:44 AM Eastern Daylight Time	08/02/2021 09:32:19 AM Eastern Daylight Time			08/04/2021 04:53:41 PM Eastern Daylight Time	AETNA BETTER HEALTH, INC. (LA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Dual Preferred Plan (HMO D-SNP)	01	01		1			H3239	005	0	2022	Northern Mississippi		2		2			1	3		1		1	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3239	006	0	1	01	01	H3239_006_0	5	1	2	1	1		0	07/08/2021	2022.01	07/08/2021 10:13:54 AM Eastern Daylight Time	08/03/2021 10:39:42 AM Eastern Daylight Time	08/02/2021 09:32:24 AM Eastern Daylight Time			08/04/2021 04:53:41 PM Eastern Daylight Time	AETNA BETTER HEALTH, INC. (LA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Dual Preferred Plan (HMO D-SNP)	01	01		1			H3239	006	0	2022	Shreveport area		2		2			1	3		1		1	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3239	007	0	1	01	01	H3239_007_0	5	1	2	1	1		0	07/08/2021	2022.01	07/08/2021 10:14:16 AM Eastern Daylight Time	08/03/2021 10:40:35 AM Eastern Daylight Time	08/02/2021 09:32:28 AM Eastern Daylight Time			08/04/2021 04:53:41 PM Eastern Daylight Time	AETNA BETTER HEALTH, INC. (LA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Dual Preferred Plan (HMO D-SNP)	01	01		1			H3239	007	0	2022	Lafayette, Alexandria and Lake Charles area		2		2			1	3		1		1	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3239	008	0	1	01	01	H3239_008_0	6	1	2	1	1		0	07/08/2021	2022.01	07/08/2021 10:14:38 AM Eastern Daylight Time	08/03/2021 10:41:32 AM Eastern Daylight Time	08/02/2021 09:32:32 AM Eastern Daylight Time			08/04/2021 04:53:41 PM Eastern Daylight Time	AETNA BETTER HEALTH, INC. (LA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Dual Preferred Plan (HMO D-SNP)	01	01		1			H3239	008	0	2022	Southern MS		2		2			1	3		1		1	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3240	013	0	1	01	01	H3240_013_0	6	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 01:21:58 PM Eastern Daylight Time	08/03/2021 06:04:04 PM Eastern Daylight Time	08/03/2021 06:04:04 PM Eastern Daylight Time			08/04/2021 02:27:41 PM Eastern Daylight Time	AMERIGROUP NEW JERSEY, INC.	Amerigroup Community Care	https://shop.amerigroup.com/medicare/	Amerivantage Dual Coordination (HMO D-SNP)	01	01		1			H3240	013	0	2022	Eastern and Central New Jersey		2		2			1	3		1		1	www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare/	(844)765-5160		(844)765-5160		(855)593-0919		(855)593-0919		(833)337-1267		(833)337-1267		(855)485-0940		(855)485-0940		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3240	017	0	1	02	01	H3240_017_0	9	1		1	2		0	07/18/2021	2022.01	07/18/2021 03:41:03 PM Pacific Daylight Time		08/03/2021 03:04:03 PM Pacific Daylight Time		08/03/2021 03:04:03 PM Pacific Daylight Time	08/04/2021 12:07:42 PM Pacific Daylight Time	AMERIGROUP NEW JERSEY, INC.	Amerigroup Community Care	https://shop.amerigroup.com/medicare/	Amerivantage ESRD Care (HMO-POS C-SNP)	01	02		1			H3240	017	0	2022	Select Counties in New Jersey		2		2			1	4			00000000100000000000		www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare/	(844)887-6350		(844)887-6350		(855)593-0920		(855)593-0920		(833)337-1268		(833)337-1268		(855)485-0942		(855)485-0942		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3240	021	0	1	01	01	H3240_021_0	8	1					0	07/15/2021	2022.01	07/15/2021 10:52:48 AM Eastern Daylight Time	08/03/2021 06:04:04 PM Eastern Daylight Time	08/03/2021 06:04:04 PM Eastern Daylight Time			08/04/2021 02:27:41 PM Eastern Daylight Time	AMERIGROUP NEW JERSEY, INC.	Amerigroup Community Care	https://shop.amerigroup.com/medicare/	Amerivantage Balance (HMO)	01	01		1			H3240	021	0	2022	Select Counties in New Jersey		2		2			2						www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare/	(866)805-4589		(866)805-4589		(855)593-0921		(855)593-0921		(833)337-1269		(833)337-1269		(855)485-0945		(855)485-0945		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3240	022	0	1	01	01	H3240_022_0	6	1					0	08/02/2021	2022.01	08/02/2021 11:28:53 AM Eastern Daylight Time	08/03/2021 06:04:04 PM Eastern Daylight Time	08/03/2021 06:04:04 PM Eastern Daylight Time			08/04/2021 02:27:41 PM Eastern Daylight Time	AMERIGROUP NEW JERSEY, INC.	Amerigroup Community Care	https://shop.amerigroup.com/medicare/	Amerivantage Classic (HMO)	01	01		1			H3240	022	0	2022	Select Counties in New Jersey		2		2			2						www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare/	(866)805-4589		(866)805-4589		(855)593-0921		(855)593-0921		(833)337-1269		(833)337-1269		(855)485-0945		(855)485-0945		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3240	024	0	1	02	01	H3240_024_0	6	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 01:22:11 PM Eastern Daylight Time	08/03/2021 06:04:04 PM Eastern Daylight Time	08/03/2021 06:04:04 PM Eastern Daylight Time			08/04/2021 02:27:41 PM Eastern Daylight Time	AMERIGROUP NEW JERSEY, INC.	Amerigroup Community Care	https://shop.amerigroup.com/medicare/	Amerivantage Dual Secure (HMO-POS D-SNP)	01	02		1			H3240	024	0	2022	Select Counties in New Jersey		2		2			1	3		1		1	www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare/	(844)765-5160		(844)765-5160		(855)593-0922		(855)593-0922		(833)337-1267		(833)337-1267		(855)485-0952		(855)485-0952		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3251	002	0	1	01	01	H3251_002_0	3	1					0	06/03/2021	2022.01	06/03/2021 11:00:36 AM Mountain Daylight Time	08/03/2021 09:33:20 AM Mountain Daylight Time	08/04/2021 04:01:02 PM Mountain Daylight Time			08/05/2021 04:53:55 PM Mountain Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of New Mexico	www.getbluenm.com/mapd	Blue Cross Medicare Advantage Select (HMO)	01	01		1			H3251	002	0	2022	Greater New Mexico Area		2	91825	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	029	0	1	01	01	H3251_029_0	7	1	2	1			0	08/04/2021	2022.01	08/04/2021 02:32:46 PM Mountain Daylight Time	08/03/2021 09:33:46 AM Mountain Daylight Time	08/04/2021 04:01:20 PM Mountain Daylight Time			08/05/2021 04:53:55 PM Mountain Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of New Mexico	www.getbluenm.com/dsnp	Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP)	01	01		1			H3251	029	0	2022	New Mexico Counties		2	18922	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			
H3251	804	0	1	01	01	H3251_804_0	1	1						05/26/2021	2022.01	05/26/2021 09:39:46 AM Central Daylight Time					05/28/2021 11:36:07 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of New Mexico	www.getbluenm.com/mapd	Blue Cross Group Medicare Advantage Plan (HMO)	01	01		1			H3251	804	0	2022	New Mexico Statewide		1	10861	2			2						www.getbluenm.com/mapd/pharmacies	www.getbluenm.com/mapd/druglist	www.getbluenm.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)-		2					2					2	2			
H3256	001	0	1	04	01	H3256_001_0	4	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 10:31:58 AM Central Daylight Time	08/03/2021 01:17:13 PM Central Daylight Time	07/29/2021 08:24:33 PM Central Daylight Time			08/04/2021 01:59:15 PM Central Daylight Time	UNITEDHEALTHCARE OF GEORGIA, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Choice LP (PPO D-SNP)	01	04		1			H3256	001	0	2022	Select Counties for Georgia		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			
H3256	002	0	1	04	01	H3256_002_0	4	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 10:30:02 AM Central Daylight Time	08/03/2021 01:17:47 PM Central Daylight Time	07/29/2021 08:24:49 PM Central Daylight Time			08/04/2021 01:59:15 PM Central Daylight Time	UNITEDHEALTHCARE OF GEORGIA, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Choice Select LP (PPO D-SNP)	01	04		1			H3256	002	0	2022	Select Counties for 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			
H3259	001	0	1	01	01	H3259_001_0	5	1	2	1			0	08/03/2021	2022.01	08/03/2021 06:09:54 PM Eastern Daylight Time	08/04/2021 10:36:42 AM Eastern Daylight Time	08/04/2021 10:31:32 AM Eastern Daylight Time			08/04/2021 03:12:04 PM Eastern Daylight Time	VOLUNTEER STATE HEALTH PLAN	BlueCare Plus Tennessee	bluecareplus.bcbst.com	BlueCare Plus (HMO D-SNP)	01	01		1			H3259	001	0	2022	Tennessee		2		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			
H3259	002	0	1	01	01	H3259_002_0	6	1	2	1			0	07/19/2021	2022.01	07/19/2021 12:43:56 PM Eastern Daylight Time	08/04/2021 10:36:55 AM Eastern Daylight Time	08/04/2021 10:31:46 AM Eastern Daylight Time			08/05/2021 10:32:54 AM Eastern Daylight Time	VOLUNTEER STATE HEALTH PLAN	BlueCare Plus Tennessee	bluecareplus.bcbst.com	BlueCare Plus Choice (HMO D-SNP)	01	01		1			H3259	002	0	2022	Tennessee		2		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			
H3274	001	0	1	01	01	H3274_001_0	6	1		1			0	08/04/2021	2022.01	08/04/2021 02:54:34 PM Eastern Daylight Time	08/05/2021 01:04:38 PM Eastern Daylight Time	08/02/2021 03:14:39 PM Eastern Daylight Time			08/05/2021 04:38:50 PM Eastern Daylight Time	ALIGN SENIOR CARE CALIFORNIA INC.	Align Senior Care	www.alignseniorcare.com	Align Senior Care (HMO I-SNP)	01	01		1			H3274	001	0	2022	California partial		2	4640	2			1	1	3				www.alignseniorcare.com	www.alignseniorcare.com	www.alignseniorcare.com	(844)205-7244		(844)205-7244		(844)205-7244		(844)205-7244		(844)205-7244		(844)205-7244		(844)205-7244		(844)205-7244		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3274	002	0	1	01	01	H3274_002_0	6	1		1			0	08/04/2021	2022.01	08/04/2021 02:55:03 PM Eastern Daylight Time	08/05/2021 01:05:13 PM Eastern Daylight Time	08/02/2021 03:15:08 PM Eastern Daylight Time			08/05/2021 04:38:50 PM Eastern Daylight Time	ALIGN SENIOR CARE CALIFORNIA INC.	Align Senior Care	www.alignseniorcare.com	Leading Age ISNP (HMO I-SNP)	01	01		1			H3274	002	0	2022	California partial		2	2358	2			1	1	3				www.alignseniorcare.com	www.alignseniorcare.com	www.alignseniorcare.com	(844)205-7244		(844)205-7244		(844)205-7244		(844)205-7244		(844)205-7244		(844)205-7244		(844)205-7244		(844)205-7244		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3274	003	0	1	01	01	H3274_003_0	6	1		1			0	08/03/2021	2022.01	08/03/2021 02:06:11 PM Eastern Daylight Time	08/05/2021 01:23:13 PM Eastern Daylight Time	08/02/2021 03:15:31 PM Eastern Daylight Time			08/05/2021 04:38:50 PM Eastern Daylight Time	ALIGN SENIOR CARE CALIFORNIA INC.	Align Senior Care	www.alignseniorcare.com	Leading Age CSNP (HMO C-SNP)	01	01		1			H3274	003	0	2022	California partial		2	2358	2			1	4			00000100000000000000		www.alignseniorcare.com	www.alignseniorcare.com	www.alignseniorcare.com	(844)205-7244		(844)205-7244		(844)205-7244		(844)205-7244		(844)205-7244		(844)205-7244		(844)205-7244		(844)205-7244		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3276	001	0	1	01	01	H3276_001_0	5	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 12:29:54 PM Eastern Daylight Time	08/05/2021 06:38:00 PM Eastern Daylight Time	08/05/2021 06:38:00 PM Eastern Daylight Time			08/05/2021 03:09:51 PM Eastern Daylight Time	CONNECTICARE INSURANCE COMPANY, INC.	ConnectiCare	www.connecticare.com/medicare	ConnectiCare Choice Dual (HMO D-SNP)	01	01		1			H3276	001	0	2022	State of Connecticut		2		2			1	3		1		1	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3276	002	0	1	01	01	H3276_002_0	5	1	2	1	2		0	08/04/2021	2022.01	08/04/2021 12:30:14 PM Eastern Daylight Time	08/05/2021 06:38:00 PM Eastern Daylight Time	08/05/2021 06:38:00 PM Eastern Daylight Time			08/05/2021 03:09:51 PM Eastern Daylight Time	CONNECTICARE INSURANCE COMPANY, INC.	ConnectiCare	www.connecticare.com/medicare	ConnectiCare Choice Dual Basic (HMO D-SNP)	01	01		1			H3276	002	0	2022	State of Connecticut		2		2			1	3		1		1	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3276	003	0	1	01	01	H3276_003_0	5	1	2	1	2		0	08/04/2021	2022.01	08/04/2021 12:30:29 PM Eastern Daylight Time	08/05/2021 06:38:00 PM Eastern Daylight Time	08/05/2021 06:38:00 PM Eastern Daylight Time			08/05/2021 03:09:51 PM Eastern Daylight Time	CONNECTICARE INSURANCE COMPANY, INC.	ConnectiCare	175 Scott Swamp Road	ConnectiCare Choice Dual Vista (HMO D-SNP)	01	01		1			H3276	003	0	2022	State of Connecticut		2		2			1	3		1		1	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3281	001	0	1	04	01	H3281_001_0	7	1					0	09/28/2021	2022.01	09/28/2021 04:49:46 PM Central Daylight Time	08/05/2021 05:33:36 PM Central Daylight Time	08/05/2021 05:34:57 PM Central Daylight Time			09/28/2021 04:55:13 PM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY OF FLORIDA	Bright Health	brighthealthcare.com/medicare	Bright Advantage Health Dollars Plan (PPO)	01	04		1			H3281	001	0	2022	Daytona, Orlando, and Southwest Florida		2	1332	2			2						brighthealthcare.com/madoctors	brighthealthcare.com/drug-search/ma	brighthealthcare.com/madoctors	(844)926-4521		(844)926-4521		(844)679-2028		(844)679-2028		(844)926-4521		(844)926-4521		(844)679-2028		(844)679-2028		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3281	010	0	1	04	01	H3281_010_0	6	1					0	08/04/2021	2022.01	08/04/2021 08:57:44 PM Central Daylight Time	08/05/2021 05:33:36 PM Central Daylight Time	08/05/2021 05:34:57 PM Central Daylight Time			08/05/2021 06:07:11 PM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY OF FLORIDA	Bright Health	brighthealthcare.com/medicare	Bright Advantage Part B Savings Plan (PPO)	01	04		1			H3281	010	0	2022	CF, DB, FL, ORL, PB		2	1200	2			2						brighthealthcare.com/madoctors	brighthealthcare.com/drug-search/ma	brighthealthcare.com/madoctors	(844)926-4521		(844)926-4521		(844)679-2028		(844)679-2028		(844)926-4521		(844)926-4521		(844)679-2028		(844)679-2028		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3284	001	0	1	20	08	H3284_001_0	2	1						08/26/2021	2022.01	08/26/2021 12:04:34 PM Pacific Daylight Time		08/26/2021 02:38:56 PM Pacific Daylight Time			08/26/2021 01:20:15 PM Pacific Daylight Time	PNW PACE PARTNERS, LLC	Pacific Northwest PACE Partners	https://pnwpacepartners.wpmudev.host/	PNW PACE Partners- Dual Eligible (PACE)	08	20		1			H3284	001	0	2022	Pierce King-Seattle Tacoma Area-WA		2		2			2						https://www.multicare.org/	https://www.multicare.org/												(253)459-7222				(253)459-7222												(253)403-1500				(253)403-1500																
H3284	002	0	1	20	08	H3284_002_0	2	1						08/26/2021	2022.01	08/26/2021 12:04:56 PM Pacific Daylight Time		08/26/2021 02:40:50 PM Pacific Daylight Time			08/26/2021 01:20:15 PM Pacific Daylight Time	PNW PACE PARTNERS, LLC	Pacific Northwest PACE Partners	https://pnwpacepartners.wpmudev.host/	PNW PACE Partners- Medicare Only (PACE)	08	20		1			H3284	002	0	2022	Pierce King-Seattle Tacoma Area-WA		2		2			2						https://www.multicare.org/	https://www.multicare.org/												(253)459-7222				(253)459-7222												(253)403-1500				(253)403-1500																
H3288	001	0	1	04	01	H3288_001_0	2	1					0	08/02/2021	2022.01	08/02/2021 02:47:05 PM Eastern Daylight Time	08/02/2021 02:50:32 PM Eastern Daylight Time	08/02/2021 09:32:36 AM Eastern Daylight Time			08/04/2021 02:44:24 PM Eastern Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H3288	001	0	2022	Bexar and Comal counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	002	0	1	04	01	H3288_002_0	2	1					0	08/02/2021	2022.01	08/02/2021 02:49:33 PM Eastern Daylight Time	08/02/2021 02:51:42 PM Eastern Daylight Time	08/02/2021 09:32:40 AM Eastern Daylight Time			08/04/2021 02:44:24 PM Eastern Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice II Plan (PPO)	01	04		1			H3288	002	0	2022	Dallas and Surrounding Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	003	0	1	04	01	H3288_003_0	2	1					0	08/02/2021	2022.01	08/02/2021 02:51:31 PM Eastern Daylight Time	08/02/2021 02:53:08 PM Eastern Daylight Time	08/02/2021 09:32:45 AM Eastern Daylight Time			08/04/2021 02:44:24 PM Eastern Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H3288	003	0	2022	Harris County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	004	0	1	04	01	H3288_004_0	2	1					0	08/02/2021	2022.01	08/02/2021 02:52:55 PM Eastern Daylight Time	08/02/2021 02:54:33 PM Eastern Daylight Time	08/02/2021 09:32:49 AM Eastern Daylight Time			08/04/2021 02:44:24 PM Eastern Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H3288	004	0	2022	Travis and Williamson Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	005	0	1	04	01	H3288_005_0	2	1					0	08/02/2021	2022.01	08/02/2021 02:54:58 PM Eastern Daylight Time	08/02/2021 02:55:45 PM Eastern Daylight Time	08/02/2021 09:32:53 AM Eastern Daylight Time			08/04/2021 02:44:24 PM Eastern Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H3288	005	0	2022	South Texas Non Metro counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	006	0	1	04	01	H3288_006_0	2	1					0	08/02/2021	2022.01	08/02/2021 02:55:41 PM Eastern Daylight Time	08/02/2021 02:56:57 PM Eastern Daylight Time	08/02/2021 09:32:57 AM Eastern Daylight Time			08/04/2021 02:44:24 PM Eastern Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H3288	006	0	2022	Southeast Non Metro		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	007	0	1	04	01	H3288_007_0	2	1					0	08/02/2021	2022.01	08/02/2021 02:56:21 PM Eastern Daylight Time	08/02/2021 02:58:18 PM Eastern Daylight Time	08/02/2021 09:33:01 AM Eastern Daylight Time			08/04/2021 02:44:24 PM Eastern Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H3288	007	0	2022	El Paso County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	008	0	1	04	01	H3288_008_0	2	1					0	08/02/2021	2022.01	08/02/2021 03:01:31 PM Eastern Daylight Time	08/02/2021 02:59:31 PM Eastern Daylight Time	08/02/2021 09:33:06 AM Eastern Daylight Time			08/04/2021 02:44:24 PM Eastern Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H3288	008	0	2022	North Texas Non Metro counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	009	0	1	04	01	H3288_009_0	2	1					0	08/02/2021	2022.01	08/02/2021 03:02:43 PM Eastern Daylight Time	08/02/2021 03:00:47 PM Eastern Daylight Time	08/02/2021 09:33:10 AM Eastern Daylight Time			08/04/2021 02:44:24 PM Eastern Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H3288	009	0	2022	Rio Grande Valley and Corpus Christi		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	010	0	1	04	01	H3288_010_0	2	1					0	08/02/2021	2022.01	08/02/2021 03:03:19 PM Eastern Daylight Time	08/02/2021 03:01:50 PM Eastern Daylight Time	08/02/2021 09:33:14 AM Eastern Daylight Time			08/04/2021 02:44:24 PM Eastern Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plus Plan (PPO)	01	04		1			H3288	010	0	2022	El Paso County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	011	0	1	04	01	H3288_011_0	2	1					0	08/02/2021	2022.01	08/02/2021 03:04:21 PM Eastern Daylight Time	08/02/2021 03:02:55 PM Eastern Daylight Time	08/02/2021 09:33:18 AM Eastern Daylight Time			08/04/2021 02:44:24 PM Eastern Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H3288	011	0	2022	Panhandle Region		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	012	0	1	04	01	H3288_012_0	2	1					0	08/02/2021	2022.01	08/02/2021 03:05:16 PM Eastern Daylight Time	08/02/2021 09:26:26 PM Eastern Daylight Time	08/02/2021 09:33:22 AM Eastern Daylight Time			08/04/2021 02:44:24 PM Eastern Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plus Plan (PPO)	01	04		1			H3288	012	0	2022	Rio Grande Valley and Corpus Christi		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	013	0	1	04	01	H3288_013_0	2	1					0	08/02/2021	2022.01	08/02/2021 03:05:48 PM Eastern Daylight Time	08/02/2021 03:05:40 PM Eastern Daylight Time	08/02/2021 09:33:27 AM Eastern Daylight Time			08/04/2021 02:44:24 PM Eastern Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plus Plan (PPO)	01	04		1			H3288	013	0	2022	Bexar County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	015	0	1	04	01	H3288_015_0	2	1					0	08/02/2021	2022.01	08/02/2021 03:06:26 PM Eastern Daylight Time	08/02/2021 03:07:03 PM Eastern Daylight Time	08/02/2021 09:33:31 AM Eastern Daylight Time			08/04/2021 02:44:24 PM Eastern Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plus Plan (PPO)	01	04		1			H3288	015	0	2022	Dallas County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	016	0	1	04	01	H3288_016_0	2	1					0	08/02/2021	2022.01	08/02/2021 03:07:17 PM Eastern Daylight Time	08/02/2021 03:08:17 PM Eastern Daylight Time	08/02/2021 09:33:35 AM Eastern Daylight Time			08/04/2021 02:44:24 PM Eastern Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H3288	016	0	2022	Dallas and Surrounding Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	017	0	1	04	01	H3288_017_0	2	1					0	08/02/2021	2022.01	08/02/2021 03:07:57 PM Eastern Daylight Time	08/02/2021 03:09:29 PM Eastern Daylight Time	08/02/2021 09:33:39 AM Eastern Daylight Time			08/04/2021 02:44:24 PM Eastern Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Preferred Plan (PPO)	01	04		1			H3288	017	0	2022	Oklahoma City and Surrounding Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	018	0	1	04	01	H3288_018_0	2	1					0	08/02/2021	2022.01	08/02/2021 03:08:33 PM Eastern Daylight Time	08/02/2021 03:10:42 PM Eastern Daylight Time	08/02/2021 09:33:43 AM Eastern Daylight Time			08/04/2021 02:44:24 PM Eastern Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice II Plan (PPO)	01	04		1			H3288	018	0	2022	Southeast Non Metro		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	019	0	1	04	01	H3288_019_0	2	1					0	08/02/2021	2022.01	08/02/2021 03:09:02 PM Eastern Daylight Time	08/02/2021 03:12:05 PM Eastern Daylight Time	08/02/2021 09:33:47 AM Eastern Daylight Time			08/04/2021 02:44:24 PM Eastern Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Preferred Plan (PPO)	01	04		1			H3288	019	0	2022	Tulsa and Surrounding Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	020	0	1	04	01	H3288_020_0	2	1					0	08/02/2021	2022.01	08/02/2021 03:10:06 PM Eastern Daylight Time	08/02/2021 03:13:15 PM Eastern Daylight Time	08/02/2021 09:33:52 AM Eastern Daylight Time			08/04/2021 02:44:24 PM Eastern Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Core Plan (PPO)	01	04		1			H3288	020	0	2022	Rural Oklahoma		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	021	0	1	04	01	H3288_021_0	2	1					0	08/02/2021	2022.01	08/02/2021 03:11:51 PM Eastern Daylight Time	08/02/2021 03:14:23 PM Eastern Daylight Time	08/02/2021 09:33:56 AM Eastern Daylight Time			08/04/2021 02:44:24 PM Eastern Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Core Plan (PPO)	01	04		1			H3288	021	0	2022	Tulsa and Surrounding Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	022	0	1	04	01	H3288_022_0	2	1					0	08/02/2021	2022.01	08/02/2021 03:13:11 PM Eastern Daylight Time	08/02/2021 03:15:30 PM Eastern Daylight Time	08/02/2021 09:34:00 AM Eastern Daylight Time			08/04/2021 02:44:24 PM Eastern Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plus Plan (PPO)	01	04		1			H3288	022	0	2022	Travis and Williamson Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	023	0	1	04	01	H3288_023_0	4	1					0	08/02/2021	2022.01	08/02/2021 07:45:54 PM Eastern Daylight Time	08/03/2021 10:42:35 AM Eastern Daylight Time	08/02/2021 09:34:04 AM Eastern Daylight Time			08/04/2021 04:57:47 PM Eastern Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	01	04		1			H3288	023	0	2022	Albany Metro and Surrounding Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	024	0	1	04	01	H3288_024_0	4	1					0	08/02/2021	2022.01	08/02/2021 12:37:55 PM Central Daylight Time	08/03/2021 10:43:34 AM Eastern Daylight Time	08/02/2021 09:34:08 AM Eastern Daylight Time			08/04/2021 04:57:47 PM Eastern Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	01	04		1			H3288	024	0	2022	Augusta Metro and Surrounding Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	025	0	1	04	01	H3288_025_0	4	1					0	08/02/2021	2022.01	08/02/2021 10:42:22 AM Eastern Daylight Time	08/03/2021 10:44:33 AM Eastern Daylight Time	08/02/2021 09:34:12 AM Eastern Daylight Time			08/04/2021 04:57:47 PM Eastern Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	01	04		1			H3288	025	0	2022	Central Georgia		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	026	0	1	04	01	H3288_026_0	4	1					0	08/02/2021	2022.01	08/02/2021 10:42:55 AM Eastern Daylight Time	08/03/2021 10:45:32 AM Eastern Daylight Time	08/02/2021 09:34:17 AM Eastern Daylight Time			08/04/2021 04:57:47 PM Eastern Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	01	04		1			H3288	026	0	2022	Columbus Metro and Surrounding Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	027	0	1	04	01	H3288_027_0	4	1					0	08/02/2021	2022.01	08/02/2021 10:43:25 AM Eastern Daylight Time	08/03/2021 10:46:32 AM Eastern Daylight Time	08/02/2021 09:34:21 AM Eastern Daylight Time			08/04/2021 04:57:47 PM Eastern Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	01	04		1			H3288	027	0	2022	Macon Metro and Surrounding Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	028	0	1	04	01	H3288_028_0	4	1					0	08/02/2021	2022.01	08/02/2021 10:44:02 AM Eastern Daylight Time	08/03/2021 10:47:28 AM Eastern Daylight Time	08/02/2021 09:34:25 AM Eastern Daylight Time			08/04/2021 04:57:47 PM Eastern Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	01	04		1			H3288	028	0	2022	Northeast Georgia		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	029	0	1	04	01	H3288_029_0	4	1					0	08/02/2021	2022.01	08/02/2021 11:18:48 AM Eastern Daylight Time	08/03/2021 10:48:19 AM Eastern Daylight Time	08/02/2021 09:34:29 AM Eastern Daylight Time			08/04/2021 04:57:47 PM Eastern Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	01	04		1			H3288	029	0	2022	Northern Georgia		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	030	0	1	04	01	H3288_030_0	4	1					0	08/02/2021	2022.01	08/02/2021 11:19:19 AM Eastern Daylight Time	08/03/2021 10:49:09 AM Eastern Daylight Time	08/02/2021 09:34:34 AM Eastern Daylight Time			08/04/2021 04:57:47 PM Eastern Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	01	04		1			H3288	030	0	2022	Savannah Metro and Surrounding Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	031	0	1	04	01	H3288_031_0	4	1					0	08/02/2021	2022.01	08/02/2021 11:19:51 AM Eastern Daylight Time	08/03/2021 10:50:02 AM Eastern Daylight Time	08/02/2021 09:34:38 AM Eastern Daylight Time			08/04/2021 04:57:47 PM Eastern Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	01	04		1			H3288	031	0	2022	South Georgia		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	032	0	1	04	01	H3288_032_0	4	1					0	08/02/2021	2022.01	08/02/2021 11:20:22 AM Eastern Daylight Time	08/03/2021 10:50:58 AM Eastern Daylight Time	08/02/2021 09:34:42 AM Eastern Daylight Time			08/04/2021 04:57:47 PM Eastern Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	01	04		1			H3288	032	0	2022	Hall County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	033	0	1	04	01	H3288_033_0	4	1					0	08/02/2021	2022.01	08/02/2021 11:20:54 AM Eastern Daylight Time	08/03/2021 10:51:45 AM Eastern Daylight Time	08/02/2021 09:34:46 AM Eastern Daylight Time			08/04/2021 04:57:47 PM Eastern Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	01	04		1			H3288	033	0	2022	Cobb and Paulding Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	034	0	1	04	01	H3288_034_0	1	1				0	0	05/26/2021	2022.01	05/26/2021 02:19:19 PM Eastern Daylight Time	06/02/2021 02:39:07 PM Eastern Daylight Time				06/03/2021 11:14:03 AM Eastern Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Eagle Plan (PPO)	01	04		1			H3288	034	0	2022	Georgia Market		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										2					2						2			
H3288	035	0	1	04	01	H3288_035_0	4	1					0	08/02/2021	2022.01	08/02/2021 11:21:30 AM Eastern Daylight Time	08/03/2021 10:53:40 AM Eastern Daylight Time	08/02/2021 09:34:50 AM Eastern Daylight Time			08/04/2021 04:57:47 PM Eastern Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	01	04		1			H3288	035	0	2022	Floyd, Haralson and Polk Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	036	0	1	04	01	H3288_036_0	4	1					0	08/02/2021	2022.01	08/02/2021 11:22:14 AM Eastern Daylight Time	08/03/2021 10:54:30 AM Eastern Daylight Time	08/02/2021 09:34:55 AM Eastern Daylight Time			08/04/2021 04:57:47 PM Eastern Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Preferred Premium Plan (PPO)	01	04		1			H3288	036	0	2022	Albany Metro and Surrounding Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	037	0	1	04	01	H3288_037_0	4	1					0	08/02/2021	2022.01	08/02/2021 11:27:28 AM Eastern Daylight Time	08/03/2021 10:55:24 AM Eastern Daylight Time	08/02/2021 09:34:59 AM Eastern Daylight Time			08/04/2021 04:57:47 PM Eastern Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Preferred Premium Plan (PPO)	01	04		1			H3288	037	0	2022	Augusta Metro and Surrounding Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	038	0	1	04	01	H3288_038_0	4	1					0	08/02/2021	2022.01	08/02/2021 11:27:57 AM Eastern Daylight Time	08/03/2021 10:56:02 AM Eastern Daylight Time	08/02/2021 09:35:03 AM Eastern Daylight Time			08/04/2021 04:57:47 PM Eastern Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Preferred Premium Plan (PPO)	01	04		1			H3288	038	0	2022	Central Georgia		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	039	0	1	04	01	H3288_039_0	4	1					0	08/02/2021	2022.01	08/02/2021 11:34:28 AM Eastern Daylight Time	08/03/2021 11:38:51 AM Eastern Daylight Time	08/02/2021 09:35:07 AM Eastern Daylight Time			08/04/2021 04:57:47 PM Eastern Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Preferred Premium Plan (PPO)	01	04		1			H3288	039	0	2022	Columbus Metro and Surrounding Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	040	0	1	04	01	H3288_040_0	4	1					0	08/02/2021	2022.01	08/02/2021 11:35:12 AM Eastern Daylight Time	08/03/2021 10:57:01 AM Eastern Daylight Time	08/02/2021 09:35:11 AM Eastern Daylight Time			08/04/2021 04:57:47 PM Eastern Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Preferred Premium Plan (PPO)	01	04		1			H3288	040	0	2022	Macon Metro and Surrounding Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	041	0	1	04	01	H3288_041_0	4	1					0	08/02/2021	2022.01	08/02/2021 11:38:12 AM Eastern Daylight Time	08/03/2021 10:57:45 AM Eastern Daylight Time	08/02/2021 09:35:15 AM Eastern Daylight Time			08/04/2021 04:57:47 PM Eastern Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Preferred Premium Plan (PPO)	01	04		1			H3288	041	0	2022	Northeast Georgia		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	042	0	1	04	01	H3288_042_0	4	1					0	08/02/2021	2022.01	08/02/2021 11:38:48 AM Eastern Daylight Time	08/03/2021 10:58:30 AM Eastern Daylight Time	08/02/2021 09:35:20 AM Eastern Daylight Time			08/04/2021 04:57:47 PM Eastern Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Preferred Premium Plan (PPO)	01	04		1			H3288	042	0	2022	Northern Georgia		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	043	0	1	04	01	H3288_043_0	4	1					0	08/02/2021	2022.01	08/02/2021 11:39:55 AM Eastern Daylight Time	08/03/2021 10:59:16 AM Eastern Daylight Time	08/02/2021 09:35:24 AM Eastern Daylight Time			08/04/2021 04:57:47 PM Eastern Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Preferred Premium Plan (PPO)	01	04		1			H3288	043	0	2022	Savannah Metro and Surrounding Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	044	0	1	04	01	H3288_044_0	4	1					0	08/02/2021	2022.01	08/02/2021 11:40:32 AM Eastern Daylight Time	08/03/2021 11:00:03 AM Eastern Daylight Time	08/02/2021 09:35:28 AM Eastern Daylight Time			08/04/2021 04:57:47 PM Eastern Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Preferred Premium Plan (PPO)	01	04		1			H3288	044	0	2022	South Georgia		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	045	0	1	04	01	H3288_045_0	4	1					0	08/02/2021	2022.01	08/02/2021 11:41:04 AM Eastern Daylight Time	08/03/2021 11:00:47 AM Eastern Daylight Time	08/02/2021 09:35:32 AM Eastern Daylight Time			08/04/2021 04:57:47 PM Eastern Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plus Plan (PPO)	01	04		1			H3288	045	0	2022	Atlanta Metro and Surrounding Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	046	0	1	04	01	H3288_046_0	2	1					0	08/02/2021	2022.01	08/02/2021 03:13:35 PM Eastern Daylight Time	08/02/2021 03:16:37 PM Eastern Daylight Time	08/02/2021 09:35:36 AM Eastern Daylight Time			08/04/2021 02:44:24 PM Eastern Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H3288	046	0	2022	Central Non Metro		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	047	0	1	04	01	H3288_047_0	2	1					0	08/02/2021	2022.01	08/02/2021 03:14:16 PM Eastern Daylight Time	08/02/2021 03:17:58 PM Eastern Daylight Time	08/02/2021 09:35:41 AM Eastern Daylight Time			08/04/2021 02:44:24 PM Eastern Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H3288	047	0	2022	Harris County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	048	0	1	04	01	H3288_048_0	2	1					0	08/02/2021	2022.01	08/02/2021 03:15:01 PM Eastern Daylight Time	08/02/2021 03:20:24 PM Eastern Daylight Time	08/02/2021 09:35:45 AM Eastern Daylight Time			08/04/2021 02:44:24 PM Eastern Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice II Plan (PPO)	01	04		1			H3288	048	0	2022	Central Non Metro		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	049	0	1	04	01	H3288_049_0	2	1				0	0	07/14/2021	2022.01	07/14/2021 11:45:21 AM Eastern Daylight Time	06/02/2021 01:15:51 PM Eastern Daylight Time				07/14/2021 12:21:24 PM Eastern Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Eagle Plan (PPO)	01	04		1			H3288	049	0	2022	Dallas County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										2					2						2			
H3288	050	0	1	04	01	H3288_050_0	2	1				0	0	07/14/2021	2022.01	07/14/2021 11:52:59 AM Eastern Daylight Time	06/02/2021 01:17:59 PM Eastern Daylight Time				07/14/2021 12:21:24 PM Eastern Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Eagle Plan (PPO)	01	04		1			H3288	050	0	2022	Harris County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										2					2						2			
H3288	051	0	1	04	01	H3288_051_0	1	1				0	0	05/25/2021	2022.01	05/25/2021 08:22:10 PM Eastern Daylight Time	06/02/2021 01:20:39 PM Eastern Daylight Time				06/03/2021 01:50:57 PM Eastern Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Eagle Plan (PPO)	01	04		1			H3288	051	0	2022	Tulsa		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										2					2						2			
H3288	052	0	1	04	01	H3288_052_0	2	1				0	0	05/25/2021	2022.01	05/25/2021 08:24:33 PM Eastern Daylight Time	06/02/2021 01:24:09 PM Eastern Daylight Time				06/03/2021 01:50:57 PM Eastern Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Eagle Plan (PPO)	01	04		1			H3288	052	0	2022	San Antonio		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										2					2						2			
H3288	801	0	1	04	01	H3288_801_0	1	1				0	0	05/27/2021	2022.01	05/27/2021 11:19:36 PM Eastern Daylight Time					06/03/2021 01:07:05 PM Eastern Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan (PPO)	01	04		1			H3288	801	0	2022	Multi-State		1	120	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H3288	802	0	1	04	01	H3288_802_0	1	1						05/27/2021	2022.01	05/27/2021 11:20:47 PM Eastern Daylight Time					06/03/2021 01:07:05 PM Eastern Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan w/Rx (PPO)	01	04		1			H3288	802	0	2022	Multi-State		1	120	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H3291	001	0	1	01	01	H3291_001_0	9	1		1			0	08/04/2021	2022.01	08/04/2021 08:31:33 AM Central Daylight Time	08/04/2021 11:35:12 AM Central Daylight Time	08/02/2021 12:27:53 PM Central Daylight Time			08/05/2021 11:18:13 AM Central Daylight Time	PRUITTHEALTH PREMIER, INC.	PruittHealth Premier	www.pruitthealthpremier.com	PruittHealth Premier (HMO I-SNP)	01	01		1			H3291	001	0	2022	Georgia (partial)		2		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			
H3291	002	0	1	01	01	H3291_002_0	8	1	2	1			0	08/04/2021	2022.01	08/04/2021 08:32:07 AM Central Daylight Time	08/04/2021 11:38:01 AM Central Daylight Time	08/02/2021 12:10:42 PM Central Daylight Time			08/05/2021 11:18:13 AM Central Daylight Time	PRUITTHEALTH PREMIER, INC.	PruittHealth Premier	www.pruitthealthpremier.com	PruittHealth Premier D-SNP (HMO D-SNP)	01	01		1			H3291	002	0	2022	Georgia (partial)		2		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	003	0	1	01	01	H3293_003_0	8	1					1	07/08/2021	2022.01	07/08/2021 06:00:30 PM Eastern Daylight Time	07/29/2021 05:19:41 PM Eastern Daylight Time	07/29/2021 05:11:48 PM Eastern Daylight Time			07/30/2021 06:43:52 PM Eastern Daylight Time	MMM OF FLORIDA, INC.	MMM of Florida, Inc.	www.mmm-fl.com	MMM EXTRA (HMO)	01	01		1			H3293	003	0	2022	Counties: Miami-Dade, Broward, Palm Beach		2		2			2						www.mmm-fl.com	www.mmm-fl.com	www.mmm-fl.com	(844)212-9858		(786)584-4608		(844)212-9858		(786)584-4608		(844)212-9858		(786)584-4608		(844)212-9858		(786)584-4608		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3293	004	0	1	01	01	H3293_004_0	8	1	2	1	1		0	07/29/2021	2022.01	07/29/2021 06:20:50 PM Eastern Daylight Time	07/29/2021 06:12:09 PM Eastern Daylight Time	07/29/2021 05:12:19 PM Eastern Daylight Time			07/30/2021 06:43:52 PM Eastern Daylight Time	MMM OF FLORIDA, INC.	MMM of Florida, Inc.	www.mmm-fl.com	MMM PLATINUM (HMO D-SNP)	01	01		1			H3293	004	0	2022	Counties: Miami-Dade, Broward, Palm Beach		2		2			1	3		2		2	www.mmm-fl.com	www.mmm-fl.com	www.mmm-fl.com	(844)212-9858		(786)584-4608		(844)212-9858		(786)584-4608		(844)212-9858		(786)584-4608		(844)212-9858		(786)584-4608		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3293	005	0	1	01	01	H3293_005_0	7	1					1	06/11/2021	2022.01	06/11/2021 12:12:57 PM Eastern Daylight Time	07/29/2021 05:20:46 PM Eastern Daylight Time	07/29/2021 05:13:13 PM Eastern Daylight Time			07/30/2021 06:43:52 PM Eastern Daylight Time	MMM OF FLORIDA, INC.	MMM of Florida, Inc.	www.mmm-fl.com	MMM ELITE (HMO)	01	01		1			H3293	005	0	2022	Counties: Miami-Dade, Broward, Palm Beach		2		2			2						www.mmm-fl.com	www.mmm-fl.com	www.mmm-fl.com	(844)212-9858		(786)584-4608		(844)212-9858		(786)584-4608		(844)212-9858		(786)584-4608		(844)212-9858		(786)584-4608		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3305	007	0	1	02	01	H3305_007_0	5	1				0	0	07/13/2021	2022.01	07/13/2021 04:07:35 PM Eastern Daylight Time	06/06/2021 04:03:34 PM Eastern Daylight Time				07/14/2021 01:52:55 PM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP HEALTH CARE	www.joinMVPmedicare.com	MVP Medicare Preferred Gold without Part D (HMO-POS)	01	02		1			H3305	007	0	2022	Western NY (Rochester/Buffalo)		2	10602	2			2						https://www.mvphealthcare.com/partD	https://www.mvphealthcare.com/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	8	1					0	07/19/2021	2022.01	07/19/2021 12:27:35 PM Eastern Daylight Time	08/04/2021 11:59:39 PM Eastern Daylight Time	08/05/2021 12:04:59 AM Eastern Daylight Time			08/05/2021 01:34:17 PM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP HEALTH CARE	www.joinMVPmedicare.com	MVP Medicare Preferred Gold with Part D (HMO-POS)	01	02		1			H3305	015	0	2022	Western NY (Rochester/Buffalo)		2	108455	2			2						https://www.mvphealthcare.com/partD	https://www.mvphealthcare.com/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	5	1				0	0	07/13/2021	2022.01	07/13/2021 04:11:06 PM Eastern Daylight Time	06/06/2021 04:04:48 PM Eastern Daylight Time				07/14/2021 01:52:55 PM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP HEALTH CARE	www.joinmvpmedicare.com	MVP Medicare Preferred Gold without Part D (HMO-POS)	01	02		1			H3305	020	0	2022	S.Tier NY, CNY, Eastern NY, Hudson Valley NY, VT		2	3192	2			2						https://www.mvphealthcare.com/partD	https://www.mvphealthcare.com/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					0	07/19/2021	2022.01	07/19/2021 11:29:03 AM Eastern Daylight Time	08/04/2021 11:59:45 PM Eastern Daylight Time	08/05/2021 12:05:03 AM Eastern Daylight Time			08/05/2021 01:34:17 PM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP HEALTH CARE	www.joinmvpmedicare.com	MVP Medicare Preferred Gold with Part D (HMO-POS)	01	02		1			H3305	021	0	2022	S.Tier NY, CNY, Eastern NY, Hudson Valley NY		2	40518	2			2						https://www.mvphealthcare.com/partD	https://www.mvphealthcare.com/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	6	1					0	07/13/2021	2022.01	07/13/2021 04:15:16 PM Eastern Daylight Time	08/04/2021 11:59:51 PM Eastern Daylight Time	08/05/2021 12:05:08 AM Eastern Daylight Time			08/05/2021 01:34:17 PM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP HEALTH CARE	www.joinmvpmedicare.com	MVP Medicare Secure Plus with Part D (HMO-POS)	01	02		1			H3305	022	0	2022	S.Tier NY, CNY, Eastern NY, Hudson Valley NY, VT		2	56796	2			2						https://www.mvphealthcare.com/partD	https://www.mvphealthcare.com/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					0	07/13/2021	2022.01	07/13/2021 04:08:27 PM Eastern Daylight Time	08/04/2021 11:59:56 PM Eastern Daylight Time	08/05/2021 12:05:14 AM Eastern Daylight Time			08/05/2021 01:34:17 PM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP HEALTH CARE	www.joinmvpmedicare.com	MVP Medicare Secure with Part D (HMO-POS)	01	02		1			H3305	030	0	2022	Western NY (Rochester/Buffalo)		2	69254	2			2						https://www.mvphealthcare.com/partD	https://www.mvphealthcare.com/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	032	0	1	02	01	H3305_032_0	6	1					0	07/13/2021	2022.01	07/13/2021 04:16:11 PM Eastern Daylight Time	08/05/2021 12:00:02 AM Eastern Daylight Time	08/05/2021 12:05:23 AM Eastern Daylight Time			08/05/2021 01:34:17 PM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP HEALTH CARE	www.joinMVPmedicare.com	MVP Medicare Secure with Part D (HMO-POS)	01	02		1			H3305	032	0	2022	S.Tier NY, CNY, Eastern NY, Hudson Valley NY		2	14400	2			2						https://www.mvphealthcare.com/partD	https://www.mvphealthcare.com/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	033	0	1	01	01	H3305_033_0	5	1	2	1			0	07/08/2021	2022.01	07/08/2021 11:59:21 AM Eastern Daylight Time	08/05/2021 12:00:07 AM Eastern Daylight Time	08/05/2021 12:05:28 AM Eastern Daylight Time			08/05/2021 01:34:17 PM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP HEALTH CARE	www.joinmvpmedicare.com	MVP DualAccess (HMO D-SNP)	01	01		1			H3305	033	0	2022	Eastern NY, Hudson Valley, NY		2		2			1	3		1		1	https://www.mvphealthcare.com/partD	https://www.mvphealthcare.com/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					1					1	2			
H3305	034	0	1	01	01	H3305_034_0	5	1	2	1			0	07/08/2021	2022.01	07/08/2021 12:00:00 PM Eastern Daylight Time	08/05/2021 12:00:12 AM Eastern Daylight Time	08/05/2021 12:05:32 AM Eastern Daylight Time			08/05/2021 01:34:17 PM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP HEALTH CARE	www.joinmvpmedicare.com	MVP DualAccess Complete (HMO D-SNP)	01	01		1			H3305	034	0	2022	Eastern NY, Hudson Valley, NY		2		2			1	3		1		1	https://www.mvphealthcare.com/partD	https://www.mvphealthcare.com/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					1					1	2			
H3305	035	0	1	01	01	H3305_035_0	5	1	2	1			0	07/08/2021	2022.01	07/08/2021 12:01:01 PM Eastern Daylight Time	08/05/2021 12:00:17 AM Eastern Daylight Time	08/05/2021 12:05:36 AM Eastern Daylight Time			08/05/2021 01:34:17 PM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP HEALTH CARE	www.joinmvpmedicare.com	MVP DualAccess Plus (HMO D-SNP)	01	01		1			H3305	035	0	2022	Eastern NY, Hudson Valley, NY		2		2			1	3		1		1	https://www.mvphealthcare.com/partD	https://www.mvphealthcare.com/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					1					1	2			
H3305	801	0	1	02	01	H3305_801_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 11:12:40 AM Eastern Daylight Time					06/05/2021 06:23:18 PM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP HEALTH CARE	www.mvphealthcare.com	MVP Preferred Gold - Employer Group (HMO-POS)	01	02		1			H3305	801	0	2022	Employer Group West Region		1	8754	2			2						https://www.mvphealthcare.com/partD	https://www.mvphealthcare.com/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	803	0	1	02	01	H3305_803_0	1	1						05/25/2021	2022.01	05/25/2021 04:53:39 PM Eastern Daylight Time					06/05/2021 06:23:18 PM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP HEALTH CARE	www.mvphealthcare.com	MVP Preferred Gold Rx - Employer Group (HMO-POS)	01	02		1			H3305	803	0	2022	Employer Group West Region		1	73554	2			2						https://www.mvphealthcare.com/partD	https://www.mvphealthcare.com/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	804	0	1	02	01	H3305_804_0	1	1						05/25/2021	2022.01	05/25/2021 05:04:45 PM Eastern Daylight Time					06/05/2021 06:23:18 PM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP HEALTH CARE	www.mvphealthcare.com	MVP Preferred Gold Rx - Employer Group (HMO-POS)	01	02		1			H3305	804	0	2022	Eastern NY, Hudson Valley NY, Vermont		1	43620	2			2						https://www.mvphealthcare.com/partD	https://www.mvphealthcare.com/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			
H3307	002	0	1	01	01	H3307_002_0	4	1					1	08/04/2021	2022.01	08/04/2021 10:10:10 AM Central Daylight Time	08/03/2021 01:01:38 PM Central Daylight Time	07/29/2021 08:25:04 PM Central Daylight Time			08/05/2021 01:46:45 PM Central Daylight Time	OXFORD HEALTH PLANS (NY), INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO)	01	01		1			H3307	002	0	2022	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					1	08/04/2021	2022.01	08/04/2021 10:11:42 AM Central Daylight Time	08/03/2021 01:02:09 PM Central Daylight Time	07/29/2021 08:25:19 PM Central Daylight Time			08/05/2021 01:46:45 PM Central Daylight Time	OXFORD HEALTH PLANS (NY), INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO)	01	01		1			H3307	012	0	2022	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	3	1					1	08/04/2021	2022.01	08/04/2021 10:13:21 AM Central Daylight Time	08/03/2021 01:02:40 PM Central Daylight Time	07/29/2021 08:25:34 PM Central Daylight Time			08/05/2021 01:46:45 PM Central Daylight Time	OXFORD HEALTH PLANS (NY), INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Prime (HMO)	01	01		1			H3307	015	0	2022	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	2	1				0	0	07/15/2021	2022.01	07/15/2021 12:33:07 PM Central Daylight Time	06/03/2021 03:45:36 PM Central Daylight Time				07/15/2021 05:35:44 PM Central Daylight Time	OXFORD HEALTH PLANS (NY), INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (HMO)	01	01		1			H3307	018	0	2022	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	3	1					1	08/04/2021	2022.01	08/04/2021 10:15:09 AM Central Daylight Time	08/03/2021 01:03:18 PM Central Daylight Time	07/29/2021 08:25:49 PM Central Daylight Time			08/05/2021 01:46:45 PM Central Daylight Time	OXFORD HEALTH PLANS (NY), INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO)	01	01		1			H3307	023	0	2022	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	2	1					1	08/04/2021	2022.01	08/04/2021 10:17:05 AM Central Daylight Time	08/03/2021 01:03:53 PM Central Daylight Time	07/29/2021 08:26:04 PM Central Daylight Time			08/05/2021 01:46:45 PM Central Daylight Time	OXFORD HEALTH PLANS (NY), INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO)	01	01		1			H3307	025	0	2022	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						05/24/2021	2022.01	05/24/2021 12:18:46 PM Central Daylight Time					06/02/2021 12:15:22 PM Central Daylight Time	OXFORD HEALTH PLANS (NY), INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H3307	802	0	2022	New York Metropolitan Area		1	3744	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1					1				
H3307	804	0	1	01	01	H3307_804_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 09:10:35 AM Central Daylight Time					06/02/2021 12:15:22 PM Central Daylight Time	OXFORD HEALTH PLANS (NY), INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H3307	804	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;15;16b;17a;18a;	2		1					1				
H3307	805	0	1	01	01	H3307_805_0	1	1						05/24/2021	2022.01	05/24/2021 12:20:20 PM Central Daylight Time					06/02/2021 12:15:22 PM Central Daylight Time	OXFORD HEALTH PLANS (NY), INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H3307	805	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1					1				
H3312	002	0	1	01	01	H3312_002_0	3	1			2		0	08/02/2021	2022.01	08/02/2021 03:22:32 PM Eastern Daylight Time	08/03/2021 09:45:25 AM Eastern Daylight Time	08/02/2021 09:35:49 AM Eastern Daylight Time			08/04/2021 03:36:50 PM Eastern Daylight Time	AETNA HEALTH INC. (NY)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H3312	002	0	2022	Metro Area: Bronx, Brooklyn, Staten Island		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3312	018	0	1	01	01	H3312_018_0	2	1			2		0	08/02/2021	2022.01	08/02/2021 03:25:31 PM Eastern Daylight Time	08/03/2021 09:48:56 AM Eastern Daylight Time	08/02/2021 09:35:53 AM Eastern Daylight Time			08/04/2021 03:36:50 PM Eastern Daylight Time	AETNA HEALTH INC. (NY)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H3312	018	0	2022	Westchester and Rockland Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3312	048	0	1	01	01	H3312_048_0	2	1			2		0	08/02/2021	2022.01	08/02/2021 03:26:12 PM Eastern Daylight Time	08/03/2021 01:52:18 PM Eastern Daylight Time	08/02/2021 09:35:57 AM Eastern Daylight Time			08/04/2021 03:36:50 PM Eastern Daylight Time	AETNA HEALTH INC. (NY)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H3312	048	0	2022	Northern Central Upstate New York		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3312	062	0	1	02	01	H3312_062_0	3	1			2		0	08/02/2021	2022.01	08/02/2021 03:27:25 PM Eastern Daylight Time	08/03/2021 09:51:52 AM Eastern Daylight Time	08/02/2021 09:36:01 AM Eastern Daylight Time			08/04/2021 03:36:50 PM Eastern Daylight Time	AETNA HEALTH INC. (NY)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO-POS)	01	02		1			H3312	062	0	2022	Capital Region and Hudson Valley Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3312	064	0	1	01	01	H3312_064_0	3	1			2		0	07/14/2021	2022.01	07/14/2021 11:13:56 AM Eastern Daylight Time	08/03/2021 09:55:00 AM Eastern Daylight Time	08/02/2021 09:36:05 AM Eastern Daylight Time			08/04/2021 03:36:50 PM Eastern Daylight Time	AETNA HEALTH INC. (NY)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H3312	064	0	2022	Nassau and Suffolk Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3312	065	0	1	02	01	H3312_065_0	2	1			2		0	08/02/2021	2022.01	08/02/2021 03:28:07 PM Eastern Daylight Time	08/03/2021 09:56:50 AM Eastern Daylight Time	08/02/2021 09:36:10 AM Eastern Daylight Time			08/04/2021 03:36:50 PM Eastern Daylight Time	AETNA HEALTH INC. (NY)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO-POS)	01	02		1			H3312	065	0	2022	Western New York		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3312	068	0	1	01	01	H3312_068_0	3	1			2		0	08/02/2021	2022.01	08/02/2021 08:47:33 PM Eastern Daylight Time	08/03/2021 09:58:25 AM Eastern Daylight Time	08/02/2021 09:36:14 AM Eastern Daylight Time			08/04/2021 03:36:50 PM Eastern Daylight Time	AETNA HEALTH INC. (NY)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite Plan (HMO)	01	01		1			H3312	068	0	2022	Metro Area: NYC and Queens		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3312	069	0	1	01	01	H3312_069_0	3	1	2	1	1		0	07/08/2021	2022.01	07/08/2021 09:59:48 AM Eastern Daylight Time	08/03/2021 11:34:12 AM Eastern Daylight Time	08/02/2021 09:36:18 AM Eastern Daylight Time			08/04/2021 03:36:50 PM Eastern Daylight Time	AETNA HEALTH INC. (NY)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Assure Plan (HMO D-SNP)	01	01		1			H3312	069	0	2022	Metro Area: LI, 5 Boroughs, Westchester/Rockland		2		2			1	3		1		1	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3312	070	0	1	01	01	H3312_070_0	4	1	2	1	1		0	07/08/2021	2022.01	07/08/2021 10:00:10 AM Eastern Daylight Time	08/03/2021 11:35:43 AM Eastern Daylight Time	08/02/2021 09:36:22 AM Eastern Daylight Time			08/04/2021 03:36:50 PM Eastern Daylight Time	AETNA HEALTH INC. (NY)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Assure Plan (HMO D-SNP)	01	01		1			H3312	070	0	2022	Upstate NY Area: HV, Capital, CNY, Rochester, WNY		2		2			1	3		1		1	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3312	801	0	1	01	01	H3312_801_0	1	1				0	0	05/27/2021	2022.01	05/27/2021 11:21:45 PM Eastern Daylight Time					06/03/2021 01:07:05 PM Eastern Daylight Time	AETNA HEALTH INC. (NY)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (HMO)	01	01		1			H3312	801	0	2022	New York		1	660	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H3312	804	0	1	01	01	H3312_804_0	1	1						05/27/2021	2022.01	05/27/2021 11:22:09 PM Eastern Daylight Time					06/03/2021 01:07:05 PM Eastern Daylight Time	AETNA HEALTH INC. (NY)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan w/Rx (HMO)	01	01		1			H3312	804	0	2022	New York		1	1640	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H3321	001	0	1	20	08	H3321_001_0	1	1						06/02/2021	2022.01	06/02/2021 01:08:45 PM Eastern Daylight Time		06/02/2021 01:14:24 PM Eastern Daylight Time			06/02/2021 01:16:18 PM 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	2022	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						06/02/2021	2022.01	06/02/2021 01:10:18 PM Eastern Daylight Time		06/02/2021 01:14:24 PM Eastern Daylight Time			06/02/2021 01:16:18 PM 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	2022	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						06/02/2021	2022.01	06/02/2021 01:13:00 PM Eastern Daylight Time		06/02/2021 08:07:55 AM Eastern Daylight Time			06/02/2021 01:28:28 PM Eastern Daylight Time	SENIOR CARE CONNECTION, INC.	Eddy SeniorCare	eddyseniorcare.com	Senior Care Connection dba Eddy SeniorCare (PACE)	08	20		1			H3322	001	0	2022	Schenectady, Albany, Rensselaer  Counties, NY		2		2			2						www.eddyseniorcare.com	www.eddyseniorcare.com										(855)376-7888		(518)382-3290		(855)376-7888		(518)382-3290										(855)376-7888	711	(518)382-3290	711	(855)376-7888		(518)382-3290																
H3322	002	0	1	20	08	H3322_002_0	1	1						06/02/2021	2022.01	06/02/2021 01:15:23 PM Eastern Daylight Time		06/02/2021 08:16:27 AM Eastern Daylight Time			06/02/2021 01:28:28 PM Eastern Daylight Time	SENIOR CARE CONNECTION, INC.	Eddy SeniorCare	eddyseniorcare.com	Senior Care Connection dba:  Eddy SeniorCare (PACE)	08	20		1			H3322	002	0	2022	Schenectady, Albany, Rensselaer Counties, NY		2		2			2						www.eddyseniorcare.com	www.eddyseniorcare.com										(855)376-7888		(518)213-7526		(855)376-7888		(518)382-3290										(855)376-7888	711	(518)213-7526	711	(855)376-7888		(518)382-3290																
H3329	001	0	1	20	08	H3329_001_0	2	1						06/03/2021	2022.01	06/03/2021 02:13:30 PM Eastern Daylight Time		06/03/2021 01:40:27 PM Eastern Daylight Time			06/03/2021 02:17:29 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	2022	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	2	1						06/03/2021	2022.01	06/03/2021 02:13:44 PM Eastern Daylight Time		06/03/2021 01:40:27 PM Eastern Daylight Time			06/03/2021 02:17:29 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	2022	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	6	1			2		0	06/02/2021	2022.01	06/02/2021 05:08:06 PM Eastern Daylight Time	08/05/2021 06:38:00 PM Eastern Daylight Time	08/05/2021 06:38:00 PM Eastern Daylight Time			08/05/2021 03:09:51 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	emblemhealth.com/medicare	EmblemHealth VIP Gold (HMO)	01	01		1			H3330	021	1	2022	NYC, Long Island and Lower Hudson Valley	Bronx, Kings, New York, Queens counties	2		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	021	2	1	01	01	H3330_021_2	6	1			2		0	06/02/2021	2022.01	06/02/2021 05:08:47 PM Eastern Daylight Time	08/05/2021 06:38:00 PM Eastern Daylight Time	08/05/2021 06:38:00 PM Eastern Daylight Time			08/05/2021 03:09:51 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	emblemhealth.com/medicare	EmblemHealth VIP Gold (HMO)	01	01		1			H3330	021	2	2022	NYC, Long Island and Lower Hudson Valley	Nassau and Richmond counties	2		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	021	3	1	01	01	H3330_021_3	6	1			2		0	06/02/2021	2022.01	06/02/2021 05:09:11 PM Eastern Daylight Time	08/05/2021 06:38:00 PM Eastern Daylight Time	08/05/2021 06:38:00 PM Eastern Daylight Time			08/05/2021 03:09:51 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	emblemhealth.com/medicare	EmblemHealth VIP Gold (HMO)	01	01		1			H3330	021	3	2022	NYC, Long Island and Lower Hudson Valley	Suffolk county	2		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	021	4	1	01	01	H3330_021_4	5	1			2		0	06/02/2021	2022.01	06/02/2021 05:09:32 PM Eastern Daylight Time	08/05/2021 06:38:00 PM Eastern Daylight Time	08/05/2021 06:38:00 PM Eastern Daylight Time			08/05/2021 03:09:51 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	emblemhealth.com/medicare	EmblemHealth VIP Gold (HMO)	01	01		1			H3330	021	4	2022	NYC, Long Island and Lower Hudson Valley	Lower Hudson Valley counties	2		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	032	1	1	01	01	H3330_032_1	6	1			2		0	08/04/2021	2022.01	08/04/2021 12:44:19 PM Eastern Daylight Time	08/05/2021 06:38:00 PM Eastern Daylight Time	08/05/2021 06:38:00 PM Eastern Daylight Time			08/05/2021 03:09:51 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	emblemhealth.com/medicare	EmblemHealth VIP Essential (HMO)	01	01		1			H3330	032	1	2022	NYC, Long Island and Lower Hudson Valley	Bronx, Kings, New York and Queens counties	2		2			2						emblemhealth.com/medicare	emblemhealth.com/medicare	emblemhealth.com/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	6	1			2		0	08/04/2021	2022.01	08/04/2021 12:44:53 PM Eastern Daylight Time	08/05/2021 06:38:00 PM Eastern Daylight Time	08/05/2021 06:38:00 PM Eastern Daylight Time			08/05/2021 03:09:51 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	emblemhealth.com/medicare	EmblemHealth VIP Essential (HMO)	01	01		1			H3330	032	2	2022	NYC, Long Island and Lower Hudson Valley	Nassau and Richmond counties	2		2			2						emblemhealth.com/medicare	emblemhealth.com/medicare	emblemhealth.com/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	6	1			2		0	08/04/2021	2022.01	08/04/2021 12:45:13 PM Eastern Daylight Time	08/05/2021 06:38:00 PM Eastern Daylight Time	08/05/2021 06:38:00 PM Eastern Daylight Time			08/05/2021 03:09:51 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	emblemhealth.com/medicare	EmblemHealth VIP Essential (HMO)	01	01		1			H3330	032	3	2022	NYC, Long Island and Lower Hudson Valley	Suffolk county	2		2			2						emblemhealth.com/medicare	emblemhealth.com/medicare	emblemhealth.com/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	6	1			2		0	08/04/2021	2022.01	08/04/2021 12:45:35 PM Eastern Daylight Time	08/05/2021 06:38:00 PM Eastern Daylight Time	08/05/2021 06:38:00 PM Eastern Daylight Time			08/05/2021 03:09:51 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	emblemhealth.com/medicare	EmblemHealth VIP Essential (HMO)	01	01		1			H3330	032	4	2022	NYC, Long Island and Lower Hudson Valley	Lower Hudson Valley counties	2		2			2						emblemhealth.com/medicare	emblemhealth.com/medicare	emblemhealth.com/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	5	1			2		0	08/04/2021	2022.01	08/04/2021 01:17:58 PM Eastern Daylight Time	08/05/2021 06:38:00 PM Eastern Daylight Time	08/05/2021 06:38:00 PM Eastern Daylight Time			08/05/2021 03:09:51 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	emblemhealth.com/medicare	EmblemHealth VIP Value (HMO)	01	01		1			H3330	036	0	2022	NYC, Long Island, Lower Hudson Valley Counties		2		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	038	0	1	01	01	H3330_038_0	4	1			2		0	06/06/2021	2022.01	06/06/2021 05:11:46 PM Eastern Daylight Time	08/05/2021 06:38:00 PM Eastern Daylight Time	08/05/2021 06:38:00 PM Eastern Daylight Time			08/05/2021 03:09:51 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	emblemhealth.com/medicare	EmblemHealth VIP Gold Plus (HMO)	01	01		1			H3330	038	0	2022	NYC, Long Island, Lower Hudson Valley Counties		2		2			2						emblemhealth.com/medicare	emblemhealth.com/medicare	emblemhealth.com/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	6	1			2		0	08/04/2021	2022.01	08/04/2021 12:51:16 PM Eastern Daylight Time	08/05/2021 06:38:00 PM Eastern Daylight Time	08/05/2021 06:38:00 PM Eastern Daylight Time			08/05/2021 03:09:51 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	emblemhealth.com/medicare	EmblemHealth VIP Rx Saver (HMO)	01	01		1			H3330	039	1	2022	Hudson Valley	Lower Hudson Valley counties	2		2			2						emblemhealth.com/medicare	emblemhealth.com/medicare	emblemhealth.com/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	6	1			2		0	08/04/2021	2022.01	08/04/2021 12:51:38 PM Eastern Daylight Time	08/05/2021 06:38:00 PM Eastern Daylight Time	08/05/2021 06:38:00 PM Eastern Daylight Time			08/05/2021 03:09:51 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	emblemhealth.com/medicare	EmblemHealth VIP Rx Saver (HMO)	01	01		1			H3330	039	2	2022	Hudson Valley	Capital Region counties	2		2			2						emblemhealth.com/medicare	emblemhealth.com/medicare	emblemhealth.com/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	5	1	2	1	1		0	08/05/2021	2022.01	08/05/2021 12:02:36 PM Eastern Daylight Time	08/05/2021 06:38:00 PM Eastern Daylight Time	08/05/2021 06:38:00 PM Eastern Daylight Time			08/05/2021 03:09:51 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	emblemhealth.com/medicare	EmblemHealth VIP Dual (HMO D-SNP)	01	01		1			H3330	042	1	2022	NYC, Long Island, Hudson Valley, Capital District	Bronx, Kings, New York and Queens	2		2			1	3		1		1	emblemhealth.com/medicare	emblemhealth.com/medicare	emblemhealth.com/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	5	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 01:41:48 PM Eastern Daylight Time	08/05/2021 06:38:00 PM Eastern Daylight Time	08/05/2021 06:38:00 PM Eastern Daylight Time			08/05/2021 03:09:51 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	emblemhealth.com/medicare	EmblemHealth VIP Dual (HMO D-SNP)	01	01		1			H3330	042	2	2022	NYC, Long Island, Hudson Valley, Capital District	Suffolk	2		2			1	3		1		1	emblemhealth.com/medicare	emblemhealth.com/medicare	emblemhealth.com/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	5	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 01:19:19 PM Eastern Daylight Time	08/05/2021 06:38:00 PM Eastern Daylight Time	08/05/2021 06:38:00 PM Eastern Daylight Time			08/05/2021 03:09:51 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	emblemhealth.com/medicare	EmblemHealth VIP Dual (HMO D-SNP)	01	01		1			H3330	042	3	2022	NYC, Long Island, Hudson Valley, Capital District	Hudson Valley and Capital District	2		2			1	3		1		1	emblemhealth.com/medicare	emblemhealth.com/medicare	emblemhealth.com/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	3	1						06/06/2021	2022.01	06/06/2021 05:24:50 PM Eastern Daylight Time					06/07/2021 04:16:18 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	emblemhealth.com/medicare	EmblemHealth VIP Premier (HMO)	01	01		1			H3330	814	0	2022	New York		1	190036	2			2						emblemhealth.com/medicare	emblemhealth.com/medicare	emblemhealth.com/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	3	1				0	0	06/06/2021	2022.01	06/06/2021 05:26:19 PM Eastern Daylight Time					06/07/2021 04:16:18 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	emblemhealth.com/medicare	EmblemHealth VIP Rx Carveout (HMO)	01	01		1			H3330	815	0	2022	New York		1	185834	2			2						emblemhealth.com/medicare	emblemhealth.com/medicare	emblemhealth.com/medicare	(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3330	820	0	1	02	01	H3330_820_0	3	1						06/06/2021	2022.01	06/06/2021 05:27:23 PM Eastern Daylight Time					06/07/2021 04:16:18 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	emblemhealth.com/medicare	EmblemHealth VIP Choice (HMO-POS)	01	02		1			H3330	820	0	2022	New York		1	600	2			2						emblemhealth.com/medicare	emblemhealth.com/medicare	emblemhealth.com/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	821	0	1	02	01	H3330_821_0	3	1				0	0	06/06/2021	2022.01	06/06/2021 05:28:20 PM Eastern Daylight Time					06/07/2021 04:16:18 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	emblemhealth.com/medicare	EmblemHealth VIP Choice Rx Carveout (HMO-POS)	01	02		1			H3330	821	0	2022	New York		1	600	2			2						emblemhealth.com/medicare	emblemhealth.com/medicare	emblemhealth.com/medicare	(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3331	001	0	1	20	08	H3331_001_0	2	1						05/28/2021	2022.01	05/28/2021 11:24:02 AM Eastern Daylight Time		05/28/2021 11:14:52 AM Eastern Daylight Time			05/28/2021 11:26:08 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	2022	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	2	1						05/28/2021	2022.01	05/28/2021 11:24:12 AM Eastern Daylight Time		05/28/2021 11:15:42 AM Eastern Daylight Time			05/28/2021 11:26:08 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	2022	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	014	0	1	04	01	H3335_014_0	7	1					1	08/05/2021	2022.01	08/05/2021 08:36:12 AM Eastern Daylight Time	08/02/2021 10:45:46 AM Eastern Daylight Time	07/30/2021 11:55:32 AM Eastern Daylight Time			08/05/2021 09:10:12 AM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare BlueSecure (PPO)	01	04		1			H3335	014	0	2022	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)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						2			
H3335	015	0	1	04	01	H3335_015_0	7	1					1	08/05/2021	2022.01	08/05/2021 08:36:22 AM Eastern Daylight Time	08/02/2021 10:46:16 AM Eastern Daylight Time	07/30/2021 11:55:48 AM Eastern Daylight Time			08/05/2021 09:10:12 AM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare BlueEnhanced (PPO)	01	04		1			H3335	015	0	2022	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)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						2			
H3335	018	0	1	04	01	H3335_018_0	6	1					0	08/05/2021	2022.01	08/05/2021 08:36:32 AM Eastern Daylight Time	08/02/2021 10:46:44 AM Eastern Daylight Time	07/30/2021 11:56:02 AM Eastern Daylight Time			08/05/2021 09:10:12 AM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare BluePlus (PPO)	01	04		1			H3335	018	0	2022	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)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						2			
H3335	038	0	1	04	01	H3335_038_0	7	1					1	08/05/2021	2022.01	08/05/2021 08:36:47 AM Eastern Daylight Time	08/04/2021 08:42:12 AM Eastern Daylight Time	07/30/2021 11:56:18 AM Eastern Daylight Time			08/05/2021 09:10:12 AM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare BlueClassic (PPO)	01	04		1			H3335	038	0	2022	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)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						2			
H3335	043	0	1	04	01	H3335_043_0	6	1				0	0	08/05/2021	2022.01	08/05/2021 08:37:00 AM Eastern Daylight Time	07/15/2021 04:47:40 PM Eastern Daylight Time				08/05/2021 09:10:12 AM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare BlueBasic (PPO)	01	04		1			H3335	043	0	2022	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)662-1220		(800)662-1220		(800)662-1220		(800)662-1220										2					2						2			
H3335	044	0	1	04	01	H3335_044_0	6	1				0	0	08/05/2021	2022.01	08/05/2021 08:37:16 AM Eastern Daylight Time	07/15/2021 04:47:42 PM Eastern Daylight Time				08/05/2021 09:10:12 AM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare BlueBasic (PPO)	01	04		1			H3335	044	0	2022	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)662-1220		(800)662-1220		(800)662-1220		(800)662-1220										2					2						2			
H3335	053	0	1	04	01	H3335_053_0	6	1					0	08/05/2021	2022.01	08/05/2021 08:37:26 AM Eastern Daylight Time	08/02/2021 10:47:44 AM Eastern Daylight Time	07/30/2021 11:56:32 AM Eastern Daylight Time			08/05/2021 09:10:12 AM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare BlueEssential (PPO)	01	04		1			H3335	053	0	2022	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)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						2			
H3335	055	0	1	04	01	H3335_055_0	6	1					0	08/05/2021	2022.01	08/05/2021 08:36:01 AM Eastern Daylight Time	08/02/2021 10:48:14 AM Eastern Daylight Time	07/30/2021 11:56:48 AM Eastern Daylight Time			08/05/2021 09:10:12 AM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare BlueActive (PPO)	01	04		1			H3335	055	0	2022	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)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						2			
H3335	801	0	1	04	01	H3335_801_0	4	1						05/27/2021	2022.01	05/27/2021 09:55:54 AM Eastern Daylight Time					06/07/2021 02:22:30 PM 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	2022	Western New York		1	2184	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)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						2			
H3335	811	0	1	04	01	H3335_811_0	4	1						05/27/2021	2022.01	05/27/2021 09:56:10 AM Eastern Daylight Time					06/07/2021 02:22:30 PM 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	2022	National and Puerto Rico		1	139482	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)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						2			
H3335	813	0	1	04	01	H3335_813_0	4	1				0	0	05/27/2021	2022.01	05/27/2021 09:57:05 AM Eastern Daylight Time					06/07/2021 02:22:30 PM 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	2022	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)662-1220		(800)662-1220		(800)662-1220		(800)662-1220										2					2						2			
H3335	819	0	1	04	01	H3335_819_0	4	1				0	0	05/27/2021	2022.01	05/27/2021 09:57:13 AM Eastern Daylight Time					06/07/2021 02:22:30 PM 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	2022	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)662-1220		(800)662-1220		(800)662-1220		(800)662-1220										2					2						2			
H3335	820	0	1	04	01	H3335_820_0	4	1						05/27/2021	2022.01	05/27/2021 09:57:23 AM Eastern Daylight Time					06/07/2021 02:22:30 PM 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	2022	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)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						2			
H3335	822	0	1	04	01	H3335_822_0	4	1						05/27/2021	2022.01	05/27/2021 09:57:32 AM Eastern Daylight Time					06/07/2021 02:22:30 PM 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	2022	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)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						2			
H3342	023	1	1	04	01	H3342_023_1	6	1					0	06/14/2021	2022.01	06/14/2021 04:05:46 PM Eastern Daylight Time	08/03/2021 06:04:01 PM Eastern Daylight Time	08/03/2021 06:04:01 PM Eastern Daylight Time			08/04/2021 02:06:25 PM Eastern Daylight Time	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Empire BlueCross BlueShield	https://shop.empireblue.com/medicare	Empire MediBlue Access (PPO)	01	04		1			H3342	023	1	2022	Select Counties in NY	Columbia, Delaware and Greene Counties	2		2			2						https://shop.empireblue.com/medicare	https://shop.empireblue.com/medicare	www.empireblue.com/medicare	(866)395-5175		(866)395-5175		(855)593-0923		(855)593-0923		(833)337-1270		(833)337-1270		(855)485-0953		(855)485-0953		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3342	023	2	1	04	01	H3342_023_2	6	1					0	06/14/2021	2022.01	06/14/2021 04:16:08 PM Eastern Daylight Time	08/03/2021 06:04:01 PM Eastern Daylight Time	08/03/2021 06:04:01 PM Eastern Daylight Time			08/04/2021 02:06:25 PM Eastern Daylight Time	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Empire BlueCross BlueShield	https://shop.empireblue.com/medicare	Empire MediBlue Access (PPO)	01	04		1			H3342	023	2	2022	Select Counties in NY	Select Counties in New York	2		2			2						https://shop.empireblue.com/medicare	https://shop.empireblue.com/medicare	www.empireblue.com/medicare	(866)395-5175		(866)395-5175		(855)593-0923		(855)593-0923		(833)337-1270		(833)337-1270		(855)485-0953		(855)485-0953		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3342	808	0	1	04	01	H3342_808_0	1	1						06/02/2021	2022.01	06/02/2021 04:10:36 PM Pacific Daylight Time					06/04/2021 09:04:16 AM Pacific Daylight Time	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Empire BlueCross BlueShield	www.empireblue.com/medicare	Empire MediBlue Freedom (PPO)	01	04		1			H3342	808	0	2022	National		1	600	2			2						www.empireblue.com/medicare	www.empireblue.com/medicare	www.empireblue.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)348-5339		(833)348-5339		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1									
H3342	809	0	1	04	01	H3342_809_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 04:10:43 PM Pacific Daylight Time					06/04/2021 09:04:16 AM Pacific Daylight Time	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Empire BlueCross BlueShield	www.empireblue.com/medicare	Empire MediBlue Freedom (PPO)	01	04		1			H3342	809	0	2022	National		1	600	2			2						www.empireblue.com/medicare	www.empireblue.com/medicare	www.empireblue.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1									
H3342	810	0	1	04	01	H3342_810_0	1	1						06/02/2021	2022.01	06/02/2021 04:10:50 PM Pacific Daylight Time					06/04/2021 09:04:16 AM Pacific Daylight Time	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Empire BlueCross BlueShield	www.empireblue.com/medicare	Empire MediBlue Freedom (PPO)	01	04		1			H3342	810	0	2022	National		1	600	2			2						www.empireblue.com/medicare	www.empireblue.com/medicare	www.empireblue.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)348-5339		(833)348-5339		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1									
H3342	812	0	1	04	01	H3342_812_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 04:10:56 PM Pacific Daylight Time					06/04/2021 09:04:16 AM Pacific Daylight Time	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Empire BlueCross BlueShield	www.empireblue.com/medicare	Empire MediBlue Freedom (PPO)	01	04		1			H3342	812	0	2022	National		1	600	2			2						www.empireblue.com/medicare	www.empireblue.com/medicare	www.empireblue.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1									
H3342	813	0	2	04	01	H3342_813_0	1	1						06/02/2021	2022.01	06/02/2021 04:11:04 PM Pacific Daylight Time					06/04/2021 09:04:16 AM Pacific Daylight Time	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Empire BlueCross BlueShield	www.empireblue.com/medicare	Empire MediBlue Freedom (PPO)	01	04		2	1		H3342	813	0	2022	National		1	600	2			2						www.empireblue.com/medicare	www.empireblue.com/medicare	www.empireblue.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)348-5339		(833)348-5339		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1									
H3342	814	0	2	04	01	H3342_814_0	1	1						06/02/2021	2022.01	06/02/2021 04:11:11 PM Pacific Daylight Time					06/04/2021 09:04:16 AM Pacific Daylight Time	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Empire BlueCross BlueShield	www.empireblue.com/medicare	Empire MediBlue Freedom (PPO)	01	04		2	1		H3342	814	0	2022	National		1	600	2			2						www.empireblue.com/medicare	www.empireblue.com/medicare	www.empireblue.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)348-5339		(833)348-5339		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1									
H3342	815	0	2	04	01	H3342_815_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 04:11:19 PM Pacific Daylight Time					06/04/2021 09:04:16 AM Pacific Daylight Time	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Empire BlueCross BlueShield	www.empireblue.com/medicare	Empire MediBlue Freedom (PPO)	01	04		2	1		H3342	815	0	2022	National		1	600	2			2						www.empireblue.com/medicare	www.empireblue.com/medicare	www.empireblue.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1									
H3342	816	0	2	04	01	H3342_816_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 04:11:25 PM Pacific Daylight Time					06/04/2021 09:04:16 AM Pacific Daylight Time	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Empire BlueCross BlueShield	www.empireblue.com/medicare	Empire MediBlue Freedom (PPO)	01	04		2	1		H3342	816	0	2022	National		1	600	2			2						www.empireblue.com/medicare	www.empireblue.com/medicare	www.empireblue.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1									
H3342	817	0	1	04	01	H3342_817_0	1	1						06/02/2021	2022.01	06/02/2021 04:11:31 PM Pacific Daylight Time					06/04/2021 09:04:16 AM Pacific Daylight Time	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Empire BlueCross BlueShield	www.empireblue.com/medicare	Empire MediBlue Freedom (PPO)	01	04		1			H3342	817	0	2022	National		1	600	2			2						www.empireblue.com/medicare	www.empireblue.com/medicare	www.empireblue.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)348-5339		(833)348-5339		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1									
H3342	818	0	1	04	01	H3342_818_0	1	1						06/02/2021	2022.01	06/02/2021 04:11:38 PM Pacific Daylight Time					06/04/2021 09:04:16 AM Pacific Daylight Time	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Empire BlueCross BlueShield	www.empireblue.com/medicare	Empire MediBlue Freedom (PPO)	01	04		1			H3342	818	0	2022	National		1	600	2			2						www.empireblue.com/medicare	www.empireblue.com/medicare	www.empireblue.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)348-5339		(833)348-5339		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1									
H3342	819	0	1	04	01	H3342_819_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 04:11:46 PM Pacific Daylight Time					06/04/2021 09:04:16 AM Pacific Daylight Time	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Empire BlueCross BlueShield	www.empireblue.com/medicare	Empire MediBlue Freedom (PPO)	01	04		1			H3342	819	0	2022	National		1	600	2			2						www.empireblue.com/medicare	www.empireblue.com/medicare	www.empireblue.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1									
H3342	820	0	1	04	01	H3342_820_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 04:11:54 PM Pacific Daylight Time					06/04/2021 09:04:16 AM Pacific Daylight Time	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Empire BlueCross BlueShield	www.empireblue.com/medicare	Empire MediBlue Freedom (PPO)	01	04		1			H3342	820	0	2022	National		1	600	2			2						www.empireblue.com/medicare	www.empireblue.com/medicare	www.empireblue.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1									
H3344	005	0	1	04	01	H3344_005_0	8	1					1	11/01/2021	2022.01	11/01/2021 10:16:24 AM Eastern Daylight Time	08/03/2021 08:22:34 PM Eastern Daylight Time	08/03/2021 07:49:00 PM Eastern Daylight Time			11/01/2021 10:30:26 AM Eastern Daylight Time	INDEPENDENT HEALTH BENEFITS CORPORATION	Independent Health	independenthealth.com/medicare	Independent Health's Medicare Passport Advantage (PPO)	01	04		1			H3344	005	0	2022	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3344	010	0	1	04	01	H3344_010_0	8	1					1	11/01/2021	2022.01	11/01/2021 10:17:10 AM Eastern Daylight Time	08/03/2021 08:24:08 PM Eastern Daylight Time	08/03/2021 07:51:18 PM Eastern Daylight Time			11/01/2021 10:30:26 AM Eastern Daylight Time	INDEPENDENT HEALTH BENEFITS CORPORATION	Independent Health	independenthealth.com/medicare	Independent Health's Medicare Passport Prime (PPO)	01	04		1			H3344	010	0	2022	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3344	801	0	1	04	01	H3344_801_0	2	1						06/17/2021	2022.01	06/17/2021 12:56:39 PM Eastern Daylight Time					06/17/2021 01:10:36 PM Eastern Daylight Time	INDEPENDENT HEALTH BENEFITS CORPORATION	Independent Health	independenthealth.com/medicare	Independent Health's Medicare PPO Base (PPO)	01	04		1			H3344	801	0	2022	IH Network and Medicare Deemed Network		1	20500	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H3344	804	0	1	04	01	H3344_804_0	2	1				0	0	06/17/2021	2022.01	06/17/2021 12:56:51 PM Eastern Daylight Time					06/17/2021 01:10:36 PM Eastern Daylight Time	INDEPENDENT HEALTH BENEFITS CORPORATION	Independent Health	independenthealth.com/medicare	Independent Health's Medicare PPO Base (PPO)	01	04		1			H3344	804	0	2022	IH Network and Medicare Deemed Network		1	17578	2			2						www.independenthealth.com	www.independenthealth.com	www.independenthealth.com	(800)665-1502		(716)250-4401		(800)958-4405		(716)635-4900										(711)-		(711)-		(711)-		(711)-										1	2		2		1									
H3344	805	0	1	04	01	H3344_805_0	2	1						06/17/2021	2022.01	06/17/2021 12:57:08 PM Eastern Daylight Time					06/17/2021 01:10:36 PM Eastern Daylight Time	INDEPENDENT HEALTH BENEFITS CORPORATION	Independent Health	www.independentheaalth.com/medicare	Independent Health's Medicare PPO Base (PPO)	01	04		1			H3344	805	0	2022	National Service Area		1	17456	2			2						www.independenthealth.com	www.independentheaalth.com/medicare	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H3347	002	0	1	01	01	H3347_002_0	5	1	2	1			0	07/18/2021	2022.01	07/18/2021 09:06:30 PM Eastern Daylight Time	07/30/2021 04:01:40 PM Eastern Daylight Time	07/30/2021 10:38:21 AM Eastern Daylight Time			08/03/2021 09:25:12 AM Eastern Daylight Time	ELDERPLAN, INC.	Elderplan	www.elderplan.org	Elderplan For Medicaid Beneficiaries (HMO D-SNP)	01	01		1			H3347	002	0	2022	Brx, Ki, Na, NY, Qu, Wes		2	57090	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			0	07/30/2021	2022.01	07/30/2021 04:11:00 PM Eastern Daylight Time	07/30/2021 04:04:01 PM Eastern Daylight Time	07/30/2021 10:38:49 AM Eastern Daylight Time			08/03/2021 09:25:12 AM Eastern Daylight Time	ELDERPLAN, INC.	Elderplan	www.elderplan.org	Elderplan Advantage For Nursing Home Residents (HMO I-SNP)	01	01		1			H3347	003	0	2022	Select Counties In New York State		2	11526	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	5	1	2	1			0	07/30/2021	2022.01	07/30/2021 04:25:54 PM Eastern Daylight Time	07/30/2021 04:05:52 PM Eastern Daylight Time	07/30/2021 10:39:18 AM Eastern Daylight Time			08/03/2021 09:25:12 AM Eastern Daylight Time	ELDERPLAN, INC.	Elderplan	www.elderplan.org	Elderplan Plus Long Term Care (HMO D-SNP)	01	01		1			H3347	007	0	2022	Brx, Dut, Ki, Na, NY, Ora, Put, Qu, Ri, Roc, Wes		2	37950	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					0	07/30/2021	2022.01	07/30/2021 04:34:12 PM Eastern Daylight Time	07/30/2021 04:07:35 PM Eastern Daylight Time	07/30/2021 10:39:44 AM Eastern Daylight Time			08/03/2021 09:25:12 AM Eastern Daylight Time	ELDERPLAN, INC.	Elderplan	www.elderplan.org	Elderplan Extra Help (HMO)	01	01		1			H3347	009	0	2022	Brx, Ki, NY, Qu, Wes		2	46800	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	015	0	1	01	01	H3347_015_0	5	1		1			0	07/30/2021	2022.01	07/30/2021 04:37:25 PM Eastern Daylight Time	07/30/2021 04:10:59 PM Eastern Daylight Time	07/30/2021 10:40:14 AM Eastern Daylight Time			08/03/2021 09:25:12 AM Eastern Daylight Time	ELDERPLAN, INC.	Elderplan	www.elderplan.org	Elderplan Assist (HMO I-SNP)	01	01		1			H3347	015	0	2022	Select Counties In New York State		2	2370	2			1	1	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				0	0	08/05/2021	2022.01	08/05/2021 08:45:32 AM Eastern Daylight Time	07/15/2021 04:47:48 PM Eastern Daylight Time				08/05/2021 09:10:12 AM 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	2022	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)662-1220		(800)662-1220		(800)662-1220		(800)662-1220										2					2					2	2			
H3351	002	0	1	02	01	H3351_002_0	7	1					1	08/05/2021	2022.01	08/05/2021 08:45:52 AM Eastern Daylight Time	08/02/2021 10:48:44 AM Eastern Daylight Time	07/30/2021 11:57:02 AM Eastern Daylight Time			08/05/2021 09:10:12 AM 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	2022	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)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					2	2			
H3351	006	0	1	02	01	H3351_006_0	7	1					1	08/05/2021	2022.01	08/05/2021 08:46:13 AM Eastern Daylight Time	08/02/2021 02:37:56 PM Eastern Daylight Time	07/30/2021 11:57:18 AM Eastern Daylight Time			08/05/2021 09:10:12 AM 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	2022	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)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					2	2			
H3351	007	0	1	02	01	H3351_007_0	6	1				0	0	08/05/2021	2022.01	08/05/2021 08:46:32 AM Eastern Daylight Time	07/15/2021 04:47:54 PM Eastern Daylight Time				08/05/2021 09:10:12 AM 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	2022	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)662-1220		(800)662-1220		(800)662-1220		(800)662-1220										2					2					2	2			
H3351	010	0	1	01	01	H3351_010_0	7	1					1	08/05/2021	2022.01	08/05/2021 08:46:53 AM Eastern Daylight Time	08/02/2021 10:49:42 AM Eastern Daylight Time	07/30/2021 11:57:34 AM Eastern Daylight Time			08/05/2021 09:10:12 AM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.UniveraMedicare.com	Univera SeniorChoice Value (HMO)	01	01		1			H3351	010	0	2022	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)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					2	2			
H3351	011	0	1	01	01	H3351_011_0	7	1					1	08/05/2021	2022.01	08/05/2021 08:47:12 AM Eastern Daylight Time	08/02/2021 10:50:10 AM Eastern Daylight Time	07/30/2021 11:57:48 AM Eastern Daylight Time			08/05/2021 09:10:12 AM 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	2022	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)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					2	2			
H3351	012	0	1	02	01	H3351_012_0	7	1					1	08/05/2021	2022.01	08/05/2021 08:47:31 AM Eastern Daylight Time	08/02/2021 10:50:38 AM Eastern Daylight Time	07/30/2021 11:58:04 AM Eastern Daylight Time			08/05/2021 09:10:12 AM 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	2022	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)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					2	2			
H3351	013	0	1	02	01	H3351_013_0	7	1					1	08/05/2021	2022.01	08/05/2021 08:47:50 AM Eastern Daylight Time	08/02/2021 10:51:06 AM Eastern Daylight Time	07/30/2021 11:58:18 AM Eastern Daylight Time			08/05/2021 09:10:12 AM 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	2022	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)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					2	2			
H3351	015	0	1	02	01	H3351_015_0	6	1					0	08/05/2021	2022.01	08/05/2021 08:48:08 AM Eastern Daylight Time	08/02/2021 10:51:34 AM Eastern Daylight Time	07/30/2021 11:58:34 AM Eastern Daylight Time			08/05/2021 09:10:12 AM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare Bassett (HMO-POS)	01	02		1			H3351	015	0	2022	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)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					2	2			
H3351	016	0	1	01	01	H3351_016_0	6	1					0	08/05/2021	2022.01	08/05/2021 08:48:29 AM Eastern Daylight Time	08/02/2021 10:52:04 AM Eastern Daylight Time	07/30/2021 11:58:48 AM Eastern Daylight Time			08/05/2021 09:10:12 AM 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	2022	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)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					2	2			
H3351	017	0	1	01	01	H3351_017_0	6	1					0	08/05/2021	2022.01	08/05/2021 08:48:48 AM Eastern Daylight Time	08/02/2021 10:52:32 AM Eastern Daylight Time	07/30/2021 11:59:04 AM Eastern Daylight Time			08/05/2021 09:10:12 AM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.UniveraMedicare.com	Univera SeniorChoice Basic (HMO)	01	01		1			H3351	017	0	2022	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)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					2	2			
H3351	018	0	1	02	01	H3351_018_0	7	1					1	08/05/2021	2022.01	08/05/2021 08:49:05 AM Eastern Daylight Time	08/02/2021 02:41:10 PM Eastern Daylight Time	07/30/2021 11:59:18 AM Eastern Daylight Time			08/05/2021 09:10:12 AM 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	2022	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)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					2	2			
H3351	019	0	1	02	01	H3351_019_0	7	1					1	08/05/2021	2022.01	08/05/2021 08:49:23 AM Eastern Daylight Time	08/04/2021 08:44:22 AM Eastern Daylight Time	07/30/2021 11:59:34 AM Eastern Daylight Time			08/05/2021 09:10:12 AM 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	2022	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)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					2	2			
H3351	020	0	1	01	01	H3351_020_0	6	1					0	08/05/2021	2022.01	08/05/2021 08:49:46 AM Eastern Daylight Time	08/02/2021 10:53:58 AM Eastern Daylight Time	07/30/2021 11:59:48 AM Eastern Daylight Time			08/05/2021 09:10:12 AM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.UniveraMedicare.com	Univera SeniorChoice Extra (HMO)	01	01		1			H3351	020	0	2022	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)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					2	2			
H3351	801	0	1	02	01	H3351_801_0	4	1						05/27/2021	2022.01	05/27/2021 09:54:14 AM Eastern Daylight Time					06/07/2021 02:22:30 PM 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	2022	Western New York		1	1536	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)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					2	2			
H3351	802	0	1	02	01	H3351_802_0	4	1						05/27/2021	2022.01	05/27/2021 09:45:10 AM Eastern Daylight Time					06/07/2021 02:22:30 PM 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	2022	Metro Rochester Area and Central New York		1	179154	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)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					2	2			
H3351	803	0	1	02	01	H3351_803_0	4	1				0	0	05/27/2021	2022.01	05/27/2021 09:13:36 PM Eastern Daylight Time					06/07/2021 02:22:30 PM 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	2022	Western New York		1	12	2			2						www.UniveraMedicare.com	www.UniveraMedicare.com	www.UniveraMedicare.com	(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577										(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220										2					2					2	2			
H3351	804	0	1	02	01	H3351_804_0	4	1				0	0	05/27/2021	2022.01	05/27/2021 09:15:05 PM Eastern Daylight Time					06/07/2021 02:22:30 PM 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	2022	Metro Rochester Area and Central New York		1	1680	2			2						www.ExcellusMedicare.com	www.ExcellusMedicare.com	www.ExcellusMedicare.com	(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577										(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220										2					2					2	2			
H3351	805	0	1	02	01	H3351_805_0	4	1						05/28/2021	2022.01	05/28/2021 08:01:02 AM Eastern Daylight Time					06/07/2021 02:22:30 PM 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	2022	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)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					2	2			
H3351	806	0	1	02	01	H3351_806_0	4	1						05/28/2021	2022.01	05/28/2021 08:02:32 AM Eastern Daylight Time					06/07/2021 02:22:30 PM 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	2022	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)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					2	2			
H3359	001	0	1	01	01	H3359_001_0	6	1			2		1	08/04/2021	2022.01	08/04/2021 02:48:44 PM Eastern Daylight Time	08/05/2021 02:35:46 PM Eastern Daylight Time	08/05/2021 12:52:24 PM Eastern Daylight Time			08/05/2021 08:07:32 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	2022	New York City and Nassau County		2		2			2						www.hfdocfinder.org	www.healthfirst.org/formularies	www.hfdocfinder.org	(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		(888)542-3821		(888)542-3821		(888)542-3821		(888)542-3821		2					2					2	2			
H3359	019	0	1	01	01	H3359_019_0	6	1			2		0	08/04/2021	2022.01	08/04/2021 08:36:05 PM Eastern Daylight Time	08/05/2021 02:37:18 PM Eastern Daylight Time	08/05/2021 12:53:28 PM Eastern Daylight Time			08/05/2021 08:07:32 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	2022	NYC, Nassau, Some Lower Hudson Valley Counties		2		2			2						www.hfdocfinder.org	www.healthfirst.org/formularies	www.hfdocfinder.org	(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		(888)542-3821		(888)542-3821		(888)542-3821		(888)542-3821		2					2					2	2			
H3359	021	0	1	01	01	H3359_021_0	8	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 07:51:31 PM Eastern Daylight Time	08/05/2021 02:38:16 PM Eastern Daylight Time	08/05/2021 12:54:02 PM Eastern Daylight Time			08/05/2021 07:39:42 PM Eastern Daylight Time	HEALTHFIRST HEALTH PLAN, INC.	Healthfirst Medicare Plan	www.healthfirst.org/medicare	Healthfirst Life Improvement Plan (HMO D-SNP)	01	01		1			H3359	021	0	2022	NYC, Nassau, Some Lower Hudson Valley Counties		2		2			1	3		1		2	www.hfdocfinder.org	www.healthfirst.org/formularies	www.hfdocfinder.org	(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		(888)542-3821		(888)542-3821		(888)542-3821		(888)542-3821		2					2					2	2			
H3359	027	0	1	01	01	H3359_027_0	7	1			2	0	0	07/16/2021	2022.01	07/16/2021 11:11:36 AM Eastern Daylight Time	06/07/2021 10:07:16 PM Eastern Daylight Time				07/22/2021 02:17:58 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	2022	New York City and Nassau County		2		2			2						www.hfdocfinder.org	www.healthfirst.org/formularies	www.hfdocfinder.org	(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	6	1	2	1	2		0	08/05/2021	2022.01	08/05/2021 10:39:38 AM Eastern Daylight Time	08/05/2021 03:42:24 PM Eastern Daylight Time	08/05/2021 12:54:30 PM Eastern Daylight Time			08/05/2021 07:49:02 PM Eastern Daylight Time	HEALTHFIRST HEALTH PLAN, INC.	Healthfirst Medicare Plan	www.healthfirst.org/medicare	Healthfirst CompleteCare (HMO D-SNP)	01	01		1			H3359	034	0	2022	NYC, Nassau, Some Lower Hudson Valley Counties		2		2			1	3		1		1	www.hfdocfinder.org	www.healthfirst.org/formularies	www.hfdocfinder.org	(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		(888)542-3821		(888)542-3821		(888)542-3821		(888)542-3821		2					2					2	2			
H3359	038	0	1	01	01	H3359_038_0	7	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 09:01:35 PM Eastern Daylight Time	08/05/2021 03:38:12 PM Eastern Daylight Time	08/05/2021 12:55:02 PM Eastern Daylight Time			08/05/2021 08:00:05 PM Eastern Daylight Time	HEALTHFIRST HEALTH PLAN, INC.	Healthfirst Medicare Plan	www.healthfirst.org/medicare	Healthfirst Connection Plan (HMO D-SNP)	01	01		1			H3359	038	0	2022	NYC, Nassau, Some Lower Hudson Valley Counties		2		2			1	3		1		2	www.hfdocfinder.org	www.healthfirst.org/formularies	www.hfdocfinder.org	(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		(888)542-3821		(888)542-3821		(888)542-3821		(888)542-3821		2					2					2	2			
H3359	808	0	1	01	01	H3359_808_0	1	1						05/04/2021	2022.01	05/04/2021 09:47:09 AM Eastern Daylight Time					05/28/2021 05:25:39 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	2022	United States		1	120	2			2						www.hfdocfinder.org	www.healthfirst.org/formularies	www.hfdocfinder.org			(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	1	1				0	0	05/04/2021	2022.01	05/04/2021 09:51:54 AM Eastern Daylight Time					06/02/2021 01:08:37 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	2022	United States		1	120	2			2						www.hfdocfinder.org	www.healthfirst.org/formularies	www.hfdocfinder.org			(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	5	1				0	0	07/19/2021	2022.01	07/19/2021 04:46:40 PM Eastern Daylight Time	07/14/2021 02:11:38 AM Eastern Daylight Time				07/20/2021 12:50:11 PM Eastern Daylight Time	INDEPENDENT HEALTH ASSOCIATION, INC.	Independent Health	independenthealth.com/medicare	Independent Health's Encompass 65 (HMO)	01	01		1			H3362	016	0	2022	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										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3362	017	0	1	01	01	H3362_017_0	8	1					1	11/01/2021	2022.01	11/01/2021 10:17:52 AM Eastern Daylight Time	08/03/2021 08:25:44 PM Eastern Daylight Time	08/03/2021 07:54:24 PM Eastern Daylight Time			11/01/2021 10:30:26 AM Eastern Daylight Time	INDEPENDENT HEALTH ASSOCIATION, INC.	Independent Health	independenthealth.com/medicare	Independent Health's Encompass 65 Basic (HMO)	01	01		1			H3362	017	0	2022	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3362	020	0	1	01	01	H3362_020_0	9	1		1			0	11/01/2021	2022.01	11/01/2021 10:18:32 AM Eastern Daylight Time	08/04/2021 12:36:06 PM Eastern Daylight Time	08/03/2021 07:56:16 PM Eastern Daylight Time			11/01/2021 10:30:26 AM Eastern Daylight Time	INDEPENDENT HEALTH ASSOCIATION, INC.	Independent Health	independenthealth.com/medicare	Independent Health's Medicare Family Choice (HMO I-SNP)	01	01		1			H3362	020	0	2022	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3362	033	0	1	01	01	H3362_033_0	10	1					1	11/01/2021	2022.01	11/01/2021 10:19:12 AM Eastern Daylight Time	08/03/2021 08:28:56 PM Eastern Daylight Time	08/03/2021 07:58:16 PM Eastern Daylight Time			11/01/2021 10:30:26 AM 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	2022	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3362	038	0	1	01	01	H3362_038_0	11	1					1	11/01/2021	2022.01	11/01/2021 10:20:32 AM Eastern Daylight Time	08/03/2021 08:30:32 PM Eastern Daylight Time	08/03/2021 08:00:10 PM Eastern Daylight Time			11/01/2021 10:30:26 AM Eastern Daylight Time	INDEPENDENT HEALTH ASSOCIATION, INC.	Independent Health	www.independenthealth.com/medicare	Independent Health's Encompass 65 Element (HMO)	01	01		1			H3362	038	0	2022	Western New York		2		2			2						www.independenthealth.com	www.independenthealth.com/medicare	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3362	039	0	1	01	01	H3362_039_0	12	1					1	11/01/2021	2022.01	11/01/2021 10:21:12 AM Eastern Daylight Time	08/03/2021 08:32:10 PM Eastern Daylight Time	08/03/2021 08:04:10 PM Eastern Daylight Time			11/01/2021 10:30:26 AM Eastern Daylight Time	INDEPENDENT HEALTH ASSOCIATION, INC.	Independent Health	independenthealth.com/medicare	Independent Health's Encompass 65 Edge (HMO)	01	01		1			H3362	039	0	2022	8 counties of 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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3362	040	0	1	01	01	H3362_040_0	9	1		1			1	11/01/2021	2022.01	11/01/2021 10:21:54 AM Eastern Daylight Time	08/03/2021 08:33:40 PM Eastern Daylight Time	08/03/2021 08:06:34 PM Eastern Daylight Time			11/01/2021 10:30:26 AM Eastern Daylight Time	INDEPENDENT HEALTH ASSOCIATION, INC.	Independent Health	independenthealth.com/medicare	Independent Health's Assure Advantage (HMO C-SNP)	01	01		1			H3362	040	0	2022	8 counties of Western New York		2		2			1	4			00001000000000000000		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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3362	801	0	1	02	01	H3362_801_0	2	1						06/17/2021	2022.01	06/17/2021 12:58:10 PM Eastern Daylight Time					06/17/2021 01:10:36 PM Eastern Daylight Time	INDEPENDENT HEALTH ASSOCIATION, INC.	Independent Health	independenthealth.com/medicare	Independent Health's Medicare Encompass (HMO-POS)	01	02		1			H3362	801	0	2022	New York State		1	62772	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1	2		2		1				
H3362	807	0	1	02	01	H3362_807_0	2	1						06/17/2021	2022.01	06/17/2021 12:57:57 PM Eastern Daylight Time					06/17/2021 01:10:36 PM Eastern Daylight Time	INDEPENDENT HEALTH ASSOCIATION, INC.	Independent Health	independenthealth.com/medicare	Independent Health's Medicare Encompass (HMO-POS)	01	02		1			H3362	807	0	2022	IH Network and Medicare Deemed Network		1	19472	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1	2		2		1				
H3362	819	0	1	02	01	H3362_819_0	2	1				0	0	06/17/2021	2022.01	06/17/2021 12:58:22 PM Eastern Daylight Time					06/17/2021 01:10:36 PM Eastern Daylight Time	INDEPENDENT HEALTH ASSOCIATION, INC.	Independent Health	independenthealth.com/medicare	Independent Health's Medicare Encompass (HMO-POS)	01	02		1			H3362	819	0	2022	IH Network and Medicare Deemed Network		1	3629	2			2						www.independenthealth.com	www.independenthealth.com	www.independenthealth.com	(800)665-1502		(716)250-4401		(800)958-4405		(716)635-4900										(711)-		(711)-		(711)-		(711)-										1	2		2		1	2		2		2				
H3362	820	0	1	02	01	H3362_820_0	2	1				0	0	06/17/2021	2022.01	06/17/2021 01:07:37 PM Eastern Daylight Time					06/17/2021 01:10:36 PM Eastern Daylight Time	INDEPENDENT HEALTH ASSOCIATION, INC.	Independent Health	independenthealth.com/medicare	Independent Health's Medicare Encompass (HMO-POS)	01	02		1			H3362	820	0	2022	New York State		1	59829	2			2						www.independenthealth.com	www.independenthealth.com	www.independenthealth.com	(800)665-1502		(716)250-4401		(800)958-4405		(716)635-4900										(711)-		(711)-		(711)-		(711)-										1	2		2		1	2		2		1				
H3379	001	0	1	01	01	H3379_001_0	3	1					1	08/04/2021	2022.01	08/04/2021 10:22:03 AM Central Daylight Time	08/03/2021 01:09:38 PM Central Daylight Time	07/29/2021 08:26:19 PM Central Daylight Time			08/05/2021 01:59:02 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW YORK, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO)	01	01		1			H3379	001	0	2022	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	3	1		1			0	08/04/2021	2022.01	08/04/2021 10:32:18 AM Central Daylight Time	08/03/2021 01:10:19 PM Central Daylight Time	07/29/2021 08:26:33 PM Central Daylight Time			08/04/2021 02:57:14 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW YORK, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan 2 (HMO I-SNP)	01	01		1			H3379	002	0	2022	New York City		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	02	01	H3379_022_0	3	1		1			0	08/04/2021	2022.01	08/04/2021 10:34:21 AM Central Daylight Time	08/03/2021 01:11:03 PM Central Daylight Time	07/29/2021 08:26:52 PM Central Daylight Time			08/04/2021 02:57:14 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW YORK, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (HMO-POS I-SNP)	01	02		1			H3379	022	0	2022	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					1	08/04/2021	2022.01	08/04/2021 10:28:15 AM Central Daylight Time	08/03/2021 01:11:50 PM Central Daylight Time	07/29/2021 08:27:07 PM Central Daylight Time			08/05/2021 01:59:02 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW YORK, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO)	01	01		1			H3379	039	0	2022	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	3	1					1	08/04/2021	2022.01	08/04/2021 10:29:44 AM Central Daylight Time	08/03/2021 01:12:46 PM Central Daylight Time	07/29/2021 08:27:22 PM Central Daylight Time			08/05/2021 01:59:02 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW YORK, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO)	01	01		1			H3379	040	0	2022	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	3	1					1	08/04/2021	2022.01	08/04/2021 10:32:10 AM Central Daylight Time	08/03/2021 01:13:37 PM Central Daylight Time	07/29/2021 08:27:37 PM Central Daylight Time			08/05/2021 01:59:02 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW YORK, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO)	01	01		1			H3379	041	0	2022	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	2	1		1			0	08/04/2021	2022.01	08/04/2021 10:37:45 AM Central Daylight Time	08/03/2021 01:14:19 PM Central Daylight Time	07/29/2021 08:27:54 PM Central Daylight Time			08/04/2021 02:57:14 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW YORK, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan 2 (HMO I-SNP)	01	01		1			H3379	042	0	2022	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	7	1					1	07/16/2021	2022.01	07/16/2021 12:34:33 PM Eastern Daylight Time	08/05/2021 10:57:22 AM Eastern Daylight Time	08/05/2021 11:05:40 AM Eastern Daylight Time			08/05/2021 11:34:20 AM Eastern Daylight Time	Highmark Western and Northeastern New York Inc.	BlueCross BlueShield of WNY and BlueShield of NENY	www.bsneny.com/medicare	Highmark Blue Shield Senior Blue 652 (HMO)	01	01		1			H3384	013	0	2022	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					1	07/16/2021	2022.01	07/16/2021 12:34:40 PM Eastern Daylight Time	08/05/2021 10:57:28 AM Eastern Daylight Time	08/05/2021 11:05:43 AM Eastern Daylight Time			08/05/2021 11:34:20 AM Eastern Daylight Time	Highmark Western and Northeastern New York Inc.	BlueCross BlueShield of WNY and BlueShield of NENY	www.bcbswny.com/medicare	Highmark Blue Cross Blue Shield Senior Blue 651 (HMO)	01	01		1			H3384	019	0	2022	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				0	0	07/16/2021	2022.01	07/16/2021 12:34:46 PM Eastern Daylight Time	06/07/2021 05:23:57 PM Eastern Daylight Time				07/16/2021 12:48:01 PM Eastern Daylight Time	Highmark Western and Northeastern New York Inc.	BlueCross BlueShield of WNY and BlueShield of NENY	www.bcbswny.com/medicare	Highmark Blue Cross Blue Shield Senior Blue 601 (HMO)	01	01		1			H3384	022	0	2022	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	6	1					1	07/16/2021	2022.01	07/16/2021 12:34:55 PM Eastern Daylight Time	08/05/2021 10:57:35 AM Eastern Daylight Time	08/05/2021 11:05:47 AM Eastern Daylight Time			08/05/2021 11:34:20 AM Eastern Daylight Time	Highmark Western and Northeastern New York Inc.	BlueCross BlueShield of WNY and BlueShield of NENY	www.bcbswny.com/medicare	Highmark Blue Cross Blue Shield Senior Blue Select (HMO)	01	01		1			H3384	058	0	2022	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	01	01	H3384_059_0	6	1					1	07/16/2021	2022.01	07/16/2021 12:35:02 PM Eastern Daylight Time	08/05/2021 10:57:43 AM Eastern Daylight Time	08/05/2021 11:05:49 AM Eastern Daylight Time			08/05/2021 11:34:20 AM Eastern Daylight Time	Highmark Western and Northeastern New York Inc.	BlueCross BlueShield of WNY and BlueShield of NENY	www.bsneny.com/medicare	Highmark Blue Shield Freedom Plus (HMO)	01	01		1			H3384	059	0	2022	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					1	08/03/2021	2022.01	08/03/2021 05:06:50 PM Eastern Daylight Time	08/05/2021 10:57:53 AM Eastern Daylight Time	08/05/2021 11:05:51 AM Eastern Daylight Time			08/05/2021 11:34:20 AM Eastern Daylight Time	Highmark Western and Northeastern New York Inc.	BlueCross BlueShield of WNY and BlueShield of NENY	www.bcbswny.com/medicare	Highmark Blue Cross Blue Shield BlueSaver (HMO)	01	01		1			H3384	062	0	2022	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	01	01	H3384_063_0	6	1					1	08/03/2021	2022.01	08/03/2021 05:53:37 PM Eastern Daylight Time	08/05/2021 10:57:59 AM Eastern Daylight Time	08/05/2021 11:05:54 AM Eastern Daylight Time			08/05/2021 11:34:20 AM Eastern Daylight Time	Highmark Western and Northeastern New York Inc.	BlueCross BlueShield of WNY and BlueShield of NENY	www.bsneny.com/medicare	Highmark Blue Shield Freedom Value (HMO)	01	01		1			H3384	063	0	2022	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	066	0	1	01	01	H3384_066_0	5	1				0	0	07/16/2021	2022.01	07/16/2021 12:37:03 PM Eastern Daylight Time	06/07/2021 05:23:30 PM Eastern Daylight Time				07/16/2021 12:48:01 PM Eastern Daylight Time	Highmark Western and Northeastern New York Inc.	BlueCross BlueShield of WNY and BlueShield of NENY	www.bsneny.com/medicare	Highmark Blue Shield Freedom (HMO)	01	01		1			H3384	066	0	2022	Northeastern New York		2	500	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										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3384	067	0	1	01	01	H3384_067_0	6	1					0	08/04/2021	2022.01	08/04/2021 02:50:17 PM Eastern Daylight Time	08/05/2021 10:58:06 AM Eastern Daylight Time	08/05/2021 11:05:56 AM Eastern Daylight Time			08/05/2021 11:34:20 AM Eastern Daylight Time	Highmark Western and Northeastern New York Inc.	BlueCross BlueShield of WNY and BlueShield of NENY	www.bcbswny.com/medicare	Highmark Blue Cross Blue Shield Senior Blue Basic (HMO)	01	01		1			H3384	067	0	2022	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	805	0	1	01	01	H3384_805_0	1	1				0	0	06/07/2021	2022.01	06/07/2021 02:01:28 PM Eastern Daylight Time					06/07/2021 02:06:24 PM Eastern Daylight Time	Highmark Western and Northeastern 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	2022	Western and Northeastern New York		1	0	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;8a;8b1;8b2;9a1;9b;10a;11a;11b;11c;15;	2		1					2				
H3384	806	0	1	01	01	H3384_806_0	1	1						06/07/2021	2022.01	06/07/2021 02:01:39 PM Eastern Daylight Time					06/07/2021 02:06:24 PM Eastern Daylight Time	Highmark Western and Northeastern 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	2022	Western and Northeastern New York		1	52414	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;8a;8b1;8b2;9a1;9b;10a;11a;11b;11c;15;	2		1					2				
H3384	811	0	1	02	01	H3384_811_0	1	1						06/07/2021	2022.01	06/07/2021 01:49:25 PM Eastern Daylight Time					06/07/2021 02:06:24 PM Eastern Daylight Time	Highmark Western and Northeastern New York Inc.	BlueCross BlueShield of WNY and BlueShield of NENY	www.nymedicare.com	HMOPOS Group (MA-PD) Calendar Year (HMO-POS)	01	02		1			H3384	811	0	2022	Western and Northeastern New York		1	0	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;8a;8b1;8b2;9a1;9b;10a;11a;11b;11c;15;	2		1	2		2		2				
H3384	812	0	1	02	01	H3384_812_0	1	1				0	0	06/07/2021	2022.01	06/07/2021 01:49:40 PM Eastern Daylight Time					06/07/2021 02:06:24 PM Eastern Daylight Time	Highmark Western and Northeastern New York Inc.	BlueCross BlueShield of WNY and BlueShield of NENY	www.nymedicare.com	HMOPOS Group MA Only Calendar Year (HMO-POS)	01	02		1			H3384	812	0	2022	Western and Northeastern New York		1	0	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;8a;8b1;8b2;9a1;10a;11a;11b;11c;15;	2		1	2		2		2				
H3387	013	0	1	01	01	H3387_013_0	4	1	2	1	1		0	08/05/2021	2022.01	08/05/2021 10:15:32 AM Central Daylight Time	08/03/2021 12:41:15 PM Central Daylight Time	07/29/2021 08:28:09 PM Central Daylight Time			08/05/2021 02:14:15 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW YORK, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete ONE (HMO D-SNP)	01	01		1			H3387	013	0	2022	Select Counties in New York		2		2			1	3		1		1	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(866)547-0772		(866)547-0772		(888)834-3721		(888)834-3721		(866)547-0772		(866)547-0772		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3387	014	1	1	01	01	H3387_014_1	4	1	2	1	1		0	08/05/2021	2022.01	08/05/2021 10:18:22 AM Central Daylight Time	08/03/2021 12:41:45 PM Central Daylight Time	07/29/2021 08:28:24 PM Central Daylight Time			08/05/2021 02:14:15 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW YORK, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Plan 1 (HMO D-SNP)	01	01		1			H3387	014	1	2022	Counties in New York	Select Counties in Upstate 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			
H3387	014	2	1	01	01	H3387_014_2	4	1	2	1	1		0	08/05/2021	2022.01	08/05/2021 10:19:30 AM Central Daylight Time	08/03/2021 12:42:15 PM Central Daylight Time	07/29/2021 08:28:40 PM Central Daylight Time			08/05/2021 02:14:15 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW YORK, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Plan 1 (HMO D-SNP)	01	01		1			H3387	014	2	2022	Counties in New York	Select Counties in Downstate 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			
H3387	015	1	1	01	01	H3387_015_1	4	1	2	1	1		0	08/05/2021	2022.01	08/05/2021 10:20:37 AM Central Daylight Time	08/03/2021 12:42:47 PM Central Daylight Time	07/29/2021 08:28:54 PM Central Daylight Time			08/05/2021 02:14:15 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW YORK, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Plan 2 (HMO D-SNP)	01	01		1			H3387	015	1	2022	Select Counties in New York	Select Counties in Upstate 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			
H3387	015	2	1	01	01	H3387_015_2	4	1	2	1	1		0	08/05/2021	2022.01	08/05/2021 10:21:40 AM Central Daylight Time	08/03/2021 12:43:17 PM Central Daylight Time	07/29/2021 08:29:09 PM Central Daylight Time			08/05/2021 02:14:15 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW YORK, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Plan 2 (HMO D-SNP)	01	01		1			H3387	015	2	2022	Select Counties in New York	Select Counties in Downstate 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	5	1			1	0	0	08/09/2021	2022.01	08/09/2021 01:36:50 PM Eastern Daylight Time	06/07/2021 08:26:52 AM Eastern Daylight Time				08/09/2021 02:40:16 PM Eastern Daylight Time	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	CDPHP Medicare Advantage	https://www.cdphp.com/medicare	CDPHP Choice (HMO)	01	01		1			H3388	001	0	2022	Greater Capital Region of New York State		2	6804	2			2						https://findadoc.cdphp.com/	https://www.cdphp.com/medicare/drug-coverage	https://findadoc.cdphp.com/	(888)248-6522		(518)641-3950		(888)519-4455		(518)641-3400										(711)-		(711)-		(711)-		(711)-										2					2					2	1	10		18a1;
H3388	002	0	1	01	01	H3388_002_0	8	1			1		1	08/09/2021	2022.01	08/09/2021 01:37:22 PM Eastern Daylight Time	08/05/2021 03:45:33 PM Eastern Daylight Time	08/05/2021 03:45:34 PM Eastern Daylight Time			08/09/2021 02:40:16 PM Eastern Daylight Time	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	CDPHP Medicare Advantage	https://www.cdphp.com/medicare	CDPHP Choice Rx (HMO)	01	01		1			H3388	002	0	2022	Greater Capital Region of New York State		2	131880	2			2						https://findadoc.cdphp.com/	https://www.cdphp.com/medicare/drug-coverage	https://findadoc.cdphp.com/	(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	10		18a1;
H3388	004	0	1	01	01	H3388_004_0	9	1			1		1	08/09/2021	2022.01	08/09/2021 01:38:41 PM Eastern Daylight Time	08/05/2021 03:45:35 PM Eastern Daylight Time	08/05/2021 03:45:35 PM Eastern Daylight Time			08/09/2021 02:40:16 PM Eastern Daylight Time	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	CDPHP Medicare Advantage	https://www.cdphp.com/medicare	CDPHP Value Rx (HMO)	01	01		1			H3388	004	0	2022	Greater Capital Region of New York State		2	118968	2			2						https://findadoc.cdphp.com/	https://www.cdphp.com/medicare/drug-coverage	https://findadoc.cdphp.com/	(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	10		18a1;
H3388	013	0	1	01	01	H3388_013_0	6	1			1		1	08/09/2021	2022.01	08/09/2021 01:39:58 PM Eastern Daylight Time	08/05/2021 03:45:36 PM Eastern Daylight Time	08/05/2021 03:45:28 PM Eastern Daylight Time			08/09/2021 02:40:16 PM Eastern Daylight Time	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	CDPHP Medicare Advantage	https://www.cdphp.com/medicare	CDPHP Basic RX (HMO)	01	01		1			H3388	013	0	2022	Greater Capital Region of New York State		2	78672	2			2						https://findadoc.cdphp.com/	https://www.cdphp.com/medicare/drug-coverage	https://findadoc.cdphp.com/	(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	10		18a1;
H3388	014	0	1	01	01	H3388_014_0	6	1			1		1	08/09/2021	2022.01	08/09/2021 01:41:51 PM Eastern Daylight Time	08/05/2021 03:45:29 PM Eastern Daylight Time	08/05/2021 03:45:30 PM Eastern Daylight Time			08/09/2021 02:40:16 PM Eastern Daylight Time	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	CDPHP Medicare Advantage	https://www.cdphp.com/medicare	CDPHP $0 Medicare Rx (HMO)	01	01		1			H3388	014	0	2022	Greater Capital Region of New York State		2	48084	2			2						https://findadoc.cdphp.com/	https://www.cdphp.com/medicare/drug-coverage	https://findadoc.cdphp.com/	(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	10		18a1;
H3388	801	0	1	01	01	H3388_801_0	3	1						05/14/2021	2022.01	05/14/2021 11:06:43 AM Eastern Daylight Time					06/07/2021 08:28:58 AM Eastern Daylight Time	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	CDPHP Medicare Advantage	https://www.cdphp.com/medicare	CDPHP Group Medicare Rx (HMO)	01	01		1			H3388	801	0	2022	Greater Capital Region of New York State		1	36	2			2						https://findadoc.cdphp.com/	https://www.cdphp.com/medicare/drug-coverage	https://findadoc.cdphp.com/	(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	1b;2;7d;7i;8a;9a1;9b;9d;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	3	1						05/14/2021	2022.01	05/14/2021 11:07:33 AM Eastern Daylight Time					06/07/2021 08:28:58 AM Eastern Daylight Time	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	CDPHP Medicare Advantage	https://www.cdphp.com/medicare	CDPHP Group Medicare Rx (HMO)	01	01		1			H3388	803	0	2022	Greater Capital Region of New York State		1	110926	2			2						https://findadoc.cdphp.com/	https://www.cdphp.com/medicare/drug-coverage	https://findadoc.cdphp.com/	(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	1b;2;7d;7g;7i;8a;9a1;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	3	1				0	0	05/14/2021	2022.01	05/14/2021 11:12:34 AM Eastern Daylight Time					06/07/2021 08:28:58 AM Eastern Daylight Time	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	CDPHP Medicare Advantage	https://www.cdphp.com/medicare	CDPHP Group Medicare (HMO)	01	01		1			H3388	804	0	2022	Greater Capital Region of New York State		1	3497	2			2						https://findadoc.cdphp.com/	https://www.cdphp.com/medicare/drug-coverage	https://findadoc.cdphp.com/	(888)248-6522		(518)641-3950		(888)519-4455		(518)641-3400										(711)-		(711)-		(711)-		(711)-										1	1	1b;2;7d;7i;8a;9a1;9b;9d;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	6	1					1	08/03/2021	2022.01	08/03/2021 09:36:11 AM Eastern Daylight Time	08/04/2021 09:19:23 AM Eastern Daylight Time	08/04/2021 09:19:03 AM Eastern Daylight Time			08/05/2021 02:34:32 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 Enhanced (PPO)	01	04		1			H3404	003	1	2022	Select North Carolina Counties	PPO Region 1	2		2			2						https://www.myprime.com/en/find-pharmacy.html	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3404	003	2	1	04	01	H3404_003_2	7	1					1	08/12/2021	2022.01	08/12/2021 02:35:27 PM Eastern Daylight Time	08/04/2021 09:19:23 AM Eastern Daylight Time	08/04/2021 09:19:04 AM Eastern Daylight Time			08/13/2021 02:31:31 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 Enhanced (PPO)	01	04		1			H3404	003	2	2022	Select North Carolina Counties	PPO Region 2	2		2			2						https://www.myprime.com/en/find-pharmacy.html	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3404	004	0	1	04	01	H3404_004_0	4	1				0	0	06/29/2021	2022.01	06/29/2021 12:44:40 PM Eastern Daylight Time	06/04/2021 08:33:19 PM Eastern Daylight Time				07/08/2021 03:20:09 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 Freedom+ (PPO)	01	04		1			H3404	004	0	2022	Select North Carolina Counties		2		2			2						https://www.myprime.com/en/find-pharmacy.html	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										(711)-		(711)-		(711)-		(711)-										2					2						2			
H3404	801	0	1	04	01	H3404_801_0	2	1				0	0	05/26/2021	2022.01	05/26/2021 12:22:50 PM Eastern Daylight Time					06/05/2021 03:32:37 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	2022	North Carolina Employer Groups		1	0	2			2						https://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										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;6;7b;7c;7d;7e;7g;7h;7i;8a;8b1;8b2;9a1;9b;10a;11a;11b;11c;15;	2		1									
H3404	803	0	1	04	01	H3404_803_0	2	1						05/18/2021	2022.01	05/18/2021 08:16:49 AM Eastern Daylight Time					06/05/2021 03:32:37 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	2022	North Carolina Employer Groups		1	218	2			2						https://www.myprime.com/en/find-pharmacy.html	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;6;7b;7c;7d;7e;7g;7h;7i;8a;8b1;8b2;9a1;9b;10a;11a;11b;11c;15;	2		1									
H3404	810	0	1	04	01	H3404_810_0	2	1						05/18/2021	2022.01	05/18/2021 08:16:42 AM Eastern Daylight Time					06/05/2021 03:32:37 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 Complete (PPO)	01	04		1			H3404	810	0	2022	NC Employer Groups		1	43	2			2						https://www.myprime.com/en/find-pharmacy.html	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;6;7b;7c;7d;7e;7g;7h;7i;8a;8b1;8b2;9a1;9b;10a;11a;11b;11c;15;	2		1									
H3407	001	0	1	01	01	H3407_001_0	7	1	2	1			0	07/19/2021	2022.01	07/19/2021 01:14:36 PM Mountain Daylight Time	08/02/2021 01:33:56 PM Mountain Daylight Time	07/30/2021 12:19:02 PM Mountain Daylight Time			08/05/2021 07:54:29 AM Mountain Daylight Time	EL PASO FIRST HEALTH PLANS, INC.	El Paso Health Advantage Dual SNP	ephmedicare.com	El Paso Health Advantage Dual SNP (HMO D-SNP)	01	01		1			H3407	001	0	2022	El Paso and Hudspeth counties		2	6000	2			1	3		1		1	ephmedicare.com	ephmedicare.com	ephmedicare.com	(833)742-3125		(833)742-3125		(833)742-3125		(833)742-3125		(833)742-3125		(833)742-3125		(833)742-3125		(833)742-3125		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3416	001	6	1	04	01	H3416_001_6	8	1					1	07/23/2021	2022.01	07/23/2021 01:15:49 PM Central Daylight Time	08/04/2021 04:48:59 PM Central Daylight Time	08/04/2021 04:49:52 PM Central Daylight Time			08/05/2021 10:49:10 AM Central Daylight Time	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	HealthPartners UnityPoint Health	Oneplanforme.com/medicareplan	HealthPartners UnityPoint Health Align (PPO)	01	04		1			H3416	001	6	2022	Central Iowa & Western Illinois	Cedar Rapids, Central IA, and Peoria Areas	2	19011	2			2						Oneplanforme.com/findapharmacy	Oneplanforme.com/myresources	Oneplanforme.com/findadoctor	(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	7	1	04	01	H3416_001_7	8	1					1	07/23/2021	2022.01	07/23/2021 01:19:10 PM Central Daylight Time	08/04/2021 04:48:52 PM Central Daylight Time	08/04/2021 04:49:52 PM Central Daylight Time			08/05/2021 10:49:10 AM Central Daylight Time	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	HealthPartners UnityPoint Health	Oneplanforme.com/medicareplan	HealthPartners UnityPoint Health Align (PPO)	01	04		1			H3416	001	7	2022	Central Iowa & Western Illinois	Fort Dodge, Quad Cities, Waterloo, Sioux City	2	19011	2			2						Oneplanforme.com/findapharmacy	Oneplanforme.com/myresources	Oneplanforme.com/findadoctor	(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	4	1	04	01	H3416_002_4	7	1					1	07/15/2021	2022.01	07/15/2021 09:28:21 AM Central Daylight Time	08/04/2021 04:48:53 PM Central Daylight Time	08/04/2021 04:49:53 PM Central Daylight Time			08/05/2021 10:49:10 AM Central Daylight Time	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	HealthPartners UnityPoint Health	Oneplanforme.com/medicareplan	HealthPartners UnityPoint Health Symmetry (PPO)	01	04		1			H3416	002	4	2022	Central Iowa & Western Illinois	Cedar Rapids, Central IA, and Peoria Areas	2	9213	2			2						Oneplanforme.com/findapharmacy	Oneplanforme.com/myresources	Oneplanforme.com/findadoctor	(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	5	1	04	01	H3416_002_5	8	1					1	07/15/2021	2022.01	07/15/2021 09:33:32 AM Central Daylight Time	08/04/2021 04:48:53 PM Central Daylight Time	08/04/2021 04:49:53 PM Central Daylight Time			08/05/2021 10:49:10 AM Central Daylight Time	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	HealthPartners UnityPoint Health	Oneplanforme.com/medicareplan	HealthPartners UnityPoint Health Symmetry (PPO)	01	04		1			H3416	002	5	2022	Central Iowa & Western Illinois	Fort Dodge, Quad Cities, Waterloo, and Sioux City	2	9213	2			2						Oneplanforme.com/findapharmacy	Oneplanforme.com/myresources	Oneplanforme.com/findadoctor	(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	1	1						06/07/2021	2022.01	06/07/2021 08:34:45 AM Central Daylight Time					06/07/2021 09:01:20 AM Central Daylight Time	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	HealthPartners UnityPoint Health	Oneplanforme.com/medicareplan	HealthPartners UnityPoint Health Group MAPD CY (PPO)	01	04		1			H3416	801	0	2022	Nationwide		1	0	2			2						Oneplanforme.com/findapharmacy	Oneplanforme.com/myresources	Oneplanforme.com/findadoctor	(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	1	1				0	0	06/07/2021	2022.01	06/07/2021 08:33:34 AM Central Daylight Time					06/07/2021 09:01:20 AM Central Daylight Time	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	HealthPartners UnityPoint Health	Oneplanforme.com/medicareplan	HealthPartners UnityPoint Health Group MA Only (PPO)	01	04		1			H3416	803	0	2022	Nationwide		1	0	2			2						Oneplanforme.com/findapharmacy	healthpartnersunitypointhealth.com	Oneplanforme.com/findadoctor	(888)360-0544		(888)360-0544		(888)360-0796		(888)360-0796										(711)-		(711)-		(711)-		(711)-										2					2						2			
H3418	001	0	1	04	01	H3418_001_0	3	1					1	08/04/2021	2022.01	08/04/2021 10:35:59 AM Central Daylight Time	08/03/2021 02:14:55 PM Central Daylight Time	07/29/2021 08:29:23 PM Central Daylight Time			08/05/2021 02:23:44 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Mosaic Choice (PPO)	01	04		1			H3418	001	0	2022	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						1	01	7a;7d;7g;	
H3418	002	0	1	04	01	H3418_002_0	3	1					1	08/05/2021	2022.01	08/05/2021 10:22:47 AM Central Daylight Time	08/03/2021 02:15:33 PM Central Daylight Time	07/29/2021 08:29:38 PM Central Daylight Time			08/05/2021 02:23:44 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Value Care (PPO)	01	04		1			H3418	002	0	2022	Dutchess, Putnam, Ulster, 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						1	01	7a;7d;7g;9b;	
H3419	001	0	1	01	01	H3419_001_0	6	1		1			0	07/13/2021	2022.01	07/13/2021 10:42:17 AM Eastern Daylight Time	08/05/2021 01:05:54 PM Eastern Daylight Time	08/02/2021 03:16:00 PM Eastern Daylight Time			08/05/2021 04:38:50 PM Eastern Daylight Time	PERENNIAL ADVANTAGE OF COLORADO, INC.	Perennial Advantage	www.perennialadvantage.com	Perennial Advantage Strive (HMO I-SNP)	01	01		1			H3419	001	0	2022	Colorado (partial)		2	1321	2			1	1	3				www.placeholder.com	www.perennialadvantage.com	www.perennialadvantage.com	(844)788-6959		(844)788-6959		(844)788-6959		(844)788-6959		(844)788-6959		(844)788-6959		(844)788-6959		(844)788-6959		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3419	002	0	1	01	01	H3419_002_0	7	1		1			0	07/13/2021	2022.01	07/13/2021 10:44:14 AM Eastern Daylight Time	08/05/2021 01:06:28 PM Eastern Daylight Time	08/04/2021 06:25:37 PM Eastern Daylight Time			08/05/2021 04:38:50 PM Eastern Daylight Time	PERENNIAL ADVANTAGE OF COLORADO, INC.	Perennial Advantage	www.perennialadvantage.com	Perennial Advantage Concierge (HMO C-SNP)	01	01		1			H3419	002	0	2022	Colorado (partial)		2	3099	2			1	4			00000000000000000010		www.placeholder.com	www.perennialadvantage.com	www.perennialadvantage.com	(844)788-6959		(844)788-6959		(844)788-6959		(844)788-6959		(844)788-6959		(844)788-6959		(844)788-6959		(844)788-6959		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3430	001	0	1	20	08	H3430_001_0	1	1						05/28/2021	2022.01	05/28/2021 01:41:34 PM Eastern Daylight Time		05/28/2021 01:29:37 PM Eastern Daylight Time			05/28/2021 01:43:09 PM Eastern Daylight Time	SUNCOAST PACE, INC.	Suncoast PACE, Inc.	www.suncoastpace.org	Suncoast PACE, Inc. (PACE)	08	20		1			H3430	001	0	2022	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						05/28/2021	2022.01	05/28/2021 01:41:53 PM Eastern Daylight Time		05/28/2021 01:29:58 PM Eastern Daylight Time			05/28/2021 01:43:09 PM Eastern Daylight Time	SUNCOAST PACE, INC.	Suncoast PACE, Inc.	www.suncoastpace.org	Suncoast PACE, Inc. (PACE)	08	20		1			H3430	002	0	2022	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																
H3442	001	0	1	04	01	H3442_001_0	3	1					1	08/04/2021	2022.01	08/04/2021 03:38:26 PM Central Daylight Time	08/03/2021 12:29:17 PM Central Daylight Time	07/29/2021 08:29:53 PM Central Daylight Time			08/05/2021 04:12:25 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF ILLINOIS	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Walgreens (PPO)	01	04		1			H3442	001	0	2022	State of Connecticut		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			
H3442	003	0	1	04	01	H3442_003_0	3	1					1	08/04/2021	2022.01	08/04/2021 03:39:54 PM Central Daylight Time	08/03/2021 12:29:52 PM Central Daylight Time	07/29/2021 08:30:09 PM Central Daylight Time			08/05/2021 04:12:25 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF ILLINOIS	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Walgreens (PPO)	01	04		1			H3442	003	0	2022	Boston Metro		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			
H3442	004	0	1	04	01	H3442_004_0	3	1					1	08/05/2021	2022.01	08/05/2021 11:02:36 AM Central Daylight Time	08/03/2021 12:30:27 PM Central Daylight Time	07/29/2021 08:30:25 PM Central Daylight Time			08/05/2021 04:12:25 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF ILLINOIS	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Walgreens (PPO)	01	04		1			H3442	004	0	2022	Outside of Boston Metro		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			
H3442	005	0	1	04	01	H3442_005_0	2	1				0	0	07/15/2021	2022.01	07/15/2021 11:42:43 AM Central Daylight Time	06/03/2021 04:05:13 PM Central Daylight Time				07/16/2021 01:10:19 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF ILLINOIS	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (PPO)	01	04		1			H3442	005	0	2022	Boston and Outside Boston Metro		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			
H3442	006	0	1	04	01	H3442_006_0	3	1					1	08/04/2021	2022.01	08/04/2021 03:43:16 PM Central Daylight Time	08/03/2021 12:31:03 PM Central Daylight Time	07/29/2021 08:30:39 PM Central Daylight Time			08/05/2021 04:12:25 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF ILLINOIS	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 1 (PPO)	01	04		1			H3442	006	0	2022	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			
H3442	007	0	1	04	01	H3442_007_0	3	1					1	08/04/2021	2022.01	08/04/2021 03:44:58 PM Central Daylight Time	08/03/2021 12:31:38 PM Central Daylight Time	07/29/2021 08:30:53 PM Central Daylight Time			08/05/2021 04:12:25 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF ILLINOIS	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Walgreens (PPO)	01	04		1			H3442	007	0	2022	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			
H3442	008	0	1	04	01	H3442_008_0	2	1				0	0	07/15/2021	2022.01	07/15/2021 11:46:33 AM Central Daylight Time	06/03/2021 04:06:48 PM Central Daylight Time				07/16/2021 01:10:19 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF ILLINOIS	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (PPO)	01	04		1			H3442	008	0	2022	Counties in New Hampshire and 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										(711)-		(711)-		(711)-		(711)-										2					2						2			
H3442	010	0	1	04	01	H3442_010_0	3	1					1	08/04/2021	2022.01	08/04/2021 03:47:14 PM Central Daylight Time	08/03/2021 12:32:14 PM Central Daylight Time	07/29/2021 08:31:08 PM Central Daylight Time			08/05/2021 04:12:25 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF ILLINOIS	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 1 (PPO)	01	04		1			H3442	010	0	2022	Vermont 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			
H3443	001	0	1	01	01	H3443_001_0	6	1					0	08/03/2021	2022.01	08/03/2021 09:51:13 PM Pacific Daylight Time	08/02/2021 11:10:18 PM Pacific Daylight Time	07/30/2021 10:33:36 AM Pacific Daylight Time			08/03/2021 10:17:01 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan Platinum (HMO)	01	01		1			H3443	001	0	2022	Maricopa		2	17702	2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247	1	(323)728-7232	6	(844)227-7616		(844)227-7616		(888)979-2247	1	(323)728-7232	6	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3443	002	0	1	01	01	H3443_002_0	6	1					0	08/03/2021	2022.01	08/03/2021 09:51:22 PM Pacific Daylight Time	08/02/2021 11:12:08 PM Pacific Daylight Time	07/30/2021 10:34:54 AM Pacific Daylight Time			08/03/2021 10:17:01 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan Platinum (HMO)	01	01		1			H3443	002	0	2022	Pima		2	13508	2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247	1	(323)728-7232	6	(844)227-7616		(844)227-7616		(888)979-2247	1	(323)728-7232	6	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3443	003	0	1	01	01	H3443_003_0	6	1		1			0	08/03/2021	2022.01	08/03/2021 09:51:32 PM Pacific Daylight Time	08/02/2021 11:15:04 PM Pacific Daylight Time	07/30/2021 10:39:20 AM Pacific Daylight Time			08/03/2021 10:17:01 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan Heart & Diabetes (HMO C-SNP)	01	01		1			H3443	003	0	2022	Maricopa, Pima		2	1962	2			1	4			00000000000000000010		www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247	1	(323)728-7232	6	(844)227-7616		(844)227-7616		(888)979-2247	1	(323)728-7232	6	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3443	801	0	1	01	01	H3443_801_0	3	1						07/12/2021	2022.01	07/12/2021 06:36:50 PM Pacific Daylight Time					07/13/2021 11:53:46 AM Pacific Daylight Time	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan Retiree Options (HMO)	01	01		1			H3443	801	0	2022	Maricopa, Pima		1	6000	2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247	1	(323)728-7232	6	(844)227-7616		(844)227-7616		(888)979-2247	1	(323)728-7232	6	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3443	802	0	1	01	01	H3443_802_0	3	1						07/12/2021	2022.01	07/12/2021 06:39:21 PM Pacific Daylight Time					07/13/2021 11:53:46 AM Pacific Daylight Time	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan Retiree Options (HMO)	01	01		1			H3443	802	0	2022	Maricopa, Pima		1	6000	2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247	1	(323)728-7232	6	(844)227-7616		(844)227-7616		(888)979-2247	1	(323)728-7232	6	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3443	803	0	1	01	01	H3443_803_0	4	1				0	0	07/13/2021	2022.01	07/13/2021 12:20:14 PM Pacific Daylight Time					07/13/2021 12:21:16 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan Retiree Options (HMO)	01	01		1			H3443	803	0	2022	Maricopa, Pima		1	6000	2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247	1	(323)728-7232	6									(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3443	804	0	1	01	01	H3443_804_0	3	1				0	0	07/12/2021	2022.01	07/12/2021 06:40:57 PM Pacific Daylight Time					07/13/2021 11:53:46 AM Pacific Daylight Time	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan Retiree Options (HMO)	01	01		1			H3443	804	0	2022	Maricopa, Pima		1	6000	2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247	1	(323)728-7232	6									(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3447	001	0	1	01	01	H3447_001_0	6	1			2		0	07/16/2021	2022.01	07/16/2021 05:00:41 PM Pacific Daylight Time	08/03/2021 06:04:08 PM Eastern Daylight Time	08/03/2021 06:04:08 PM Eastern Daylight Time			08/04/2021 01:51:40 PM Eastern Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	https://shop.anthem.com/medicare	Anthem MediBlue Local (HMO)	01	01		1			H3447	001	0	2022	Richmond Metropolitan, West & So. of Richmond Area		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(888)326-3584		(888)326-3584		(855)679-0538		(855)679-0538		(833)339-3516		(833)339-3516		(855)485-0954		(855)485-0954		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3447	003	0	1	01	01	H3447_003_0	6	1		1	2		0	07/18/2021	2022.01	07/18/2021 01:53:28 PM Pacific Daylight Time	08/03/2021 06:04:08 PM Eastern Daylight Time	08/03/2021 06:04:08 PM Eastern Daylight Time			08/04/2021 01:51:40 PM Eastern Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	https://shop.anthem.com/medicare	Anthem MediBlue COPD (HMO C-SNP)	01	01		1			H3447	003	0	2022	Richmond Metropolitan, West & So. of Richmond Area		2		2			1	4			00000000000100000000		https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(888)326-3584		(888)326-3584		(855)679-0539		(855)679-0539		(833)339-3516		(833)339-3516		(855)485-0955		(855)485-0955		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3447	004	0	1	01	01	H3447_004_0	6	1		1	2		1	07/18/2021	2022.01	07/18/2021 01:53:36 PM Pacific Daylight Time	08/03/2021 06:04:08 PM Eastern Daylight Time	08/03/2021 06:04:08 PM Eastern Daylight Time			08/04/2021 01:51:40 PM Eastern Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	https://shop.anthem.com/medicare	Anthem MediBlue Diabetes and Heart Care (HMO C-SNP)	01	01		1			H3447	004	0	2022	Richmond Metropolitan, West & So. of Richmond Area		2		2			1	4			00000000000000000010		https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(888)326-3584		(888)326-3584		(855)679-0539		(855)679-0539		(833)339-3516		(833)339-3516		(855)485-0955		(855)485-0955		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3447	005	0	1	01	01	H3447_005_0	6	1			2		0	07/18/2021	2022.01	07/18/2021 01:54:19 PM Pacific Daylight Time	08/03/2021 06:04:08 PM Eastern Daylight Time	08/03/2021 06:04:08 PM Eastern Daylight Time			08/04/2021 01:51:40 PM Eastern Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	https://shop.anthem.com/medicare	Anthem MediBlue Smart Fit (HMO)	01	01		1			H3447	005	0	2022	Richmond Metropolitan, West & So. of Richmond Area		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(888)326-3584		(888)326-3584		(855)679-0538		(855)679-0538		(833)339-3516		(833)339-3516		(855)485-0954		(855)485-0954		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3447	010	0	1	01	01	H3447_010_0	6	1		1	2		0	07/18/2021	2022.01	07/18/2021 03:13:01 PM Pacific Daylight Time	08/03/2021 06:04:08 PM Eastern Daylight Time	08/03/2021 06:04:08 PM Eastern Daylight Time			08/04/2021 01:51:40 PM Eastern Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	https://shop.anthem.com/medicare	Anthem MediBlue Care on Site (HMO I-SNP)	01	01		1			H3447	010	0	2022	Richmond Metropolitan, West & So. of Richmond Area		2		2			1	1	3				https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(888)326-3584		(888)326-3584		(855)679-0540		(855)679-0540		(833)339-3516		(833)339-3516		(855)485-0956		(855)485-0956		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3447	011	0	1	01	01	H3447_011_0	6	1	2	1	1		0	07/18/2021	2022.01	07/18/2021 01:09:43 PM Eastern Daylight Time	08/03/2021 06:04:04 PM Eastern Daylight Time	08/03/2021 06:04:04 PM Eastern Daylight Time			08/04/2021 02:27:41 PM Eastern Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	https://shop.anthem.com/medicare	Anthem MediBlue Full Dual Advantage (HMO D-SNP)	01	01		1			H3447	011	0	2022	Select Counties in Virginia		2		2			1	3		1		1	https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(855)363-0724		(855)363-0724		(855)679-0541		(855)679-0541		(833)339-3515		(833)339-3515		(855)485-0957		(855)485-0957		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3447	013	0	1	01	01	H3447_013_0	7	1			2		1	08/03/2021	2022.01	08/03/2021 04:40:32 PM Eastern Daylight Time	08/03/2021 06:04:04 PM Eastern Daylight Time	08/03/2021 06:04:04 PM Eastern Daylight Time			08/04/2021 02:27:41 PM Eastern Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	https://shop.anthem.com/medicare	Anthem MediBlue Plus (HMO)	01	01		1			H3447	013	0	2022	Southern Virginia Counties		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(844)395-1019		(844)395-1019		(855)679-0538		(855)679-0538		(833)337-1271		(833)337-1271		(855)485-0954		(855)485-0954		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3447	014	0	1	01	01	H3447_014_0	6	1			2		1	07/15/2021	2022.01	07/15/2021 01:20:01 PM Eastern Daylight Time	08/03/2021 06:04:04 PM Eastern Daylight Time	08/03/2021 06:04:04 PM Eastern Daylight Time			08/04/2021 02:27:41 PM Eastern Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	https://shop.anthem.com/medicare	Anthem MediBlue Plus (HMO)	01	01		1			H3447	014	0	2022	Northern Virginia Counties		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(844)395-1019		(844)395-1019		(855)679-0538		(855)679-0538		(833)337-1271		(833)337-1271		(855)485-0954		(855)485-0954		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3447	018	0	1	01	01	H3447_018_0	7	1	2	1	1		0	07/28/2021	2022.01	07/28/2021 03:13:48 PM Eastern Daylight Time	08/03/2021 06:04:00 PM Eastern Daylight Time	08/03/2021 06:04:00 PM Eastern Daylight Time			08/04/2021 02:28:17 PM Eastern Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	https://shop.anthem.com/medicare	Anthem MediBlue Dual Advantage (HMO D-SNP)	01	01		1			H3447	018	0	2022	Select Counties in Missouri		2		2			1	3		1		1	https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(844)879-3611		(844)879-3611		(855)679-0541		(855)679-0541		(833)339-3512		(833)339-3512		(855)485-0957		(855)485-0957		(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	1		0	08/04/2021	2022.01	08/04/2021 04:35:23 PM Eastern Daylight Time	08/04/2021 04:13:25 PM Eastern Daylight Time	08/03/2021 06:04:00 PM Eastern Daylight Time			08/04/2021 04:39:26 PM Eastern Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	https://shop.anthem.com/medicare	Anthem MediBlue Dual Advantage (HMO D-SNP)	01	01		1			H3447	020	0	2022	Indiana		2		2			1	3		1		1	https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(844)533-2021		(844)533-2021		(855)679-0541		(855)679-0541		(833)337-1283		(833)337-1283		(855)485-0957		(855)485-0957		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3447	022	0	1	01	01	H3447_022_0	7	1			2		0	08/02/2021	2022.01	08/02/2021 02:18:44 PM Eastern Daylight Time	08/03/2021 06:04:00 PM Eastern Daylight Time	08/03/2021 06:04:00 PM Eastern Daylight Time			08/04/2021 02:28:17 PM Eastern Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	https://shop.anthem.com/medicare	Anthem MediBlue Plus (HMO)	01	01		1			H3447	022	0	2022	Select Counties in Indiana		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(855)251-8827		(855)251-8827		(855)679-0538		(855)679-0538		(833)339-3514		(833)339-3514		(855)485-0954		(855)485-0954		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3447	024	0	1	01	01	H3447_024_0	7	1			2		0	07/19/2021	2022.01	07/19/2021 01:53:14 PM Eastern Daylight Time	08/03/2021 06:04:00 PM Eastern Daylight Time	08/03/2021 06:04:00 PM Eastern Daylight Time			08/04/2021 02:28:17 PM Eastern Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	https://shop.anthem.com/medicare	Anthem MediBlue Extra (HMO)	01	01		1			H3447	024	0	2022	Indiana		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(855)251-8827		(855)251-8827		(855)679-0538		(855)679-0538		(833)339-3514		(833)339-3514		(855)485-0954		(855)485-0954		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3447	025	0	1	01	01	H3447_025_0	7	1			2		1	07/18/2021	2022.01	07/18/2021 01:12:17 PM Eastern Daylight Time	08/03/2021 06:04:05 PM Eastern Daylight Time	08/03/2021 06:04:05 PM Eastern Daylight Time			08/04/2021 02:27:41 PM Eastern Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/medicare	Anthem MediBlue Essential (HMO)	01	01		1			H3447	025	0	2022	Select Counties in Virginia		2		2			2						www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(844)395-1019		(844)395-1019		(855)679-0538		(855)679-0538		(833)337-1271		(833)337-1271		(855)485-0954		(855)485-0954		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3447	026	0	1	01	01	H3447_026_0	8	1		1	2		0	06/04/2021	2022.01	06/04/2021 07:58:21 AM Pacific Daylight Time	08/03/2021 03:04:03 PM Pacific Daylight Time	08/03/2021 03:04:03 PM Pacific Daylight Time			08/04/2021 12:07:42 PM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	https://shop.anthem.com/medicare	Anthem MediBlue Care To You (HMO I-SNP)	01	01		1			H3447	026	0	2022	Select Counties in Virginia		2		2			1	1	3				https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(844)209-6375		(844)209-6375		(855)679-0540		(855)679-0540		(833)385-9049		(833)385-9049		(855)485-0956		(855)485-0956		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3447	027	0	1	01	01	H3447_027_0	7	1			2		0	07/18/2021	2022.01	07/18/2021 01:12:57 PM Eastern Daylight Time	08/03/2021 06:04:05 PM Eastern Daylight Time	08/03/2021 06:04:05 PM Eastern Daylight Time			08/04/2021 02:27:41 PM Eastern Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/medicare	Anthem MediBlue Extra (HMO)	01	01		1			H3447	027	0	2022	Select Counties in Virginia		2		2			2						www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(844)395-1019		(844)395-1019		(855)679-0538		(855)679-0538		(833)337-1271		(833)337-1271		(855)485-0954		(855)485-0954		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3447	028	0	1	01	01	H3447_028_0	6	1			2		0	07/18/2021	2022.01	07/18/2021 01:13:42 PM Eastern Daylight Time	08/03/2021 06:04:05 PM Eastern Daylight Time	08/03/2021 06:04:05 PM Eastern Daylight Time			08/04/2021 02:27:41 PM Eastern Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/medicare	Anthem MediBlue Extra (HMO)	01	01		1			H3447	028	0	2022	Select Counties in Virginia		2		2			2						www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(844)395-1019		(844)395-1019		(855)679-0538		(855)679-0538		(833)337-1271		(833)337-1271		(855)485-0954		(855)485-0954		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3447	030	0	1	01	01	H3447_030_0	7	1	2	1	1		0	07/18/2021	2022.01	07/18/2021 01:14:34 PM Eastern Daylight Time	08/03/2021 06:04:05 PM Eastern Daylight Time	08/03/2021 06:04:05 PM Eastern Daylight Time			08/04/2021 02:27:41 PM Eastern Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	https://shop.anthem.com/medicare	Anthem MediBlue Dual Advantage (HMO D-SNP)	01	01		1			H3447	030	0	2022	Select Counties in Virginia		2		2			1	3		1		1	https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(855)363-0724		(855)363-0724		(855)679-0541		(855)679-0541		(833)339-3515		(833)339-3515		(855)485-0957		(855)485-0957		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3447	033	0	1	01	01	H3447_033_0	11	1		1	2		0	07/18/2021	2022.01	07/18/2021 09:22:55 PM Pacific Daylight Time		08/03/2021 03:04:03 PM Pacific Daylight Time		08/03/2021 03:04:03 PM Pacific Daylight Time	08/04/2021 12:07:42 PM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	https://shop.anthem.com/medicare	Anthem MediBlue ESRD Care (HMO C-SNP)	01	01		1			H3447	033	0	2022	Select Counties in VA		2		2			1	4			00000000100000000000		https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(844)395-1019		(844)395-1019		(855)679-0538		(855)679-0538		(833)337-1271		(833)337-1271		(855)485-0954		(855)485-0954		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3447	035	1	1	01	01	H3447_035_1	7	1			2		0	08/02/2021	2022.01	08/02/2021 02:18:27 PM Eastern Daylight Time	08/03/2021 06:04:00 PM Eastern Daylight Time	08/03/2021 06:04:00 PM Eastern Daylight Time			08/04/2021 02:28:17 PM Eastern Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	https://shop.anthem.com/medicare	Anthem MediBlue Plus (HMO)	01	01		1			H3447	035	1	2022	Select counties in Indiana	Surrounding Ft Wayne Counties	2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(855)251-8827		(855)251-8827		(855)679-0538		(855)679-0538		(833)339-3514		(833)339-3514		(855)485-0954		(855)485-0954		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3447	035	2	1	01	01	H3447_035_2	7	1			2		0	08/03/2021	2022.01	08/03/2021 03:06:53 PM Eastern Daylight Time	08/03/2021 06:04:00 PM Eastern Daylight Time	08/03/2021 06:04:00 PM Eastern Daylight Time			08/04/2021 02:28:17 PM Eastern Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	https://shop.anthem.com/medicare	Anthem MediBlue Plus (HMO)	01	01		1			H3447	035	2	2022	Select counties in Indiana	Ft Wayne Counties	2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(855)251-8827		(855)251-8827		(855)679-0538		(855)679-0538		(833)339-3514		(833)339-3514		(855)485-0954		(855)485-0954		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3447	036	1	1	01	01	H3447_036_1	7	1			2		0	08/02/2021	2022.01	08/02/2021 02:20:33 PM Eastern Daylight Time	08/03/2021 06:04:00 PM Eastern Daylight Time	08/03/2021 06:04:00 PM Eastern Daylight Time			08/04/2021 02:28:17 PM Eastern Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	https://shop.anthem.com/medicare	Anthem MediBlue Plus (HMO)	01	01		1			H3447	036	1	2022	Select counties in Indiana	Surrounding Indianapolis Counties	2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(855)251-8827		(855)251-8827		(855)679-0538		(855)679-0538		(833)339-3514		(833)339-3514		(855)485-0954		(855)485-0954		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3447	036	2	1	01	01	H3447_036_2	7	1			2		0	07/30/2021	2022.01	07/30/2021 08:43:56 AM Eastern Daylight Time	08/03/2021 06:04:00 PM Eastern Daylight Time	08/03/2021 06:04:00 PM Eastern Daylight Time			08/04/2021 02:28:17 PM Eastern Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	https://shop.anthem.com/medicare	Anthem MediBlue Plus (HMO)	01	01		1			H3447	036	2	2022	Select counties in Indiana	Indianapolis Counties	2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(855)251-8827		(855)251-8827		(855)679-0538		(855)679-0538		(833)339-3514		(833)339-3514		(855)485-0954		(855)485-0954		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3447	037	0	1	01	01	H3447_037_0	6	1		1	2		1	07/18/2021	2022.01	07/18/2021 03:05:18 PM Pacific Daylight Time	08/03/2021 06:04:08 PM Eastern Daylight Time	08/03/2021 06:04:08 PM Eastern Daylight Time			08/04/2021 01:51:40 PM Eastern Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	https://shop.anthem.com/medicare	Anthem Diabetes and Heart Care (HMO C-SNP)	01	01		1			H3447	037	0	2022	Select Counties in VA		2		2			1	4			00000000000000000010		https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(844)395-1019		(844)395-1019		(855)679-0538		(855)679-0538		(833)337-1271		(833)337-1271		(855)485-0954		(855)485-0954		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3447	038	1	1	01	01	H3447_038_1	7	1			2		0	08/02/2021	2022.01	08/02/2021 02:21:03 PM Eastern Daylight Time	08/03/2021 06:04:00 PM Eastern Daylight Time	08/03/2021 06:04:00 PM Eastern Daylight Time			08/04/2021 02:28:17 PM Eastern Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	https://shop.anthem.com/medicare	Anthem MediBlue Plus (HMO)	01	01		1			H3447	038	1	2022	Select counties in Missouri	Surrounding St. Louis Counties	2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(855)251-8826		(855)251-8826		(855)679-0538		(855)679-0538		(833)339-3513		(833)339-3513		(855)485-0954		(855)485-0954		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3447	038	2	1	01	01	H3447_038_2	7	1			2		0	07/19/2021	2022.01	07/19/2021 02:14:55 PM Eastern Daylight Time	08/03/2021 06:04:00 PM Eastern Daylight Time	08/03/2021 06:04:00 PM Eastern Daylight Time			08/04/2021 02:28:17 PM Eastern Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	https://shop.anthem.com/medicare	Anthem MediBlue Plus (HMO)	01	01		1			H3447	038	2	2022	Select counties in Missouri	St. Louis Counties	2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(855)251-8826		(855)251-8826		(855)679-0538		(855)679-0538		(833)339-3513		(833)339-3513		(855)485-0954		(855)485-0954		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3447	039	0	1	01	01	H3447_039_0	7	1			2		0	08/04/2021	2022.01	08/04/2021 02:50:35 PM Eastern Daylight Time	08/04/2021 03:45:16 PM Eastern Daylight Time	07/29/2021 07:07:51 PM Eastern Daylight Time			08/04/2021 07:09:46 PM Eastern Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	https://shop.anthem.com/medicare	Anthem MediBlue + Kroger (HMO)	01	01		1			H3447	039	0	2022	Select counties in Virginia		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(844)395-1019		(844)395-1019		(855)679-0538		(855)679-0538		(833)337-1271		(833)337-1271		(855)485-0954		(855)485-0954		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3447	802	0	1	01	01	H3447_802_0	1	1						06/02/2021	2022.01	06/02/2021 04:29:24 PM Pacific Daylight Time					06/04/2021 10:11:41 AM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/va/medicare	Anthem MediBlue EGWP MAPD (HMO)	01	01		1			H3447	802	0	2022	Virginia		1	600	2			2						www.anthem.com/va/medicare	www.anthem.com/va/medicare	www.anthem.com/va/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)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1					1				
H3447	804	0	1	01	01	H3447_804_0	1	1						06/04/2021	2022.01	06/04/2021 10:10:13 AM Pacific Daylight Time					06/04/2021 10:11:41 AM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/va/medicare	Anthem MediBlue (HMO)	01	01		1			H3447	804	0	2022	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		(833)848-8729		(833)848-8729		(833)348-5340		(833)348-5340		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1					1				
H3447	805	0	1	01	01	H3447_805_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 03:41:05 PM Pacific Daylight Time					06/04/2021 10:11:41 AM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/va/medicare	Anthem MediBlue (HMO)	01	01		1			H3447	805	0	2022	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		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1					1				
H3447	806	0	2	01	01	H3447_806_0	1	1						06/02/2021	2022.01	06/02/2021 03:41:13 PM Pacific Daylight Time					06/04/2021 10:11:41 AM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/va/medicare	Anthem MediBlue (HMO)	01	01		2	1		H3447	806	0	2022	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		(833)848-8729		(833)848-8729		(833)348-5340		(833)348-5340		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1					1				
H3447	807	0	2	01	01	H3447_807_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 03:41:58 PM Pacific Daylight Time					06/04/2021 10:11:41 AM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/va/medicare	Anthem MediBlue (HMO)	01	01		2	1		H3447	807	0	2022	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		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1					1				
H3447	809	0	1	01	01	H3447_809_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 03:42:15 PM Pacific Daylight Time					06/04/2021 10:11:41 AM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/va/medicare	Anthem MediBlue (HMO)	01	01		1			H3447	809	0	2022	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		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1					1				
H3447	811	0	1	01	01	H3447_811_0	1	1						06/02/2021	2022.01	06/02/2021 03:44:06 PM Pacific Daylight Time					06/04/2021 10:11:41 AM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/IN/medicare	Anthem MediBlue (HMO)	01	01		1			H3447	811	0	2022	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		(833)848-8729		(833)848-8729		(833)370-7406		(833)370-7406		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1					1				
H3447	812	0	1	01	01	H3447_812_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 03:44:17 PM Pacific Daylight Time					06/04/2021 10:11:41 AM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/IN/medicare	Anthem MediBlue (HMO)	01	01		1			H3447	812	0	2022	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		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1					1				
H3447	813	0	2	01	01	H3447_813_0	1	1						06/02/2021	2022.01	06/02/2021 03:44:27 PM Pacific Daylight Time					06/04/2021 10:11:41 AM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/IN/medicare	Anthem MediBlue (HMO)	01	01		2	1		H3447	813	0	2022	Select Indiana Counties		1	600	2			2						www.anthem.com/IN/medicare	www.anthem.com/IN/medicare	www.anthem.com/IN/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)348-5340		(833)348-5340		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1					1				
H3447	814	0	2	01	01	H3447_814_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 03:44:39 PM Pacific Daylight Time					06/04/2021 10:11:41 AM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/IN/medicare	Anthem MediBlue (HMO)	01	01		2	1		H3447	814	0	2022	Select Indiana Counties		1	600	2			2						www.anthem.com/IN/medicare	www.anthem.com/IN/medicare	www.anthem.com/IN/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1					1				
H3447	816	0	1	01	01	H3447_816_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 03:44:51 PM Pacific Daylight Time					06/04/2021 10:11:41 AM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/IN/medicare	Anthem MediBlue (HMO)	01	01		1			H3447	816	0	2022	Select Indiana Counties		1	600	2			2						www.anthem.com/IN/medicare	www.anthem.com/IN/medicare	www.anthem.com/IN/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1					1				
H3447	818	0	1	01	01	H3447_818_0	1	1						06/02/2021	2022.01	06/02/2021 03:45:29 PM Pacific Daylight Time					06/04/2021 10:11:41 AM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/MO/medicare	Anthem MediBlue (HMO)	01	01		1			H3447	818	0	2022	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		(833)848-8729		(833)848-8729		(833)370-7402		(833)370-7402		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1					1				
H3447	819	0	1	01	01	H3447_819_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 03:45:38 PM Pacific Daylight Time					06/04/2021 10:11:41 AM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/MO/medicare	Anthem MediBlue (HMO)	01	01		1			H3447	819	0	2022	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		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1					1				
H3447	820	0	2	01	01	H3447_820_0	1	1						06/02/2021	2022.01	06/02/2021 03:45:46 PM Pacific Daylight Time					06/04/2021 10:11:41 AM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/MO/medicare	Anthem MediBlue (HMO)	01	01		2	1		H3447	820	0	2022	Select Missouri Counties		1	600	2			2						www.anthem.com/MO/medicare	www.anthem.com/MO/medicare	www.anthem.com/MO/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)348-5340		(833)348-5340		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1					1				
H3447	821	0	2	01	01	H3447_821_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 03:46:01 PM Pacific Daylight Time					06/04/2021 10:11:41 AM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/MO/medicare	Anthem MediBlue (HMO)	01	01		2	1		H3447	821	0	2022	Select Missouri Counties		1	600	2			2						www.anthem.com/MO/medicare	www.anthem.com/MO/medicare	www.anthem.com/MO/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1					1				
H3447	823	0	1	01	01	H3447_823_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 03:48:38 PM Pacific Daylight Time					06/04/2021 10:11:41 AM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/MO/medicare	Anthem MediBlue (HMO)	01	01		1			H3447	823	0	2022	Select Missouri Counties		1	600	2			2						www.anthem.com/MO/medicare	www.anthem.com/MO/medicare	www.anthem.com/MO/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1					1				
H3447	825	0	2	01	01	H3447_825_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 03:43:43 PM Pacific Daylight Time					06/04/2021 10:11:41 AM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/va/medicare	Anthem MediBlue (HMO)	01	01		2	1		H3447	825	0	2022	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		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1					1				
H3447	826	0	2	01	01	H3447_826_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 03:45:18 PM Pacific Daylight Time					06/04/2021 10:11:41 AM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/IN/medicare	Anthem MediBlue (HMO)	01	01		2	1		H3447	826	0	2022	Select Indiana Counties		1	600	2			2						www.anthem.com/IN/medicare	www.anthem.com/IN/medicare	www.anthem.com/IN/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1					1				
H3447	827	0	2	01	01	H3447_827_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 03:48:53 PM Pacific Daylight Time					06/04/2021 10:11:41 AM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/MO/medicare	Anthem MediBlue (HMO)	01	01		2	1		H3447	827	0	2022	Select MO Counties		1	600	2			2						www.anthem.com/MO/medicare	www.anthem.com/MO/medicare	www.anthem.com/MO/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1					1				
H3449	012	0	1	01	01	H3449_012_0	4	1				0	0	06/30/2021	2022.01	06/30/2021 08:48:15 AM Eastern Daylight Time	06/04/2021 04:28:12 PM Eastern Daylight Time				07/08/2021 03:20:09 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 Medical Only (HMO)	01	01		1			H3449	012	0	2022	Select North Carolina Counties		2		2			2						https://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										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3449	023	1	1	01	01	H3449_023_1	6	1					1	08/03/2021	2022.01	08/03/2021 09:22:37 AM Eastern Daylight Time	08/04/2021 09:19:23 AM Eastern Daylight Time	08/04/2021 09:19:04 AM Eastern Daylight Time			08/05/2021 02:34:32 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 Essential Plus (HMO)	01	01		1			H3449	023	1	2022	Select North Carolina Counties	Essential Plus Region 1	2		2			2						https://www.myprime.com/en/find-pharmacy.html	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3449	023	2	1	01	01	H3449_023_2	6	1					1	08/03/2021	2022.01	08/03/2021 09:22:50 AM Eastern Daylight Time	08/04/2021 09:19:24 AM Eastern Daylight Time	08/04/2021 09:19:05 AM Eastern Daylight Time			08/05/2021 02:34:32 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 Essential Plus (HMO)	01	01		1			H3449	023	2	2022	Select North Carolina Counties	Essential Plus Region 2	2		2			2						https://www.myprime.com/en/find-pharmacy.html	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3449	023	4	1	01	01	H3449_023_4	6	1					1	08/03/2021	2022.01	08/03/2021 09:23:03 AM Eastern Daylight Time	08/04/2021 09:19:24 AM Eastern Daylight Time	08/04/2021 09:19:05 AM Eastern Daylight Time			08/05/2021 02:34:32 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 Essential Plus (HMO)	01	01		1			H3449	023	4	2022	Select North Carolina Counties	Essential Plus Region 4	2		2			2						https://www.myprime.com/en/find-pharmacy.html	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3449	023	5	1	01	01	H3449_023_5	6	1					1	08/03/2021	2022.01	08/03/2021 09:23:16 AM Eastern Daylight Time	08/04/2021 09:19:25 AM Eastern Daylight Time	08/04/2021 09:19:06 AM Eastern Daylight Time			08/05/2021 02:34:32 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 Essential Plus (HMO)	01	01		1			H3449	023	5	2022	Select North Carolina Counties	Essential Plus Region 5	2		2			2						https://www.myprime.com/en/find-pharmacy.html	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3449	024	1	1	01	01	H3449_024_1	5	1					1	08/03/2021	2022.01	08/03/2021 09:23:30 AM Eastern Daylight Time	08/04/2021 09:19:25 AM Eastern Daylight Time	08/04/2021 09:19:06 AM Eastern Daylight Time			08/05/2021 02:34:32 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 Enhanced (HMO)	01	01		1			H3449	024	1	2022	Select North Carolina Counties	Enhanced Region 1	2		2			2						https://www.myprime.com/en/find-pharmacy.html	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3449	024	2	1	01	01	H3449_024_2	5	1					1	08/03/2021	2022.01	08/03/2021 09:23:43 AM Eastern Daylight Time	08/04/2021 09:19:25 AM Eastern Daylight Time	08/04/2021 09:19:07 AM Eastern Daylight Time			08/05/2021 02:34:32 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 Enhanced (HMO)	01	01		1			H3449	024	2	2022	Select North Carolina Counties	Enhanced Region 2	2		2			2						https://www.myprime.com/en/find-pharmacy.html	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3449	024	3	1	01	01	H3449_024_3	5	1					1	08/03/2021	2022.01	08/03/2021 09:23:55 AM Eastern Daylight Time	08/04/2021 09:19:26 AM Eastern Daylight Time	08/04/2021 09:19:07 AM Eastern Daylight Time			08/05/2021 02:34:32 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 Enhanced (HMO)	01	01		1			H3449	024	3	2022	Select North Carolina Counties	Enhanced Region 3	2		2			2						https://www.myprime.com/en/find-pharmacy.html	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3449	026	0	1	01	01	H3449_026_0	5	1					1	08/03/2021	2022.01	08/03/2021 09:24:07 AM Eastern Daylight Time	08/04/2021 09:19:26 AM Eastern Daylight Time	08/04/2021 09:19:08 AM Eastern Daylight Time			08/05/2021 02:34:32 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 Choice (HMO)	01	01		1			H3449	026	0	2022	Select North Carolina Counties		2		2			2						https://www.myprime.com/en/find-pharmacy.html	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3449	027	1	1	01	01	H3449_027_1	5	1					1	08/03/2021	2022.01	08/03/2021 09:24:24 AM Eastern Daylight Time	08/04/2021 09:19:26 AM Eastern Daylight Time	08/04/2021 09:19:08 AM Eastern Daylight Time			08/05/2021 02:34:32 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 Essential (HMO)	01	01		1			H3449	027	1	2022	Select North Carolina Counties	Segment 1	2		2			2						https://www.myprime.com/en/find-pharmacy.html	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3449	027	2	1	01	01	H3449_027_2	5	1					1	08/03/2021	2022.01	08/03/2021 09:28:33 AM Eastern Daylight Time	08/04/2021 09:19:27 AM Eastern Daylight Time	08/04/2021 09:19:08 AM Eastern Daylight Time			08/05/2021 02:34:32 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 Essential (HMO)	01	01		1			H3449	027	2	2022	Select North Carolina Counties	Segment 2	2		2			2						https://www.myprime.com/en/find-pharmacy.html	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3449	801	0	1	01	01	H3449_801_0	2	1						05/26/2021	2022.01	05/26/2021 12:33:25 PM Eastern Daylight Time					06/05/2021 03:32:37 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	2022	North Carolina Employer Groups		1	667	2			2						https://www.myprime.com/en/find-pharmacy.html	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;6;7b;7c;7d;7e;7g;7h;7i;8a;8b1;8b2;9a1;9b;10a;11a;11b;11c;15;16b;	2		1					1				
H3449	805	0	1	01	01	H3449_805_0	2	1				0	0	05/11/2021	2022.01	05/11/2021 03:42:47 PM Eastern Daylight Time					06/05/2021 03:32:37 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	2022	North Carolina Employer Groups		1	0	2			2						https://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										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;6;7b;7c;7d;7e;7g;7h;7i;8a;8b1;8b2;9a1;9b;10a;11a;11b;11c;15;16b;	2		1					1				
H3449	814	0	1	01	01	H3449_814_0	2	1						05/11/2021	2022.01	05/11/2021 03:43:12 PM Eastern Daylight Time					06/05/2021 03:32:37 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 Complete (HMO)	01	01		1			H3449	814	0	2022	NC Employer Groups		1	0	2			2						https://www.myprime.com/en/find-pharmacy.html	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;6;7b;7c;7d;7e;7g;7h;7i;8a;8b1;8b2;9a1;9b;10a;11a;11b;11c;15;16b;	2		1					1				
H3464	001	0	1	01	01	H3464_001_0	3	1					1	08/04/2021	2022.01	08/04/2021 10:27:31 AM Central Daylight Time	08/03/2021 01:42:04 PM Central Daylight Time	07/29/2021 08:31:22 PM Central Daylight Time			08/04/2021 01:59:15 PM Central Daylight Time	UNITEDHEALTHCARE OF ARKANSAS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO)	01	01		1			H3464	001	0	2022	Select Counties in Arkansas		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	3	1					1	08/04/2021	2022.01	08/04/2021 10:26:00 AM Central Daylight Time	08/03/2021 01:42:42 PM Central Daylight Time	07/29/2021 08:31:37 PM Central Daylight Time			08/04/2021 01:59:15 PM Central Daylight Time	UNITEDHEALTHCARE OF ARKANSAS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO)	01	01		1			H3464	002	0	2022	Select Counties in Arkansas		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	007	0	1	01	01	H3464_007_0	2	1				0	0	07/14/2021	2022.01	07/14/2021 04:26:41 PM Central Daylight Time	06/03/2021 03:37:06 PM Central Daylight Time				07/15/2021 12:44:14 PM Central Daylight Time	UNITEDHEALTHCARE OF ARKANSAS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (HMO)	01	01		1			H3464	007	0	2022	Entire state of Arkansas		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			
H3467	001	0	1	01	01	H3467_001_0	7	1		1			0	07/12/2021	2022.01	07/12/2021 04:59:29 PM Central Daylight Time	08/04/2021 11:40:37 AM Central Daylight Time	08/02/2021 12:12:18 PM Central Daylight Time			08/05/2021 11:18:13 AM Central Daylight Time	PROCARE ADVANTAGE, LLC	ProCare Advantage	www.procareadvantageplan.com	ProCare Advantage (HMO I-SNP)	01	01		1			H3467	001	0	2022	Texas (partial)		2		2			1	1	1				www.procareadvantageplan.com	www.procareadvantageplan.com	www.procareadvantageplan.com	(844)206-3719		(844)206-3719		(844)206-3719		(844)206-3719		(844)206-3719		(844)206-3719		(844)206-3719		(844)206-3719		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3471	001	0	1	01	01	H3471_001_0	10	1					1	09/27/2021	2022.01	09/27/2021 08:51:19 AM Central Daylight Time	08/02/2021 11:50:36 PM Central Daylight Time	07/30/2021 02:10:01 PM Central Daylight Time			09/27/2021 12:09:43 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	2022	Okanogan, Chelan, Douglas, Grant		2	16865	2			2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)750-3350		(509)662-0736		(877)561-1463		(877)561-1463		(877)750-3350		(509)662-0736		(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	10	1					1	09/27/2021	2022.01	09/27/2021 08:52:40 AM Central Daylight Time	08/02/2021 11:52:22 PM Central Daylight Time	07/30/2021 02:10:33 PM Central Daylight Time			09/27/2021 12:09:43 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	2022	Okanogan, Chelan, Douglas, Grant County		2	3578	2			2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)750-3350		(509)662-0736		(877)561-1463		(877)561-1463		(877)750-3350		(509)662-0736		(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				0	0	09/27/2021	2022.01	09/27/2021 08:55:09 AM Central Daylight Time	08/02/2021 11:54:10 PM Central Daylight Time				09/27/2021 12:09:43 PM 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	2022	Okanogan, Chelan, Douglas, Grant County		2	1793	2			2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)750-3350		(509)662-0736		(877)561-1463		(877)561-1463										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3471	004	0	1	01	01	H3471_004_0	11	1					1	09/29/2021	2022.01	09/29/2021 12:04:35 PM Central Daylight Time	08/02/2021 11:55:55 PM Central Daylight Time	07/30/2021 02:11:01 PM Central Daylight Time			09/29/2021 12:45:36 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	2022	Yakima County		2	9439	2			2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)795-6117		(509)453-1210		(877)642-3331		(509)453-1318		(877)795-6117		(509)453-1210		(877)642-3331		(509)453-1318		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3471	005	0	1	01	01	H3471_005_0	11	1					1	09/29/2021	2022.01	09/29/2021 12:04:58 PM Central Daylight Time	08/02/2021 11:57:40 PM Central Daylight Time	07/30/2021 02:11:31 PM Central Daylight Time			09/29/2021 12:45:36 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	2022	Yakima County		2	6620	2			2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)795-6117		(509)453-1210		(877)642-3331		(509)453-1318		(877)795-6117		(509)453-1210		(877)642-3331		(509)453-1318		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3471	006	0	1	01	01	H3471_006_0	8	1				0	0	09/29/2021	2022.01	09/29/2021 12:05:20 PM Central Daylight Time	08/02/2021 11:59:25 PM Central Daylight Time				09/29/2021 12:45:36 PM 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	2022	Yakima County		2	717	2			2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)795-6117		(509)453-1210		(877)642-3331		(509)453-1318										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3471	010	0	1	01	01	H3471_010_0	10	1					1	09/27/2021	2022.01	09/27/2021 08:52:22 AM Central Daylight Time	08/03/2021 12:01:12 AM Central Daylight Time	07/30/2021 02:11:59 PM Central Daylight Time			09/27/2021 12:09:43 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	2022	Okanogan, Chelan, Douglas, Grant County		2	20585	2			2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)750-3350		(509)662-0736		(877)561-1463		(877)561-1463		(877)750-3350		(509)662-0736		(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	11	1					1	09/29/2021	2022.01	09/29/2021 12:05:53 PM Central Daylight Time	08/03/2021 12:02:55 AM Central Daylight Time	07/30/2021 02:12:29 PM Central Daylight Time			09/29/2021 12:45:36 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	2022	Yakima County		2	645	2			2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)795-6117		(509)453-1210		(877)642-3331		(509)453-1318		(877)795-6117		(509)453-1210		(877)642-3331		(509)453-1318		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3471	014	0	1	02	01	H3471_014_0	11	1					1	09/29/2021	2022.01	09/29/2021 12:06:19 PM Central Daylight Time	08/03/2021 12:04:38 AM Central Daylight Time	07/30/2021 02:12:57 PM Central Daylight Time			09/29/2021 12:45:36 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	2022	Yakima County		2	1529	2			2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)795-6117		(509)453-1210		(877)642-3331		(509)453-1318		(877)795-6117		(509)453-1210		(877)642-3331		(509)453-1318		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3471	017	0	1	01	01	H3471_017_0	10	1					1	09/27/2021	2022.01	09/27/2021 08:50:53 AM Central Daylight Time	08/03/2021 12:06:25 AM Central Daylight Time	07/30/2021 02:13:26 PM Central Daylight Time			09/27/2021 12:09:43 PM Central Daylight Time	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Health Alliance Northwest	www.healthalliancemedicare.org	Health Alliance NW Companion Basic Rx 2 (HMO)	01	01		1			H3471	017	0	2022	Okanogan, Chelan, Douglas, Grant		2	79309	2			2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)750-3350		(509)662-0736		(877)561-1463		(877)561-1463		(877)750-3350		(509)662-0736		(877)561-1463		(877)561-1463		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3471	018	0	1	02	01	H3471_018_0	10	1					1	09/27/2021	2022.01	09/27/2021 10:51:51 AM Central Daylight Time	08/03/2021 12:08:12 AM Central Daylight Time	07/30/2021 02:13:55 PM Central Daylight Time			09/27/2021 12:09:43 PM Central Daylight Time	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Health Alliance Northwest	www.healthalliancemedicare.org	Health Alliance NW Companion POS Rx (HMO-POS)	01	02		1			H3471	018	0	2022	Okanogan, Chelan, Douglas, Grant		2	590	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	019	0	1	01	01	H3471_019_0	11	1					1	09/27/2021	2022.01	09/27/2021 08:50:24 AM Central Daylight Time	08/03/2021 12:09:55 AM Central Daylight Time	07/30/2021 02:14:23 PM Central Daylight Time			09/27/2021 12:09:43 PM Central Daylight Time	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Health Alliance Northwest	www.healthalliancemedicare.org	Health Alliance NW SignalAdvantage HMO Basic Rx (HMO)	01	01		1			H3471	019	0	2022	Yakima County		2	5748	2			2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)795-6117		(509)453-1210		(877)642-3331		(509)453-1318		(877)795-6117		(509)453-1210		(877)642-3331		(509)453-1318		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3471	801	0	1	01	01	H3471_801_0	4	1				0	0	04/21/2021	2022.01	04/21/2021 03:40:07 PM US Eastern Daylight Time					06/06/2021 01:28:52 PM Eastern Daylight Time	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Health Alliance Northwest	www.healthalliancemedicare.org	Medicare Employer HMO (HMO)	01	01		1			H3471	801	0	2022	Central Washington		1	23	1	1		2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)795-6117		(877)795-6117		(877)642-3331		(877)561-1463										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;7b;7c;7i;8a;8b1;8b2;9a1;9a2;9b;10a;11a;11b;15;	1	2;	1					1				
H3471	802	0	1	01	01	H3471_802_0	4	1						04/21/2021	2022.01	04/21/2021 03:39:20 PM US Eastern Daylight Time					06/06/2021 01:28:52 PM Eastern Daylight Time	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Health Alliance Northwest	www.healthalliancemedicare.org	Medicare Employer HMO Rx (HMO)	01	01		1			H3471	802	0	2022	Central Washington		1	23	1	1		2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)795-6117		(877)795-6117		(877)642-3331		(877)561-1463		(877)795-6117		(877)795-6117		(877)561-1463		(877)561-1463		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;7b;7c;7i;8a;8b1;8b2;9a1;9a2;9b;10a;11a;11b;15;	1	2;	1					1				
H3471	803	0	1	01	01	H3471_803_0	4	1						04/21/2021	2022.01	04/21/2021 03:47:10 PM US Eastern Daylight Time					06/06/2021 01:28:52 PM Eastern 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	2022	Central Washington		1	12	1	1		2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)795-6117		(877)795-6117		(877)642-3331		(877)561-1463		(877)795-6117		(877)795-6117		(877)642-3331		(877)561-1463		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;7b;7c;7i;8a;8b1;8b2;9a1;9a2;9b;10a;11a;11b;15;	1	2;	1					1				
H3471	804	0	1	02	01	H3471_804_0	4	1				0	0	04/21/2021	2022.01	04/21/2021 03:47:25 PM US Eastern Daylight Time					06/06/2021 01:28:52 PM Eastern 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	2022	Central Washington		1	12	1	1		2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)795-6117		(877)795-6117		(877)642-3331		(877)561-1463										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;7b;7c;7i;8a;8b1;8b2;9a1;9b;10a;11a;11b;15;	1	2;	1	1	1a;1b;2;5;7b;7c;8a;8b1;8b2;9a1;9a2;9b;10a;11a;11b;15;	2		1				
H3471	805	0	1	02	01	H3471_805_0	4	1						04/21/2021	2022.01	04/21/2021 03:51:01 PM US Eastern Daylight Time					06/06/2021 01:28:52 PM Eastern 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	2022	Central Washington		1	12	1	1		2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)795-6117		(877)795-6117		(877)642-3331		(877)561-1463		(877)795-6117		(877)795-6117		(877)561-1463		(877)561-1463		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;7b;7c;7i;8a;8b1;8b2;9a1;9a2;9b;10a;11a;11b;15;	1	2;	1	1	1a;1b;2;7b;7c;7i;8a;8b1;8b2;9a1;9a2;10a;11a;11b;15;	2		1				
H3471	806	0	1	02	01	H3471_806_0	4	1						04/21/2021	2022.01	04/21/2021 03:55:28 PM US Eastern Daylight Time					06/06/2021 01:28:52 PM Eastern 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	2022	Central Washington		1	12	1	1		2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)795-6117		(877)795-6117		(877)642-3331		(877)531-1463		(877)795-6117		(877)795-6117		(877)561-1463		(877)561-1463		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;7b;7c;7i;8a;8b1;8b2;9a1;9a2;9b;10a;11a;11b;15;	1	2;	1	1	1a;1b;2;5;7b;7c;7i;8a;8b1;8b2;9a1;9a2;9b;10a;11a;11b;15;	2		1				
H3473	001	0	1	20	08	H3473_001_0	1	1						05/27/2021	2022.01	05/27/2021 09:16:33 AM Mountain Daylight Time		05/27/2021 08:41:43 AM Mountain Daylight Time			05/27/2021 09:22:18 AM Mountain Daylight Time	INNOVAGE VIRGINIA PACE-CHARLOTTESVILLE, LLC	InnovAge Virginia PACE - Blue Ridge	www.MyInnovAge.com	Blue Ridge PACE Dual (PACE)	08	20		1			H3473	001	0	2022	Blue Ridge PACE Dual		2		2			2						https://www.granerx.com/	N/A - no formulary										(844)704-9613	711	(844)704-9613		(844)704-9613		(844)704-9613										(844)704-9613	711	(844)704-9613	711	(844)704-9613		(844)704-9613																
H3473	002	0	1	20	08	H3473_002_0	1	1						05/27/2021	2022.01	05/27/2021 09:16:46 AM Mountain Daylight Time		05/27/2021 08:41:43 AM Mountain Daylight Time			05/27/2021 09:22:18 AM Mountain Daylight Time	INNOVAGE VIRGINIA PACE-CHARLOTTESVILLE, LLC	InnovAge Virginia PACE - Blue Ridge	www.MyInnovAge.com	Blue Ridge PACE Medicare Only (PACE)	08	20		1			H3473	002	0	2022	Blue Ridge PACE Medicare Only		2		2			2						https://www.granerx.com/	N/A - no formulary										(844)704-9613	711	(844)704-9613		(844)704-9613		(844)704-9613										(844)704-9613	711	(844)704-9613	711	(844)704-9613		(844)704-9613																
H3493	001	0	1	20	08	H3493_001_0	3	1						05/28/2021	2022.01	05/28/2021 10:39:30 AM Eastern Daylight Time		05/27/2021 01:06:28 PM Eastern Daylight Time			05/28/2021 10:42:35 AM Eastern Daylight Time	LIFE AT LOURDES, INC.	Trinity Health LIFE New Jersey	http://www.trinityhealthpace.org	LIFE at Lourdes, Inc (PACE)	08	20		1			H3493	001	0	2022	Trinity Health New Jersey, Camden and Burlington		2		2			2						www.pharmastar.com	www.trinityhealthpace.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	3	1						05/28/2021	2022.01	05/28/2021 10:39:41 AM Eastern Daylight Time		05/27/2021 01:08:33 PM Eastern Daylight Time			05/28/2021 10:42:35 AM Eastern Daylight Time	LIFE AT LOURDES, INC.	Trinity Health LIFE New Jersey	http://www.trinityhealthpace.org	LIFE at Lourdes, Inc (PACE)	08	20		1			H3493	002	0	2022	Trinity Health New Jersey, Camden and Burlington		2		2			2						www.pharmastar.com	www.trinityhealthpace.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	002	0	1	01	01	H3499_002_0	3	1					0	08/03/2021	2022.01	08/03/2021 10:24:52 AM Eastern Daylight Time	08/04/2021 08:40:56 AM Eastern Daylight Time	07/30/2021 11:16:56 AM Eastern Daylight Time			08/04/2021 10:34:28 PM Eastern Daylight Time	COORDINATED CARE CORPORATION	Wellcare by Allwell	www.wellcare.com/allwellIN	Wellcare No Premium (HMO)	01	01		1			H3499	002	0	2022	Select counties in IN		2	15888	2			2						www.wellcare.com/allwellIN	www.wellcare.com/allwellIN	www.wellcare.com/allwellIN	(855)766-1541		(855)766-1541		(866)277-6583		(866)277-6583		(855)766-1541		(855)766-1541		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3499	005	0	1	01	01	H3499_005_0	3	1	2	1			0	08/03/2021	2022.01	08/03/2021 10:32:46 AM Eastern Daylight Time	08/04/2021 08:32:23 AM Eastern Daylight Time	07/30/2021 11:17:16 AM Eastern Daylight Time			08/04/2021 10:34:28 PM Eastern Daylight Time	COORDINATED CARE CORPORATION	Wellcare by Allwell	www.wellcare.com/allwellIN	Wellcare Dual Access (HMO D-SNP)	01	01		1			H3499	005	0	2022	All counties in IN		2	19326	2			1	3		1		1	www.wellcare.com/allwellIN	www.wellcare.com/allwellIN	www.wellcare.com/allwellIN	(833)202-4704		(833)202-4704		(866)277-6583		(866)277-6583		(833)202-4704		(833)202-4704		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3499	007	0	1	01	01	H3499_007_0	3	1					0	08/03/2021	2022.01	08/03/2021 10:36:38 AM Eastern Daylight Time	08/04/2021 08:30:01 AM Eastern Daylight Time	07/30/2021 11:17:36 AM Eastern Daylight Time			08/04/2021 10:34:28 PM Eastern Daylight Time	COORDINATED CARE CORPORATION	Wellcare by Allwell	www.wellcare.com/allwellIN	Wellcare Giveback (HMO)	01	01		1			H3499	007	0	2022	Select counties in IN		2	2541	2			2						www.wellcare.com/allwellIN	www.wellcare.com/allwellIN	www.wellcare.com/allwellIN	(855)766-1541		(855)766-1541		(866)277-6583		(866)277-6583		(855)766-1541		(855)766-1541		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3499	008	0	1	01	01	H3499_008_0	3	1					0	06/04/2021	2022.01	06/04/2021 01:14:46 PM Eastern Daylight Time	08/04/2021 08:35:39 AM Eastern Daylight Time	07/30/2021 11:17:56 AM Eastern Daylight Time			08/04/2021 10:34:28 PM Eastern Daylight Time	COORDINATED CARE CORPORATION	Wellcare by Allwell	www.wellcare.com/allwellIN	Wellcare Assist (HMO)	01	01		1			H3499	008	0	2022	Select counties in IN		2	3323	2			2						www.wellcare.com/allwellIN	www.wellcare.com/allwellIN	www.wellcare.com/allwellIN	(855)766-1541		(855)766-1541		(866)277-6583		(866)277-6583		(855)766-1541		(855)766-1541		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3499	801	0	1	01	01	H3499_801_0	2	1						05/03/2021	2022.01	05/03/2021 01:37:11 PM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	COORDINATED CARE CORPORATION	Wellcare by Allwell	allwell.mhsindiana.com	Allwell Group (HMO)	01	01		1			H3499	801	0	2022	Indiana		1	100	2			2						allwell.mhsindiana.com/findadoctor	allwell.mhsindiana.com/formulary	allwell.mhsindiana.com/findadoctor	(855)766-1541		(855)766-1541		(844)942-0039		(844)942-0039		(855)766-1541		(855)766-1541		(844)942-0039		(844)942-0039		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H3499	802	0	1	01	01	H3499_802_0	2	1				0	0	05/03/2021	2022.01	05/03/2021 01:37:19 PM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	COORDINATED CARE CORPORATION	Wellcare by Allwell	www.wellcare.com/allwellIN	Allwell Group (HMO)	01	01		1			H3499	802	0	2022	Indiana		1	100	2			2						www.wellcare.com/allwellIN	www.wellcare.com/allwellIN	www.wellcare.com/allwellIN	(855)766-1541		(855)766-1541		(844)942-0039		(844)942-0039										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H3499	803	0	1	01	01	H3499_803_0	2	1						05/03/2021	2022.01	05/03/2021 01:37:27 PM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	COORDINATED CARE CORPORATION	Wellcare by Allwell	allwell.mhsindiana.com	Allwell Group (HMO)	01	01		1			H3499	803	0	2022	Indiana		1	100	2			2						allwell.mhsindiana.com/findadoctor	allwell.mhsindiana.com/formulary	allwell.mhsindiana.com/findadoctor	(855)766-1541		(855)766-1541		(844)942-0039		(844)942-0039		(855)766-1541		(855)766-1541		(844)942-0039		(844)942-0039		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H3517	001	0	1	20	08	H3517_001_0	1	1						06/02/2021	2022.01	06/02/2021 11:42:17 AM Pacific Daylight Time		06/02/2021 11:41:04 AM Pacific Daylight Time			06/02/2021 11:49:20 AM 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	2022	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	1	1						06/02/2021	2022.01	06/02/2021 11:42:38 AM Pacific Daylight Time		06/02/2021 11:41:04 AM Pacific Daylight Time			06/02/2021 11:49:20 AM 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	2022	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)-																
H3522	001	0	1	20	08	H3522_001_0	1	1						06/02/2021	2022.01	06/02/2021 06:49:58 PM Eastern Daylight Time		06/02/2021 06:47:33 PM Eastern Daylight Time			06/02/2021 06:52:11 PM Eastern Daylight Time	REID HOSPITAL & HEALTH CARE SERVICES, INC.	Reid Health PACE Center	https://www.reidhealth.org/pace	Reid Health PACE Center (PACE)	08	20		1			H3522	001	0	2022	Indiana Counties: WY, F, HN, R, U, FR		2		2			2						https://www.carekinesis.com/	N/A												(765)935-8959				(765)935-8959										(800)643-2255		(800)643-2255		(800)643-2255		(800)643-2255																
H3522	002	0	1	20	08	H3522_002_0	1	1						06/02/2021	2022.01	06/02/2021 06:50:06 PM Eastern Daylight Time		06/02/2021 06:48:04 PM Eastern Daylight Time			06/02/2021 06:52:11 PM Eastern Daylight Time	REID HOSPITAL & HEALTH CARE SERVICES, INC.	Reid Health PACE Center	https://www.reidhealth.org/pace	Reid Health PACE Center (PACE)	08	20		1			H3522	002	0	2022	Indiana Counties: WY, F, HN, R, U, FR		2		2			2						https://www.carekinesis.com/	N/A												(765)935-8959				(765)935-8959										(800)643-2255		(800)643-2255		(800)643-2255		(800)643-2255																
H3528	003	0	1	01	01	H3528_003_0	3	1				0	0	06/06/2021	2022.01	06/06/2021 05:36:24 PM Eastern Daylight Time	07/14/2021 07:03:00 PM Eastern Daylight Time				07/14/2021 03:33:24 PM Eastern Daylight Time	CONNECTICARE, INC.	ConnectiCare	www.connecticare.com/medicare	ConnectiCare Choice Plan 2 (HMO)	01	01		1			H3528	003	0	2022	State of Connecticut		2		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										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3528	006	0	1	02	01	H3528_006_0	4	1					0	07/21/2021	2022.01	07/21/2021 11:35:33 AM Eastern Daylight Time	08/05/2021 06:38:00 PM Eastern Daylight Time	08/05/2021 06:38:00 PM Eastern Daylight Time			08/05/2021 03:09:51 PM Eastern Daylight Time	CONNECTICARE, INC.	ConnectiCare	www.connecticare.com/medicare	ConnectiCare Flex Plan 1 (HMO-POS)	01	02		1			H3528	006	0	2022	State of Connecticut		2		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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3528	010	0	1	01	01	H3528_010_0	3	1					0	08/05/2021	2022.01	08/05/2021 12:00:04 PM Eastern Daylight Time	08/05/2021 06:38:00 PM Eastern Daylight Time	08/05/2021 06:38:00 PM Eastern Daylight Time			08/05/2021 03:09:51 PM Eastern Daylight Time	CONNECTICARE, INC.	ConnectiCare	www.connecticare.com/medicare	ConnectiCare Passage Plan 1 (HMO)	01	01		1			H3528	010	0	2022	State of Connecticut		2		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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3528	011	1	1	02	01	H3528_011_1	3	1					0	06/06/2021	2022.01	06/06/2021 05:38:20 PM Eastern Daylight Time	08/05/2021 06:38:00 PM Eastern Daylight Time	08/05/2021 06:38:00 PM Eastern Daylight Time			08/05/2021 03:09:51 PM Eastern Daylight Time	CONNECTICARE, INC.	ConnectiCare	www.connecticare.com/medicare	ConnectiCare Flex Plan 3 (HMO-POS)	01	02		1			H3528	011	1	2022	State of Connecticut	Hartford, Litchfield, Middlesex, Tolland counties	2		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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3528	011	2	1	02	01	H3528_011_2	3	1					0	06/05/2021	2022.01	06/05/2021 05:09:01 PM Eastern Daylight Time	08/05/2021 06:38:00 PM Eastern Daylight Time	08/05/2021 06:38:00 PM Eastern Daylight Time			08/05/2021 03:09:51 PM Eastern Daylight Time	CONNECTICARE, INC.	ConnectiCare	www.connecticare.com/medicare	ConnectiCare Flex Plan 3 (HMO-POS)	01	02		1			H3528	011	2	2022	State of Connecticut	Fairfield, New Haven, New London, Windham counties	2		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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3528	014	0	1	01	01	H3528_014_0	4	1					0	08/04/2021	2022.01	08/04/2021 12:22:17 PM Eastern Daylight Time	08/05/2021 06:38:00 PM Eastern Daylight Time	08/05/2021 06:38:00 PM Eastern Daylight Time			08/05/2021 03:09:51 PM Eastern Daylight Time	CONNECTICARE, INC.	ConnectiCare	www.connecticare.com/medicare	ConnectiCare Choice Plan 3 (HMO)	01	01		1			H3528	014	0	2022	State of Connecticut		2		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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3528	015	0	1	02	01	H3528_015_0	3	1					0	06/02/2021	2022.01	06/02/2021 10:54:17 AM Eastern Daylight Time	08/05/2021 06:38:00 PM Eastern Daylight Time	08/05/2021 06:38:00 PM Eastern Daylight Time			08/05/2021 03:09:51 PM Eastern Daylight Time	CONNECTICARE, INC.	ConnectiCare	www.connecticare.com/medicare	ConnectiCare Flex Plan 2 (HMO-POS)	01	02		1			H3528	015	0	2022	State of Connecticut		2		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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3528	016	0	1	01	01	H3528_016_0	4	1					0	06/02/2021	2022.01	06/02/2021 10:47:30 AM Eastern Daylight Time	08/05/2021 06:38:00 PM Eastern Daylight Time	08/05/2021 06:38:00 PM Eastern Daylight Time			08/05/2021 03:09:51 PM Eastern Daylight Time	CONNECTICARE, INC.	ConnectiCare	www.connecticare.com/medicare	ConnectiCare Choice Plan 1 (HMO)	01	01		1			H3528	016	0	2022	State of Connecticut		2		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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3528	017	0	1	01	01	H3528_017_0	4	1					0	08/05/2021	2022.01	08/05/2021 12:06:25 PM Eastern Daylight Time	08/05/2021 06:38:00 PM Eastern Daylight Time	08/05/2021 06:38:00 PM Eastern Daylight Time			08/05/2021 03:09:51 PM Eastern Daylight Time	CONNECTICARE, INC.	ConnectiCare	www.connecticare.com/medicare	ConnectiCare Choice Part B Saver (HMO)	01	01		1			H3528	017	0	2022	State of Connecticut		2		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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3528	801	0	1	01	01	H3528_801_0	2	1						06/06/2021	2022.01	06/06/2021 05:43:39 PM Eastern Daylight Time					06/07/2021 04:16:18 PM Eastern Daylight Time	CONNECTICARE, INC.	ConnectiCare	www.connecticare.com/medicare	ConnectiCare Employer Group Plan (HMO)	01	01		1			H3528	801	0	2022	State of Connecticut		1	3112	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3528	805	0	1	01	01	H3528_805_0	2	1				0	0	06/06/2021	2022.01	06/06/2021 05:42:41 PM Eastern Daylight Time					06/07/2021 04:16:18 PM Eastern Daylight Time	CONNECTICARE, INC.	ConnectiCare	www.connecticare.com/medicare	ConnectiCare Employer Group Plan (HMO)	01	01		1			H3528	805	0	2022	State of Connecticut		1	600	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										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3528	806	0	1	02	01	H3528_806_0	2	1						06/06/2021	2022.01	06/06/2021 05:43:00 PM Eastern Daylight Time					06/07/2021 04:16:18 PM Eastern Daylight Time	CONNECTICARE, INC.	ConnectiCare	www.connecticare.com/medicare	ConnectiCare Employer Group Plan (HMO-POS)	01	02		1			H3528	806	0	2022	U.S and Territories		1	3712	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3528	807	0	1	02	01	H3528_807_0	2	1				0	0	06/06/2021	2022.01	06/06/2021 05:43:22 PM Eastern Daylight Time					06/07/2021 04:16:18 PM Eastern Daylight Time	CONNECTICARE, INC.	ConnectiCare	www.connecticare.com/medicare	ConnectiCare Employer Group Plan (HMO-POS)	01	02		1			H3528	807	0	2022	U.S and Territories		1	600	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										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3533	001	0	1	01	01	H3533_001_0	4	1			1		1	08/01/2021	2022.01	08/01/2021 12:23:23 PM Eastern Daylight Time	08/03/2021 05:42:55 PM Eastern Daylight Time	07/30/2021 10:37:40 AM Eastern Daylight Time			08/04/2021 01:51:34 PM 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	2022	Select Counties in New York		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	1		0	07/22/2021	2022.01	07/22/2021 02:17:59 PM Eastern Daylight Time	08/03/2021 05:43:55 PM Eastern Daylight Time	07/30/2021 10:37:54 AM Eastern Daylight Time			08/04/2021 02:16:27 PM Eastern Daylight Time	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H3533-002 (HMO D-SNP)	01	01		1			H3533	002	0	2022	Select Counties in New York		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		1	08/03/2021	2022.01	08/03/2021 04:38:02 PM Eastern Daylight Time	08/03/2021 05:41:58 PM Eastern Daylight Time	07/30/2021 10:38:06 AM Eastern Daylight Time			08/04/2021 02:16:27 PM 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	2022	Select Counties in New York		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		1	08/03/2021	2022.01	08/03/2021 04:26:50 PM Eastern Daylight Time	08/03/2021 05:42:36 PM Eastern Daylight Time	07/30/2021 10:38:18 AM Eastern Daylight Time			08/04/2021 02:01:21 PM 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	2022	Nassau and Suffolk counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		1	07/22/2021	2022.01	07/22/2021 02:18:14 PM Eastern Daylight Time	08/03/2021 05:43:15 PM Eastern Daylight Time	07/30/2021 10:38:30 AM Eastern Daylight Time			08/04/2021 02:16:27 PM 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	2022	Select Counties in New York		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		0	08/01/2021	2022.01	08/01/2021 12:33:52 PM Eastern Daylight Time	08/03/2021 05:46:12 PM Eastern Daylight Time	07/30/2021 10:38:42 AM Eastern Daylight Time			08/04/2021 02:01:21 PM 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	2022	New York City and Long Island		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	032	1	1	01	01	H3533_032_1	4	1			1		1	07/22/2021	2022.01	07/22/2021 01:40:34 PM Eastern Daylight Time	08/03/2021 05:50:15 PM Eastern Daylight Time	07/30/2021 10:38:54 AM Eastern Daylight Time			08/04/2021 02:01:21 PM Eastern Daylight Time	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H3533-032 (HMO)	01	01		1			H3533	032	1	2022	New York City	Select Counties in New York City	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	032	2	1	01	01	H3533_032_2	4	1			1		1	07/22/2021	2022.01	07/22/2021 01:40:42 PM Eastern Daylight Time	08/03/2021 05:50:34 PM Eastern Daylight Time	07/30/2021 10:39:06 AM Eastern Daylight Time			08/04/2021 02:01:21 PM Eastern Daylight Time	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H3533-032 (HMO)	01	01		1			H3533	032	2	2022	New York City	Richmond County	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	033	0	1	01	01	H3533_033_0	4	1			1		1	08/01/2021	2022.01	08/01/2021 12:35:01 PM Eastern Daylight Time	08/03/2021 05:51:51 PM Eastern Daylight Time	07/30/2021 10:39:20 AM Eastern Daylight Time			08/04/2021 02:01:21 PM Eastern Daylight Time	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H3533-033 (HMO)	01	01		1			H3533	033	0	2022	Brooklyn and Queens		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	034	1	1	01	01	H3533_034_1	4	1	2	1	1		0	08/01/2021	2022.01	08/01/2021 12:35:24 PM Eastern Daylight Time	08/03/2021 06:03:28 PM Eastern Daylight Time	07/30/2021 10:39:32 AM Eastern Daylight Time			08/04/2021 02:01:21 PM Eastern Daylight Time	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H3533-034 (HMO D-SNP)	01	01		1			H3533	034	1	2022	New York City	Select Counties in New York City	2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	034	2	1	01	01	H3533_034_2	4	1	2	1	1		0	08/01/2021	2022.01	08/01/2021 01:57:32 PM Eastern Daylight Time	08/03/2021 05:52:55 PM Eastern Daylight Time	07/30/2021 10:39:46 AM Eastern Daylight Time			08/04/2021 02:01:21 PM Eastern Daylight Time	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H3533-034 (HMO D-SNP)	01	01		1			H3533	034	2	2022	New York City	Long Island and Select Counties in New York City	2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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						05/25/2021	2022.01	05/25/2021 02:28:19 PM Eastern Daylight Time					06/04/2021 08:33:40 AM 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	2022	Select Counties in NY		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242		(866)396-8810		(866)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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H3533	803	0	1	01	01	H3533_803_0	1	1				0	0	05/25/2021	2022.01	05/25/2021 02:30:55 PM Eastern Daylight Time					06/04/2021 08:33:40 AM 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	2022	Select Counties in NY		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H3533	805	0	1	01	01	H3533_805_0	1	1						05/27/2021	2022.01	05/27/2021 03:33:51 PM Eastern Daylight Time					06/04/2021 08:33:40 AM Eastern Daylight Time	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H3533	805	0	2022	Select counties in NY		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242		(866)396-8810		(866)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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					2				
H3533	806	0	1	01	01	H3533_806_0	1	1				0	0	05/27/2021	2022.01	05/27/2021 03:35:47 PM Eastern Daylight Time					06/04/2021 08:33:40 AM Eastern Daylight Time	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H3533	806	0	2022	Select counties in NY		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					2				
H3536	002	0	1	01	01	H3536_002_0	6	1					0	06/04/2021	2022.01	06/04/2021 09:53:32 AM Eastern Daylight Time	08/03/2021 06:04:01 PM Eastern Daylight Time	08/03/2021 06:04:01 PM Eastern Daylight Time			08/04/2021 02:06:25 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	2022	State of  New Hampshire		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(855)310-2473		(855)310-2473		(855)679-0542		(855)679-0542		(833)339-3517		(833)339-3517		(855)485-0958		(855)485-0958		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3536	004	0	1	01	01	H3536_004_0	6	1					0	07/16/2021	2022.01	07/16/2021 12:45:55 PM Eastern Daylight Time	08/03/2021 06:04:01 PM Eastern Daylight Time	08/03/2021 06:04:01 PM Eastern Daylight Time			08/04/2021 02:06:25 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	2022	Select Counties in New Hampshire		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(855)310-2473		(855)310-2473		(855)679-0542		(855)679-0542		(833)339-3517		(833)339-3517		(855)485-0958		(855)485-0958		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3536	005	0	1	01	01	H3536_005_0	6	1					0	06/04/2021	2022.01	06/04/2021 05:34:02 PM Eastern Daylight Time	08/03/2021 06:04:01 PM Eastern Daylight Time	08/03/2021 06:04:01 PM Eastern Daylight Time			08/04/2021 02:06:25 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	2022	Select Counties in New Hampshire		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(855)310-2473		(855)310-2473		(855)679-0542		(855)679-0542		(833)339-3517		(833)339-3517		(855)485-0958		(855)485-0958		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3536	006	0	1	01	01	H3536_006_0	7	1					0	07/18/2021	2022.01	07/18/2021 01:03:37 PM Eastern Daylight Time	08/03/2021 06:04:01 PM Eastern Daylight Time	08/03/2021 06:04:01 PM Eastern Daylight Time			08/04/2021 02:06:25 PM Eastern Daylight Time	MATTHEW THORNTON HEALTH PLAN, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Select Plus (HMO)	01	01		1			H3536	006	0	2022	Select Counties in New Hampshire		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(855)310-2473		(855)310-2473		(855)679-0542		(855)679-0542		(833)339-3517		(833)339-3517		(855)485-0958		(855)485-0958		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3536	801	0	1	01	01	H3536_801_0	1	1						06/02/2021	2022.01	06/02/2021 03:49:21 PM Pacific Daylight Time					06/04/2021 10:18:17 AM 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	2022	Select counties in New Hampshire		1	600	2			2						www.anthem.com/nh/medicare	www.anthem.com/nh/medicare	www.anthem.com/nh/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)360-3660		(833)360-3660		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1					1				
H3536	802	0	1	01	01	H3536_802_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 03:49:28 PM Pacific Daylight Time					06/04/2021 10:18:17 AM 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	2022	Select Counties in New Hampshire		1	600	2			2						www.anthem.com/nh/medicare	www.anthem.com/nh/medicare	www.anthem.com/nh/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1					1				
H3536	803	0	2	01	01	H3536_803_0	1	1						06/02/2021	2022.01	06/02/2021 03:49:35 PM Pacific Daylight Time					06/04/2021 10:18:17 AM 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	2022	New Hampshire - Select Counties		1	600	2			2						www.anthem.com/nh/medicare	www.anthem.com/nh/medicare	www.anthem.com/nh/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)360-3660		(833)360-3660		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1					1				
H3536	804	0	2	01	01	H3536_804_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 03:49:43 PM Pacific Daylight Time					06/04/2021 10:18:17 AM 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	2022	Select New Hampshire Counties		1	600	2			2						www.anthem.com/nh/medicare	www.anthem.com/nh/medicare	www.anthem.com/nh/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1					1				
H3536	806	0	1	01	01	H3536_806_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 03:49:56 PM Pacific Daylight Time					06/04/2021 10:18:17 AM 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	2022	Select New Hampshire Counties		1	600	2			2						www.anthem.com/nh/medicare	www.anthem.com/nh/medicare	www.anthem.com/nh/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1					1				
H3536	808	0	2	01	01	H3536_808_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 03:50:08 PM Pacific Daylight Time					06/04/2021 10:18:17 AM 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	2022	Select NH counties		1	600	2			2						www.anthem.com/nh/medicare	www.anthem.com/nh/medicare	www.anthem.com/nh/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1					1				
H3554	002	0	1	04	01	H3554_002_0	4	1					1	08/04/2021	2022.01	08/04/2021 05:04:05 PM Central Daylight Time	08/04/2021 05:12:43 PM Central Daylight Time	08/04/2021 05:17:57 PM Central Daylight Time			08/04/2021 05:33:00 PM Central Daylight Time	USABLE PPO INSURANCE COMPANY	Arkansas Blue Medicare	www.arkansasbluecross.com/medicare	BlueMedicare Saver Choice (PPO)	01	04		1			H3554	002	0	2022	Select Counties in Arkansas		2	13131	2			2						www.arkansasbluecross.com/medicare	www.arkansasbluecross.com/medicare	www.arkansasbluecross.com	(844)201-4934		(844)201-4934		(888)605-0322		(888)605-0322		(844)201-4934		(844)201-4934		(888)605-0322		(888)605-0322		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3554	003	0	1	04	01	H3554_003_0	4	1					1	08/04/2021	2022.01	08/04/2021 05:05:49 PM Central Daylight Time	08/04/2021 05:12:48 PM Central Daylight Time	08/04/2021 05:18:01 PM Central Daylight Time			08/04/2021 05:33:00 PM Central Daylight Time	USABLE PPO INSURANCE COMPANY	Arkansas Blue Medicare	www.arkansasbluecross.com/medicare	BlueMedicare Value Choice (PPO)	01	04		1			H3554	003	0	2022	Select Counties in Northwest, West, and Central AR		2	2738	2			2						www.arkansasbluecross.com/medicare	www.arkansasbluecross.com/medicare	www.arkansasbluecross.com	(844)201-4934		(844)201-4934		(888)605-0322		(888)605-0322		(844)201-4934		(844)201-4934		(888)605-0322		(888)605-0322		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3554	004	0	1	04	01	H3554_004_0	4	1					1	08/04/2021	2022.01	08/04/2021 05:06:52 PM Central Daylight Time	08/04/2021 05:12:52 PM Central Daylight Time	08/04/2021 05:18:05 PM Central Daylight Time			08/04/2021 05:33:00 PM Central Daylight Time	USABLE PPO INSURANCE COMPANY	Arkansas Blue Medicare	www.arkansasbluecross.com/medicare	BlueMedicare Value Choice (PPO)	01	04		1			H3554	004	0	2022	Select Counties in Arkansas		2	5876	2			2						www.arkansasbluecross.com/medicare	www.arkansasbluecross.com/medicare	www.arkansasbluecross.com	(844)201-4934		(844)201-4934		(888)605-0322		(888)605-0322		(844)201-4934		(844)201-4934		(888)605-0322		(888)605-0322		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3554	007	0	1	04	01	H3554_007_0	4	1					1	08/04/2021	2022.01	08/04/2021 05:07:54 PM Central Daylight Time	08/04/2021 05:12:58 PM Central Daylight Time	08/04/2021 05:18:09 PM Central Daylight Time			08/04/2021 05:33:00 PM Central Daylight Time	USABLE PPO INSURANCE COMPANY	Arkansas Blue Medicare	www.arkansasbluecross.com/medicare	BlueMedicare Premier Choice (PPO)	01	04		1			H3554	007	0	2022	Select Counties in Northwest, West, and Central AR		2	14685	2			2						www.arkansasbluecross.com/medicare	www.arkansasbluecross.com/medicare	www.arkansasbluecross.com	(844)201-4934		(844)201-4934		(888)605-0322		(888)605-0322		(844)201-4934		(844)201-4934		(888)605-0322		(888)605-0322		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3554	008	0	1	04	01	H3554_008_0	4	1					1	08/04/2021	2022.01	08/04/2021 05:08:46 PM Central Daylight Time	08/04/2021 05:13:03 PM Central Daylight Time	08/04/2021 05:18:13 PM Central Daylight Time			08/04/2021 05:33:00 PM Central Daylight Time	USABLE PPO INSURANCE COMPANY	Arkansas Blue Medicare	www.arkansasbluecross.com/medicare	BlueMedicare Premier Choice (PPO)	01	04		1			H3554	008	0	2022	Select Counties in Arkansas		2	11849	2			2						www.arkansasbluecross.com/medicare	www.arkansasbluecross.com/medicare	www.arkansasbluecross.com	(844)201-4934		(844)201-4934		(888)605-0322		(888)605-0322		(844)201-4934		(844)201-4934		(888)605-0322		(888)605-0322		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3554	801	0	1	04	01	H3554_801_0	1	1						05/27/2021	2022.01	05/27/2021 03:43:27 PM Central Daylight Time					06/02/2021 03:29:18 PM Central Daylight Time	USABLE PPO INSURANCE COMPANY	Arkansas Blue Medicare	www.arkbluemedicare.com	BlueMedicare Premier Group CY (PPO)	01	04		1			H3554	801	0	2022	Employer Group Plan		1	999	2			2						http://www.arkansasbluecross.com/medicare	http://www.arkansasbluecross.com/medicare	www.arkbluemedicare.com	(844)201-4934		(844)201-4934		(888)605-0322		(888)605-0322		(844)201-4934		(844)201-4934		(888)605-0322		(888)605-0322		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H3554	802	0	1	04	01	H3554_802_0	1	1						05/25/2021	2022.01	05/25/2021 12:04:26 PM Central Daylight Time					06/02/2021 03:29:18 PM Central Daylight Time	USABLE PPO INSURANCE COMPANY	Arkansas Blue Medicare	www.arkbluemedicare.com	BlueMedicare Premier Group NCY (PPO)	01	04		1			H3554	802	0	2022	Employer Group Plan		1	999	2			2						http://www.arkansasbluecross.com/medicare	http://www.arkansasbluecross.com/medicare	www.arkbluemedicare.com	(844)201-4934		(844)201-4934		(888)605-0322		(888)605-0322		(844)201-4934		(844)201-4934		(888)605-0322		(888)605-0322		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H3554	803	0	1	04	01	H3554_803_0	1	1				0	0	05/25/2021	2022.01	05/25/2021 12:06:19 PM Central Daylight Time					06/02/2021 03:29:18 PM Central Daylight Time	USABLE PPO INSURANCE COMPANY	Arkansas Blue Medicare	www.arkbluemedicare.com	BlueMedicare Value Group CY (PPO)	01	04		1			H3554	803	0	2022	Employer Group Plan		1	999	2			2						http://www.arkansasbluecross.com/medicare	http://www.arkansasbluecross.com/medicare	www.arkbluemedicare.com	(844)201-4934		(844)201-4934		(888)605-0322		(888)605-0322										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H3554	804	0	1	04	01	H3554_804_0	1	1				0	0	05/25/2021	2022.01	05/25/2021 12:06:58 PM Central Daylight Time					06/02/2021 03:29:18 PM Central Daylight Time	USABLE PPO INSURANCE COMPANY	Arkansas Blue Medicare	www.arkbluemedicare.com	BlueMedicare Value Group NCY (PPO)	01	04		1			H3554	804	0	2022	Employer Group Plan		1	999	2			2						http://www.arkansasbluecross.com/medicare	http://www.arkansasbluecross.com/medicare	www.arkbluemedicare.com	(844)201-4934		(844)201-4934		(888)605-0322		(888)605-0322										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H3557	001	0	1	04	01	H3557_001_0	8	1					1	08/04/2021	2022.01	08/04/2021 10:57:55 AM Eastern Daylight Time	08/05/2021 08:54:10 AM Eastern Daylight Time	08/05/2021 08:54:12 AM Eastern Daylight Time			08/05/2021 01:26:32 PM Eastern Daylight Time	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Blue Cross & Blue Shield of Rhode Island	www.BCBSRI.com/Medicare	HealthMate for Medicare (PPO)	01	04		1			H3557	001	0	2022	State of Rhode Island		2	81148	2			2						www.BCBSRI.com/Medicare	www.BCBSRI.com/Medicare	https://www.bcbsri.com/finddoctor	(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						1	01	7a;	
H3557	801	0	1	04	01	H3557_801_0	6	1						06/07/2021	2022.01	06/07/2021 01:32:22 PM Eastern Daylight Time					06/07/2021 04:58:56 PM Eastern Daylight Time	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Blue Cross & Blue Shield of Rhode Island	www.BCBSRI.com/Medicare	HealthMate Coast-to-Coast for Medicare Group (PPO)	01	04		1			H3557	801	0	2022	RI, Nationwide		1	24632	2			2						www.BCBSRI.com/Medicare	www.BCBSRI.com/Medicare	https://www.bcbsri.com/finddoctor	(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			
H3557	802	0	1	04	01	H3557_802_0	6	1						06/07/2021	2022.01	06/07/2021 01:32:34 PM Eastern Daylight Time					06/07/2021 04:58:56 PM Eastern Daylight Time	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Blue Cross & Blue Shield of Rhode Island	www.BCBSRI.com/Medicare	HealthMate Coast-to-Coast for Medicare Group (PPO)	01	04		1			H3557	802	0	2022	RI, Nationwide		1	250	2			2						www.BCBSRI.com/Medicare	www.BCBSRI.com/Medicare	https://www.bcbsri.com/finddoctor	(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			
H3557	803	0	1	04	01	H3557_803_0	6	1				0	0	06/07/2021	2022.01	06/07/2021 01:32:50 PM Eastern Daylight Time					06/07/2021 04:58:56 PM Eastern Daylight Time	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Blue Cross & Blue Shield of Rhode Island	www.BCBSRI.com/Medicare	HealthMate Coast-to-Coast for Medicare Group (PPO)	01	04		1			H3557	803	0	2022	RI, Nationwide		1	250	2			2						www.bcbsri.com	www.bcbsri.com	https://www.bcbsri.com/finddoctor	(800)267-0439		(401)277-2958		(800)505-2583		(401)351-2583										(711)-		(711)-		(711)-		(711)-										2					2						2			
H3561	001	0	1	01	01	H3561_001_0	5	1	2	1			0	07/14/2021	2022.01	07/14/2021 01:05:55 PM Eastern Daylight Time	08/04/2021 12:08:44 AM Eastern Daylight Time	07/30/2021 11:18:16 AM Eastern Daylight Time			08/04/2021 11:49:10 PM Eastern Daylight Time	HEALTH NET COMMUNITY SOLUTIONS, INC.	Health Net	www.wellcare.com/healthnetCA	Wellcare Dual Liberty Amber (HMO D-SNP)	01	01		1			H3561	001	0	2022	Select counties in CA		2	12852	2			1	3		1		1	www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	(800)275-4737		(800)275-4737		(866)277-6583		(866)277-6583		(800)275-4737		(800)275-4737		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3561	002	0	1	01	01	H3561_002_0	4	1					0	06/03/2021	2022.01	06/03/2021 10:27:56 AM Eastern Daylight Time	08/04/2021 12:09:12 AM Eastern Daylight Time	07/30/2021 11:18:48 AM Eastern Daylight Time			08/04/2021 11:49:10 PM Eastern Daylight Time	HEALTH NET COMMUNITY SOLUTIONS, INC.	Health Net	www.wellcare.com/healthnetCA	Wellcare Plus Sapphire II (HMO)	01	01		1			H3561	002	0	2022	Select counties in CA		2	227205	2			2						www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	(800)275-4737		(800)275-4737		(866)277-6583		(866)277-6583		(800)275-4737		(800)275-4737		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3561	801	0	1	01	01	H3561_801_0	2	1						05/03/2021	2022.01	05/03/2021 01:37:37 PM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	HEALTH NET COMMUNITY SOLUTIONS, INC.	Wellcare by Health Net	healthnet.com	Health Net Seniority Plus Employer (HMO)	01	01		1			H3561	801	0	2022	California		1	100	2			2						ca.healthnetadvantage.com/findadoctor	ca.healthnetadvantage.com/formulary	ca.healthnetadvantage.com/findadoctor	(800)275-4737		(800)275-4737		(844)942-0039		(844)942-0039		(800)275-4737		(800)275-4737		(844)942-0039		(844)942-0039		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H3561	802	0	1	01	01	H3561_802_0	2	1				0	0	05/03/2021	2022.01	05/03/2021 01:37:44 PM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	HEALTH NET COMMUNITY SOLUTIONS, INC.	Wellcare by Health Net	healthnet.com	Health Net Seniority Plus Employer (HMO)	01	01		1			H3561	802	0	2022	California		1	100	2			2						ca.healthnetadvantage.com/findadoctor	ca.healthnetadvantage.com/formulary	ca.healthnetadvantage.com/findadoctor	(800)275-4737		(800)275-4737		(844)942-0039		(844)942-0039										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H3561	803	0	1	01	01	H3561_803_0	2	1						05/03/2021	2022.01	05/03/2021 01:37:51 PM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	HEALTH NET COMMUNITY SOLUTIONS, INC.	Wellcare by Health Net	healthnet.com	Health Net Seniority Plus Employer (HMO)	01	01		1			H3561	803	0	2022	California		1	100	2			2						ca.healthnetadvantage.com/findadoctor	ca.healthnetadvantage.com/formulary	ca.healthnetadvantage.com/findadoctor	(800)275-4737		(800)275-4737		(844)942-0039		(844)942-0039		(800)275-4737		(800)275-4737		(844)942-0039		(844)942-0039		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H3563	001	0	1	20	08	H3563_001_0	1	1						06/01/2021	2022.01	06/01/2021 09:47:23 AM Pacific Daylight Time		06/01/2021 09:31:08 AM Pacific Daylight Time			06/01/2021 09:50:54 AM Pacific Daylight Time	GARY AND MARY WEST SENIOR SERVICES, INC.	Gary and Mary West PACE	westpace.org	Gary and Mary West Senior Services, Inc (PACE)	08	20		1			H3563	001	0	2022	San Diego North County		2		2			2						www.Carekinesis.com	www.westpace.org												(760)280-2230				(760)280-2230												(800)920-7098				(800)920-7098																
H3563	002	0	1	20	08	H3563_002_0	1	1						06/01/2021	2022.01	06/01/2021 09:48:10 AM Pacific Daylight Time		06/01/2021 09:31:08 AM Pacific Daylight Time			06/01/2021 09:50:54 AM Pacific Daylight Time	GARY AND MARY WEST SENIOR SERVICES, INC.	Gary and Mary West PACE	westpace.org	Gary and Mary West Senior Services, Inc (PACE)	08	20		1			H3563	002	0	2022	San Diego North County		2		2			2						www.Carekinesis.com	www.westpace.org												(760)280-2230				(760)280-2230												(800)920-7098				(800)920-7098																
H3597	001	0	1	01	01	H3597_001_0	3	1			2		0	08/02/2021	2022.01	08/02/2021 03:10:32 PM Eastern Daylight Time	08/02/2021 04:26:08 PM Eastern Daylight Time	08/02/2021 09:36:27 AM Eastern Daylight Time			08/04/2021 01:33:15 PM Eastern Daylight Time	AETNA HEALTH INC. (ME)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H3597	001	0	2022	Southern Maine		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3597	007	0	1	01	01	H3597_007_0	3	1			2		0	08/02/2021	2022.01	08/02/2021 03:11:14 PM Eastern Daylight Time	08/02/2021 04:33:43 PM Eastern Daylight Time	08/02/2021 09:36:31 AM Eastern Daylight Time			08/04/2021 01:33:15 PM Eastern Daylight Time	AETNA HEALTH INC. (ME)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H3597	007	0	2022	Mid Maine		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3597	009	0	1	01	01	H3597_009_0	3	1			2		0	08/02/2021	2022.01	08/02/2021 03:16:39 PM Eastern Daylight Time	08/02/2021 04:35:21 PM Eastern Daylight Time	08/02/2021 09:36:35 AM Eastern Daylight Time			08/04/2021 01:33:15 PM Eastern Daylight Time	AETNA HEALTH INC. (ME)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H3597	009	0	2022	Northern and Additional Maine		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3597	011	0	1	02	01	H3597_011_0	5	1	2	1	1		0	07/08/2021	2022.01	07/08/2021 10:25:48 AM Eastern Daylight Time	08/02/2021 04:37:35 PM Eastern Daylight Time	08/02/2021 09:36:39 AM Eastern Daylight Time			08/04/2021 01:33:15 PM Eastern Daylight Time	AETNA HEALTH INC. (ME)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Assure Plan (HMO-POS D-SNP)	01	02		1			H3597	011	0	2022	Maine		2		2			1	3		1		1	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3597	801	0	1	01	01	H3597_801_0	1	1				0	0	05/27/2021	2022.01	05/27/2021 11:23:04 PM Eastern Daylight Time					06/03/2021 01:07:05 PM Eastern Daylight Time	AETNA HEALTH INC. (ME)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (HMO)	01	01		1			H3597	801	0	2022	Maine		1	280	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H3597	802	0	1	01	01	H3597_802_0	1	1						05/27/2021	2022.01	05/27/2021 11:23:58 PM Eastern Daylight Time					06/03/2021 01:07:05 PM Eastern Daylight Time	AETNA HEALTH INC. (ME)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan w/Rx (HMO)	01	01		1			H3597	802	0	2022	Maine		1	120	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H3613	001	0	1	20	08	H3613_001_0	1	1						05/27/2021	2022.01	05/27/2021 11:51:34 AM Eastern Daylight Time		05/27/2021 11:48:26 AM Eastern Daylight Time			05/27/2021 11:53:51 AM Eastern Daylight Time	MCGREGOR PACE	McGregor PACE	http://www.mcgregorpace.org/	McGregor PACE Dual Eligibles (PACE)	08	20		1			H3613	001	0	2022	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						05/27/2021	2022.01	05/27/2021 11:51:54 AM Eastern Daylight Time		05/27/2021 11:48:36 AM Eastern Daylight Time			05/27/2021 11:53:51 AM Eastern Daylight Time	MCGREGOR PACE	McGregor PACE	http://www.mcgregorpace.org/	McGregor PACE Medicare Only Eligibles (PACE)	08	20		1			H3613	002	0	2022	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																
H3632	001	0	1	04	01	H3632_001_0	5	1					1	07/14/2021	2022.01	07/14/2021 02:32:43 PM Central Daylight Time	08/05/2021 08:33:03 AM Central Daylight Time	08/05/2021 11:26:00 AM Central Daylight Time			08/05/2021 02:08:04 PM Central Daylight Time	MEDICA COMMUNITY HEALTH PLAN	Medica	medica.com	Medica Advantage Solution H3632-001 (PPO)	01	04		1			H3632	001	0	2022	Select counties in IA and NE		2		2			2						medica.com/Members	medica.com/Members	medica.com/Members	(866)398-7374		(952)992-2134		(800)906-5432		(952)992-2345		(866)398-7374		(952)992-2134		(800)906-5432		(952)992-2345		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3653	004	0	1	01	01	H3653_004_0	6	1					1	07/08/2021	2022.01	07/08/2021 02:15:45 PM Eastern Daylight Time	08/02/2021 11:42:42 AM Eastern Daylight Time	08/02/2021 11:27:08 AM Eastern Daylight Time			08/04/2021 04:23:28 PM Eastern Daylight Time	PARAMOUNT CARE, INC.	Paramount Elite Medicare Plans	paramounthealthcare.com/medicareplans	Paramount Elite Enhanced (HMO)	01	01		1			H3653	004	0	2022	Paramount Elite Enhanced (Northern OH / SE Mich)		2		2			2						http://www.paramounthealthcare.com/medicareplans	http://www.paramounthealthcare.com/medicareplans	http://www.paramounthealthcare.com/medicareplans	(833)554-2335		(567)585-9888		(833)554-2335		(567)585-9888		(833)554-2335		(567)585-9888		(833)554-2335		(567)585-9888		(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					0	07/07/2021	2022.01	07/07/2021 01:26:02 PM Eastern Daylight Time	08/02/2021 11:43:56 AM Eastern Daylight Time	08/02/2021 11:28:36 AM Eastern Daylight Time			08/04/2021 04:23:28 PM Eastern Daylight Time	PARAMOUNT CARE, INC.	Paramount Elite Medicare Plans	paramounthealthcare.com/medicareplans	Paramount Elite Standard (HMO)	01	01		1			H3653	015	0	2022	Paramount Elite Standard (Northern OH / SE Mich)		2		2			2						http://www.paramounthealthcare.com/medicareplans	http://www.paramounthealthcare.com/medicareplans	http://www.paramounthealthcare.com/medicareplans	(833)554-2335		(567)585-9888		(833)554-2335		(567)585-9888		(833)554-2335		(567)585-9888		(833)554-2335		(567)585-9888		(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	5	1				0	0	07/07/2021	2022.01	07/07/2021 01:34:38 PM Eastern Daylight Time	06/07/2021 08:43:28 AM Eastern Daylight Time				07/09/2021 01:48:55 PM Eastern Daylight Time	PARAMOUNT CARE, INC.	Paramount Elite Medicare Plans	paramounthealthcare.com/medicareplans	Paramount Elite Enhanced Medical Only (HMO)	01	01		1			H3653	018	0	2022	Paramount Elite Medical Only (North OH/ SE Mich)		2		2			2						http://www.paramounthealthcare.com/medicareplans	http://www.paramounthealthcare.com/medicareplans	http://www.paramounthealthcare.com/medicareplans	(833)554-2335		(567)585-9888		(833)554-2335		(567)585-9888										(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					1	07/07/2021	2022.01	07/07/2021 01:41:03 PM Eastern Daylight Time	08/02/2021 11:45:26 AM Eastern Daylight Time	08/02/2021 11:29:20 AM Eastern Daylight Time			08/04/2021 04:23:28 PM Eastern Daylight Time	PARAMOUNT CARE, INC.	Paramount Elite Medicare Plans	paramounthealthcare.com/medicareplans	Paramount Elite Prime (HMO)	01	01		1			H3653	022	0	2022	Paramount Elite Prime (Northern OH / SE Mich)		2		2			2						http://www.paramounthealthcare.com/medicareplans	http://www.paramounthealthcare.com/medicareplans	http://www.paramounthealthcare.com/medicareplans	(833)554-2335		(567)585-9888		(833)554-2335		(567)585-9888		(833)554-2335		(567)585-9888		(833)554-2335		(567)585-9888		(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	023	0	1	01	01	H3653_023_0	6	1					1	07/07/2021	2022.01	07/07/2021 01:47:17 PM Eastern Daylight Time	08/02/2021 11:46:10 AM Eastern Daylight Time	08/02/2021 11:30:02 AM Eastern Daylight Time			08/04/2021 04:23:28 PM Eastern Daylight Time	PARAMOUNT CARE, INC.	Paramount Elite Medicare Plans	paramounthealthcare.com/medicareplans	Paramount Elite Choice (HMO)	01	01		1			H3653	023	0	2022	Paramount Elite Choice (Southwestern Ohio)		2		2			2						http://www.paramounthealthcare.com/medicareplans	http://www.paramounthealthcare.com/medicareplans	http://www.paramounthealthcare.com/medicareplans	(833)554-2335		(567)585-9888		(833)554-2335		(567)585-9888		(833)554-2335		(567)585-9888		(833)554-2335		(567)585-9888		(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	024	0	1	01	01	H3653_024_0	6	1					1	07/07/2021	2022.01	07/07/2021 01:51:03 PM Eastern Daylight Time	08/02/2021 11:46:58 AM Eastern Daylight Time	08/02/2021 11:30:44 AM Eastern Daylight Time			08/04/2021 04:23:28 PM Eastern Daylight Time	PARAMOUNT CARE, INC.	Paramount Elite Medicare Plans	paramounthealthcare.com/medicareplans	Paramount Elite Essential (HMO)	01	01		1			H3653	024	0	2022	Paramount Elite Essential (Southwestern Ohio)		2		2			2						http://www.paramounthealthcare.com/medicareplans	http://www.paramounthealthcare.com/medicareplans	http://www.paramounthealthcare.com/medicareplans	(833)554-2335		(567)585-9888		(833)554-2335		(567)585-9888		(833)554-2335		(567)585-9888		(833)554-2335		(567)585-9888		(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				0	0	05/27/2021	2022.01	05/27/2021 12:00:56 PM Eastern Daylight Time					06/01/2021 10:50:47 AM Eastern Daylight Time	PARAMOUNT CARE, INC.	Paramount Elite Medicare Plans	paramounthealthcare.com/medicareplans	Paramount Elite - Emp Group A/B No Rx (HMO)	01	01		1			H3653	803	0	2022	Paramount Elite - Emp Group A/B No Rx		1	8436	2			2						http://www.paramounthealthcare.com/medicareplans	http://www.paramounthealthcare.com/medicareplans	http://www.paramounthealthcare.com/medicareplans	(833)554-2335		(567)585-9888		(833)554-2335		(567)585-9888										(888)740-5670		(888)740-5670		(888)740-5670		(888)740-5670										1	1	1a;1b;2;5;6;7b;7c;7g;7h;7i;8a;8b1;9a1;9b;9c;10a;11a;11b;15;	2		1					1				
H3653	806	0	2	01	01	H3653_806_0	1	1				0	0	05/27/2021	2022.01	05/27/2021 12:01:25 PM Eastern Daylight Time					06/01/2021 10:50:47 AM Eastern Daylight Time	PARAMOUNT CARE, INC.	Paramount Elite Medicare Plans	paramounthealthcare.com/medicareplans	Paramount Elite - Emp Group B Only No Rx (HMO)	01	01		2	2		H3653	806	0	2022	Paramount Elite - Emp Group B Only No Rx		1	840	2			2						http://www.paramounthealthcare.com/medicareplans	http://www.paramounthealthcare.com/medicareplans	http://www.paramounthealthcare.com/medicareplans	(833)554-2335		(567)585-9888		(833)554-2335		(567)585-9888										(888)740-5670		(888)740-5670		(888)740-5670		(888)740-5670										1	1	1a;1b;2;5;6;7b;7c;7g;7h;7i;8a;8b1;9a1;9b;9c;10a;11a;11b;15;	2		1					1				
H3653	809	0	1	01	01	H3653_809_0	1	1						05/27/2021	2022.01	05/27/2021 12:01:55 PM Eastern Daylight Time					06/01/2021 10:50:47 AM Eastern Daylight Time	PARAMOUNT CARE, INC.	Paramount Elite Medicare Plans	paramounthealthcare.com/medicareplans	Paramount Elite-Emp Group A/B Rx (HMO)	01	01		1			H3653	809	0	2022	Paramount Elite-Emp Group A/B Rx		1	528	2			2						http://www.paramounthealthcare.com/medicareplans	http://www.paramounthealthcare.com/medicareplans	http://www.paramounthealthcare.com/medicareplans	(833)554-2335		(567)585-9888		(833)554-2335		(567)585-9888		(833)554-2335		(567)585-9888		(833)554-2335		(567)585-9888		(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;7b;7c;7g;7h;7i;8a;8b1;9a1;9b;9c;10a;11a;11b;15;	2		1					1				
H3655	033	0	1	01	01	H3655_033_0	7	1	2	1	1		0	07/19/2021	2022.01	07/19/2021 02:42:36 PM Eastern Daylight Time	08/03/2021 06:03:59 PM Eastern Daylight Time	08/03/2021 06:03:59 PM Eastern Daylight Time			08/04/2021 02:00:52 PM Eastern Daylight Time	COMMUNITY INSURANCE COMPANY	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Dual Advantage (HMO D-SNP)	01	01		1			H3655	033	0	2022	Select Counties in Ohio		2		2			1	3		1		1	https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(844)879-3610		(844)879-3610		(855)679-0544		(855)679-0544		(833)339-3518		(833)339-3518		(855)485-0960		(855)485-0960		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3655	034	0	1	01	01	H3655_034_0	7	1			2		0	07/19/2021	2022.01	07/19/2021 02:42:50 PM Eastern Daylight Time	08/03/2021 06:03:59 PM Eastern Daylight Time	08/03/2021 06:03:59 PM Eastern Daylight Time			08/04/2021 02:00:52 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	2022	Select Counties in Ohio		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(855)690-7796		(855)690-7796		(855)679-0543		(855)679-0543		(833)339-3519		(833)339-3519		(855)485-0959		(855)485-0959		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3655	038	0	1	01	01	H3655_038_0	7	1			2		0	07/19/2021	2022.01	07/19/2021 02:43:06 PM Eastern Daylight Time	08/03/2021 06:03:59 PM Eastern Daylight Time	08/03/2021 06:03:59 PM Eastern Daylight Time			08/04/2021 02:00:52 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	2022	Select Counties in Ohio		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(855)690-7796		(855)690-7796		(855)679-0543		(855)679-0543		(833)339-3519		(833)339-3519		(855)485-0959		(855)485-0959		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3655	041	0	1	01	01	H3655_041_0	7	1			2		0	07/19/2021	2022.01	07/19/2021 02:43:24 PM Eastern Daylight Time	08/03/2021 06:03:59 PM Eastern Daylight Time	08/03/2021 06:03:59 PM Eastern Daylight Time			08/04/2021 02:00:52 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	2022	Select Counties in Ohio		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(855)690-7796		(855)690-7796		(855)679-0543		(855)679-0543		(833)339-3519		(833)339-3519		(855)485-0959		(855)485-0959		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3655	042	0	1	01	01	H3655_042_0	7	1			2		0	07/19/2021	2022.01	07/19/2021 02:43:40 PM Eastern Daylight Time	08/03/2021 06:03:59 PM Eastern Daylight Time	08/03/2021 06:03:59 PM Eastern Daylight Time			08/04/2021 02:00:52 PM Eastern Daylight Time	COMMUNITY INSURANCE COMPANY	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Preferred Plus (HMO)	01	01		1			H3655	042	0	2022	Select counties in Ohio		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(855)690-7796		(855)690-7796		(855)679-0543		(855)679-0543		(833)339-3519		(833)339-3519		(855)485-0959		(855)485-0959		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3655	044	0	1	01	01	H3655_044_0	7	1	2	1	1		0	07/19/2021	2022.01	07/19/2021 02:44:23 PM Eastern Daylight Time	08/03/2021 06:03:59 PM Eastern Daylight Time	08/03/2021 06:03:59 PM Eastern Daylight Time			08/04/2021 02:00:52 PM Eastern Daylight Time	COMMUNITY INSURANCE COMPANY	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue + Kroger Dual Advantage (HMO D-SNP)	01	01		1			H3655	044	0	2022	Select counties in OH		2		2			1	3		1		1	https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(855)690-7796		(855)690-7796		(855)679-0543		(855)679-0543		(833)339-3519		(833)339-3519		(855)485-0959		(855)485-0959		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3655	045	1	1	01	01	H3655_045_1	7	1			2		0	08/02/2021	2022.01	08/02/2021 12:34:14 PM Eastern Daylight Time	08/03/2021 06:03:59 PM Eastern Daylight Time	08/03/2021 06:03:59 PM Eastern Daylight Time			08/04/2021 02:00:52 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	045	1	2022	Select counties in OH	Toledo/Rural/All Other OH	2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(855)690-7796		(855)690-7796		(855)679-0543		(855)679-0543		(833)339-3519		(833)339-3519		(855)485-0959		(855)485-0959		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3655	045	2	1	01	01	H3655_045_2	7	1			2		0	07/19/2021	2022.01	07/19/2021 02:44:44 PM Eastern Daylight Time	08/03/2021 06:03:59 PM Eastern Daylight Time	08/03/2021 06:03:59 PM Eastern Daylight Time			08/04/2021 02:00:52 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	045	2	2022	Select counties in OH	Cincinnati/Dayton OH	2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(855)690-7796		(855)690-7796		(855)679-0543		(855)679-0543		(833)339-3519		(833)339-3519		(855)485-0959		(855)485-0959		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3655	045	3	1	01	01	H3655_045_3	7	1			2		0	07/19/2021	2022.01	07/19/2021 02:44:56 PM Eastern Daylight Time	08/03/2021 06:03:59 PM Eastern Daylight Time	08/03/2021 06:03:59 PM Eastern Daylight Time			08/04/2021 02:00:52 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	045	3	2022	Select counties in OH	Columbus OH	2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(855)690-7796		(855)690-7796		(855)679-0543		(855)679-0543		(833)339-3519		(833)339-3519		(855)485-0959		(855)485-0959		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3655	045	4	1	01	01	H3655_045_4	7	1			2		0	07/19/2021	2022.01	07/19/2021 02:45:06 PM Eastern Daylight Time	08/03/2021 06:03:59 PM Eastern Daylight Time	08/03/2021 06:03:59 PM Eastern Daylight Time			08/04/2021 02:00:52 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	045	4	2022	Select counties in OH	Cleveland/Akron/Ytown OH	2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(855)690-7796		(855)690-7796		(855)679-0543		(855)679-0543		(833)339-3519		(833)339-3519		(855)485-0959		(855)485-0959		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3655	801	0	1	01	01	H3655_801_0	1	1						06/02/2021	2022.01	06/02/2021 03:51:05 PM Pacific Daylight Time					06/04/2021 10:18:17 AM 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	2022	Ohio		1	2548	2			2						www.anthem.com/oh/medicare	www.anthem.com/oh/medicare	www.anthem.com/oh/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)360-3661		(833)360-3661		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1					1				
H3655	803	0	1	01	01	H3655_803_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 03:51:18 PM Pacific Daylight Time					06/04/2021 10:18:17 AM 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	2022	Ohio		1	240	2			2						www.anthem.com/oh/medicare	www.anthem.com/oh/medicare	www.anthem.com/oh/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1					1				
H3655	805	0	2	01	01	H3655_805_0	1	1						06/02/2021	2022.01	06/02/2021 03:51:26 PM Pacific Daylight Time					06/04/2021 10:18:17 AM 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	2022	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		(833)848-8729		(833)848-8729		(833)360-3661		(833)360-3661		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1					1				
H3655	806	0	2	01	01	H3655_806_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 03:51:33 PM Pacific Daylight Time					06/04/2021 10:18:17 AM 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	2022	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		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1					1				
H3655	808	0	1	01	01	H3655_808_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 03:51:43 PM Pacific Daylight Time					06/04/2021 10:18:17 AM 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	2022	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		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1					1				
H3655	810	0	2	01	01	H3655_810_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 03:51:58 PM Pacific Daylight Time					06/04/2021 10:18:17 AM 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	2022	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		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1					1				
H3660	028	0	1	02	01	H3660_028_0	5	1					0	08/04/2021	2022.01	08/04/2021 11:50:40 AM Eastern Daylight Time	08/05/2021 11:53:11 AM Eastern Daylight Time	08/05/2021 11:53:11 AM Eastern Daylight Time			08/05/2021 11:58:26 AM Eastern Daylight Time	SUMMACARE INC.	SummaCare Medicare Advantage Plans	www.summacare.com/medicare	SummaCare Medicare Emerald (HMO-POS)	01	02		1			H3660	028	0	2022	Northeast Ohio		2	13708	2			2						www.summacare.com/medicare	www.summacare.com/medicare	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	7	1					0	08/04/2021	2022.01	08/04/2021 05:35:35 PM Eastern Daylight Time	08/05/2021 11:53:11 AM Eastern Daylight Time	08/05/2021 11:53:11 AM Eastern Daylight Time			08/05/2021 11:58:26 AM Eastern Daylight Time	SUMMACARE INC.	SummaCare Medicare Advantage Plans	www.summacare.com/medicare	SummaCare Medicare Sapphire (HMO-POS)	01	02		1			H3660	029	0	2022	Northeast & Northwest Ohio		2	60006	2			2						www.summacare.com/medicare	www.summacare.com/medicare	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	8	1					0	08/04/2021	2022.01	08/04/2021 05:35:59 PM Eastern Daylight Time	08/05/2021 11:53:11 AM Eastern Daylight Time	08/05/2021 11:53:11 AM Eastern Daylight Time			08/05/2021 11:58:26 AM Eastern Daylight Time	SUMMACARE INC.	SummaCare Medicare Advantage Plans	www.summacare.com/medicare	SummaCare Medicare Ruby (HMO)	01	01		1			H3660	044	0	2022	Northeast & Northwest Ohio		2	59875	2			2						www.summacare.com/medicare	www.summacare.com/medicare	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	5	1					0	08/04/2021	2022.01	08/04/2021 11:54:58 AM Eastern Daylight Time	08/05/2021 11:53:11 AM Eastern Daylight Time	08/05/2021 11:53:11 AM Eastern Daylight Time			08/05/2021 11:58:26 AM Eastern Daylight Time	SUMMACARE INC.	SummaCare Medicare Advantage Plans	www.summacare.com/medicare	SummaCare Medicare Topaz (HMO)	01	01		1			H3660	050	0	2022	Northeast Ohio		2	129005	2			2						www.summacare.com/medicare	www.summacare.com/medicare	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	052	1	1	01	01	H3660_052_1	3	1				0	0	07/08/2021	2022.01	07/08/2021 04:57:08 PM Eastern Daylight Time	06/02/2021 07:32:12 PM Eastern Daylight Time				07/08/2021 05:09:12 PM Eastern Daylight Time	SUMMACARE INC.	SummaCare Medicare Advantage Plans	www.summacare.com/medicare	SummaCare Medicare Amber (HMO)	01	01		1			H3660	052	1	2022	Northeast and Northwest Ohio	Northeast Ohio	2	1524	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										2					2					2	2			
H3660	052	2	1	01	01	H3660_052_2	3	1				0	0	07/08/2021	2022.01	07/08/2021 04:58:03 PM Eastern Daylight Time	06/02/2021 07:32:54 PM Eastern Daylight Time				07/08/2021 05:09:12 PM Eastern Daylight Time	SUMMACARE INC.	SummaCare Medicare Advantage Plans	www.summacare.com/medicare	SummaCare Medicare Amber (HMO)	01	01		1			H3660	052	2	2022	Northeast and Northwest Ohio	Northwest Ohio	2	240	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										2					2					2	2			
H3660	053	1	1	01	01	H3660_053_1	5	1					0	08/04/2021	2022.01	08/04/2021 11:55:32 AM Eastern Daylight Time	08/05/2021 11:53:11 AM Eastern Daylight Time	08/05/2021 11:53:11 AM Eastern Daylight Time			08/05/2021 11:58:26 AM Eastern Daylight Time	SUMMACARE INC.	SummaCare Medicare Advantage Plans	www.summacare.com/medicare	SummaCare Medicare Garnet (HMO)	01	01		1			H3660	053	1	2022	Cuyahoga, Geauga, Lake, Lorain, Mahoning, Trumbull	Summit, Stark, Portage, Medina and Wayne Counties	2	20520	2			2						www.summacare.com/medicare	www.summacare.com/medicare	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	053	2	1	01	01	H3660_053_2	5	1					0	08/04/2021	2022.01	08/04/2021 11:56:02 AM Eastern Daylight Time	08/05/2021 11:53:11 AM Eastern Daylight Time	08/05/2021 11:53:11 AM Eastern Daylight Time			08/05/2021 11:58:26 AM Eastern Daylight Time	SUMMACARE INC.	SummaCare Medicare Advantage Plans	www.summacare.com/medicare	SummaCare Medicare Garnet (HMO)	01	01		1			H3660	053	2	2022	Cuyahoga, Geauga, Lake, Lorain, Mahoning, Trumbull	Cuyahoga, Geauga, Lake, Lorain, Mahoning, Trumbull	2	8223	2			2						www.summacare.com/medicare	www.summacare.com/medicare	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	5	1						07/15/2021	2022.01	07/15/2021 10:41:10 AM Eastern Daylight Time					07/15/2021 10:45:49 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	2022	Nationwide Service Area		1	2656	2			2						www.summacare.com/medicare	www.summacare.com/medicare	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;9b;15;	2		1					1				
H3660	802	0	1	01	01	H3660_802_0	3	1				0	0	06/05/2021	2022.01	06/05/2021 06:15:37 PM Eastern Daylight Time					06/05/2021 06:28:56 PM 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	2022	Nationwide Service Area		1	0	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;9b;15;	2		1					1				
H3660	805	0	1	02	01	H3660_805_0	5	1						07/15/2021	2022.01	07/15/2021 10:42:48 AM Eastern Daylight Time					07/15/2021 10:45:49 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	2022	Nationwide Service Area		1	3320	2			2						www.summacare.com/medicare	www.summacare.com/medicare	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;9b;10a;11a;11b;15;	2		1	1	1a;1b;2;7d;8a;8b1;8b2;8b3;9a1;10a;11a;11b;15;	2		1				
H3660	806	0	1	02	01	H3660_806_0	3	1				0	0	06/05/2021	2022.01	06/05/2021 06:24:42 PM Eastern Daylight Time					06/05/2021 06:28:56 PM 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	2022	Nationwide Service Area		1	60	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;9b;10a;11a;11b;15;	2		1	1	1a;1b;2;7d;8a;8b1;8b2;8b3;9a1;9b;10a;11a;11b;15;	2		1				
H3664	014	0	1	02	01	H3664_014_0	3	1				0	0	07/06/2021	2022.01	07/06/2021 03:21:22 PM Eastern Daylight Time	06/05/2021 08:10:58 PM Eastern Daylight Time				07/06/2021 04:10:53 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	2022	Operating in 12 counties in Northeastern Ohio		2	5809	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					1	08/02/2021	2022.01	08/02/2021 09:20:46 AM Eastern Daylight Time	08/02/2021 04:12:21 PM Eastern Daylight Time	08/02/2021 04:15:54 PM Eastern Daylight Time			08/02/2021 04:25:32 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	2022	Operating in 12 counties in Northeastern Ohio		2	73773	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					1	08/02/2021	2022.01	08/02/2021 09:17:00 AM Eastern Daylight Time	08/02/2021 04:17:21 PM Eastern Daylight Time	08/02/2021 04:18:38 PM Eastern Daylight Time			08/02/2021 04:25:32 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	2022	Operating in 12 counties in Northeastern Ohio		2	50891	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					1	08/02/2021	2022.01	08/02/2021 09:17:38 AM Eastern Daylight Time	08/02/2021 04:19:49 PM Eastern Daylight Time	08/02/2021 04:20:45 PM Eastern Daylight Time			08/02/2021 04:25:32 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	2022	Operating in 12 counties in Northeastern Ohio		2	40392	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						05/24/2021	2022.01	05/24/2021 03:25:38 PM Eastern Daylight Time					06/05/2021 08:15:54 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	2022	National Service Area		1	5736	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;3-4;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				0	0	06/04/2021	2022.01	06/04/2021 08:56:06 AM Eastern Daylight Time					06/05/2021 08:15:54 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	2022	National Service Area		1	9936	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;3-4;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						06/04/2021	2022.01	06/04/2021 08:55:27 AM Eastern Daylight Time					06/05/2021 08:15:54 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	2022	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;3-4;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						05/24/2021	2022.01	05/24/2021 03:26:09 PM Eastern Daylight Time					06/05/2021 08:15:54 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	2022	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;3-4;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				0	0	05/24/2021	2022.01	05/24/2021 03:26:17 PM Eastern Daylight Time					06/05/2021 08:15:54 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	2022	Part B Only MA National Service Area		1	1380	2			2						www.primetimehealthplan.com	www.primetimehealthplan.com	www.primetimehealthplan.com	(858)005-7750		(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;3-4;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						05/24/2021	2022.01	05/24/2021 03:26:27 PM Eastern Daylight Time					06/05/2021 08:15:54 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	2022	National Service Area		1	1404	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;3-4;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	5	1				0	0	07/17/2021	2022.01	07/17/2021 08:40:32 AM Eastern Daylight Time	07/19/2021 06:58:40 AM Eastern Daylight Time				07/19/2021 07:48:08 AM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.MediGold.com	MediGold Medical Only (HMO)	01	01		1			H3668	013	0	2022	Central, Southeast, Southwest and Northwest OH		2		2			2						www.MediGold.com	www.MediGold.com	www.MediGold.com	(800)240-3851		(800)240-3851		(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					1	08/04/2021	2022.01	08/04/2021 08:09:20 AM Eastern Daylight Time	08/05/2021 07:00:53 AM Eastern Daylight Time	08/05/2021 07:00:53 AM Eastern Daylight Time			08/05/2021 07:34:42 AM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.MediGold.com	MediGold Southeast OH Classic Preferred (HMO)	01	01		1			H3668	014	0	2022	Southeast Ohio		2		2			2						www.MediGold.com	www.MediGold.com	www.MediGold.com	(800)240-3851		(800)240-3851		(800)964-4525		(800)964-4525		(800)240-3851		(800)240-3851		(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					1	08/04/2021	2022.01	08/04/2021 08:11:24 AM Eastern Daylight Time	08/05/2021 07:00:54 AM Eastern Daylight Time	08/05/2021 07:01:10 AM Eastern Daylight Time			08/05/2021 07:34:42 AM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.MediGold.com	MediGold Southeast OH Essential Care (HMO)	01	01		1			H3668	015	0	2022	Southeast Ohio		2		2			2						www.MediGold.com	www.MediGold.com	www.MediGold.com	(800)240-3851		(800)240-3851		(800)964-4525		(800)964-4525		(800)240-3851		(800)240-3851		(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					1	08/04/2021	2022.01	08/04/2021 08:12:57 AM Eastern Daylight Time	08/05/2021 07:01:11 AM Eastern Daylight Time	08/05/2021 07:01:12 AM Eastern Daylight Time			08/05/2021 07:34:42 AM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.MediGold.com	MediGold Southwest OH Classic Preferred (HMO)	01	01		1			H3668	016	0	2022	Greater Cincinnati and Champaign County Ohio		2		2			2						www.MediGold.com	www.MediGold.com	www.MediGold.com	(800)240-3851		(800)240-3851		(800)964-4525		(800)964-4525		(800)240-3851		(800)240-3851		(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					1	08/04/2021	2022.01	08/04/2021 08:15:03 AM Eastern Daylight Time	08/05/2021 07:01:17 AM Eastern Daylight Time	08/05/2021 07:01:33 AM Eastern Daylight Time			08/05/2021 07:34:42 AM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.MediGold.com	MediGold Southwest OH Essential Care (HMO)	01	01		1			H3668	017	0	2022	Greater Cincinnati and Champaign County Ohio		2		2			2						www.MediGold.com	www.MediGold.com	www.MediGold.com	(800)240-3851		(800)240-3851		(800)964-4525		(800)964-4525		(800)240-3851		(800)240-3851		(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					1	08/04/2021	2022.01	08/04/2021 07:54:33 AM Eastern Daylight Time	08/05/2021 07:01:39 AM Eastern Daylight Time	08/05/2021 07:01:40 AM Eastern Daylight Time			08/05/2021 07:34:42 AM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.MediGold.com	MediGold Classic Preferred (HMO)	01	01		1			H3668	018	1	2022	Greater Central Ohio	Greater Columbus Ohio	2		2			2						www.MediGold.com	www.MediGold.com	www.MediGold.com	(800)240-3851		(800)240-3851		(800)964-4525		(800)964-4525		(800)240-3851		(800)240-3851		(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					1	08/04/2021	2022.01	08/04/2021 07:57:57 AM Eastern Daylight Time	08/05/2021 07:01:41 AM Eastern Daylight Time	08/05/2021 07:01:42 AM Eastern Daylight Time			08/05/2021 07:34:42 AM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.MediGold.com	MediGold Classic Preferred (HMO)	01	01		1			H3668	018	2	2022	Greater Central Ohio	Greater Dayton Ohio	2		2			2						www.MediGold.com	www.MediGold.com	www.MediGold.com	(800)240-3851		(800)240-3851		(800)964-4525		(800)964-4525		(800)240-3851		(800)240-3851		(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					1	08/04/2021	2022.01	08/04/2021 08:00:14 AM Eastern Daylight Time	08/05/2021 07:02:00 AM Eastern Daylight Time	08/05/2021 07:02:00 AM Eastern Daylight Time			08/05/2021 07:34:42 AM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.MediGold.com	MediGold Classic Preferred (HMO)	01	01		1			H3668	018	3	2022	Greater Central Ohio	Southern Ohio	2		2			2						www.MediGold.com	www.MediGold.com	www.MediGold.com	(800)240-3851		(800)240-3851		(800)964-4525		(800)964-4525		(800)240-3851		(800)240-3851		(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					1	08/04/2021	2022.01	08/04/2021 08:02:03 AM Eastern Daylight Time	08/05/2021 07:02:01 AM Eastern Daylight Time	08/05/2021 07:02:02 AM Eastern Daylight Time			08/05/2021 07:34:42 AM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.MediGold.com	MediGold Essential Care (HMO)	01	01		1			H3668	019	1	2022	Greater Central Ohio	Greater Columbus Ohio	2		2			2						www.MediGold.com	www.MediGold.com	www.MediGold.com	(800)240-3851		(800)240-3851		(800)964-4525		(800)964-4525		(800)240-3851		(800)240-3851		(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					1	08/04/2021	2022.01	08/04/2021 08:04:27 AM Eastern Daylight Time	08/05/2021 07:02:14 AM Eastern Daylight Time	08/05/2021 07:02:39 AM Eastern Daylight Time			08/05/2021 07:34:42 AM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.MediGold.com	MediGold Essential Care (HMO)	01	01		1			H3668	019	2	2022	Greater Central Ohio	Greater Dayton Ohio	2		2			2						www.MediGold.com	www.MediGold.com	www.MediGold.com	(800)240-3851		(800)240-3851		(800)964-4525		(800)964-4525		(800)240-3851		(800)240-3851		(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	5	1					1	08/04/2021	2022.01	08/04/2021 08:06:21 AM Eastern Daylight Time	08/05/2021 07:02:40 AM Eastern Daylight Time	08/05/2021 07:02:41 AM Eastern Daylight Time			08/05/2021 07:34:42 AM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.MediGold.com	MediGold Essential Care (HMO)	01	01		1			H3668	019	3	2022	Greater Central Ohio	Southern Ohio	2		2			2						www.MediGold.com	www.MediGold.com	www.MediGold.com	(800)240-3851		(800)240-3851		(800)964-4525		(800)964-4525		(800)240-3851		(800)240-3851		(800)964-4525		(800)964-4525		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3668	020	0	1	01	01	H3668_020_0	5	1					1	08/04/2021	2022.01	08/04/2021 08:23:12 AM Eastern Daylight Time	08/05/2021 07:03:11 AM Eastern Daylight Time	08/05/2021 07:03:12 AM Eastern Daylight Time			08/05/2021 07:34:42 AM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.MediGold.com	MediGold Essential Care (HMO)	01	01		1			H3668	020	0	2022	Greater Toledo Ohio		2		2			2						www.MediGold.com	www.MediGold.com	www.MediGold.com	(800)240-3851		(800)240-3851		(800)964-4525		(800)964-4525		(800)240-3851		(800)240-3851		(800)964-4525		(800)964-4525		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3668	021	0	1	01	01	H3668_021_0	5	1					1	08/04/2021	2022.01	08/04/2021 08:25:01 AM Eastern Daylight Time	08/05/2021 07:03:28 AM Eastern Daylight Time	08/05/2021 07:03:39 AM Eastern Daylight Time			08/05/2021 07:34:42 AM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.MediGold.com	MediGold True Advantage (HMO)	01	01		1			H3668	021	0	2022	Greater Toledo Ohio		2		2			2						www.MediGold.com	www.MediGold.com	www.MediGold.com	(800)240-3851		(800)240-3851		(800)964-4525		(800)964-4525		(800)240-3851		(800)240-3851		(800)964-4525		(800)964-4525		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3668	022	0	1	01	01	H3668_022_0	5	1					1	08/04/2021	2022.01	08/04/2021 08:17:19 AM Eastern Daylight Time	08/05/2021 07:03:43 AM Eastern Daylight Time	08/05/2021 07:03:44 AM Eastern Daylight Time			08/05/2021 07:34:42 AM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.MediGold.com	MediGold True Advantage (HMO)	01	01		1			H3668	022	0	2022	Greater Columbus Ohio		2		2			2						www.MediGold.com	www.MediGold.com	www.MediGold.com	(800)240-3851		(800)240-3851		(800)964-4525		(800)964-4525		(800)240-3851		(800)240-3851		(800)964-4525		(800)964-4525		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3668	023	0	1	01	01	H3668_023_0	5	1					1	08/04/2021	2022.01	08/04/2021 08:19:07 AM Eastern Daylight Time	08/05/2021 07:03:45 AM Eastern Daylight Time	08/05/2021 07:03:56 AM Eastern Daylight Time			08/05/2021 07:34:42 AM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.MediGold.com	MediGold True Advantage (HMO)	01	01		1			H3668	023	0	2022	Greater Dayton Ohio		2		2			2						www.MediGold.com	www.MediGold.com	www.MediGold.com	(800)240-3851		(800)240-3851		(800)964-4525		(800)964-4525		(800)240-3851		(800)240-3851		(800)964-4525		(800)964-4525		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3668	024	0	1	01	01	H3668_024_0	5	1					1	08/04/2021	2022.01	08/04/2021 08:21:05 AM Eastern Daylight Time	08/05/2021 07:03:57 AM Eastern Daylight Time	08/05/2021 07:03:57 AM Eastern Daylight Time			08/05/2021 07:34:42 AM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.MediGold.com	MediGold True Advantage (HMO)	01	01		1			H3668	024	0	2022	Greater Cincinnati and Champaign County Ohio		2		2			2						www.MediGold.com	www.MediGold.com	www.MediGold.com	(800)240-3851		(800)240-3851		(800)964-4525		(800)964-4525		(800)240-3851		(800)240-3851		(800)964-4525		(800)964-4525		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3668	025	0	1	01	01	H3668_025_0	5	1					1	08/04/2021	2022.01	08/04/2021 08:38:57 AM Eastern Daylight Time	08/05/2021 07:03:58 AM Eastern Daylight Time	08/05/2021 07:04:20 AM Eastern Daylight Time			08/05/2021 07:34:42 AM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.MediGold.com	MediGold Essential Care (HMO)	01	01		1			H3668	025	0	2022	Select Counties in Iowa		2		2			2						www.MediGold.com	www.MediGold.com	www.MediGold.com	(800)240-3851		(800)240-3851		(800)964-4525		(800)964-4525		(800)240-3851		(800)240-3851		(800)964-4525		(800)964-4525		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3668	026	0	1	01	01	H3668_026_0	5	1					1	08/04/2021	2022.01	08/04/2021 08:43:34 AM Eastern Daylight Time	08/05/2021 07:04:21 AM Eastern Daylight Time	08/05/2021 07:04:22 AM Eastern Daylight Time			08/05/2021 07:34:42 AM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.MediGold.com	MediGold True Advantage (HMO)	01	01		1			H3668	026	0	2022	Select Counties in Iowa		2		2			2						www.MediGold.com	www.MediGold.com	www.MediGold.com	(800)240-3851		(800)240-3851		(800)964-4525		(800)964-4525		(800)240-3851		(800)240-3851		(800)964-4525		(800)964-4525		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3668	029	0	1	01	01	H3668_029_0	4	1				0	0	07/17/2021	2022.01	07/17/2021 09:48:22 AM Eastern Daylight Time	07/19/2021 06:58:02 AM Eastern Daylight Time				07/19/2021 07:48:08 AM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.MediGold.com	MediGold Medical Only (HMO)	01	01		1			H3668	029	0	2022	Select Counties in Iowa		2		2			2						www.MediGold.com	www.MediGold.com	www.MediGold.com	(800)240-3851		(800)240-3851		(800)964-4525		(800)964-4525										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3668	801	0	1	01	01	H3668_801_0	3	1				0	0	05/20/2021	2022.01	05/20/2021 10:15:58 AM Eastern Daylight Time					06/06/2021 10:22:15 AM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.MediGold.com	EGWP MediGold Medical Only (HMO)	01	01		1			H3668	801	0	2022	Central, Southeast and Southwest OH		1	12	2			2						www.MediGold.com	www.MediGold.com	www.MediGold.com	(800)240-3851		(800)240-3851		(800)964-4525		(800)964-4525										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;6;8a;9a1;9b;10a;11a;11b;15;	2		1					1				
H3668	802	0	1	01	01	H3668_802_0	3	1						05/20/2021	2022.01	05/20/2021 10:48:39 AM Eastern Daylight Time					06/06/2021 10:22:15 AM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.MediGold.com	EGWP MediGold Classic (HMO)	01	01		1			H3668	802	0	2022	Central, Southeast and Southwest OH		1	6648	2			2						www.MediGold.com	www.MediGold.com	www.MediGold.com	(800)240-3851		(800)240-3851		(800)964-4525		(800)964-4525		(800)240-3851		(800)240-3851		(800)964-4525		(800)964-4525		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;6;8a;9a1;9b;10a;11a;11b;15;	2		1					1				
H3668	803	0	1	01	01	H3668_803_0	3	1						05/20/2021	2022.01	05/20/2021 11:53:43 AM Eastern Daylight Time					06/06/2021 10:22:15 AM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.MediGold.com	EGWP MediGold Custom (HMO)	01	01		1			H3668	803	0	2022	Central, Southeast and Southwest OH		1	12	2			2						www.MediGold.com	www.MediGold.com	www.MediGold.com	(800)240-3851		(800)240-3851		(800)964-4525		(800)964-4525		(800)240-3851		(800)240-3851		(800)964-4525		(800)964-4525		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;6;8a;9a1;9b;10a;11a;11b;15;	2		1					1				
H3668	804	0	1	01	01	H3668_804_0	3	1						05/20/2021	2022.01	05/20/2021 12:00:51 PM Eastern Daylight Time					06/06/2021 10:22:15 AM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.MediGold.com	EGWP MediGold Classic (HMO)	01	01		1			H3668	804	0	2022	Central, Southeast and Southwest OH		1	12	2			2						www.MediGold.com	www.MediGold.com	www.MediGold.com	(800)240-3851		(800)240-3851		(800)964-4525		(800)964-4525		(800)240-3851		(800)240-3851		(800)964-4525		(800)964-4525		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;6;8a;9a1;9b;10a;11a;11b;15;	2		1					1				
H3668	805	0	1	01	01	H3668_805_0	3	1				0	0	05/20/2021	2022.01	05/20/2021 12:07:41 PM Eastern Daylight Time					06/06/2021 10:22:15 AM 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	2022	Southeast Ohio		1	12	2			2						www.MediGold.com	www.MediGold.com	www.MediGold.com	(800)240-3851		(800)240-3851		(800)964-4525		(800)964-4525										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;6;8a;9a1;9b;10a;11a;11b;15;	2		1					1				
H3668	806	0	1	01	01	H3668_806_0	3	1						05/20/2021	2022.01	05/20/2021 12:14:19 PM Eastern Daylight Time					06/06/2021 10:22:15 AM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.MediGold.com	EGWP MediGold Southeast OH Classic (HMO)	01	01		1			H3668	806	0	2022	Southeast Ohio		1	12	2			2						www.MediGold.com	www.MediGold.com	www.MediGold.com	(800)240-3851		(800)240-3851		(800)964-4525		(800)964-4525		(800)240-3851		(800)240-3851		(800)964-4525		(800)964-4525		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;6;8a;9a1;9b;10a;11a;11b;15;	2		1					1				
H3668	807	0	1	01	01	H3668_807_0	3	1						05/20/2021	2022.01	05/20/2021 12:20:29 PM Eastern Daylight Time					06/06/2021 10:22:15 AM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.MediGold.com	EGWP MediGold Southeast OH Custom (HMO)	01	01		1			H3668	807	0	2022	Southeast Ohio		1	12	2			2						www.MediGold.com	www.MediGold.com	www.MediGold.com	(800)240-3851		(800)240-3851		(800)964-4525		(800)964-4525		(800)240-3851		(800)240-3851		(800)964-4525		(800)964-4525		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;6;8a;9a1;9b;10a;11a;11b;15;	2		1					1				
H3668	808	0	1	01	01	H3668_808_0	3	1				0	0	05/20/2021	2022.01	05/20/2021 12:27:18 PM Eastern Daylight Time					06/06/2021 10:22:15 AM 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	2022	Southwest Ohio		1	12	2			2						www.MediGold.com	www.MediGold.com	www.MediGold.com	(800)240-3851		(800)240-3851		(800)964-4525		(800)964-4525										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;6;8a;9a1;9b;10a;11a;11b;15;	2		1					1				
H3668	809	0	1	01	01	H3668_809_0	3	1						05/20/2021	2022.01	05/20/2021 12:34:02 PM Eastern Daylight Time					06/06/2021 10:22:15 AM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.MediGold.com	EGWP MediGold Southwest OH Classic (HMO)	01	01		1			H3668	809	0	2022	Southwest Ohio		1	12	2			2						www.MediGold.com	www.MediGold.com	www.MediGold.com	(800)240-3851		(800)240-3851		(800)964-4525		(800)964-4525		(800)240-3851		(800)240-3851		(800)964-4525		(800)964-4525		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;6;8a;9a1;9b;10a;11a;11b;15;	2		1					1				
H3668	810	0	1	01	01	H3668_810_0	3	1						05/20/2021	2022.01	05/20/2021 12:42:54 PM Eastern Daylight Time					06/06/2021 10:22:15 AM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.MediGold.com	EGWP MediGold Southwest OH Custom (HMO)	01	01		1			H3668	810	0	2022	Southwest Ohio		1	12	2			2						www.MediGold.com	www.MediGold.com	www.MediGold.com	(800)240-3851		(800)240-3851		(800)964-4525		(800)964-4525		(800)240-3851		(800)240-3851		(800)964-4525		(800)964-4525		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;6;8a;9a1;9b;10a;11a;11b;15;	2		1					1				
H3672	013	0	1	01	01	H3672_013_0	6	1					0	08/04/2021	2022.01	08/04/2021 10:49:38 AM Eastern Daylight Time	08/05/2021 10:20:32 AM Eastern Daylight Time	07/30/2021 08:05:50 AM Eastern Daylight Time			08/05/2021 02:04:52 PM Eastern Daylight Time	THE HEALTH PLAN OF WEST VIRGINIA, INC.	The Health Plan	www.healthplan.org/medicare	The Health Plan SecureCare - Option II (HMO)	01	01		1			H3672	013	0	2022	East Central Ohio		2	31177	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	5	1				0	0	07/15/2021	2022.01	07/15/2021 02:23:38 PM Eastern Daylight Time	06/03/2021 11:51:16 PM Eastern Daylight Time				07/15/2021 02:47:32 PM Eastern Daylight Time	THE HEALTH PLAN OF WEST VIRGINIA, INC.	The Health Plan	www.healthplan.org/medicare	The Health Plan SecureCare - Option I, MA Only (HMO)	01	01		1			H3672	014	0	2022	East Central Ohio		2	4264	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	019	0	1	01	01	H3672_019_0	6	1	2	1			0	08/04/2021	2022.01	08/04/2021 03:33:58 PM Eastern Daylight Time	08/05/2021 10:22:28 AM Eastern Daylight Time	07/30/2021 08:06:24 AM Eastern Daylight Time			08/05/2021 02:04:52 PM Eastern Daylight Time	THE HEALTH PLAN OF WEST VIRGINIA, INC.	The Health Plan	www.healthplan.org/medicare	The Health Plan SecureCare SNP (HMO D-SNP)	01	01		1			H3672	019	0	2022	Southeastern Ohio, West Virginia		2	45849	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	8	1					0	07/15/2021	2022.01	07/15/2021 02:25:46 PM Eastern Daylight Time	08/05/2021 10:25:16 AM Eastern Daylight Time	07/30/2021 08:06:54 AM Eastern Daylight Time			08/05/2021 02:04:52 PM Eastern Daylight Time	THE HEALTH PLAN OF WEST VIRGINIA, INC.	The Health Plan	www.healthplan.org/medicare	The Health Plan SecureCare - Option II (HMO)	01	01		1			H3672	020	0	2022	Southeastern OH, West Virginia		2	50647	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	5	1				0	0	07/15/2021	2022.01	07/15/2021 02:26:50 PM Eastern Daylight Time	06/03/2021 11:59:20 PM Eastern Daylight Time				07/15/2021 02:47:32 PM Eastern Daylight Time	THE HEALTH PLAN OF WEST VIRGINIA, INC.	The Health Plan	www.healthplan.org/medicare	The Health Plan SecureCare - Option I, MA Only (HMO)	01	01		1			H3672	021	0	2022	Southeastern OH, West Virginia		2	6096	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	6	1					0	08/04/2021	2022.01	08/04/2021 10:52:19 AM Eastern Daylight Time	08/05/2021 10:27:36 AM Eastern Daylight Time	07/30/2021 08:07:26 AM Eastern Daylight Time			08/05/2021 02:04:52 PM Eastern Daylight Time	THE HEALTH PLAN OF WEST VIRGINIA, INC.	The Health Plan	www.healthplan.org/medicare	The Health Plan SecureCare Capitol Plan (HMO)	01	01		1			H3672	023	0	2022	Kanawha and Surrounding Counties		2	2496	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	5	1				0	0	07/15/2021	2022.01	07/15/2021 02:28:25 PM Eastern Daylight Time	06/04/2021 12:02:10 AM Eastern Daylight Time				07/15/2021 02:47:32 PM Eastern Daylight Time	THE HEALTH PLAN OF WEST VIRGINIA, INC.	The Health Plan	www.healthplan.org/medicare	The Health Plan SecureCare Capitol Plan, MA Only (HMO)	01	01		1			H3672	024	0	2022	Kanawha and Surrounding Counties		2	298	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	4	1						06/04/2021	2022.01	06/04/2021 03:12:36 PM Eastern Daylight Time					06/04/2021 03:17:07 PM Eastern Daylight Time	THE HEALTH PLAN OF WEST VIRGINIA, INC.	The Health Plan	www.healthplan.org/medicare	The Health Plan SecureCare - Employer (HMO)	01	01		1			H3672	805	0	2022	East Ohio and West Virginia, National		1	9000	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	9	1					0	07/08/2021	2022.01	07/08/2021 11:27:03 AM Central Daylight Time	07/30/2021 05:57:20 PM Central Daylight Time	07/30/2021 01:58:12 PM Central Daylight Time			08/04/2021 02:20:08 PM Central Daylight Time	GLOBALHEALTH, INC.	GlobalHealth	www.GlobalHealth.com/medicare	Generations Classic (HMO)	01	01		1			H3706	001	0	2022	Oklahoma (Partial)		2	105438	2			2						www.GlobalHealth.com/pharmacy-directories	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	8	1				0	0	07/08/2021	2022.01	07/08/2021 11:27:42 AM Central Daylight Time	07/17/2021 10:32:19 AM Central Daylight Time				07/26/2021 07:05:46 AM Central Daylight Time	GLOBALHEALTH, INC.	GlobalHealth	www.GlobalHealth.com/medicare	Generations Value (HMO)	01	01		1			H3706	009	0	2022	Oklahoma (Partial)		2	3269	2			2						www.GlobalHealth.com/pharmacy-directories	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	9	1					0	07/08/2021	2022.01	07/08/2021 11:28:26 AM Central Daylight Time	07/30/2021 06:00:50 PM Central Daylight Time	07/30/2021 01:58:26 PM Central Daylight Time			08/04/2021 02:20:08 PM Central Daylight Time	GLOBALHEALTH, INC.	GlobalHealth	www.GlobalHealth.com/medicare	Generations Select (HMO)	01	01		1			H3706	018	0	2022	Oklahoma (Partial)		2	16941	2			2						www.GlobalHhealth.com/pharmacy-directories	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	021	0	1	02	01	H3706_021_0	9	1					0	07/08/2021	2022.01	07/08/2021 11:29:04 AM Central Daylight Time	07/30/2021 06:01:30 PM Central Daylight Time	07/30/2021 01:58:40 PM Central Daylight Time			08/04/2021 02:20:08 PM Central Daylight Time	GLOBALHEALTH, INC.	GlobalHealth	www.GlobalHealth.com/medicare	Generations Classic Choice (HMO-POS)	01	02		1			H3706	021	0	2022	Oklahoma (Partial)		2	367	2			2						www.GlobalHealth.com/pharmacy-directories	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	022	0	1	01	01	H3706_022_0	9	1					0	07/08/2021	2022.01	07/08/2021 11:29:40 AM Central Daylight Time	07/30/2021 06:02:32 PM Central Daylight Time	07/30/2021 01:58:54 PM Central Daylight Time			08/04/2021 02:20:08 PM Central Daylight Time	GLOBALHEALTH, INC.	GlobalHealth	www.GlobalHealth.com/medicare	Generations Classic Plus (HMO)	01	01		1			H3706	022	0	2022	Tulsa Metro		2	1218	2			2						www.GlobalHealth.com/pharmacy-directories	www.GlobalHealth.com/medicare/member-materials	www.GlobalHealth.com/provider-search	(844)280-5555		(405)280-5600		(844)280-5555		(405)280-5600		(844)280-5555		(405)280-5600		(844)280-5555		(405)280-5600		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3706	023	0	1	01	01	H3706_023_0	9	1					0	07/08/2021	2022.01	07/08/2021 11:30:16 AM Central Daylight Time	07/30/2021 06:06:14 PM Central Daylight Time	07/30/2021 01:59:10 PM Central Daylight Time			08/04/2021 02:20:08 PM Central Daylight Time	GLOBALHEALTH, INC.	GlobalHealth	www.GlobalHealth.com/medicare	Generations Classic Plus (HMO)	01	01		1			H3706	023	0	2022	Oklahoma City Metro		2	1218	2			2						www.GlobalHealth.com/pharmacy-directories	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)-		2					2					2	2			
H3706	024	0	1	01	01	H3706_024_0	8	1		1			1	07/08/2021	2022.01	07/08/2021 11:30:47 AM Central Daylight Time	07/30/2021 06:07:20 PM Central Daylight Time	07/30/2021 01:59:24 PM Central Daylight Time			08/04/2021 02:20:08 PM Central Daylight Time	GLOBALHEALTH, INC.	GlobalHealth	www.GlobalHealth.com/medicare	Generations Special Care (HMO C-SNP)	01	01		1			H3706	024	0	2022	Partial Oklahoma		2	3046	2			1	4			00000000000000000010		www.GlobalHealth.com/pharmacy-directories	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)-		2					2					2	2			
H3706	025	0	1	01	01	H3706_025_0	9	1		1			1	07/08/2021	2022.01	07/08/2021 11:31:21 AM Central Daylight Time	07/30/2021 06:11:04 PM Central Daylight Time	07/30/2021 01:59:38 PM Central Daylight Time			08/04/2021 02:20:08 PM Central Daylight Time	GLOBALHEALTH, INC.	GlobalHealth	www.GlobalHealth.com/medicare	Generations Special Care Savings (HMO C-SNP)	01	01		1			H3706	025	0	2022	Partial Oklahoma		2	3046	2			1	4			00000000000000000010		www.GlobalHealth.com/pharmacy-directories	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)-		2					2					2	2			
H3706	803	0	1	01	01	H3706_803_0	6	1						04/14/2021	2022.01	04/14/2021 09:17:51 AM Central Daylight Time					06/07/2021 01:57:54 PM Central Daylight Time	GLOBALHEALTH, INC.	GlobalHealth	www.GlobalHealth.com/medicare	Generations EGHP CY (HMO)	01	01		1			H3706	803	0	2022	Oklahoma (Partial)		1	25622	2			2						www.GlobalHealth.com/pharmacy-directories	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;3-4;5;6;7c;7i;8b1;8b2;9a1;9b;11a;11b;11c;12;15;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7c;7i;8b1;8b2;9a1;12;	1					2				
H3708	001	0	1	01	01	H3708_001_0	2	1		1			0	08/03/2021	2022.01	08/03/2021 11:11:32 AM Central Daylight Time	08/05/2021 08:08:03 AM Central Daylight Time	08/05/2021 08:08:21 AM Central Daylight Time			08/05/2021 08:36:45 AM Central Daylight Time	OKLAHOMA SUPERIOR SELECT, INC.	American Health Advantage of Oklahoma	ok.AmHealthPlans.com	American Health Advantage of Oklahoma (HMO I-SNP)	01	01		1			H3708	001	0	2022	Central and East Oklahoma		2	4548	2			1	1	3				ok.AmHealthPlans.com	ok.AmHealthPlans.com	ok.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					2					2	2			
H3727	001	1	1	01	01	H3727_001_1	7	1		1			1	07/15/2021	2022.01	07/15/2021 10:19:06 AM Eastern Daylight Time	08/03/2021 06:45:09 PM Eastern Daylight Time	08/03/2021 06:45:10 PM Eastern Daylight Time			08/03/2021 06:52:52 PM Eastern Daylight Time	OH CHS SNP INC.	Communicare Advantage	www.communicare-advantage.com	CommuniCare Advantage CSNP (HMO C-SNP)	01	01		1			H3727	001	1	2022	Indiana, Maryland and Ohio	Marion County Indiana	2	4865	2			1	4			00000000000000000010		www.communicare-advantage.com	www.communicare-advantage.com	www.communicare-advantage.com	(855)969-5869		(855)969-5869		(855)969-5869		(855)969-5869		(833)685-5387		(833)685-5387		(855)969-5869		(855)969-5869		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3727	001	2	1	01	01	H3727_001_2	7	1		1			1	07/15/2021	2022.01	07/15/2021 10:20:50 AM Eastern Daylight Time	08/03/2021 06:45:12 PM Eastern Daylight Time	08/03/2021 06:45:13 PM Eastern Daylight Time			08/03/2021 06:52:52 PM Eastern Daylight Time	OH CHS SNP INC.	Communicare Advantage	www.communicare-advantage.com	CommuniCare Advantage CSNP (HMO C-SNP)	01	01		1			H3727	001	2	2022	Indiana, Maryland and Ohio	Baltimore City, MD	2	1430	2			1	4			00000000000000000010		www.communicare-advantage.com	www.communicare-advantage.com	www.communicare-advantage.com	(855)969-5869		(855)969-5869		(855)969-5869		(855)969-5869		(833)685-5387		(833)685-5387		(855)969-5869		(855)969-5869		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3727	001	3	1	01	01	H3727_001_3	6	1		1			1	07/15/2021	2022.01	07/15/2021 10:20:10 AM Eastern Daylight Time	08/03/2021 06:45:15 PM Eastern Daylight Time	08/03/2021 06:45:16 PM Eastern Daylight Time			08/03/2021 06:52:52 PM Eastern Daylight Time	OH CHS SNP INC.	Communicare Advantage	www.communicare-advantage.com	CommuniCare Advantage CSNP (HMO C-SNP)	01	01		1			H3727	001	3	2022	Indiana, Maryland and Ohio	Cuyahoga & Hamilton Ohio	2	1430	2			1	4			00000000000000000010		www.communicare-advantage.com	www.communicare-advantage.com	www.communicare-advantage.com	(855)969-5869		(855)969-5869		(855)969-5869		(855)969-5869		(833)685-5387		(833)685-5387		(855)969-5869		(855)969-5869		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3727	002	1	1	01	01	H3727_002_1	5	1		1			0	08/02/2021	2022.01	08/02/2021 11:12:08 AM Eastern Daylight Time	08/03/2021 06:45:18 PM Eastern Daylight Time	08/03/2021 06:45:19 PM Eastern Daylight Time			08/03/2021 06:52:52 PM Eastern Daylight Time	OH CHS SNP INC.	Communicare Advantage	www.communicare-advantage.com	CommuniCare Advantage ISNP (HMO I-SNP)	01	01		1			H3727	002	1	2022	Indiana, Maryland and Ohio	Indiana	2	7925	2			1	1	1				www.communicare-advantage.com	www.communicare-advantage.com	www.communicare-advantage.com	(855)969-5861		(855)969-5861		(855)969-5861		(855)969-5861		(833)697-8516		(833)697-8516		(855)969-5861		(855)969-5861		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3727	002	2	1	01	01	H3727_002_2	5	1		1			0	08/02/2021	2022.01	08/02/2021 11:14:02 AM Eastern Daylight Time	08/03/2021 06:45:21 PM Eastern Daylight Time	08/03/2021 06:45:22 PM Eastern Daylight Time			08/03/2021 06:52:52 PM Eastern Daylight Time	OH CHS SNP INC.	Communicare Advantage	www.communicare-advantage.com	CommuniCare Advantage ISNP (HMO I-SNP)	01	01		1			H3727	002	2	2022	Indiana, Maryland and Ohio	Maryland	2	8175	2			1	1	1				www.communicare-advantage.com	www.communicare-advantage.com	www.communicare-advantage.com	(855)969-5861		(855)969-5861		(855)969-5861		(855)969-5861		(833)697-8516		(833)697-8516		(855)969-5861		(855)969-5861		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3727	002	3	1	01	01	H3727_002_3	5	1		1			0	08/02/2021	2022.01	08/02/2021 11:15:05 AM Eastern Daylight Time	08/03/2021 06:45:24 PM Eastern Daylight Time	08/03/2021 06:45:25 PM Eastern Daylight Time			08/03/2021 06:52:52 PM Eastern Daylight Time	OH CHS SNP INC.	Communicare Advantage	www.communicare-advantage.com	CommuniCare Advantage ISNP (HMO I-SNP)	01	01		1			H3727	002	3	2022	Indiana, Maryland and Ohio	Ohio	2	13550	2			1	1	1				www.communicare-advantage.com	www.communicare-advantage.com	www.communicare-advantage.com	(855)969-5861		(855)969-5861		(855)969-5861		(855)969-5861		(833)697-8516		(833)697-8516		(855)969-5861		(855)969-5861		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3748	001	0	1	02	01	H3748_001_0	2	1					0	08/02/2021	2022.01	08/02/2021 01:24:26 PM Eastern Daylight Time	08/02/2021 02:40:39 PM Eastern Daylight Time	08/02/2021 09:36:43 AM Eastern Daylight Time			08/04/2021 01:38:04 PM Eastern Daylight Time	AETNA BETTER HEALTH OF WASHINGTON, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO-POS)	01	02		1			H3748	001	0	2022	Spokane County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3748	003	0	1	02	01	H3748_003_0	2	1					0	08/02/2021	2022.01	08/02/2021 01:26:45 PM Eastern Daylight Time	08/02/2021 04:41:58 PM Eastern Daylight Time	08/02/2021 09:36:47 AM Eastern Daylight Time			08/04/2021 01:38:04 PM Eastern Daylight Time	AETNA BETTER HEALTH OF WASHINGTON, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plus Plan (HMO-POS)	01	02		1			H3748	003	0	2022	Puget Sound Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3748	004	0	1	02	01	H3748_004_0	2	1					0	06/02/2021	2022.01	06/02/2021 04:59:30 PM Eastern Daylight Time	08/02/2021 02:43:17 PM Eastern Daylight Time	08/02/2021 09:36:51 AM Eastern Daylight Time			08/04/2021 03:16:36 PM Eastern Daylight Time	AETNA BETTER HEALTH OF WASHINGTON, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Platinum Plus Plan (HMO-POS)	01	02		1			H3748	004	0	2022	Puget Sound Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3748	005	0	1	02	01	H3748_005_0	2	1					0	08/02/2021	2022.01	08/02/2021 01:28:12 PM Eastern Daylight Time	08/02/2021 02:44:33 PM Eastern Daylight Time	08/02/2021 09:36:56 AM Eastern Daylight Time			08/04/2021 01:38:04 PM Eastern Daylight Time	AETNA BETTER HEALTH OF WASHINGTON, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO-POS)	01	02		1			H3748	005	0	2022	Clark and Cowlitz Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3748	006	0	1	02	01	H3748_006_0	2	1					0	08/02/2021	2022.01	08/02/2021 01:28:48 PM Eastern Daylight Time	08/02/2021 02:45:46 PM Eastern Daylight Time	08/02/2021 09:37:00 AM Eastern Daylight Time			08/04/2021 01:38:04 PM Eastern Daylight Time	AETNA BETTER HEALTH OF WASHINGTON, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite Plan (HMO-POS)	01	02		1			H3748	006	0	2022	Clark and Cowlitz Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3748	007	0	1	02	01	H3748_007_0	2	1					0	08/02/2021	2022.01	08/02/2021 01:29:31 PM Eastern Daylight Time	08/02/2021 02:47:02 PM Eastern Daylight Time	08/02/2021 09:37:04 AM Eastern Daylight Time			08/04/2021 01:38:04 PM Eastern Daylight Time	AETNA BETTER HEALTH OF WASHINGTON, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite Plan (HMO-POS)	01	02		1			H3748	007	0	2022	Spokane County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3748	008	0	1	02	01	H3748_008_0	2	1					0	08/02/2021	2022.01	08/02/2021 01:30:24 PM Eastern Daylight Time	08/02/2021 02:48:12 PM Eastern Daylight Time	08/02/2021 09:37:08 AM Eastern Daylight Time			08/04/2021 01:38:04 PM Eastern Daylight Time	AETNA BETTER HEALTH OF WASHINGTON, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime Plan (HMO-POS)	01	02		1			H3748	008	0	2022	Pierce County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3748	009	0	1	02	01	H3748_009_0	3	1					0	08/02/2021	2022.01	08/02/2021 01:31:08 PM Eastern Daylight Time	08/02/2021 02:49:54 PM Eastern Daylight Time	08/02/2021 09:37:12 AM Eastern Daylight Time			08/04/2021 01:38:04 PM Eastern Daylight Time	AETNA BETTER HEALTH OF WASHINGTON, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite Plan (HMO-POS)	01	02		1			H3748	009	0	2022	Puget Sound Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3748	801	0	1	01	01	H3748_801_0	1	1				0	0	05/27/2021	2022.01	05/27/2021 11:24:25 PM Eastern Daylight Time					06/03/2021 01:07:05 PM Eastern Daylight Time	AETNA BETTER HEALTH OF WASHINGTON, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (HMO)	01	01		1			H3748	801	0	2022	Washington		1	120	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H3748	802	0	1	01	01	H3748_802_0	1	1						05/27/2021	2022.01	05/27/2021 11:24:44 PM Eastern Daylight Time					06/03/2021 01:07:05 PM Eastern Daylight Time	AETNA BETTER HEALTH OF WASHINGTON, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan w/Rx (HMO)	01	01		1			H3748	802	0	2022	Washington		1	120	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H3749	001	0	1	02	01	H3749_001_0	5	1			1		1	08/04/2021	2022.01	08/04/2021 11:09:41 AM Central Daylight Time	08/03/2021 12:26:55 PM Central Daylight Time	07/29/2021 08:31:52 PM Central Daylight Time			08/05/2021 01:05:44 PM Central Daylight Time	UNITEDHEALTHCARE OF OKLAHOMA, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO-POS)	01	02		1			H3749	001	0	2022	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	02	01	H3749_017_0	5	1			1		1	08/04/2021	2022.01	08/04/2021 11:11:09 AM Central Daylight Time	08/03/2021 12:27:30 PM Central Daylight Time	07/29/2021 08:32:06 PM Central Daylight Time			08/05/2021 01:05:44 PM Central Daylight Time	UNITEDHEALTHCARE OF OKLAHOMA, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO-POS)	01	02		1			H3749	017	0	2022	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	02	01	H3749_018_0	5	1			1		1	08/04/2021	2022.01	08/04/2021 11:12:40 AM Central Daylight Time	08/03/2021 12:28:05 PM Central Daylight Time	07/29/2021 08:32:21 PM Central Daylight Time			08/05/2021 01:05:44 PM Central Daylight Time	UNITEDHEALTHCARE OF OKLAHOMA, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO-POS)	01	02		1			H3749	018	0	2022	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	02	01	H3749_020_0	5	1			1		1	08/04/2021	2022.01	08/04/2021 11:15:22 AM Central Daylight Time	08/03/2021 12:28:41 PM Central Daylight Time	07/29/2021 08:32:35 PM Central Daylight Time			08/05/2021 01:05:44 PM Central Daylight Time	UNITEDHEALTHCARE OF OKLAHOMA, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO-POS)	01	02		1			H3749	020	0	2022	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				0	0	06/02/2021	2022.01	06/02/2021 09:11:07 AM Central Daylight Time					06/02/2021 12:17:31 PM Central Daylight Time	UNITEDHEALTHCARE OF OKLAHOMA, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H3749	801	0	2022	OK Employer Sponsored Plan Service Area		1	420	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1					1				
H3749	803	0	1	01	01	H3749_803_0	1	1						05/24/2021	2022.01	05/24/2021 12:21:25 PM Central Daylight Time					06/02/2021 12:17:31 PM Central Daylight Time	UNITEDHEALTHCARE OF OKLAHOMA, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H3749	803	0	2022	OK Employer Sponsored Plan Service Area		1	5532	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1					1				
H3749	804	0	1	01	01	H3749_804_0	1	1						05/24/2021	2022.01	05/24/2021 12:21:45 PM Central Daylight Time					06/02/2021 12:17:31 PM Central Daylight Time	UNITEDHEALTHCARE OF OKLAHOMA, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H3749	804	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1					1				
H3755	001	0	1	01	01	H3755_001_0	8	1					1	08/05/2021	2022.01	08/05/2021 06:02:43 PM Central Daylight Time	08/05/2021 06:02:24 PM Central Daylight Time	08/05/2021 04:38:13 PM Central Daylight Time			08/05/2021 06:04:31 PM Central Daylight Time	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	CommunityCare Senior Health Plan (HMO)	www.ccokadvantage.com/2022/SHP	Senior Health Plan Platinum (HMO)	01	01		1			H3755	001	0	2022	Select counties in N.E. Oklahoma		2		2			2						www.ccokadvantage.com/2022/SHP/Pharmacy-and-Rx-Info.asp	www.medicareplanrx.com/jccf/ccok_shp_formulary_22.html	www.ccokadvantage.com/2022/SHP	(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	3	1				0	0	07/12/2021	2022.01	07/12/2021 04:07:31 PM Central Daylight Time	06/24/2021 01:26:35 PM Central Daylight Time				07/13/2021 12:28:02 PM Central Daylight Time	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	CommunityCare Senior Health Plan (HMO)	www.ccokadvantage.com/2022/SHP	Senior Health Plan Silver (HMO)	01	01		1			H3755	002	0	2022	Select counties in N.E. Oklahoma		2		2			2						www.ccokadvantage.com/2022/shp/pharmacy-and-Rx-info.asp	www.medicareplanrx.com/jccf/ccok_shp_formulary_22.html	www.ccokadvantage.com/2022/SHP	(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					1	08/04/2021	2022.01	08/04/2021 12:35:09 PM Central Daylight Time	08/05/2021 04:36:53 PM Central Daylight Time	08/05/2021 04:38:22 PM Central Daylight Time			08/05/2021 04:58:57 PM Central Daylight Time	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	CommunityCare Senior Health Plan (HMO)	www.ccokadvantage.com/2022/SHP	Senior Health Plan Platinum Plus (HMO)	01	01		1			H3755	004	0	2022	Select counties in N.E. Oklahoma		2		2			2						www.ccokadvantage.com/2022/SHP/Pharmacy-and-Rx-Info.asp	www.medicareplanrx.com/jccf/ccok_shp_formulary_22.html	www.ccokadvantage.com/2022/SHP	(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	005	0	1	01	01	H3755_005_0	7	1					1	08/04/2021	2022.01	08/04/2021 12:36:30 PM Central Daylight Time	08/05/2021 04:37:02 PM Central Daylight Time	08/05/2021 04:38:32 PM Central Daylight Time			08/05/2021 04:58:57 PM Central Daylight Time	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	CommunityCare Senior Health Plan (HMO)	www.ccokadvantage.com/2022/SHP	Senior Health Plan Silver Plus (HMO)	01	01		1			H3755	005	0	2022	Select counties in N.E. Oklahoma		2		2			2						www.ccokadvantage.com/2022/SHP/Pharmacy-and-Rx-Info.asp	www.medicareplanrx.com/jccf/ccok_shp_formulary_22.html	www.ccokadvantage.com/2022/SHP	(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	1	1						06/08/2021	2022.01	06/08/2021 08:26:00 AM Central Daylight Time					06/08/2021 08:26:27 AM Central Daylight Time	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	CommunityCare Senior Health Plan (HMO)	www.ccokadvantage.com/2021/SHP	Senior Health EGHP+D (HMO)	01	01		1			H3755	801	0	2022	Select counties in N.E. Oklahoma		1	22800	2			2						www.ccokadvantage.com/2021/SHP/Pharmacy-and-Rx-Info.asp	www.medicareplanrx.com/jccf/ccok_shp_formulary_21.html	www.ccokadvantage.com/2021/SHP	(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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;11a;12;14a;14e2;16b;	1	5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9d;12;14a;14e2;16b;	1					1				
H3777	001	2	1	01	01	H3777_001_2	10	1					1	08/16/2021	2022.01	08/16/2021 11:14:16 AM Eastern Daylight Time	08/03/2021 01:11:11 PM Eastern Daylight Time	08/03/2021 01:48:32 PM Eastern Daylight Time			08/16/2021 11:16:01 AM Eastern Daylight Time	EXPERIENCE HEALTH, INC.	Experience Health, Inc.	www.experiencehealthnc.com	Experience Health Medicare Advantage (HMO)	01	01		1			H3777	001	2	2022	Triangle and surrounding area	Durham Region	2	17688	2			2						www.experiencehealthnc.com	www.experiencehealthnc.com		(833)777-7394		(984)364-3974		(833)905-1299		(919)646-9835		(833)777-7394		(984)364-3974		(833)905-1299		(919)646-9835		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3777	001	3	1	01	01	H3777_001_3	10	1					1	08/16/2021	2022.01	08/16/2021 11:14:37 AM Eastern Daylight Time	08/03/2021 01:13:45 PM Eastern Daylight Time	08/03/2021 01:54:11 PM Eastern Daylight Time			08/16/2021 11:16:01 AM Eastern Daylight Time	EXPERIENCE HEALTH, INC.	Experience Health, Inc.	www.experiencehealthnc.com	Experience Health Medicare Advantage (HMO)	01	01		1			H3777	001	3	2022	Triangle and surrounding area	Orange Region	2	11556	2			2						www.experiencehealthnc.com	www.experiencehealthnc.com		(833)777-7394		(984)364-3974		(833)905-1299		(919)646-9835		(833)777-7394		(984)364-3974		(833)905-1299		(919)646-9835		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3777	001	4	1	01	01	H3777_001_4	10	1					1	08/16/2021	2022.01	08/16/2021 11:14:52 AM Eastern Daylight Time	08/03/2021 01:15:08 PM Eastern Daylight Time	08/03/2021 01:59:35 PM Eastern Daylight Time			08/16/2021 11:16:01 AM Eastern Daylight Time	EXPERIENCE HEALTH, INC.	Experience Health, Inc.	www.experiencehealthnc.com	Experience Health Medicare Advantage (HMO)	01	01		1			H3777	001	4	2022	Triangle and surrounding area	Raleigh Region	2	24324	2			2						www.experiencehealthnc.com	www.experiencehealthnc.com		(833)777-7394		(984)364-3974		(833)905-1299		(919)646-9835		(833)777-7394		(984)364-3974		(833)905-1299		(919)646-9835		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3794	002	0	1	01	01	H3794_002_0	5	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 10:08:54 AM Central Daylight Time	08/03/2021 01:41:38 PM Central Daylight Time	07/29/2021 08:32:50 PM Central Daylight Time			08/04/2021 04:20:48 PM Central Daylight Time	CARE IMPROVEMENT PLUS WISCONSIN INSURANCE COMPANY	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete LP1 (HMO D-SNP)	01	01		1			H3794	002	0	2022	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			
H3800	001	0	1	01	01	H3800_001_0	18	1		1			0	08/05/2021	2022.01	08/05/2021 04:15:22 PM Eastern Daylight Time	08/05/2021 07:33:37 PM Eastern Daylight Time	08/05/2021 07:33:37 PM Eastern Daylight Time			08/05/2021 07:41:08 PM Eastern Daylight Time	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Provider Partners Health Plans	www.pphealthplan.com	Provider Partners Illinois Advantage Plan (HMO I-SNP)	01	01		1			H3800	001	0	2022	Illinois (partial)		2		2			1	1	1				www.pphealthplan.com	www.pphealthplan.com	www.pphealthplan.com	(800)405-9681		(800)405-9681		(800)405-9681		(800)405-9681		(844)846-8007		(844)846-8007		(800)405-9681		(800)405-9681		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3800	002	0	1	01	01	H3800_002_0	20	1		1			0	08/05/2021	2022.01	08/05/2021 05:18:25 PM Eastern Daylight Time	08/05/2021 07:33:37 PM Eastern Daylight Time	08/05/2021 07:33:37 PM Eastern Daylight Time			08/05/2021 07:41:08 PM Eastern Daylight Time	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Provider Partners Health Plans	www.pphealthplan.com	Provider Partners Illinois Community Plan (HMO I-SNP)	01	01		1			H3800	002	0	2022	Illinois (partial)		2		2			1	1	2				www.pphealthplan.com	www.pphealthplan.com	www.pphealthplan.com	(800)405-9681		(800)405-9681		(800)405-9681		(800)405-9681		(844)846-8007		(844)846-8007		(800)405-9681		(800)405-9681		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3805	001	0	1	01	01	H3805_001_0	3	1					1	08/04/2021	2022.01	08/04/2021 12:49:32 PM Central Daylight Time	08/03/2021 12:11:05 PM Central Daylight Time	07/29/2021 08:33:05 PM Central Daylight Time			08/04/2021 09:35:31 PM Central Daylight Time	UNITEDHEALTHCARE OF OREGON, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO)	01	01		1			H3805	001	0	2022	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					1	08/04/2021	2022.01	08/04/2021 12:52:26 PM Central Daylight Time	08/03/2021 12:11:38 PM Central Daylight Time	07/29/2021 08:33:20 PM Central Daylight Time			08/04/2021 09:35:31 PM Central Daylight Time	UNITEDHEALTHCARE OF OREGON, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO)	01	01		1			H3805	007	0	2022	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	015	0	1	01	01	H3805_015_0	4	1					1	08/04/2021	2022.01	08/04/2021 12:54:39 PM Central Daylight Time	08/03/2021 12:12:14 PM Central Daylight Time	07/29/2021 08:33:36 PM Central Daylight Time			08/04/2021 09:35:31 PM Central Daylight Time	UNITEDHEALTHCARE OF OREGON, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 3 (HMO)	01	01		1			H3805	015	0	2022	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	017	0	1	01	01	H3805_017_0	3	1					1	08/04/2021	2022.01	08/04/2021 12:56:23 PM Central Daylight Time	08/03/2021 12:12:51 PM Central Daylight Time	07/29/2021 08:33:51 PM Central Daylight Time			08/04/2021 09:35:31 PM Central Daylight Time	UNITEDHEALTHCARE OF OREGON, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO)	01	01		1			H3805	017	0	2022	Select Counties in 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	019	0	1	01	01	H3805_019_0	3	1					1	08/04/2021	2022.01	08/04/2021 12:59:28 PM Central Daylight Time	08/03/2021 12:13:29 PM Central Daylight Time	07/29/2021 08:34:06 PM Central Daylight Time			08/04/2021 09:35:31 PM Central Daylight Time	UNITEDHEALTHCARE OF OREGON, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO)	01	01		1			H3805	019	0	2022	Kitsap, Pierce, 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	023	1	1	01	01	H3805_023_1	3	1					1	08/04/2021	2022.01	08/04/2021 01:01:47 PM Central Daylight Time	08/03/2021 12:14:07 PM Central Daylight Time	07/29/2021 08:34:21 PM Central Daylight Time			08/04/2021 09:35:31 PM Central Daylight Time	UNITEDHEALTHCARE OF OREGON, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO)	01	01		1			H3805	023	1	2022	Benton, Lane, and Linn Counties	Benton and Lane 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	023	2	1	01	01	H3805_023_2	3	1					1	08/04/2021	2022.01	08/04/2021 01:03:49 PM Central Daylight Time	08/03/2021 12:14:43 PM Central Daylight Time	07/29/2021 08:34:35 PM Central Daylight Time			08/04/2021 09:35:31 PM Central Daylight Time	UNITEDHEALTHCARE OF OREGON, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO)	01	01		1			H3805	023	2	2022	Benton, Lane, and Linn Counties	Linn 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	025	1	1	01	01	H3805_025_1	3	1					1	08/04/2021	2022.01	08/04/2021 01:05:29 PM Central Daylight Time	08/03/2021 12:15:20 PM Central Daylight Time	07/29/2021 08:34:50 PM Central Daylight Time			08/04/2021 09:35:31 PM Central Daylight Time	UNITEDHEALTHCARE OF OREGON, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO)	01	01		1			H3805	025	1	2022	Thurston and Lewis Counties	Lewis 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	025	2	1	01	01	H3805_025_2	3	1					1	08/04/2021	2022.01	08/04/2021 01:08:11 PM Central Daylight Time	08/03/2021 12:15:56 PM Central Daylight Time	07/29/2021 08:35:04 PM Central Daylight Time			08/04/2021 09:35:31 PM Central Daylight Time	UNITEDHEALTHCARE OF OREGON, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO)	01	01		1			H3805	025	2	2022	Thurston and Lewis Counties	Thurston 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	029	0	1	01	01	H3805_029_0	3	1					1	08/04/2021	2022.01	08/04/2021 01:13:15 PM Central Daylight Time	08/03/2021 12:16:32 PM Central Daylight Time	07/29/2021 08:35:19 PM Central Daylight Time			08/04/2021 09:35:31 PM Central Daylight Time	UNITEDHEALTHCARE OF OREGON, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO)	01	01		1			H3805	029	0	2022	Benton, Franklin, Yakima and Walla Walla 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	030	0	1	01	01	H3805_030_0	3	1					1	08/04/2021	2022.01	08/04/2021 01:24:28 PM Central Daylight Time	08/03/2021 12:17:07 PM Central Daylight Time	07/29/2021 08:35:33 PM Central Daylight Time			08/04/2021 09:35:31 PM Central Daylight Time	UNITEDHEALTHCARE OF OREGON, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Walgreens (HMO)	01	01		1			H3805	030	0	2022	Clark 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	032	0	1	02	01	H3805_032_0	5	1					1	08/04/2021	2022.01	08/04/2021 01:27:09 PM Central Daylight Time	08/03/2021 12:17:42 PM Central Daylight Time	07/29/2021 08:35:48 PM Central Daylight Time			08/04/2021 09:46:08 PM Central Daylight Time	UNITEDHEALTHCARE OF OREGON, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Walgreens (HMO-POS)	01	02		1			H3805	032	0	2022	King, Pierce, Snohomish and Thurston 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	033	0	1	02	01	H3805_033_0	3	1					1	08/04/2021	2022.01	08/04/2021 01:29:01 PM Central Daylight Time	08/03/2021 12:18:17 PM Central Daylight Time	07/29/2021 08:36:03 PM Central Daylight Time			08/04/2021 09:46:08 PM Central Daylight Time	UNITEDHEALTHCARE OF OREGON, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO-POS)	01	02		1			H3805	033	0	2022	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			
H3805	034	0	1	02	01	H3805_034_0	3	1					1	08/04/2021	2022.01	08/04/2021 01:30:57 PM Central Daylight Time	08/03/2021 12:18:51 PM Central Daylight Time	07/29/2021 08:36:17 PM Central Daylight Time			08/04/2021 09:46:08 PM Central Daylight Time	UNITEDHEALTHCARE OF OREGON, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO-POS)	01	02		1			H3805	034	0	2022	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			
H3805	035	0	1	02	01	H3805_035_0	2	1				0	0	07/15/2021	2022.01	07/15/2021 09:33:18 AM Central Daylight Time	06/03/2021 03:11:36 PM Central Daylight Time				07/16/2021 01:16:17 PM Central Daylight Time	UNITEDHEALTHCARE OF OREGON, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (HMO-POS)	01	02		1			H3805	035	0	2022	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			
H3805	036	0	1	01	01	H3805_036_0	3	1					1	08/04/2021	2022.01	08/04/2021 01:36:59 PM Central Daylight Time	08/03/2021 12:19:24 PM Central Daylight Time	07/29/2021 08:36:32 PM Central Daylight Time			08/04/2021 09:46:08 PM Central Daylight Time	UNITEDHEALTHCARE OF OREGON, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO)	01	01		1			H3805	036	0	2022	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	037	0	1	01	01	H3805_037_0	3	1					1	08/04/2021	2022.01	08/04/2021 01:39:15 PM Central Daylight Time	08/03/2021 12:19:59 PM Central Daylight Time	07/29/2021 08:36:46 PM Central Daylight Time			08/04/2021 09:46:08 PM Central Daylight Time	UNITEDHEALTHCARE OF OREGON, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO)	01	01		1			H3805	037	0	2022	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	801	0	1	01	01	H3805_801_0	1	1				0	0	06/03/2021	2022.01	06/03/2021 09:42:22 AM Eastern Daylight Time					06/03/2021 09:54:18 AM Eastern Daylight Time	UNITEDHEALTHCARE OF OREGON, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H3805	801	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H3805	803	0	1	01	01	H3805_803_0	1	1						05/24/2021	2022.01	05/24/2021 12:36:09 PM Eastern Daylight Time					06/03/2021 09:54:18 AM Eastern Daylight Time	UNITEDHEALTHCARE OF OREGON, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H3805	803	0	2022	OR Employer Sponsored Plan Service Area		1	1416	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H3805	804	0	1	01	01	H3805_804_0	1	1						05/24/2021	2022.01	05/24/2021 12:36:26 PM Eastern Daylight Time					06/03/2021 09:54:18 AM Eastern Daylight Time	UNITEDHEALTHCARE OF OREGON, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H3805	804	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H3805	805	0	1	01	01	H3805_805_0	1	1				0	0	06/03/2021	2022.01	06/03/2021 09:43:22 AM Eastern Daylight Time					06/03/2021 09:54:18 AM Eastern Daylight Time	UNITEDHEALTHCARE OF OREGON, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H3805	805	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H3805	806	0	1	01	01	H3805_806_0	1	1						05/24/2021	2022.01	05/24/2021 12:37:16 PM Eastern Daylight Time					06/03/2021 09:54:18 AM Eastern Daylight Time	UNITEDHEALTHCARE OF OREGON, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H3805	806	0	2022	Select counties in Washington		1	2556	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H3805	807	0	1	01	01	H3805_807_0	1	1						05/24/2021	2022.01	05/24/2021 12:37:38 PM Eastern Daylight Time					06/03/2021 09:54:18 AM Eastern Daylight Time	UNITEDHEALTHCARE OF OREGON, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H3805	807	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H3809	001	0	1	20	08	H3809_001_0	1	1						06/01/2021	2022.01	06/01/2021 01:44:10 PM Pacific Daylight Time		06/01/2021 01:28:06 PM Pacific Daylight Time			06/01/2021 01:45:58 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	2022	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						06/01/2021	2022.01	06/01/2021 01:43:59 PM Pacific Daylight Time		06/01/2021 01:28:06 PM Pacific Daylight Time			06/01/2021 01:45:58 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	2022	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	4	1				0	0	07/08/2021	2022.01	07/08/2021 02:09:43 PM Pacific Daylight Time	06/05/2021 06:57:10 PM Pacific Daylight Time				07/12/2021 09:19:22 AM Pacific Daylight Time	ALLCARE HEALTH PLAN, INC.	AllCare Advantage	www.AllCareHealth.com/Advantage	AllCare Advantage Gold (HMO)	01	01		1			H3810	001	0	2022	Josephine, Jackson, Douglas*		2	2196	2			2						www.AllCareHealth.com/Advantage/Pharmacy	www.allcarehealth.com/medicare/allcare-advantage-2019/lookup-tools/formulary-search	www.AllCareHealth.com/Advantage/Providers	(888)460-0185		(541)471-4106		(888)460-0185		(541)471-4106										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3810	003	0	1	01	01	H3810_003_0	6	1					0	08/04/2021	2022.01	08/04/2021 01:43:36 PM Pacific Daylight Time	08/04/2021 01:29:17 PM Pacific Daylight Time	08/04/2021 01:29:17 PM Pacific Daylight Time			08/05/2021 08:08:48 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	2022	Josephine, Jackson, Douglas*		2	6377	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3810	020	0	1	01	01	H3810_020_0	6	1					0	08/04/2021	2022.01	08/04/2021 08:50:58 AM Pacific Daylight Time	08/04/2021 01:29:17 PM Pacific Daylight Time	08/04/2021 01:29:17 PM Pacific Daylight Time			08/05/2021 08:08:48 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	2022	Josephine, Jackson, Douglas*		2	32180	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3810	021	0	1	01	01	H3810_021_0	4	1				0	0	07/08/2021	2022.01	07/08/2021 03:09:47 PM Pacific Daylight Time	06/05/2021 06:58:46 PM Pacific Daylight Time				07/12/2021 09:19:22 AM Pacific Daylight Time	ALLCARE HEALTH PLAN, INC.	AllCare Advantage	www.AllCareHealth.com/Advantage	AllCare Advantage Focus (HMO)	01	01		1			H3810	021	0	2022	Josephine, Jackson, Douglas*		2	1673	2			2						www.AllCareHealth.com/Advantage/Pharmacy	www.allcarehealth.com/medicare/allcare-advantage-2019/lookup-tools/formulary-search	www.AllCareHealth.com/Advantage/Providers	(888)460-0185		(541)471-4106		(888)460-0185		(541)471-4106										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3810	022	0	1	01	01	H3810_022_0	6	1					0	08/04/2021	2022.01	08/04/2021 01:43:49 PM Pacific Daylight Time	08/04/2021 01:29:17 PM Pacific Daylight Time	08/04/2021 01:29:17 PM Pacific Daylight Time			08/05/2021 08:08:48 AM Pacific Daylight Time	ALLCARE HEALTH PLAN, INC.	AllCare Advantage	www.AllCareHealth.com/Advantage	AllCare Advantage Focus Rx (HMO)	01	01		1			H3810	022	0	2022	Josephine, Jackson, Douglas*		2	10515	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3811	001	0	1	01	01	H3811_001_0	4	1				0	0	07/12/2021	2022.01	07/12/2021 12:25:19 PM Pacific Daylight Time	06/07/2021 04:31:00 PM Pacific Daylight Time				07/12/2021 12:37:26 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	2022	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					0	08/04/2021	2022.01	08/04/2021 02:01:04 PM Pacific Daylight Time	08/04/2021 01:55:01 PM Pacific Daylight Time	08/04/2021 01:54:28 PM Pacific Daylight Time			08/04/2021 03:25:42 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	2022	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	4	1	2	1			0	08/04/2021	2022.01	08/04/2021 02:02:11 PM Pacific Daylight Time	08/04/2021 01:54:53 PM Pacific Daylight Time	08/04/2021 01:54:30 PM Pacific Daylight Time			08/04/2021 03:25:42 PM Pacific Daylight Time	SAMARITAN HEALTH PLANS, INC.	Samaritan Advantage Health Plan	https://medicare.samhealthplans.org	Samaritan Advantage Special Needs Plan (HMO D-SNP)	01	01		1			H3811	003	0	2022	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	6	1					0	08/04/2021	2022.01	08/04/2021 02:03:09 PM Pacific Daylight Time	08/04/2021 01:54:58 PM Pacific Daylight Time	08/04/2021 01:54:25 PM Pacific Daylight Time			08/04/2021 03:25:42 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	2022	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				0	0	07/02/2021	2022.01	07/02/2021 08:56:05 AM Pacific Daylight Time	06/04/2021 04:24:36 PM Pacific Daylight Time				07/02/2021 10:51:24 AM 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	2022	Western Oregon		2		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	009	0	1	04	01	H3813_009_0	7	1					0	08/03/2021	2022.01	08/03/2021 11:42:24 AM Pacific Daylight Time	08/04/2021 11:02:03 AM Pacific Daylight Time	08/04/2021 11:02:05 AM Pacific Daylight Time			08/04/2021 11:35:36 AM 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	2022	Greater Portland Metro		2		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	010	0	1	04	01	H3813_010_0	7	1					0	07/02/2021	2022.01	07/02/2021 09:01:43 AM Pacific Daylight Time	08/04/2021 11:02:06 AM Pacific Daylight Time	08/04/2021 11:02:08 AM Pacific Daylight Time			08/04/2021 11:35:36 AM Pacific Daylight Time	MODA HEALTH PLAN, INC.	Moda Health Plan, Inc.	www.modahealth.com/medicare	Moda Health Central PPORX (PPO)	01	04		1			H3813	010	0	2022	Central Oregon		2		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	011	0	1	04	01	H3813_011_0	7	1					0	07/02/2021	2022.01	07/02/2021 09:08:11 AM Pacific Daylight Time	08/04/2021 11:02:10 AM Pacific Daylight Time	08/04/2021 11:02:12 AM Pacific Daylight Time			08/04/2021 11:35:36 AM Pacific Daylight Time	MODA HEALTH PLAN, INC.	Moda Health Plan, Inc.	www.modahealth.com/medicare	Moda Health NW PPORX (PPO)	01	04		1			H3813	011	0	2022	Northwest Oregon		2		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	012	0	1	04	01	H3813_012_0	7	1					0	07/02/2021	2022.01	07/02/2021 09:11:46 AM Pacific Daylight Time	08/04/2021 11:02:14 AM Pacific Daylight Time	08/04/2021 11:02:16 AM Pacific Daylight Time			08/04/2021 11:35:36 AM Pacific Daylight Time	MODA HEALTH PLAN, INC.	Moda Health Plan, Inc.	www.modahealth.com/medicare	Moda Health Southern PPORX (PPO)	01	04		1			H3813	012	0	2022	Southern Oregon		2		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	013	0	1	04	01	H3813_013_0	7	1					0	07/02/2021	2022.01	07/02/2021 09:54:25 AM Pacific Daylight Time	08/04/2021 11:02:18 AM Pacific Daylight Time	08/04/2021 11:02:20 AM Pacific Daylight Time			08/04/2021 11:35:36 AM Pacific Daylight Time	MODA HEALTH PLAN, INC.	Moda Health Plan, Inc.	www.modahealth.com/medicare	Moda Health Metro PPORX (PPO)	01	04		1			H3813	013	0	2022	Greater Portland Metro		2		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	014	0	1	04	01	H3813_014_0	8	1					0	09/03/2021	2022.01	09/03/2021 08:34:22 AM Pacific Daylight Time	08/04/2021 11:02:22 AM Pacific Daylight Time	08/04/2021 11:02:24 AM Pacific Daylight Time			09/03/2021 08:48:43 AM Pacific Daylight Time	MODA HEALTH PLAN, INC.	Moda Health Plan, Inc.	www.modahealth.com/medicare	Moda Health Mid-valley PPORX (PPO)	01	04		1			H3813	014	0	2022	Mid-West Oregon		2		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	804	0	1	04	01	H3813_804_0	4	1						04/21/2021	2022.01	04/21/2021 11:48:29 AM Pacific Daylight Time					06/03/2021 10:35:09 AM Pacific Daylight Time	MODA HEALTH PLAN, INC.	Moda Health Plan, Inc.	www.modahealth.com/medicare	Moda Health Group Plan + Rx (PPO)	01	04		1			H3813	804	0	2022	Statewide		1	6000	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)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;8b1;8b2;9a1;9b;11a;11b;11c;15;	2		1									
H3814	007	0	1	01	01	H3814_007_0	4	1	2	1			0	08/05/2021	2022.01	08/05/2021 11:24:28 AM Pacific Daylight Time	08/04/2021 11:08:22 AM Pacific Daylight Time	08/04/2021 10:15:11 AM Pacific Daylight Time			08/05/2021 11:35:58 AM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	atriohp.com	ATRIO Special Needs Plan (HMO D-SNP)	01	01		1			H3814	007	0	2022	Douglas and Klamath Counties		2		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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3815	001	0	1	01	01	H3815_001_0	4	1			2		0	08/04/2021	2022.01	08/04/2021 09:50:32 AM Pacific Daylight Time	08/02/2021 10:06:16 PM Pacific Daylight Time	08/02/2021 08:50:02 AM Pacific Daylight Time			08/04/2021 04:09:03 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	My Choice (HMO)	01	01		1			H3815	001	0	2022	LA, Orange, San Bernardino & Riverside Counties		2	51612	2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247	1	(323)728-7232	6	(844)227-7616		(844)227-7616		(888)979-2247	1	(323)728-7232	6	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3815	006	0	1	01	01	H3815_006_0	3	1			2		0	08/04/2021	2022.01	08/04/2021 09:55:50 AM Pacific Daylight Time	08/02/2021 10:08:42 PM Pacific Daylight Time	08/02/2021 08:54:44 AM Pacific Daylight Time			08/04/2021 04:09:03 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	My Choice (HMO)	01	01		1			H3815	006	0	2022	Stanislaus, San Joaquin Counties		2	71850	2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247	1	(323)728-7232	6	(844)227-7616		(844)227-7616		(888)979-2247	1	(323)728-7232	6	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3815	007	0	1	01	01	H3815_007_0	3	1			2		0	08/04/2021	2022.01	08/04/2021 09:56:49 AM Pacific Daylight Time	08/02/2021 10:11:04 PM Pacific Daylight Time	08/02/2021 08:57:30 AM Pacific Daylight Time			08/04/2021 04:09:03 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	My Choice (HMO)	01	01		1			H3815	007	0	2022	Santa Clara & San Francisco		2	85206	2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247	1	(323)728-7232	6	(844)227-7616		(844)227-7616		(888)979-2247	1	(323)728-7232	6	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3815	008	0	1	01	01	H3815_008_0	3	1			2		0	08/04/2021	2022.01	08/04/2021 09:56:58 AM Pacific Daylight Time	08/04/2021 04:25:48 PM Pacific Daylight Time	08/02/2021 09:00:48 AM Pacific Daylight Time			08/04/2021 04:09:03 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Platinum (HMO)	01	01		1			H3815	008	0	2022	Los Angeles and Orange Counties		2	94866	2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247	1	(323)728-7232	6	(844)227-7616		(844)227-7616		(888)979-2247	1	(323)728-7232	6	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3815	009	0	1	01	01	H3815_009_0	4	1			2		0	08/04/2021	2022.01	08/04/2021 09:57:09 AM Pacific Daylight Time	08/04/2021 01:09:28 PM Pacific Daylight Time	07/30/2021 12:42:56 PM Pacific Daylight Time			08/04/2021 04:09:03 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	CalPlus (HMO)	01	01		1			H3815	009	0	2022	SoCal & NorCal		2	176164	2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247	1	(323)728-7232	6	(844)227-7616		(844)227-7616		(888)979-2247	1	(323)728-7232	6	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3815	010	0	1	01	01	H3815_010_0	3	1		1	2		0	08/04/2021	2022.01	08/04/2021 09:57:17 AM Pacific Daylight Time	08/03/2021 04:54:56 PM Pacific Daylight Time	08/02/2021 09:04:30 AM Pacific Daylight Time			08/04/2021 04:09:03 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Heart & Diabetes (HMO C-SNP)	01	01		1			H3815	010	0	2022	LA, OC, SB, SD, SF and ST Counties		2	21820	2			1	4			00000000000000000010		www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247	1	(323)728-7232	6	(844)227-7616		(844)227-7616		(888)979-2247	1	(323)728-7232	6	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3815	011	0	1	01	01	H3815_011_0	3	1			2		0	08/04/2021	2022.01	08/04/2021 09:57:25 AM Pacific Daylight Time	08/02/2021 10:15:04 PM Pacific Daylight Time	08/02/2021 09:09:36 AM Pacific Daylight Time			08/04/2021 04:09:03 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	AllCare Preferred Plan (HMO)	01	01		1			H3815	011	0	2022	Stanislaus County		2	109140	2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247	1	(323)728-7232	6	(844)227-7616		(844)227-7616		(888)979-2247	1	(323)728-7232	6	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3815	013	0	1	01	01	H3815_013_0	5	1			1		0	08/04/2021	2022.01	08/04/2021 09:57:33 AM Pacific Daylight Time	08/03/2021 10:32:18 PM Pacific Daylight Time	08/02/2021 09:07:12 AM Pacific Daylight Time			08/04/2021 04:09:03 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	smartHMO (HMO)	01	01		1			H3815	013	0	2022	Los Angeles		2	31635	2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247	1	(323)728-7232	6	(844)227-7616		(844)227-7616		(888)979-2247	1	(323)728-7232	6	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3815	015	0	1	01	01	H3815_015_0	3	1			2		0	08/04/2021	2022.01	08/04/2021 09:57:42 AM Pacific Daylight Time	08/04/2021 03:26:48 PM Pacific Daylight Time	08/02/2021 09:11:52 AM Pacific Daylight Time			08/04/2021 04:09:03 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Platinum (HMO)	01	01		1			H3815	015	0	2022	San Bernardino, Riverside		2	61658	2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247	1	(323)728-7232	6	(844)227-7616		(844)227-7616		(888)979-2247	1	(323)728-7232	6	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3815	016	0	1	01	01	H3815_016_0	4	1			2		0	08/04/2021	2022.01	08/04/2021 09:57:51 AM Pacific Daylight Time	08/03/2021 10:45:06 PM Pacific Daylight Time	08/02/2021 09:15:20 AM Pacific Daylight Time			08/04/2021 04:09:03 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Platinum (HMO)	01	01		1			H3815	016	0	2022	San Diego		2	83323	2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247	1	(323)728-7232	6	(844)227-7616		(844)227-7616		(888)979-2247	1	(323)728-7232	6	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3815	018	0	1	01	01	H3815_018_0	3	1			2		0	08/04/2021	2022.01	08/04/2021 09:58:01 AM Pacific Daylight Time	08/04/2021 03:28:20 PM Pacific Daylight Time	08/02/2021 09:17:24 AM Pacific Daylight Time			08/04/2021 04:09:03 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Platinum (HMO)	01	01		1			H3815	018	0	2022	Marin County		2	2706	2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247	1	(323)728-7232	6	(844)227-7616		(844)227-7616		(888)979-2247	1	(323)728-7232	6	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3815	019	0	1	01	01	H3815_019_0	4	1			2		0	08/04/2021	2022.01	08/04/2021 09:58:09 AM Pacific Daylight Time	08/02/2021 10:24:44 PM Pacific Daylight Time	07/30/2021 12:56:56 PM Pacific Daylight Time			08/04/2021 04:09:03 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Sutter Advantage (HMO)	01	01		1			H3815	019	0	2022	Sacramento, Placer & Yolo Counties		2	91416	2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247	1	(323)728-7232	6	(844)227-7616		(844)227-7616		(888)979-2247	1	(323)728-7232	6	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3815	020	0	1	01	01	H3815_020_0	3	1			2		0	08/04/2021	2022.01	08/04/2021 09:58:17 AM Pacific Daylight Time	08/02/2021 10:27:18 PM Pacific Daylight Time	07/30/2021 12:59:44 PM Pacific Daylight Time			08/04/2021 04:09:03 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Sutter Advantage (HMO)	01	01		1			H3815	020	0	2022	Santa Clara County		2	19338	2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247	1	(323)728-7232	6	(844)227-7616		(844)227-7616		(888)979-2247	1	(323)728-7232	6	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3815	021	0	1	01	01	H3815_021_0	3	1			2		0	08/04/2021	2022.01	08/04/2021 09:58:24 AM Pacific Daylight Time	08/02/2021 10:31:16 PM Pacific Daylight Time	07/30/2021 01:01:24 PM Pacific Daylight Time			08/04/2021 04:09:03 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Sutter Advantage (HMO)	01	01		1			H3815	021	0	2022	Santa Cruz County		2	24252	2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247	1	(323)728-7232	6	(844)227-7616		(844)227-7616		(888)979-2247	1	(323)728-7232	6	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3815	023	0	1	01	01	H3815_023_0	3	1			2		0	08/04/2021	2022.01	08/04/2021 09:58:32 AM Pacific Daylight Time	08/02/2021 10:32:54 PM Pacific Daylight Time	07/30/2021 01:02:24 PM Pacific Daylight Time			08/04/2021 04:09:03 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Sutter Advantage (HMO)	01	01		1			H3815	023	0	2022	Sonoma, San Mateo, San Francisco Counties		2	22146	2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247	1	(323)728-7232	6	(844)227-7616		(844)227-7616		(888)979-2247	1	(323)728-7232	6	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3815	025	0	1	01	01	H3815_025_0	3	1			2		0	08/04/2021	2022.01	08/04/2021 10:03:21 AM Pacific Daylight Time	08/02/2021 11:41:20 PM Pacific Daylight Time	07/30/2021 01:03:52 PM Pacific Daylight Time			08/04/2021 04:09:03 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Platinum (HMO)	01	01		1			H3815	025	0	2022	San Joaquin		2	2112	2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247	1	(323)728-7232	6	(844)227-7616		(844)227-7616		(888)979-2247	1	(323)728-7232	6	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3815	026	0	1	01	01	H3815_026_0	5	1			2		0	08/04/2021	2022.01	08/04/2021 10:03:46 AM Pacific Daylight Time	08/03/2021 04:56:30 PM Pacific Daylight Time	08/02/2021 09:35:40 AM Pacific Daylight Time			08/04/2021 04:09:03 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	AVA (HMO)	01	01		1			H3815	026	0	2022	Santa Clara, Stanislaus Counties		2	1560	2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247	1	(323)728-7232	6	(844)227-7616		(844)227-7616		(888)979-2247	1	(323)728-7232	6	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3815	027	0	1	01	01	H3815_027_0	5	1			2		0	08/04/2021	2022.01	08/04/2021 10:03:56 AM Pacific Daylight Time	08/03/2021 04:58:22 PM Pacific Daylight Time	07/30/2021 01:05:52 PM Pacific Daylight Time			08/04/2021 04:09:03 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	AVA (HMO)	01	01		1			H3815	027	0	2022	SD, LA, OC, SLO, Ventura		2	2482	2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247	1	(323)728-7232	6	(844)227-7616		(844)227-7616		(888)979-2247	1	(323)728-7232	6	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3815	028	0	1	01	01	H3815_028_0	3	1			2		0	08/04/2021	2022.01	08/04/2021 10:04:32 AM Pacific Daylight Time	08/04/2021 03:30:32 PM Pacific Daylight Time	08/02/2021 09:19:12 AM Pacific Daylight Time			08/04/2021 04:09:03 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	My Choice (HMO)	01	01		1			H3815	028	0	2022	San Luis Obispo		2	25896	2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247	1	(323)728-7232	6	(844)227-7616		(844)227-7616		(888)979-2247	1	(323)728-7232	6	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3815	029	0	1	01	01	H3815_029_0	3	1			2		0	08/04/2021	2022.01	08/04/2021 10:04:40 AM Pacific Daylight Time	08/04/2021 03:32:38 PM Pacific Daylight Time	08/02/2021 09:20:56 AM Pacific Daylight Time			08/04/2021 04:09:03 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	My Choice (HMO)	01	01		1			H3815	029	0	2022	Ventura		2	2520	2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247	1	(323)728-7232	6	(844)227-7616		(844)227-7616		(888)979-2247	1	(323)728-7232	6	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3815	030	0	1	01	01	H3815_030_0	4	1	2	1	2		0	08/04/2021	2022.01	08/04/2021 10:04:48 AM Pacific Daylight Time	08/04/2021 04:35:42 PM Pacific Daylight Time	07/30/2021 01:08:26 PM Pacific Daylight Time			08/04/2021 04:09:03 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	CalPlusDuals (HMO D-SNP)	01	01		1			H3815	030	0	2022	ST, SJ, Marin, San Francisco, Ventura, SLO		2	32799	2			1	3		1		1	www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247	1	(323)728-7232	6	(844)227-7616		(844)227-7616		(888)979-2247	1	(323)728-7232	6	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3815	031	0	1	01	01	H3815_031_0	3	1			2		0	08/04/2021	2022.01	08/04/2021 10:04:56 AM Pacific Daylight Time	08/04/2021 03:35:28 PM Pacific Daylight Time	08/02/2021 09:22:34 AM Pacific Daylight Time			08/04/2021 04:09:03 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Harmony (HMO)	01	01		1			H3815	031	0	2022	San Diego, Santa Clara		2	20896	2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247	1	(323)728-7232	6	(844)227-7616		(844)227-7616		(888)979-2247	1	(323)728-7232	6	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3815	032	0	1	01	01	H3815_032_0	3	1			2		0	08/04/2021	2022.01	08/04/2021 10:05:05 AM Pacific Daylight Time	08/04/2021 03:36:50 PM Pacific Daylight Time	08/02/2021 09:24:54 AM Pacific Daylight Time			08/04/2021 04:09:03 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Select (HMO)	01	01		1			H3815	032	0	2022	San Diego		2	2550	2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247	1	(323)728-7232	6	(844)227-7616		(844)227-7616		(888)979-2247	1	(323)728-7232	6	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3815	033	0	1	01	01	H3815_033_0	5	1		1	2		0	08/04/2021	2022.01	08/04/2021 10:05:13 AM Pacific Daylight Time		08/02/2021 09:28:52 AM Pacific Daylight Time		08/02/2021 11:42:28 PM Pacific Daylight Time	08/04/2021 04:09:03 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	ESRD Balance (HMO C-SNP)	01	01		1			H3815	033	0	2022	Los Angeles and Orange		2	252	2			1	4			00000000100000000000		www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247	1	(323)728-7232	6	(844)227-7616		(844)227-7616		(888)979-2247	1	(323)728-7232	6	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3815	034	0	1	01	01	H3815_034_0	3	1			2		0	08/04/2021	2022.01	08/04/2021 10:05:22 AM Pacific Daylight Time	08/04/2021 03:40:08 PM Pacific Daylight Time	08/02/2021 09:31:10 AM Pacific Daylight Time			08/04/2021 04:09:03 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	the ONE + Rite Aid (HMO)	01	01		1			H3815	034	0	2022	LA, OC, SD, SB, SC, Riverside		2	1344	2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247	1	(323)728-7232	6	(844)227-7616		(844)227-7616		(888)979-2247	1	(323)728-7232	6	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3815	801	0	1	01	01	H3815_801_0	2	1						07/12/2021	2022.01	07/12/2021 07:21:58 PM Pacific Daylight Time					07/13/2021 11:53:46 AM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan Retiree Options (HMO)	01	01		1			H3815	801	0	2022	Southern California and Northern California		1	6000	2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247	1	(323)728-7232	6	(844)227-7616		(844)227-7616		(888)979-2247	1	(323)728-7232	6	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3815	802	0	1	01	01	H3815_802_0	2	1						07/12/2021	2022.01	07/12/2021 07:25:41 PM Pacific Daylight Time					07/13/2021 11:53:46 AM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan Retiree Options (HMO)	01	01		1			H3815	802	0	2022	Northern and Southern California		1	6000	2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247	1	(323)728-7232	6	(844)227-7616		(844)227-7616		(888)979-2247	1	(323)728-7232	6	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3815	803	0	1	01	01	H3815_803_0	2	1				0	0	07/12/2021	2022.01	07/12/2021 07:28:18 PM Pacific Daylight Time					07/13/2021 11:53:46 AM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan Retiree Options (HMO)	01	01		1			H3815	803	0	2022	Northern and Southern California		1	8000	2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247	1	(323)728-7232	6									(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3815	804	0	1	01	01	H3815_804_0	2	1				0	0	07/12/2021	2022.01	07/12/2021 07:26:24 PM Pacific Daylight Time					07/13/2021 11:53:46 AM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan Retiree Options (HMO)	01	01		1			H3815	804	0	2022	Northern and Southern California		1	8000	2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247	1	(323)728-7232	6									(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3815	805	0	1	01	01	H3815_805_0	2	1						07/13/2021	2022.01	07/13/2021 10:46:00 AM Pacific Daylight Time					07/13/2021 11:53:46 AM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan Retiree Options (HMO)	01	01		1			H3815	805	0	2022	Northern and Southern California		1	8000	2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247	1	(323)728-7232	6	(844)227-7616		(844)227-7616		(888)979-2247	1	(323)728-7232	6	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3815	806	0	1	01	01	H3815_806_0	2	1						07/12/2021	2022.01	07/12/2021 07:27:32 PM Pacific Daylight Time					07/13/2021 11:53:46 AM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan Retiree Options (HMO)	01	01		1			H3815	806	0	2022	Northern and Southern California		1	8000	2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247	1	(323)728-7232	6	(844)227-7616		(844)227-7616		(888)979-2247	1	(323)728-7232	6	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3817	008	1	1	04	01	H3817_008_1	7	1			1		1	08/03/2021	2022.01	08/03/2021 12:46:14 PM Pacific Daylight Time	08/04/2021 12:45:17 PM Pacific Daylight Time	08/06/2021 10:02:33 AM Pacific Daylight Time			08/09/2021 09:46:09 AM Pacific 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	2022	Select Counties in Oregon/Clark Co, WA	Metro	2	138973	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	7	1			1		1	08/03/2021	2022.01	08/03/2021 12:45:55 PM Pacific Daylight Time	08/04/2021 12:45:58 PM Pacific Daylight Time	08/06/2021 10:04:01 AM Pacific Daylight Time			08/09/2021 09:46:09 AM Pacific 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	2022	Select Counties in Oregon/Clark Co, WA	Non-Metro	2	163424	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	7	1			1		1	07/07/2021	2022.01	07/07/2021 11:28:16 AM Pacific Daylight Time	08/04/2021 12:46:37 PM Pacific Daylight Time	08/06/2021 10:05:35 AM Pacific Daylight Time			08/09/2021 09:46:09 AM Pacific 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	2022	Select Counties in Oregon/Clark Co, WA	Metro	2	44670	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	7	1			1		1	07/07/2021	2022.01	07/07/2021 11:28:08 AM Pacific Daylight Time	08/04/2021 12:47:19 PM Pacific Daylight Time	08/06/2021 10:07:11 AM Pacific Daylight Time			08/09/2021 09:46:09 AM Pacific 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	2022	Select Counties in Oregon/Clark Co, WA	Non-Metro	2	50046	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	4	1			2	0	0	07/07/2021	2022.01	07/07/2021 11:27:58 AM Pacific Daylight Time	07/01/2021 02:16:14 PM Pacific Daylight Time				07/07/2021 03:24:11 PM Pacific Daylight Time	REGENCE BLUECROSS BLUESHIELD OF OREGON	Regence BlueCross BlueShield of Oregon	www.regence.com/medicare	Regence Valiance (PPO)	01	04		1			H3817	010	0	2022	Select Counties in Oregon/Clark Co, WA		2	184453	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	7	1			1		1	08/03/2021	2022.01	08/03/2021 12:46:26 PM Pacific Daylight Time	08/04/2021 12:47:58 PM Pacific Daylight Time	08/06/2021 10:08:50 AM Pacific Daylight Time			08/09/2021 09:46:09 AM Pacific 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	2022	Select Counties in Oregon/Clark Co, WA	Metro	2	64598	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	7	1			1		1	08/03/2021	2022.01	08/03/2021 12:46:37 PM Pacific Daylight Time	08/04/2021 12:48:42 PM Pacific Daylight Time	08/06/2021 10:10:35 AM Pacific Daylight Time			08/09/2021 09:46:09 AM Pacific 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	2022	Select Counties in Oregon/Clark Co, WA	Non-Metro	2	256348	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	4	1				0	0	06/02/2021	2022.01	06/02/2021 10:41:05 AM Pacific Daylight Time					06/03/2021 11:12:52 AM Pacific 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	2022	Nationwide except territories		1	15500	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;7e;7h;7i;7k;8a;8b1;8b2;9a1;9a2;9b;9c;10a;11a;11b;11c;15;	2		1									
H3817	802	0	1	04	01	H3817_802_0	4	1						06/02/2021	2022.01	06/02/2021 10:41:31 AM Pacific Daylight Time					06/03/2021 11:12:52 AM Pacific 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	2022	Nationwide except territories		1	41554	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;7k;8a;8b1;8b2;9a1;9a2;9b;9c;10a;11a;11b;11c;15;	2		1									
H3817	803	0	1	04	01	H3817_803_0	4	1						06/02/2021	2022.01	06/02/2021 10:41:57 AM Pacific Daylight Time					06/03/2021 11:12:52 AM Pacific 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	2022	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;7e;7h;7i;7k;8a;8b1;8b2;9a1;9a2;9b;9c;10a;11a;11b;11c;15;	2		1									
H3817	804	0	1	04	01	H3817_804_0	4	1						06/02/2021	2022.01	06/02/2021 10:42:19 AM Pacific Daylight Time					06/03/2021 11:12:52 AM Pacific 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	2022	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;7e;7h;7i;7k;8a;8b1;8b2;9a1;9a2;9b;9c;10a;11a;11b;11c;15;	2		1									
H3822	001	0	1	01	01	H3822_001_0	4	1					0	07/23/2021	2022.01	07/23/2021 09:23:08 AM Central Daylight Time	08/03/2021 10:34:12 AM Central Daylight Time	08/04/2021 05:01:40 PM Central Daylight Time			08/05/2021 05:27:00 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM	www.getblueil.com/mapd	Blue Cross Medicare Advantage Basic (HMO)	01	01		1			H3822	001	0	2022	Chicago Metro Area		2	169964	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	6	1					0	07/15/2021	2022.01	07/15/2021 08:43:04 AM Mountain Daylight Time	08/03/2021 09:34:36 AM Mountain Daylight Time	08/04/2021 04:01:58 PM Mountain Daylight Time			08/05/2021 04:53:55 PM Mountain Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM	www.getbluenm.com/mapd	Blue Cross Medicare Advantage Basic (HMO)	01	01		1			H3822	002	0	2022	Bernalillo, Sandoval, Torrance and Valencia cntys		2	17932	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	007	0	1	02	01	H3822_007_0	4	1					0	06/30/2021	2022.01	06/30/2021 03:51:49 PM Central Daylight Time	08/03/2021 10:35:02 AM Central Daylight Time	08/04/2021 05:02:18 PM Central Daylight Time			08/05/2021 05:27:00 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM	www.getblueil.com/mapd	Blue Cross Medicare Advantage Basic Plus (HMO-POS)	01	02		1			H3822	007	0	2022	Chicago Metro Area		2	41171	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	5	1					0	06/30/2021	2022.01	06/30/2021 03:51:54 PM Central Daylight Time	08/03/2021 10:35:30 AM Central Daylight Time	08/04/2021 05:02:36 PM Central Daylight Time			08/05/2021 05:27:00 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM	www.getblueil.com/mapd	Blue Cross Medicare Advantage Premier Plus (HMO-POS)	01	02		1			H3822	008	0	2022	Chicago Metro Area		2	12574	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	012	0	1	01	01	H3822_012_0	3	1					0	06/03/2021	2022.01	06/03/2021 12:00:20 PM Central Daylight Time	08/03/2021 10:35:56 AM Central Daylight Time	08/04/2021 05:02:56 PM Central Daylight Time			08/05/2021 05:27:00 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM	www.getblueil.com/mapd	Blue Cross Medicare Advantage Basic (HMO)	01	01		1			H3822	012	0	2022	Springfield and Central Illinois		2	3372	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	013	0	1	01	01	H3822_013_0	4	1					0	06/03/2021	2022.01	06/03/2021 12:00:41 PM Central Daylight Time	08/03/2021 10:36:22 AM Central Daylight Time	08/04/2021 05:03:14 PM Central Daylight Time			08/05/2021 05:27:00 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM	www.getblueil.com/mapd	Blue Cross Medicare Advantage Basic (HMO)	01	01		1			H3822	013	0	2022	Macoupin, Madison, Monroe, & St. Clair Counties		2	4662	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	014	0	1	01	01	H3822_014_0	4	1					0	06/03/2021	2022.01	06/03/2021 12:01:05 PM Central Daylight Time	08/03/2021 10:36:48 AM Central Daylight Time	08/04/2021 05:03:32 PM Central Daylight Time			08/05/2021 05:27:00 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM	www.getblueil.com/mapd	Blue Cross Medicare Advantage Basic (HMO)	01	01		1			H3822	014	0	2022	Rockford Metro Market		2	2755	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	015	0	1	01	01	H3822_015_0	3	1					0	06/03/2021	2022.01	06/03/2021 12:01:24 PM Central Daylight Time	08/03/2021 10:37:12 AM Central Daylight Time	08/04/2021 05:03:52 PM Central Daylight Time			08/05/2021 05:27:00 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM	www.getblueil.com/mapd	Blue Cross Medicare Advantage Basic (HMO)	01	01		1			H3822	015	0	2022	Peoria, Tazewell, & McLean Counties		2	2402	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	1	1						05/26/2021	2022.01	05/26/2021 09:40:23 AM Central Daylight Time					05/28/2021 11:36:07 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM	www.hcsc.com	Blue Cross Group Medicare Advantage Plan (HMO)	01	01		1			H3822	801	0	2022	Statewide in 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)-		2					2					2	2			
H3822	802	0	1	01	01	H3822_802_0	1	1						05/26/2021	2022.01	05/26/2021 09:42:00 AM Central Daylight Time					05/28/2021 11:36:07 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM	www.hcsc.com	Blue Cross Group Medicare Advantage Plan (HMO)	01	01		1			H3822	802	0	2022	Statewide in New Mexico		1	44243	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)-		2					2					2	2			
H3822	805	0	1	01	01	H3822_805_0	1	1						05/26/2021	2022.01	05/26/2021 09:42:25 AM Central Daylight Time					05/28/2021 11:36:07 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM	www.hcsc.com	Blue Cross Group Medicare Advantage Plan (HMO)	01	01		1			H3822	805	0	2022	Statewide in 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)-		2					2					2	2			
H3822	806	0	1	01	01	H3822_806_0	1	1						05/26/2021	2022.01	05/26/2021 09:42:43 AM Central Daylight Time					05/28/2021 11:36:07 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM	www.hcsc.com	Blue Cross Group Medicare Advantage Plan (HMO)	01	01		1			H3822	806	0	2022	Statewide in 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)-		2					2					2	2			
H3822	809	0	1	01	01	H3822_809_0	1	1				0	0	05/26/2021	2022.01	05/26/2021 09:43:08 AM Central Daylight Time					05/28/2021 11:36:07 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM	www.hcsc.com	Blue Cross Group Medicare Advantage Plan (HMO)	01	01		1			H3822	809	0	2022	Statewide in 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)-										2					2					2	2			
H3822	810	0	1	01	01	H3822_810_0	1	1				0	0	05/26/2021	2022.01	05/26/2021 09:43:44 AM Central Daylight Time					05/28/2021 11:36:07 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM	www.hcsc.com	Blue Cross Group Medicare Advantage Plan (HMO)	01	01		1			H3822	810	0	2022	Statewide in 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)-										2					2					2	2			
H3822	813	0	1	01	01	H3822_813_0	2	1						05/25/2021	2022.01	05/25/2021 01:54:14 PM Central Daylight Time					06/03/2021 05:04:16 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM	www.hcsc.com	Blue Cross Group Medicare Advantage Plan (HMO)	01	01		1			H3822	813	0	2022	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)-		2					2					2	2			
H3822	814	0	1	01	01	H3822_814_0	2	1						05/25/2021	2022.01	05/25/2021 01:54:19 PM Central Daylight Time					06/03/2021 05:04:16 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM	www.hcsc.com	Blue Cross Group Medicare Advantage Plan (HMO)	01	01		1			H3822	814	0	2022	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)-		2					2					2	2			
H3822	815	0	1	01	01	H3822_815_0	1	1				0	0	05/26/2021	2022.01	05/26/2021 09:44:10 AM Central Daylight Time					05/28/2021 11:36:07 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM	www.hcsc.com	Blue Cross Group Medicare Advantage Plan (HMO)	01	01		1			H3822	815	0	2022	Statewide in Montana		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)-										2					2					2	2			
H3832	007	0	1	04	01	H3832_007_0	8	1			1		0	08/09/2021	2022.01	08/09/2021 12:39:10 PM Hawaiian Standard Time	08/09/2021 12:38:22 PM Hawaiian Standard Time	08/09/2021 12:38:23 PM Hawaiian Standard Time			08/09/2021 12:41:42 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	2022	Hawaii, Kalawao, Kauai and Maui counties		2	29898	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			1		0	08/11/2021	2022.01	08/11/2021 11:43:45 AM Hawaiian Standard Time	08/05/2021 09:56:35 AM Hawaiian Standard Time	08/09/2021 12:38:25 PM Hawaiian Standard Time			08/11/2021 11:49:00 AM 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	2022	Hawaii, Kalawao, Kauai and Maui counties		2	59834	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	7	1			1		0	08/11/2021	2022.01	08/11/2021 11:44:51 AM Hawaiian Standard Time	08/05/2021 09:56:39 AM Hawaiian Standard Time	08/09/2021 12:38:26 PM Hawaiian Standard Time			08/11/2021 11:54:55 AM 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	2022	Honolulu County		2	56024	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			1		0	08/11/2021	2022.01	08/11/2021 11:45:32 AM Hawaiian Standard Time	08/05/2021 09:56:45 AM Hawaiian Standard Time	08/09/2021 12:38:28 PM Hawaiian Standard Time			08/11/2021 11:58:58 AM 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	2022	Honolulu County		2	153608	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	11	1	2	1	1		0	09/27/2021	2022.01	09/27/2021 04:02:02 PM Hawaiian Standard Time	08/17/2021 09:48:26 AM Hawaiian Standard Time	08/05/2021 09:56:50 AM Hawaiian Standard Time			09/27/2021 04:04:21 PM Hawaiian Standard Time	HAWAII MEDICAL SERVICE ASSOCIATION	HMSA Akamai Advantage	www.hmsa.com/advantage	HMSA Akamai Advantage Dual Care (PPO D-SNP)	01	04		1			H3832	011	0	2022	Hawaii, Kalawao, Kauai, Maui and Honolulu counties		2	26820	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						07/20/2021	2022.01	07/20/2021 04:08:53 PM Hawaiian Standard Time					07/20/2021 04:43:07 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	2022	National		1	58204	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;6;7c;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;14a;15;	2		1									
H3832	802	0	1	04	01	H3832_802_0	2	1						07/20/2021	2022.01	07/20/2021 04:09:37 PM Hawaiian Standard Time					07/20/2021 04:46:04 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	2022	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;6;7c;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;14a;15;	2		1									
H3832	805	0	1	04	01	H3832_805_0	2	1				0	0	07/20/2021	2022.01	07/20/2021 04:10:11 PM Hawaiian Standard Time					07/20/2021 04:49:18 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	2022	National		1	28172	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;6;7c;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;14a;15;	2		1									
H3832	807	0	1	04	01	H3832_807_0	2	1						07/20/2021	2022.01	07/20/2021 04:10:38 PM Hawaiian Standard Time					07/20/2021 04:52:31 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	2022	National		1	63986	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;6;7c;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;14a;15;	2		1									
H3864	002	0	1	01	01	H3864_002_0	5	1				0	0	07/20/2021	2022.01	07/20/2021 03:19:43 PM Pacific Daylight Time	06/06/2021 01:04:48 PM Pacific Daylight Time				07/21/2021 01:22:29 PM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Essentials 2 (HMO)	01	01		1			H3864	002	0	2022	Central, Eastern, Mid-Columbia Gorge, Lane		2		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	4	1					0	08/05/2021	2022.01	08/05/2021 08:11:17 AM Pacific Daylight Time	08/03/2021 08:33:14 AM Pacific Daylight Time	07/30/2021 02:05:26 PM Pacific Daylight Time			08/05/2021 02:34:04 PM 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	2022	Central, Eastern Oregon and Mid-Columbia Gorge		2		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					0	08/05/2021	2022.01	08/05/2021 08:11:23 AM Pacific Daylight Time	08/03/2021 08:34:17 AM Pacific Daylight Time	07/30/2021 02:05:46 PM Pacific Daylight Time			08/05/2021 02:34:04 PM 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	2022	Central, Eastern Oregon and Mid-Columbia Gorge		2		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					0	08/05/2021	2022.01	08/05/2021 08:11:29 AM Pacific Daylight Time	08/03/2021 08:35:36 AM Pacific Daylight Time	07/30/2021 02:06:04 PM Pacific Daylight Time			08/05/2021 02:34:04 PM 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	2022	Eastern Idaho		2		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	6	1					0	08/05/2021	2022.01	08/05/2021 08:11:38 AM Pacific Daylight Time	08/03/2021 08:36:51 AM Pacific Daylight Time	07/30/2021 02:06:22 PM Pacific Daylight Time			08/05/2021 02:34:04 PM 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	2022	Southwest and Southern Idaho		2		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	027	0	1	01	01	H3864_027_0	5	1					0	08/05/2021	2022.01	08/05/2021 08:11:48 AM Pacific Daylight Time	08/03/2021 08:38:20 AM Pacific Daylight Time	07/30/2021 02:06:40 PM Pacific Daylight Time			08/05/2021 02:34:04 PM 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	2022	Central, Eastern Oregon and Mid-Columbia Gorge		2		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	02	01	H3864_029_0	4	1					0	08/05/2021	2022.01	08/05/2021 08:11:56 AM Pacific Daylight Time	08/03/2021 08:41:36 AM Pacific Daylight Time	07/30/2021 02:06:58 PM Pacific Daylight Time			08/05/2021 02:34:04 PM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare MyCare Choice Rx 29 (HMO-POS)	01	02		1			H3864	029	0	2022	Yellowstone County		2		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	3	1				0	0	07/20/2021	2022.01	07/20/2021 03:50:47 PM Pacific Daylight Time	06/06/2021 01:09:41 PM Pacific Daylight Time				07/21/2021 01:22:29 PM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare MyCare 30 (HMO)	01	01		1			H3864	030	0	2022	Yellowstone County		2		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					0	08/05/2021	2022.01	08/05/2021 08:13:35 AM Pacific Daylight Time	08/03/2021 08:43:15 AM Pacific Daylight Time	07/30/2021 02:07:22 PM Pacific Daylight Time			08/05/2021 02:34:04 PM 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	2022	Southwest and Southern Idaho		2		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	02	01	H3864_033_0	6	1					0	08/05/2021	2022.01	08/05/2021 08:13:30 AM Pacific Daylight Time	08/03/2021 08:44:45 AM Pacific Daylight Time	07/30/2021 02:07:40 PM Pacific Daylight Time			08/05/2021 02:34:04 PM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare MyCare Choice Rx 33 (HMO-POS)	01	02		1			H3864	033	0	2022	Spokane County		2		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	02	01	H3864_034_0	5	1					0	08/05/2021	2022.01	08/05/2021 08:13:25 AM Pacific Daylight Time	08/03/2021 08:46:47 AM Pacific Daylight Time	07/30/2021 02:07:58 PM Pacific Daylight Time			08/05/2021 02:34:04 PM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare MyCare Choice Rx 34 (HMO-POS)	01	02		1			H3864	034	0	2022	Pierce County		2		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	3	1				0	0	07/21/2021	2022.01	07/21/2021 07:57:59 AM Pacific Daylight Time	06/06/2021 01:11:36 PM Pacific Daylight Time				07/21/2021 01:22:29 PM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare MyCare 35 (HMO)	01	01		1			H3864	035	0	2022	Spokane and Pierce Counties		2		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					0	08/05/2021	2022.01	08/05/2021 08:13:11 AM Pacific Daylight Time	08/03/2021 08:49:33 AM Pacific Daylight Time	07/30/2021 02:08:18 PM Pacific Daylight Time			08/05/2021 02:34:04 PM 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	2022	Lane County		2		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	4	1					0	08/05/2021	2022.01	08/05/2021 08:13:05 AM Pacific Daylight Time	08/05/2021 09:21:48 AM Pacific Daylight Time	07/30/2021 02:08:36 PM Pacific Daylight Time			08/05/2021 02:34:04 PM 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	2022	Clark County		2		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	4	1					0	08/05/2021	2022.01	08/05/2021 08:12:59 AM Pacific Daylight Time	08/05/2021 09:24:46 AM Pacific Daylight Time	07/30/2021 02:08:56 PM Pacific Daylight Time			08/05/2021 02:34:04 PM 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	2022	Portland Area		2		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	041	0	1	01	01	H3864_041_0	4	1					0	08/05/2021	2022.01	08/05/2021 08:12:52 AM Pacific Daylight Time	08/03/2021 08:53:38 AM Pacific Daylight Time	07/30/2021 02:09:20 PM Pacific Daylight Time			08/05/2021 02:34:04 PM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Essentials Rx 41 (HMO)	01	01		1			H3864	041	0	2022	Coos, Curry and Lane Counties		2		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	042	0	1	01	01	H3864_042_0	4	1					0	08/05/2021	2022.01	08/05/2021 08:12:47 AM Pacific Daylight Time	08/03/2021 08:54:54 AM Pacific Daylight Time	07/30/2021 02:09:34 PM Pacific Daylight Time			08/05/2021 02:34:04 PM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Essentials Rx 42 (HMO)	01	01		1			H3864	042	0	2022	Douglas County		2		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	043	0	1	01	01	H3864_043_0	7	1	2	1			0	08/05/2021	2022.01	08/05/2021 08:12:42 AM Pacific Daylight Time	08/05/2021 09:58:16 AM Pacific Daylight Time	07/30/2021 02:24:32 PM Pacific Daylight Time			08/05/2021 02:34:04 PM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Dual Care (HMO D-SNP)	01	01		1			H3864	043	0	2022	Central, Mid-Columbia Gorge, Willamette Valley		2		2			1	3		1		1	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	2	1				0	0	06/05/2021	2022.01	06/05/2021 07:28:32 PM Pacific Daylight Time					06/06/2021 05:08:28 PM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Essentials 801 (HMO)	01	01		1			H3864	801	0	2022	Statewide - Idaho, Montana, Oregon 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										2					2					2	2			
H3864	803	0	1	01	01	H3864_803_0	2	1						06/05/2021	2022.01	06/05/2021 07:28:27 PM Pacific Daylight Time					06/06/2021 05:08:28 PM 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	2022	Statewide - Idaho, Montana, Oregon and Washington		1	14698	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	805	0	1	02	01	H3864_805_0	2	1				0	0	06/05/2021	2022.01	06/05/2021 07:28:21 PM Pacific Daylight Time					06/06/2021 05:08:28 PM 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	2022	Statewide - Idaho, Montana, Oregon 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										2					2					2	2			
H3864	806	0	1	02	01	H3864_806_0	2	1						06/05/2021	2022.01	06/05/2021 07:28:16 PM Pacific Daylight Time					06/06/2021 05:08:28 PM 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	2022	Statewide - Idaho, Montana, Oregon 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		2					2					2	2			
H3890	001	0	1	04	01	H3890_001_0	5	1					1	08/04/2021	2022.01	08/04/2021 11:07:56 PM US Eastern Daylight Time	08/04/2021 11:42:50 PM US Eastern Daylight Time	08/04/2021 11:43:17 PM US Eastern Daylight Time			08/04/2021 11:48:28 PM US Eastern Daylight Time	HOPKINS HEALTH ADVANTAGE, INC.	Johns Hopkins HealthCare	www.hopkinsmedicare.com/	Johns Hopkins Advantage MD (PPO)	01	04		1			H3890	001	0	2022	Counties: AA BL CR FR HW SS WH WC WR		2	43752	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)-		2					2						2			
H3890	002	0	1	04	01	H3890_002_0	6	1					1	08/04/2021	2022.01	08/04/2021 11:08:23 PM US Eastern Daylight Time	08/04/2021 11:42:51 PM US Eastern Daylight Time	08/04/2021 11:43:17 PM US Eastern Daylight Time			08/04/2021 11:48:28 PM US Eastern Daylight Time	HOPKINS HEALTH ADVANTAGE, INC.	Johns Hopkins HealthCare	www.hopkinsmedicare.com/	Johns Hopkins Advantage MD Plus (PPO)	01	04		1			H3890	002	0	2022	Counties: AA BL CR FR HW SS WH WC WR		2	70884	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)-		2					2						2			
H3890	004	0	1	04	01	H3890_004_0	5	1					1	08/04/2021	2022.01	08/04/2021 11:45:30 PM US Eastern Daylight Time	08/04/2021 11:42:50 PM US Eastern Daylight Time	08/04/2021 11:43:17 PM US Eastern Daylight Time			08/04/2021 11:48:28 PM US Eastern Daylight Time	HOPKINS HEALTH ADVANTAGE, INC.	Johns Hopkins HealthCare	www.hopkinsmedicare.com/	Johns Hopkins Advantage MD Premier (PPO)	01	04		1			H3890	004	0	2022	Montgomery County		2	3600	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)-		2					2						2			
H3890	801	0	1	04	01	H3890_801_0	3	1						06/04/2021	2022.01	06/04/2021 04:34:53 PM US Eastern Daylight Time					06/07/2021 09:33:40 AM US 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	2022	DC, DE, FL, GA, MD, NC, PA, SC, VA		1	96	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	2		2		1									
H3907	002	0	1	01	01	H3907_002_0	6	1				0	0	07/11/2021	2022.01	07/11/2021 08:31:55 PM Eastern Daylight Time	07/16/2021 04:22:48 PM Eastern Daylight Time				07/20/2021 02:49:30 PM Eastern Daylight Time	UPMC HEALTH PLAN, INC.	UPMC for Life	https://www.upmchealthplan.com/medicare/	UPMC for Life HMO No Rx (HMO)	01	01		1			H3907	002	0	2022	Western and North Eastern Pennsylvania		2	89003	2			2						https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/	https://findcare.upmchealthplan.com/browse?caretype=Medical	(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765										(711)-		(711)-		(711)-		(711)-										2					2					2	1	11	7b;	7b1;
H3907	006	0	1	01	01	H3907_006_0	6	1					1	08/04/2021	2022.01	08/04/2021 02:14:40 PM Eastern Daylight Time	08/05/2021 08:14:28 AM Eastern Daylight Time	08/05/2021 12:26:47 PM Eastern Daylight Time			08/05/2021 01:57:30 PM Eastern Daylight Time	UPMC HEALTH PLAN, INC.	UPMC for Life	https://www.upmchealthplan.com/medicare/	UPMC for Life HMO Rx Enhanced (HMO)	01	01		1			H3907	006	0	2022	Western and North Eastern Pennsylvania		2	23916	2			2						https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/	https://findcare.upmchealthplan.com/browse?caretype=Medical	(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	11	7b;	7b1;
H3907	029	0	1	01	01	H3907_029_0	7	1					1	08/04/2021	2022.01	08/04/2021 03:07:37 PM Eastern Daylight Time	08/05/2021 08:14:31 AM Eastern Daylight Time	08/05/2021 12:26:50 PM Eastern Daylight Time			08/05/2021 01:57:30 PM Eastern Daylight Time	UPMC HEALTH PLAN, INC.	UPMC for Life	https://www.upmchealthplan.com/medicare/	UPMC for Life HMO Rx (HMO)	01	01		1			H3907	029	0	2022	Western, Central, and North Eastern Pennsylvania		2	469527	2			2						https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/	https://findcare.upmchealthplan.com/browse?caretype=Medical	(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	11	7b;	7b1;
H3907	037	0	1	01	01	H3907_037_0	7	1					1	08/04/2021	2022.01	08/04/2021 02:23:26 PM Eastern Daylight Time	08/05/2021 08:14:35 AM Eastern Daylight Time	08/05/2021 12:26:54 PM Eastern Daylight Time			08/05/2021 01:57:30 PM Eastern Daylight Time	UPMC HEALTH PLAN, INC.	UPMC for Life	https://www.upmchealthplan.com/medicare/	UPMC for Life HMO Deductible Rx (HMO)	01	01		1			H3907	037	0	2022	Western, Central, and North Eastern Pennsylvania		2	333562	2			2						https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/	https://findcare.upmchealthplan.com/browse?caretype=Medical	(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	7b;	
H3907	045	0	1	01	01	H3907_045_0	7	1					1	08/04/2021	2022.01	08/04/2021 02:25:23 PM Eastern Daylight Time	08/05/2021 08:14:39 AM Eastern Daylight Time	08/05/2021 12:26:57 PM Eastern Daylight Time			08/05/2021 01:57:30 PM Eastern Daylight Time	UPMC HEALTH PLAN, INC.	UPMC for Life	https://www.upmchealthplan.com/medicare/	UPMC for Life HMO Premier Rx (HMO)	01	01		1			H3907	045	0	2022	Berks County		2	7145	2			2						https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/	https://findcare.upmchealthplan.com/browse?caretype=Medical	(844)870-2231		(844)870-2231		(877)381-3765		(877)381-3765		(844)870-2231		(844)870-2231		(877)381-3765		(877)381-3765		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	7b;	
H3907	046	0	1	01	01	H3907_046_0	7	1					1	08/04/2021	2022.01	08/04/2021 02:31:12 PM Eastern Daylight Time	08/05/2021 08:14:41 AM Eastern Daylight Time	08/05/2021 12:27:00 PM Eastern Daylight Time			08/05/2021 01:57:30 PM Eastern Daylight Time	UPMC HEALTH PLAN, INC.	UPMC for Life	https://www.upmchealthplan.com/medicare/	UPMC for Life HMO Premier Rx (HMO)	01	01		1			H3907	046	0	2022	South Western and North Central Pennsylvania		2	113526	2			2						https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/	https://findcare.upmchealthplan.com/browse?caretype=Medical	(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	7b;	
H3907	049	0	1	01	01	H3907_049_0	7	1					1	07/11/2021	2022.01	07/11/2021 08:37:01 PM Eastern Daylight Time	08/05/2021 08:14:44 AM Eastern Daylight Time	08/05/2021 12:27:02 PM Eastern Daylight Time			08/05/2021 01:57:30 PM Eastern Daylight Time	UPMC HEALTH PLAN, INC.	UPMC for Life	https://www.upmchealthplan.com/medicare/	UPMC for Life HMO Rx Choice (HMO)	01	01		1			H3907	049	0	2022	Western Pennsylvania		2	670257	2			2						https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/	https://findcare.upmchealthplan.com/browse?caretype=Medical	(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	7b;	
H3907	050	0	1	01	01	H3907_050_0	7	1					1	08/04/2021	2022.01	08/04/2021 02:32:55 PM Eastern Daylight Time	08/05/2021 08:14:49 AM Eastern Daylight Time	08/05/2021 12:27:04 PM Eastern Daylight Time			08/05/2021 01:57:30 PM Eastern Daylight Time	UPMC HEALTH PLAN, INC.	UPMC for Life	https://www.upmchealthplan.com/medicare/	UPMC for Life HMO Premier Rx (HMO)	01	01		1			H3907	050	0	2022	Erie, Lawrence, Mercer, Venango Counties		2	18548	2			2						https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/	https://findcare.upmchealthplan.com/browse?caretype=Medical	(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	7b;	
H3907	051	0	1	01	01	H3907_051_0	7	1					1	08/04/2021	2022.01	08/04/2021 02:35:23 PM Eastern Daylight Time	08/05/2021 08:14:53 AM Eastern Daylight Time	08/05/2021 12:27:06 PM Eastern Daylight Time			08/05/2021 01:57:30 PM Eastern Daylight Time	UPMC HEALTH PLAN, INC.	UPMC for Life	https://www.upmchealthplan.com/medicare/	UPMC for Life HMO Premier Rx (HMO)	01	01		1			H3907	051	0	2022	Armstrong, Fayette, Greene, Westmoreland Counties		2	39142	2			2						https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/	https://findcare.upmchealthplan.com/browse?caretype=Medical	(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	7b;	
H3907	052	0	1	01	01	H3907_052_0	7	1					1	08/04/2021	2022.01	08/04/2021 02:38:30 PM Eastern Daylight Time	08/05/2021 08:14:55 AM Eastern Daylight Time	08/05/2021 12:27:08 PM Eastern Daylight Time			08/05/2021 01:57:30 PM Eastern Daylight Time	UPMC HEALTH PLAN, INC.	UPMC for Life	https://www.upmchealthplan.com/medicare/	UPMC for Life HMO Premier Rx (HMO)	01	01		1			H3907	052	0	2022	Cumberland, Dauphin, Lancaster, and York Counties		2	6527	2			2						https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/	https://findcare.upmchealthplan.com/browse?caretype=Medical	(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	7b;	
H3907	053	0	1	01	01	H3907_053_0	5	1				0	0	07/11/2021	2022.01	07/11/2021 08:38:58 PM Eastern Daylight Time	06/06/2021 04:45:27 PM Eastern Daylight Time				07/12/2021 09:12:42 PM Eastern Daylight Time	UPMC HEALTH PLAN, INC.	UPMC for Life	https://www.upmchealthplan.com/medicare/	UPMC for Life HMO Salute (HMO)	01	01		1			H3907	053	0	2022	Western Pennsylvania		2	46702	2			2						https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/	https://findcare.upmchealthplan.com/browse?caretype=Medical	(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765										(711)-		(711)-		(711)-		(711)-										2					2					2	1	01	7b;	
H3907	054	0	1	01	01	H3907_054_0	6	1					1	08/04/2021	2022.01	08/04/2021 02:40:28 PM Eastern Daylight Time	08/05/2021 08:14:58 AM Eastern Daylight Time	08/05/2021 12:27:10 PM Eastern Daylight Time			08/05/2021 01:57:30 PM Eastern Daylight Time	UPMC HEALTH PLAN, INC.	UPMC for Life	https://www.upmchealthplan.com/medicare/	UPMC for Life HMO Premier Rx (HMO)	01	01		1			H3907	054	0	2022	Northwest Pennsylvania		2	4078	2			2						https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/	https://findcare.upmchealthplan.com/browse?caretype=Medical	(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	7b;	
H3907	055	0	1	01	01	H3907_055_0	6	1					1	08/04/2021	2022.01	08/04/2021 02:45:19 PM Eastern Daylight Time	08/05/2021 08:15:01 AM Eastern Daylight Time	08/05/2021 12:27:12 PM Eastern Daylight Time			08/05/2021 01:57:30 PM Eastern Daylight Time	UPMC HEALTH PLAN, INC.	UPMC for Life	https://www.upmchealthplan.com/medicare/	UPMC for Life HMO Access Rx (HMO)	01	01		1			H3907	055	0	2022	Allegheny County		2	36288	2			2						https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/	https://findcare.upmchealthplan.com/browse?caretype=Medical	(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	7b;	
H3907	056	0	1	01	01	H3907_056_0	6	1					1	08/04/2021	2022.01	08/04/2021 02:49:20 PM Eastern Daylight Time	08/05/2021 08:15:03 AM Eastern Daylight Time	08/05/2021 12:27:13 PM Eastern Daylight Time			08/05/2021 01:57:30 PM Eastern Daylight Time	UPMC HEALTH PLAN, INC.	UPMC for Life	https://www.upmchealthplan.com/medicare/	UPMC for Life HMO Access Rx (HMO)	01	01		1			H3907	056	0	2022	Southwestern Pennsylvania		2	27895	2			2						https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/	https://findcare.upmchealthplan.com/browse?caretype=Medical	(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	7b;	
H3907	801	0	1	01	01	H3907_801_0	1	1				0	0	05/26/2021	2022.01	05/26/2021 10:49:45 AM Eastern Daylight Time					06/02/2021 08:16:51 AM Eastern Daylight Time	UPMC HEALTH PLAN, INC.	UPMC for Life	http://www.upmchealthplan.com/medicare	UPMC Employer Group (HMO)	01	01		1			H3907	801	0	2022	Western Pennsylvania		1	0	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										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;6;7b;7c;7d;7i;7k;8a;8b1;8b2;9a1;9a2;9b;10a;11a;11b;15;	2		1					1				
H3907	802	0	1	01	01	H3907_802_0	1	1						05/26/2021	2022.01	05/26/2021 10:57:44 AM Eastern Daylight Time					06/02/2021 08:16:51 AM Eastern Daylight Time	UPMC HEALTH PLAN, INC.	UPMC for Life	http://www.upmchealthplan.com/medicare	UPMC Employer Group Rx (HMO)	01	01		1			H3907	802	0	2022	Western Pennsylvania		1	55479	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;6;7b;7c;7d;7i;7k;8a;8b1;8b2;9a1;9a2;9b;10a;11a;11b;15;	2		1					1				
H3907	803	0	1	01	01	H3907_803_0	1	1						05/26/2021	2022.01	05/26/2021 11:01:58 AM Eastern Daylight Time					06/02/2021 08:16:51 AM Eastern Daylight Time	UPMC HEALTH PLAN, INC.	UPMC for Life	http://www.upmchealthplan.com/medicare	UPMC Employer Group Rx (HMO)	01	01		1			H3907	803	0	2022	Western Pennsylvania		1	0	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;6;7b;7c;7d;7i;7k;8a;8b1;8b2;9a1;9a2;9b;10a;11a;11b;15;	2		1					1				
H3908	001	0	1	20	08	H3908_001_0	1	1						06/03/2021	2022.01	06/03/2021 02:13:05 PM Eastern Daylight Time		06/03/2021 02:04:22 PM Eastern Daylight Time			06/03/2021 02:28:58 PM Eastern Daylight Time	TRINITY HEALTH LIFE PENNSYLVANIA, INC.	Mercy LIFE - West Philadelphia	https://www.trinityhealthpace.org	Trinity Health LIFE Pennsylvania (PACE)	08	20		1			H3908	001	0	2022	Counties: PHL (partial), DelCo (partial)		2		2			2						https://www.carekinesis.com/	www.trinityhealthpace.org	https://www.trinityhealthpace.org/											(267)787-8282				(267)787-8282												(800)654-5984				(800)654-5984																
H3908	002	0	1	20	08	H3908_002_0	1	1						06/03/2021	2022.01	06/03/2021 02:14:03 PM Eastern Daylight Time		06/03/2021 02:04:21 PM Eastern Daylight Time			06/03/2021 02:28:58 PM Eastern Daylight Time	TRINITY HEALTH LIFE PENNSYLVANIA, INC.	Mercy LIFE - West Philadelphia	www.trinityhealthpace.org	Trinity Health LIFE Pennsylvania (PACE)	08	20		1			H3908	002	0	2022	Counties: PHL (partial), DelCo (partial)		2		2			2						https://www.carekinesis.com	www.trinityhealthpace.org	www.trinityhealthpace.org											(267)787-8282				(267)787-8282												(800)654-5984				(800)654-5984																
H3909	001	0	1	04	01	H3909_001_0	3	1					0	05/24/2021	2022.01	05/24/2021 02:26:41 PM Eastern Daylight Time	08/03/2021 02:10:52 PM Eastern Daylight Time	07/30/2021 11:15:30 AM Eastern Daylight Time			08/04/2021 03:46:03 PM Eastern Daylight Time	QCC INSURANCE COMPANY	Independence Blue Cross	www.ibxmedicare.com	Personal Choice 65 Rx (PPO)	01	04		1			H3909	001	0	2022	Bucks, Philadelphia Counties		2	18404	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	2	1				0	0	05/24/2021	2022.01	05/24/2021 02:13:33 PM Eastern Daylight Time	07/07/2021 05:06:58 PM Eastern Daylight Time				07/19/2021 03:10:35 PM Eastern Daylight Time	QCC INSURANCE COMPANY	Independence Blue Cross	www.ibxmedicare.com	Personal Choice 65 Medical Only (PPO)	01	04		1			H3909	007	0	2022	Bucks, Philadelphia Counties		2	1563	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	2	1					0	05/24/2021	2022.01	05/24/2021 02:05:46 PM Eastern Daylight Time	08/03/2021 01:43:26 PM Eastern Daylight Time	07/30/2021 11:06:54 AM Eastern Daylight Time			08/04/2021 03:46:03 PM Eastern Daylight Time	QCC INSURANCE COMPANY	Independence Blue Cross	www.ibxmedicare.com	Personal Choice 65 Rx (PPO)	01	04		1			H3909	009	0	2022	Chester, Delaware, Montgomery Counties		2	31339	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	014	0	1	04	01	H3909_014_0	2	1					0	08/03/2021	2022.01	08/03/2021 11:20:33 AM Eastern Daylight Time	08/03/2021 01:58:20 PM Eastern Daylight Time	07/30/2021 11:07:08 AM Eastern Daylight Time			08/04/2021 04:47:21 PM Eastern Daylight Time	QCC INSURANCE COMPANY	Independence Blue Cross	www.ibxmedicare.com	Personal Choice 65 Prime Rx (PPO)	01	04		1			H3909	014	0	2022	Bucks, Philadelphia Counties		2	69426	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	015	0	1	04	01	H3909_015_0	3	1					0	08/02/2021	2022.01	08/02/2021 04:16:34 PM Eastern Daylight Time	08/03/2021 02:24:26 PM Eastern Daylight Time	07/30/2021 11:07:20 AM Eastern Daylight Time			08/04/2021 04:47:21 PM Eastern Daylight Time	QCC INSURANCE COMPANY	Independence Blue Cross	www.ibxmedicare.com	Personal Choice 65 Prime Rx (PPO)	01	04		1			H3909	015	0	2022	Chester, Delaware, Montgomery Counties		2	79274	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	016	0	1	04	01	H3909_016_0	3	1					0	08/02/2021	2022.01	08/02/2021 04:08:53 PM Eastern Daylight Time	08/04/2021 10:27:50 AM Eastern Daylight Time	07/30/2021 11:07:32 AM Eastern Daylight Time			08/04/2021 05:05:47 PM Eastern Daylight Time	QCC INSURANCE COMPANY	Independence Blue Cross	www.ibxmedicare.com	Personal Choice 65 Saver Rx (PPO)	01	04		1			H3909	016	0	2022	Philadelphia, Bucks, Chester, Delaware, Montgomery		2	8421	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	017	0	1	04	01	H3909_017_0	3	1					0	06/02/2021	2022.01	06/02/2021 12:44:17 PM Eastern Daylight Time	08/03/2021 02:52:22 PM Eastern Daylight Time	07/30/2021 11:07:46 AM Eastern Daylight Time			08/04/2021 05:05:47 PM Eastern Daylight Time	QCC INSURANCE COMPANY	Independence Blue Cross	www.ibxmedicare.com	Personal Choice 65 Elite Rx (PPO)	01	04		1			H3909	017	0	2022	Philadelphia, Bucks, Chester, Delaware, Montgomery		2	7491	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				0	0	05/21/2021	2022.01	05/21/2021 03:08:26 PM Eastern Daylight Time					06/04/2021 07:50:51 PM Eastern Daylight Time	QCC INSURANCE COMPANY	Independence Blue Cross	www.ibxmedicare.com	Personal Choice 65 Group Medical Only (PPO)	01	04		1			H3909	801	0	2022	National		1	8381	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;7c;7e;7i;8a;8b1;8b2;8b3;9a1;9b;10a;11a;11b;11c;14a;15;	2		1									
H3909	802	0	1	04	01	H3909_802_0	1	1						05/21/2021	2022.01	05/21/2021 03:21:56 PM Eastern Daylight Time					06/04/2021 07:50:51 PM Eastern Daylight Time	QCC INSURANCE COMPANY	Independence Blue Cross	www.ibxmedicare.com	Personal Choice 65 Group Rx (PPO)	01	04		1			H3909	802	0	2022	National		1	16451	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;7c;7e;7i;8a;8b1;8b2;8b3;9a1;9b;10a;11a;11b;11c;14a;15;	2		1									
H3916	001	0	1	04	01	H3916_001_0	6	1					0	08/04/2021	2022.01	08/04/2021 09:22:13 AM Eastern Daylight Time	08/03/2021 10:39:50 AM Eastern Daylight Time	07/30/2021 01:36:34 PM Eastern Daylight Time			08/05/2021 08:12:54 AM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Freedom Blue PPO Classic (PPO)	01	04		1			H3916	001	0	2022	Southwestern PA		2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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	6	1					0	08/04/2021	2022.01	08/04/2021 09:22:47 AM Eastern Daylight Time	08/03/2021 10:40:54 AM Eastern Daylight Time	07/30/2021 01:37:39 PM Eastern Daylight Time			08/05/2021 08:12:54 AM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Freedom Blue PPO Classic (PPO)	01	04		1			H3916	002	0	2022	West Central PA		2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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	6	1					0	07/16/2021	2022.01	07/16/2021 09:59:59 AM Eastern Daylight Time	08/03/2021 10:42:21 AM Eastern Daylight Time	07/30/2021 01:38:45 PM Eastern Daylight Time			08/05/2021 08:12:54 AM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Freedom Blue PPO Deluxe (PPO)	01	04		1			H3916	005	0	2022	Central and Northeastern PA		2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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	5	1				0	0	07/16/2021	2022.01	07/16/2021 10:00:27 AM Eastern Daylight Time	07/15/2021 02:32:47 PM Eastern Daylight Time				07/21/2021 10:12:24 AM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Freedom Blue PPO Basic (PPO)	01	04		1			H3916	012	0	2022	Central and Northeastern PA		2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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	6	1					0	07/16/2021	2022.01	07/16/2021 10:00:56 AM Eastern Daylight Time	08/03/2021 10:45:07 AM Eastern Daylight Time	07/30/2021 01:39:51 PM Eastern Daylight Time			08/05/2021 08:12:54 AM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Freedom Blue PPO Standard (PPO)	01	04		1			H3916	015	0	2022	Central and Northeastern PA		2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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	6	1					0	08/04/2021	2022.01	08/04/2021 09:26:17 AM Eastern Daylight Time	08/03/2021 10:46:24 AM Eastern Daylight Time	07/30/2021 01:40:57 PM Eastern Daylight Time			08/05/2021 08:12:54 AM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Freedom Blue PPO ValueRx (PPO)	01	04		1			H3916	018	0	2022	Central and Northeastern PA		2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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	6	1					0	08/04/2021	2022.01	08/04/2021 09:19:47 AM Eastern Daylight Time	08/03/2021 10:47:28 AM Eastern Daylight Time	07/30/2021 01:42:04 PM Eastern Daylight Time			08/05/2021 08:12:54 AM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Freedom Blue PPO Select (PPO)	01	04		1			H3916	022	0	2022	Southwestern PA		2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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	6	1					0	08/04/2021	2022.01	08/04/2021 09:20:25 AM Eastern Daylight Time	08/03/2021 10:49:10 AM Eastern Daylight Time	07/30/2021 01:43:10 PM Eastern Daylight Time			08/05/2021 08:12:54 AM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Freedom Blue PPO Select (PPO)	01	04		1			H3916	024	0	2022	West Central PA		2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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	6	1					0	08/04/2021	2022.01	08/04/2021 09:11:38 AM Eastern Daylight Time	08/03/2021 10:50:26 AM Eastern Daylight Time	07/30/2021 01:44:20 PM Eastern Daylight Time			08/05/2021 08:12:54 AM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Freedom Blue PPO ValueRx (PPO)	01	04		1			H3916	032	0	2022	Southwestern PA		2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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	6	1					0	08/04/2021	2022.01	08/04/2021 09:12:58 AM Eastern Daylight Time	08/03/2021 10:51:38 AM Eastern Daylight Time	07/30/2021 01:45:31 PM Eastern Daylight Time			08/05/2021 08:12:54 AM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Freedom Blue PPO ValueRx (PPO)	01	04		1			H3916	033	0	2022	West Central PA		2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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	6	1					1	08/04/2021	2022.01	08/04/2021 09:23:33 AM Eastern Daylight Time	08/03/2021 10:53:06 AM Eastern Daylight Time	07/30/2021 01:46:35 PM Eastern Daylight Time			08/05/2021 08:12:54 AM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Community Blue Medicare PPO Distinct (PPO)	01	04		1			H3916	034	1	2022	North Central PA	Lehigh Valley	2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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	6	1					1	08/04/2021	2022.01	08/04/2021 09:24:05 AM Eastern Daylight Time	08/03/2021 10:55:27 AM Eastern Daylight Time	07/30/2021 01:47:51 PM Eastern Daylight Time			08/05/2021 08:12:54 AM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Community Blue Medicare PPO Distinct (PPO)	01	04		1			H3916	034	3	2022	North Central PA	South Central PA	2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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	6	1					1	08/04/2021	2022.01	08/04/2021 09:24:31 AM Eastern Daylight Time	08/03/2021 10:54:57 AM Eastern Daylight Time	07/30/2021 01:49:15 PM Eastern Daylight Time			08/05/2021 08:12:54 AM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Community Blue Medicare PPO Distinct (PPO)	01	04		1			H3916	034	4	2022	North Central PA	North Central	2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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	6	1					1	08/04/2021	2022.01	08/04/2021 09:25:09 AM Eastern Daylight Time	08/03/2021 10:57:51 AM Eastern Daylight Time	07/30/2021 01:50:32 PM Eastern Daylight Time			08/05/2021 08:12:54 AM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Community Blue Medicare PPO Distinct (PPO)	01	04		1			H3916	034	5	2022	North Central PA	Lancaster	2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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	6	1					1	08/04/2021	2022.01	08/04/2021 09:08:26 AM Eastern Daylight Time	08/03/2021 11:04:16 AM Eastern Daylight Time	07/30/2021 01:51:54 PM Eastern Daylight Time			08/05/2021 08:12:54 AM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Complete Blue PPO Distinct (PPO)	01	04		1			H3916	035	1	2022	Western PA	Southwest PA	2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(833)227-9375		(833)227-9375		(833)544-1060		(833)544-1060		(833)227-9375		(833)227-9375		(833)544-1060		(833)544-1060		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3916	035	2	1	04	01	H3916_035_2	6	1					1	08/04/2021	2022.01	08/04/2021 09:09:37 AM Eastern Daylight Time	08/03/2021 11:05:33 AM Eastern Daylight Time	07/30/2021 01:53:15 PM Eastern Daylight Time			08/05/2021 08:12:54 AM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Complete Blue PPO Distinct (PPO)	01	04		1			H3916	035	2	2022	Western PA	West Central PA	2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(833)227-9375		(833)227-9375		(833)544-1060		(833)544-1060		(833)227-9375		(833)227-9375		(833)544-1060		(833)544-1060		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3916	035	4	1	04	01	H3916_035_4	6	1					1	08/04/2021	2022.01	08/04/2021 09:10:49 AM Eastern Daylight Time	08/03/2021 11:11:27 AM Eastern Daylight Time	07/30/2021 01:54:30 PM Eastern Daylight Time			08/05/2021 08:12:54 AM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Complete Blue PPO Distinct (PPO)	01	04		1			H3916	035	4	2022	Western PA	Northwest PA	2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(833)227-9375		(833)227-9375		(833)544-1060		(833)544-1060		(833)227-9375		(833)227-9375		(833)544-1060		(833)544-1060		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3916	036	0	1	04	01	H3916_036_0	6	1					1	08/04/2021	2022.01	08/04/2021 09:25:55 AM Eastern Daylight Time	08/03/2021 11:07:15 AM Eastern Daylight Time	07/30/2021 01:55:37 PM Eastern Daylight Time			08/05/2021 08:12:54 AM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Community Blue Medicare Plus PPO Distinct (PPO)	01	04		1			H3916	036	0	2022	Counties: TA, LG, SN, CN		2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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	037	1	1	04	01	H3916_037_1	6	1					0	07/13/2021	2022.01	07/13/2021 04:19:06 PM Eastern Daylight Time	08/03/2021 11:09:07 AM Eastern Daylight Time	07/30/2021 01:56:44 PM Eastern Daylight Time			08/05/2021 08:12:54 AM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Community Blue Medicare PPO Signature (PPO)	01	04		1			H3916	037	1	2022	Central PA	Lehigh Valley PA	2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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	037	2	1	04	01	H3916_037_2	6	1					0	07/13/2021	2022.01	07/13/2021 04:19:43 PM Eastern Daylight Time	08/03/2021 11:12:29 AM Eastern Daylight Time	07/30/2021 01:58:09 PM Eastern Daylight Time			08/05/2021 08:12:54 AM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Community Blue Medicare PPO Signature (PPO)	01	04		1			H3916	037	2	2022	Central PA	South Central PA	2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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	037	3	1	04	01	H3916_037_3	6	1					0	07/13/2021	2022.01	07/13/2021 04:20:08 PM Eastern Daylight Time	08/03/2021 11:15:08 AM Eastern Daylight Time	07/30/2021 01:59:25 PM Eastern Daylight Time			08/05/2021 08:12:54 AM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Community Blue Medicare PPO Signature (PPO)	01	04		1			H3916	037	3	2022	Central PA	NEPA	2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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	037	4	1	04	01	H3916_037_4	6	1					0	07/13/2021	2022.01	07/13/2021 04:20:37 PM Eastern Daylight Time	08/03/2021 11:16:14 AM Eastern Daylight Time	07/30/2021 02:00:39 PM Eastern Daylight Time			08/05/2021 08:12:54 AM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Community Blue Medicare PPO Signature (PPO)	01	04		1			H3916	037	4	2022	Central PA	Lancaster PA	2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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	038	0	1	04	01	H3916_038_0	6	1					0	07/13/2021	2022.01	07/13/2021 04:21:07 PM Eastern Daylight Time	08/03/2021 11:17:42 AM Eastern Daylight Time	07/30/2021 02:01:46 PM Eastern Daylight Time			08/05/2021 08:12:54 AM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Complete Blue PPO Signature (PPO)	01	04		1			H3916	038	0	2022	Northwestern PA		2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(833)227-9375		(833)227-9375		(833)544-1060		(833)544-1060		(833)227-9375		(833)227-9375		(833)544-1060		(833)544-1060		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3916	039	0	1	04	01	H3916_039_0	6	1					0	07/13/2021	2022.01	07/13/2021 04:21:56 PM Eastern Daylight Time	08/03/2021 11:18:57 AM Eastern Daylight Time	07/30/2021 02:03:12 PM Eastern Daylight Time			08/05/2021 08:12:54 AM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Community Blue Medicare Plus PPO Signature (PPO)	01	04		1			H3916	039	0	2022	Counties: TA, CN, LG, SN		2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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	041	1	1	04	01	H3916_041_1	6	1					0	07/13/2021	2022.01	07/13/2021 04:22:25 PM Eastern Daylight Time	08/03/2021 11:20:08 AM Eastern Daylight Time	07/30/2021 02:04:38 PM Eastern Daylight Time			08/05/2021 08:12:54 AM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Complete Blue PPO Signature (PPO)	01	04		1			H3916	041	1	2022	WPA	Southwest	2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(833)227-9375		(833)227-9375		(833)544-1060		(833)544-1060		(833)227-9375		(833)227-9375		(833)544-1060		(833)544-1060		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3916	041	2	1	04	01	H3916_041_2	6	1					0	07/13/2021	2022.01	07/13/2021 04:22:54 PM Eastern Daylight Time	08/03/2021 11:21:40 AM Eastern Daylight Time	07/30/2021 02:05:37 PM Eastern Daylight Time			08/05/2021 08:12:54 AM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Complete Blue PPO Signature (PPO)	01	04		1			H3916	041	2	2022	WPA	West Central	2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(833)227-9375		(833)227-9375		(833)544-1060		(833)544-1060		(833)227-9375		(833)227-9375		(833)544-1060		(833)544-1060		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3916	801	0	1	04	01	H3916_801_0	1	1				0	0	05/07/2021	2022.01	05/07/2021 12:01:19 PM Eastern Daylight Time					06/04/2021 01:39:56 PM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Freedom Blue PPO MA PA CALENDAR (PPO)	01	04		1			H3916	801	0	2022	Pennsylvania		1	294174	2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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;3-4;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;15;16b;	2		1									
H3916	802	0	1	04	01	H3916_802_0	1	1						05/07/2021	2022.01	05/07/2021 12:05:01 PM Eastern Daylight Time					06/04/2021 01:39:56 PM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Freedom Blue PPO MAPD PA CALENDAR (PPO)	01	04		1			H3916	802	0	2022	Pennsylvania		1	601032	2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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;3-4;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;15;16b;	2		1									
H3916	804	0	1	04	01	H3916_804_0	1	1						05/07/2021	2022.01	05/07/2021 12:06:09 PM Eastern Daylight Time					06/04/2021 01:39:56 PM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Freedom Blue PPO MAPD PA Non-Calendar (PPO)	01	04		1			H3916	804	0	2022	Pennsylvania		1	0	2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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;3-4;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;15;16b;	2		1									
H3916	805	0	1	04	01	H3916_805_0	1	1				0	0	05/07/2021	2022.01	05/07/2021 12:06:57 PM Eastern Daylight Time					06/04/2021 01:39:56 PM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Community Blue Medicare PPO MA PA Calendar (PPO)	01	04		1			H3916	805	0	2022	Pennsylvania		1	0	2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(888)757-2946		(888)757-2946		(844)785-1787		(844)785-1787										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;15;16b;	2		1									
H3916	806	0	1	04	01	H3916_806_0	1	1						05/07/2021	2022.01	05/07/2021 12:07:53 PM Eastern Daylight Time					06/04/2021 01:39:56 PM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Community Blue Medicare PPO PA MAPD Calendar (PPO)	01	04		1			H3916	806	0	2022	Pennsylvania		1	39414	2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;15;16b;	2		1									
H3916	807	0	1	04	01	H3916_807_0	1	1						05/07/2021	2022.01	05/07/2021 12:08:41 PM Eastern Daylight Time					06/04/2021 01:39:56 PM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Community Blue Medicare Plus PPO MAPD Calendar (PPO)	01	04		1			H3916	807	0	2022	Pennsylvania		1	0	2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;15;16b;	2		1									
H3917	001	0	1	20	08	H3917_001_0	2	1						07/01/2021	2022.01	07/01/2021 12:40:54 PM Eastern Daylight Time		07/01/2021 08:20:18 AM Eastern Daylight Time			07/01/2021 12:42:23 PM Eastern Daylight Time	PITTSBURGH CARE PARTNERSHIP, INC.	Community LIFE	http://www.commlife.org/	Community LIFE (PACE)	08	20		1			H3917	001	0	2022	Alleghny Westmrlnd Washingtn part, Bedford, Fulton		2	9784	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	2	1						07/01/2021	2022.01	07/01/2021 12:40:29 PM Eastern Daylight Time		07/01/2021 08:20:34 AM Eastern Daylight Time			07/01/2021 12:42:23 PM Eastern Daylight Time	PITTSBURGH CARE PARTNERSHIP, INC.	Community LIFE	http://www.commlife.org/	Community LIFE (PACE)	08	20		1			H3917	002	0	2022	Alleghny Westmrlnd Washingtn part, Bedford, Fulton		2	37	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						05/28/2021	2022.01	05/28/2021 04:19:16 PM Eastern Daylight Time		05/28/2021 04:11:36 PM Eastern Daylight Time			05/28/2021 04:21:59 PM Eastern Daylight Time	LIVING INDEPENDENCE FOR THE ELDERLY PITTSBURGH INC	LIFE Pittsburgh	LIFEPittsburgh.org	LIFE Pittsburgh Dual Eligibles Pharmacy (PACE)	08	20		1			H3918	001	0	2022	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	2	1						05/28/2021	2022.01	05/28/2021 04:19:53 PM Eastern Daylight Time		05/28/2021 04:13:18 PM Eastern Daylight Time			05/28/2021 04:38:55 PM Eastern Daylight Time	LIVING INDEPENDENCE FOR THE ELDERLY PITTSBURGH INC	LIFE Pittsburgh	LIFEPittsburgh.org	LIFE Pittsburgh Medicare Only Pharmacy (PACE)	08	20		1			H3918	002	0	2022	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						06/02/2021	2022.01	06/02/2021 01:08:45 PM Eastern Daylight Time		06/02/2021 12:49:37 PM Eastern Daylight Time			06/02/2021 01:28:20 PM Eastern Daylight Time	ST. AGNES CONTINUING CARE CENTER	Mercy LIFE	trinityhealthpace.org	Mercy LIFE SEPA (PACE)	08	20		1			H3919	001	0	2022	Delaware County & Partial PHL, Montco, Chester		2		2			2						www.mercylife.org	www.mercylife.org												(215)339-4747				(215)339-4747												(800)654-5984				(800)654-5984																
H3919	002	0	1	20	08	H3919_002_0	1	1						05/14/2021	2022.01	05/14/2021 11:47:22 AM Eastern Daylight Time		06/02/2021 12:49:37 PM Eastern Daylight Time			06/02/2021 01:28:20 PM Eastern Daylight Time	ST. AGNES CONTINUING CARE CENTER	Mercy LIFE	trinityhealthpace.org	Mercy LIFE SEPA (PACE)	08	20		1			H3919	002	0	2022	Delaware County & Partial PHL, Montco, Chester		2		2			2						www.mercylife.org	www.mercylife.org												(215)339-4747				(215)339-4747												(800)654-5984				(800)654-5984																
H3923	013	0	1	04	01	H3923_013_0	5	1					1	08/03/2021	2022.01	08/03/2021 02:18:15 PM Eastern Daylight Time	08/03/2021 03:49:38 PM Eastern Daylight Time	08/04/2021 11:13:12 AM Eastern Daylight Time			08/04/2021 04:03:13 PM Eastern Daylight Time	CAPITAL ADVANTAGE INSURANCE COMPANY	Capital Advantage Insurance Company	www.capitalbluemedicare.com	BlueJourney Classic (PPO)	01	04		1			H3923	013	0	2022	21 Counties in Central PA		2		2			2						www.capitalbluemedicare.com	www.capitalbluemedicare.com	www.capitalbluemedicare.com	(866)987-4213		(866)987-4213		(866)987-4213		(866)987-4213		(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	4	1					1	07/16/2021	2022.01	07/16/2021 08:50:20 AM Eastern Daylight Time	08/03/2021 03:53:36 PM Eastern Daylight Time	08/03/2021 03:49:24 PM Eastern Daylight Time			08/04/2021 04:06:51 PM Eastern Daylight Time	CAPITAL ADVANTAGE INSURANCE COMPANY	Capital Advantage Insurance Company	www.capitalbluemedicare.com	BlueJourney Prime (PPO)	01	04		1			H3923	017	0	2022	21 Counties in Central PA		2		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	028	0	1	04	01	H3923_028_0	7	1					1	08/04/2021	2022.01	08/04/2021 03:23:37 PM Eastern Daylight Time	08/03/2021 03:57:06 PM Eastern Daylight Time	08/04/2021 11:16:36 AM Eastern Daylight Time			08/04/2021 04:09:29 PM Eastern Daylight Time	CAPITAL ADVANTAGE INSURANCE COMPANY	Capital Advantage Insurance Company	www.capitalbluemedicare.com	BlueJourney Select (PPO)	01	04		1			H3923	028	0	2022	21 Counties in Central PA		2		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	029	0	1	04	01	H3923_029_0	4	1					1	08/03/2021	2022.01	08/03/2021 02:27:57 PM Eastern Daylight Time	08/03/2021 04:00:40 PM Eastern Daylight Time	08/03/2021 03:56:00 PM Eastern Daylight Time			08/04/2021 04:12:51 PM Eastern Daylight Time	CAPITAL ADVANTAGE INSURANCE COMPANY	Capital Advantage Insurance Company	www.capitalbluemedicare.com	Capital Blue Cross | WellSpan Health Advantage (PPO)	01	04		1			H3923	029	0	2022	6 County Central PA		2		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	030	0	1	04	01	H3923_030_0	4	1					1	08/03/2021	2022.01	08/03/2021 02:25:07 PM Eastern Daylight Time	08/03/2021 04:06:14 PM Eastern Daylight Time	08/03/2021 04:05:56 PM Eastern Daylight Time			08/04/2021 04:15:19 PM Eastern Daylight Time	CAPITAL ADVANTAGE INSURANCE COMPANY	Capital Advantage Insurance Company	www.capitalbluemedicare.com	Capital Blue Cross | WellSpan Health AdvantagePlus (PPO)	01	04		1			H3923	030	0	2022	6 County Central PA		2		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						06/03/2021	2022.01	06/03/2021 02:21:45 PM Eastern Daylight Time					06/04/2021 11:41:28 AM Eastern Daylight Time	CAPITAL ADVANTAGE INSURANCE COMPANY	Capital Advantage Insurance Company	www.capitalbluemedicare.com	BlueJourney Group PPO Silver Rx (PPO)	01	04		1			H3923	801	0	2022	National		1	13968	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;3-4;5;6;7c;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;	2		1									
H3923	802	0	1	04	01	H3923_802_0	1	1				0	0	06/03/2021	2022.01	06/03/2021 02:23:18 PM Eastern Daylight Time					06/04/2021 11:41:28 AM Eastern Daylight Time	CAPITAL ADVANTAGE INSURANCE COMPANY	Capital Advantage Insurance Company	www.capitalbluemedicare.com	BlueJourney Group PPO Without Rx (PPO)	01	04		1			H3923	802	0	2022	National		1	696	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;3-4;5;6;7c;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;	2		1									
H3923	803	0	1	04	01	H3923_803_0	1	1						06/03/2021	2022.01	06/03/2021 02:25:42 PM Eastern Daylight Time					06/04/2021 11:41:28 AM Eastern Daylight Time	CAPITAL ADVANTAGE INSURANCE COMPANY	Capital Advantage Insurance Company	www.capitalbluemedicare.com	BlueJourney Group PPO Bronze Rx FY (PPO)	01	04		1			H3923	803	0	2022	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;3-4;5;6;7c;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;	2		1									
H3923	817	0	1	04	01	H3923_817_0	1	1						06/03/2021	2022.01	06/03/2021 03:00:11 PM Eastern Daylight Time					06/04/2021 11:41:28 AM Eastern Daylight Time	CAPITAL ADVANTAGE INSURANCE COMPANY	Capital Advantage Insurance Company	www.capitalbluemedicare.com	BlueJourney Group PPO Gold Rx (PPO)	01	04		1			H3923	817	0	2022	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;3-4;5;6;7c;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;	2		1									
H3923	818	0	1	04	01	H3923_818_0	1	1						06/03/2021	2022.01	06/03/2021 02:28:09 PM Eastern Daylight Time					06/04/2021 11:50:30 AM Eastern Daylight Time	CAPITAL ADVANTAGE INSURANCE COMPANY	Capital Advantage Insurance Company	www.capitalbluemedicare.com	BlueJourney Group PPO Platinum Rx (PPO)	01	04		1			H3923	818	0	2022	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;3-4;5;6;7c;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;	2		1									
H3923	819	0	1	04	01	H3923_819_0	1	1						06/03/2021	2022.01	06/03/2021 02:30:01 PM Eastern Daylight Time					06/04/2021 11:50:30 AM Eastern Daylight Time	CAPITAL ADVANTAGE INSURANCE COMPANY	Capital Advantage Insurance Company	www.capitalbluemedicare.com	BlueJourney Group PPO Bronze Rx (PPO)	01	04		1			H3923	819	0	2022	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;3-4;5;6;7c;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;	2		1									
H3923	820	0	1	04	01	H3923_820_0	1	1						06/03/2021	2022.01	06/03/2021 02:31:11 PM Eastern Daylight Time					06/04/2021 11:50:30 AM Eastern Daylight Time	CAPITAL ADVANTAGE INSURANCE COMPANY	Capital Advantage Insurance Company	www.capitalbluemedicare.com	BlueJourney Group PPO Platinum Rx FY (PPO)	01	04		1			H3923	820	0	2022	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;3-4;5;6;7c;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;	2		1									
H3923	821	0	1	04	01	H3923_821_0	1	1						06/03/2021	2022.01	06/03/2021 02:32:45 PM Eastern Daylight Time					06/04/2021 11:50:30 AM Eastern Daylight Time	CAPITAL ADVANTAGE INSURANCE COMPANY	Capital Advantage Insurance Company	www.capitalbluemedicare.com	BlueJourney Group PPO Gold Rx FY (PPO)	01	04		1			H3923	821	0	2022	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;3-4;5;6;7c;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;	2		1									
H3923	822	0	1	04	01	H3923_822_0	1	1						06/03/2021	2022.01	06/03/2021 02:35:26 PM Eastern Daylight Time					06/04/2021 11:52:48 AM Eastern Daylight Time	CAPITAL ADVANTAGE INSURANCE COMPANY	Capital Advantage Insurance Company	www.capitalbluemedicare.com	BlueJourney Group PPO Silver Rx FY (PPO)	01	04		1			H3923	822	0	2022	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;3-4;5;6;7c;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;	2		1									
H3923	823	0	1	04	01	H3923_823_0	1	1				0	0	06/03/2021	2022.01	06/03/2021 02:37:37 PM Eastern Daylight Time					06/04/2021 11:52:48 AM Eastern Daylight Time	CAPITAL ADVANTAGE INSURANCE COMPANY	Capital Advantage Insurance Company	www.capitalbluemedicare.com	Capital Blue Cross | WellSpan Health Without Rx (PPO)	01	04		1			H3923	823	0	2022	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										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7c;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;	2		1									
H3923	824	0	1	04	01	H3923_824_0	1	1						06/03/2021	2022.01	06/03/2021 02:38:53 PM Eastern Daylight Time					06/04/2021 11:52:48 AM Eastern Daylight Time	CAPITAL ADVANTAGE INSURANCE COMPANY	Capital Advantage Insurance Company	www.capitalbluemedicare.com	Capital Blue Cross | WellSpan Health Bronze (PPO)	01	04		1			H3923	824	0	2022	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;3-4;5;6;7c;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;	2		1									
H3923	825	0	1	04	01	H3923_825_0	1	1						06/03/2021	2022.01	06/03/2021 02:40:45 PM Eastern Daylight Time					06/04/2021 11:52:48 AM Eastern Daylight Time	CAPITAL ADVANTAGE INSURANCE COMPANY	Capital Advantage Insurance Company	www.capitalbluemedicare.com	Capital Blue Cross | WellSpan Health Silver (PPO)	01	04		1			H3923	825	0	2022	National		1	2880	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;3-4;5;6;7c;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;	2		1									
H3923	826	0	1	04	01	H3923_826_0	1	1						06/03/2021	2022.01	06/03/2021 02:43:45 PM Eastern Daylight Time					06/04/2021 11:55:59 AM Eastern Daylight Time	CAPITAL ADVANTAGE INSURANCE COMPANY	Capital Advantage Insurance Company	www.capitalbluemedicare.com	Capital Blue Cross | WellSpan Health Gold (PPO)	01	04		1			H3923	826	0	2022	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;3-4;5;6;7c;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;	2		1									
H3923	827	0	1	04	01	H3923_827_0	1	1						06/03/2021	2022.01	06/03/2021 02:45:20 PM Eastern Daylight Time					06/04/2021 11:55:59 AM Eastern Daylight Time	CAPITAL ADVANTAGE INSURANCE COMPANY	Capital Advantage Insurance Company	www.capitalbluemedicare.com	Capital Blue Cross | WellSpan Health Platinum (PPO)	01	04		1			H3923	827	0	2022	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;3-4;5;6;7c;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;	2		1									
H3923	828	0	1	04	01	H3923_828_0	1	1						06/03/2021	2022.01	06/03/2021 02:47:20 PM Eastern Daylight Time					06/04/2021 11:55:59 AM Eastern Daylight Time	CAPITAL ADVANTAGE INSURANCE COMPANY	Capital Advantage Insurance Company	www.capitalbluemedicare.com	Capital Blue Cross | WellSpan Health Bronze FY (PPO)	01	04		1			H3923	828	0	2022	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;3-4;5;6;7c;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;	2		1									
H3923	829	0	1	04	01	H3923_829_0	2	1						06/03/2021	2022.01	06/03/2021 02:50:26 PM Eastern Daylight Time					06/04/2021 11:55:59 AM Eastern Daylight Time	CAPITAL ADVANTAGE INSURANCE COMPANY	Capital Advantage Insurance Company	www.capitalbluemedicare.com	Capital Blue Cross | WellSpan Health Silver FY (PPO)	01	04		1			H3923	829	0	2022	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;3-4;5;6;7c;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;	2		1									
H3923	830	0	1	04	01	H3923_830_0	2	1						06/03/2021	2022.01	06/03/2021 02:57:51 PM Eastern Daylight Time					06/04/2021 11:55:59 AM Eastern Daylight Time	CAPITAL ADVANTAGE INSURANCE COMPANY	Capital Advantage Insurance Company	www.capitalbluemedicare.com	Capital Blue Cross | WellSpan Health Gold FY (PPO)	01	04		1			H3923	830	0	2022	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;3-4;5;6;7c;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;	2		1									
H3923	831	0	1	04	01	H3923_831_0	2	1						06/03/2021	2022.01	06/03/2021 02:59:20 PM Eastern Daylight Time					06/04/2021 11:55:59 AM Eastern Daylight Time	CAPITAL ADVANTAGE INSURANCE COMPANY	Capital Advantage Insurance Company	www.capitalbluemedicare.com	Capital Blue Cross | WellSpan Health Platinum FY (PPO)	01	04		1			H3923	831	0	2022	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;3-4;5;6;7c;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;	2		1									
H3924	059	21	1	04	01	H3924_059_21	5	1					1	08/04/2021	2022.01	08/04/2021 10:25:10 AM Eastern Daylight Time	08/04/2021 11:58:38 AM Eastern Daylight Time	07/29/2021 04:31:24 PM Eastern Daylight Time			08/05/2021 07:32:40 PM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Preferred Advantage Rx (PPO)	01	04		1			H3924	059	21	2022	Pennsylvania	Northeast, Central, & Midwest PA	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	22	1	04	01	H3924_059_22	5	1					1	07/19/2021	2022.01	07/19/2021 02:30:18 PM Eastern Daylight Time	08/04/2021 12:01:28 PM Eastern Daylight Time	07/29/2021 04:36:38 PM Eastern Daylight Time			08/05/2021 07:32:40 PM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Preferred Advantage Rx (PPO)	01	04		1			H3924	059	22	2022	Pennsylvania	South & East Pennsylvania	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	21	1	04	01	H3924_062_21	5	1					1	08/05/2021	2022.01	08/05/2021 02:32:32 PM Eastern Daylight Time	08/04/2021 12:04:22 PM Eastern Daylight Time	07/29/2021 04:40:40 PM Eastern Daylight Time			08/05/2021 07:32:40 PM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	GeisingerGold.com	Geisinger Gold Preferred Enhanced Rx (PPO)	01	04		1			H3924	062	21	2022	Pennsylvania	Pennsylvania Mountains & Valleys	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	22	1	04	01	H3924_062_22	5	1					1	08/05/2021	2022.01	08/05/2021 02:31:54 PM Eastern Daylight Time	08/04/2021 12:07:12 PM Eastern Daylight Time	07/29/2021 04:42:02 PM Eastern Daylight Time			08/05/2021 07:32:40 PM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	GeisingerGold.com	Geisinger Gold Preferred Enhanced Rx (PPO)	01	04		1			H3924	062	22	2022	Pennsylvania	Pennsylvania Heartland	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	23	1	04	01	H3924_062_23	5	1					1	08/05/2021	2022.01	08/05/2021 02:30:47 PM Eastern Daylight Time	08/04/2021 02:03:46 PM Eastern Daylight Time	07/29/2021 04:44:00 PM Eastern Daylight Time			08/05/2021 07:32:40 PM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	GeisingerGold.com	Geisinger Gold Preferred Enhanced Rx (PPO)	01	04		1			H3924	062	23	2022	Pennsylvania	Pennsylvania Town & Country	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	065	0	1	04	01	H3924_065_0	5	1					1	08/05/2021	2022.01	08/05/2021 12:08:37 PM Eastern Daylight Time	08/04/2021 12:10:50 PM Eastern Daylight Time	07/29/2021 04:51:18 PM Eastern Daylight Time			08/05/2021 07:32:40 PM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Preferred Complete Rx (PPO)	01	04		1			H3924	065	0	2022	Pennsylvania		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	066	0	1	04	01	H3924_066_0	5	1					1	08/05/2021	2022.01	08/05/2021 12:12:16 PM Eastern Daylight Time	08/04/2021 12:13:28 PM Eastern Daylight Time	07/29/2021 04:53:34 PM Eastern Daylight Time			08/05/2021 07:32:40 PM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Preferred 360 Rx (PPO)	01	04		1			H3924	066	0	2022	Pennsylvania		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	804	0	1	04	01	H3924_804_0	3	1						05/24/2021	2022.01	05/24/2021 02:52:10 PM Eastern Daylight Time					06/04/2021 07:45:10 AM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Preferred Rx Employer Group Plan (PPO)	01	04		1			H3924	804	0	2022	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	2	1						04/28/2021	2022.01	04/28/2021 04:02:14 PM Eastern Daylight Time		07/27/2021 02:07:32 PM Eastern Daylight Time			07/27/2021 02:39:58 PM Eastern Daylight Time	PENNSYLVANIA PACE, INC.	Senior LIFE Johnstown, Inc.	www.seniorlifepa.com	Senior LIFE Johnstown Dual Eligible (PACE)	08	20		1			H3925	001	0	2022	Cambria and Somerset Counties		2		2			2						http://granerx.com/	NA										(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000										(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000																
H3925	002	0	1	20	08	H3925_002_0	2	1						04/28/2021	2022.01	04/28/2021 04:02:24 PM Eastern Daylight Time		07/27/2021 02:08:05 PM Eastern Daylight Time			07/27/2021 02:39:58 PM Eastern Daylight Time	PENNSYLVANIA PACE, INC.	Senior LIFE Johnstown, Inc.	www.seniorlifejohnstown.com	Senior LIFE Johnstown Medicare Only (PACE)	08	20		1			H3925	002	0	2022	Cambria and Somerset Counties		2		2			2						http://granerx.com/	NA										(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000										(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000																
H3928	001	0	1	01	01	H3928_001_0	4	1					0	08/02/2021	2022.01	08/02/2021 10:48:50 AM Eastern Daylight Time	08/03/2021 11:01:34 AM Eastern Daylight Time	08/02/2021 09:37:17 AM Eastern Daylight Time			08/04/2021 05:01:48 PM Eastern Daylight Time	AETNA HEALTH INC. (LA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Plan (HMO)	01	01		1			H3928	001	0	2022	New Orleans - Baton Rouge Metro Parishes		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3928	002	0	1	01	01	H3928_002_0	5	1					0	08/02/2021	2022.01	08/02/2021 10:49:16 AM Eastern Daylight Time	08/03/2021 11:02:23 AM Eastern Daylight Time	08/02/2021 09:37:21 AM Eastern Daylight Time			08/04/2021 05:01:48 PM Eastern Daylight Time	AETNA HEALTH INC. (LA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Plan (HMO)	01	01		1			H3928	002	0	2022	Bossier, Caddo and St. Tammany Parishes		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3928	801	0	1	01	01	H3928_801_0	1	1						05/27/2021	2022.01	05/27/2021 11:25:14 PM Eastern Daylight Time					06/03/2021 01:07:05 PM Eastern Daylight Time	AETNA HEALTH INC. (LA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan w/Rx (HMO)	01	01		1			H3928	801	0	2022	Louisiana		1	120	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H3928	803	0	1	01	01	H3928_803_0	1	1				0	0	05/27/2021	2022.01	05/27/2021 11:25:37 PM Eastern Daylight Time					06/03/2021 01:07:05 PM Eastern Daylight Time	AETNA HEALTH INC. (LA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (HMO)	01	01		1			H3928	803	0	2022	Louisiana		1	120	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H3931	004	0	1	01	01	H3931_004_0	2	1			1		0	08/02/2021	2022.01	08/02/2021 04:19:07 PM Eastern Daylight Time	08/02/2021 05:24:45 PM Eastern Daylight Time	08/02/2021 09:37:25 AM Eastern Daylight Time			08/04/2021 12:52:13 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plus (HMO)	01	01		1			H3931	004	0	2022	Southeast Pennsylvania		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	064	0	1	02	01	H3931_064_0	2	1			2		0	06/02/2021	2022.01	06/02/2021 03:53:49 PM Eastern Daylight Time	08/02/2021 05:25:31 PM Eastern Daylight Time	08/02/2021 09:37:29 AM Eastern Daylight Time			08/04/2021 12:52:13 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (HMO-POS)	01	02		1			H3931	064	0	2022	Southeast Pennsylvania		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	070	0	1	01	01	H3931_070_0	2	1			2		0	06/01/2021	2022.01	06/01/2021 04:06:30 PM Eastern Daylight Time	08/02/2021 05:26:19 PM Eastern Daylight Time	08/02/2021 09:37:34 AM Eastern Daylight Time			08/04/2021 12:52:13 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Silver (HMO)	01	01		1			H3931	070	0	2022	Pennsylvania		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	091	0	1	01	01	H3931_091_0	2	1			2		0	08/02/2021	2022.01	08/02/2021 03:42:44 PM Eastern Daylight Time	08/02/2021 05:27:12 PM Eastern Daylight Time	08/02/2021 09:37:38 AM Eastern Daylight Time			08/04/2021 12:52:13 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare PinnacleHealth Prime (HMO)	01	01		1			H3931	091	0	2022	Cumberland and Dauphin counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	092	0	1	01	01	H3931_092_0	3	1					0	08/02/2021	2022.01	08/02/2021 11:13:34 AM Eastern Daylight Time	08/03/2021 01:16:27 PM Eastern Daylight Time	08/02/2021 09:37:42 AM Eastern Daylight Time			08/04/2021 03:43:15 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime Plan (HMO)	01	01		1			H3931	092	0	2022	Maricopa County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	093	0	1	01	01	H3931_093_0	2	1					0	08/02/2021	2022.01	08/02/2021 03:13:29 PM Central Daylight Time	08/03/2021 01:13:19 PM Central Daylight Time	08/02/2021 08:37:46 AM Central Daylight Time			08/04/2021 01:00:17 PM Central Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime (HMO)	01	01		1			H3931	093	0	2022	Denver Metro		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	094	0	1	02	01	H3931_094_0	2	1					0	08/02/2021	2022.01	08/02/2021 01:39:45 PM Eastern Daylight Time	08/02/2021 03:10:41 PM Eastern Daylight Time	08/02/2021 09:37:50 AM Eastern Daylight Time			08/04/2021 01:38:04 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO-POS)	01	02		1			H3931	094	0	2022	Clark County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	095	0	1	02	01	H3931_095_0	2	1					0	08/02/2021	2022.01	08/02/2021 03:27:32 PM Central Daylight Time	08/03/2021 12:30:25 PM Central Daylight Time	08/02/2021 08:37:55 AM Central Daylight Time			08/04/2021 02:07:30 PM Central Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Standard Plan (HMO-POS)	01	02		1			H3931	095	0	2022	District of Columbia		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	096	0	1	02	01	H3931_096_0	5	1			2		0	08/05/2021	2022.01	08/05/2021 04:42:16 PM Central Daylight Time	08/03/2021 12:32:01 PM Central Daylight Time	08/02/2021 08:37:59 AM Central Daylight Time			08/05/2021 04:52:55 PM Central Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime Plan (HMO-POS)	01	02		1			H3931	096	0	2022	Fairfax County and Surrounding Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	097	0	1	01	01	H3931_097_0	2	1			2		0	06/01/2021	2022.01	06/01/2021 03:37:08 PM Central Daylight Time	08/03/2021 12:38:17 PM Central Daylight Time	08/02/2021 08:38:03 AM Central Daylight Time			08/04/2021 02:07:30 PM Central Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Connect Plus (HMO)	01	01		1			H3931	097	0	2022	Southern Maryland		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	098	0	1	02	01	H3931_098_0	2	1					0	08/02/2021	2022.01	08/02/2021 03:28:59 PM Central Daylight Time	08/03/2021 12:40:28 PM Central Daylight Time	08/02/2021 08:38:07 AM Central Daylight Time			08/04/2021 02:07:30 PM Central Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO-POS)	01	02		1			H3931	098	0	2022	Richmond and Surrounding Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	099	0	1	02	01	H3931_099_0	2	1					0	08/02/2021	2022.01	08/02/2021 03:29:16 PM Central Daylight Time	08/03/2021 12:42:03 PM Central Daylight Time	08/02/2021 08:38:12 AM Central Daylight Time			08/04/2021 02:07:30 PM Central Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO-POS)	01	02		1			H3931	099	0	2022	Danville and Surrounding Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	100	0	1	02	01	H3931_100_0	2	1					0	08/02/2021	2022.01	08/02/2021 03:29:34 PM Central Daylight Time	08/03/2021 12:45:38 PM Central Daylight Time	08/02/2021 08:38:16 AM Central Daylight Time			08/04/2021 02:07:30 PM Central Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO-POS)	01	02		1			H3931	100	0	2022	Newport News and Surrounding Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	101	0	1	02	01	H3931_101_0	2	1					0	08/02/2021	2022.01	08/02/2021 03:29:53 PM Central Daylight Time	08/03/2021 12:48:18 PM Central Daylight Time	08/02/2021 08:38:20 AM Central Daylight Time			08/04/2021 02:07:30 PM Central Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO-POS)	01	02		1			H3931	101	0	2022	Roanoke and Surrounding Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	102	0	1	01	01	H3931_102_0	2	1			2		1	06/02/2021	2022.01	06/02/2021 08:59:19 AM Eastern Daylight Time	08/02/2021 05:28:02 PM Eastern Daylight Time	08/02/2021 09:38:24 AM Eastern Daylight Time			08/04/2021 12:52:13 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plus (HMO)	01	01		1			H3931	102	0	2022	New Castle, Kent and Sussex Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	104	0	1	01	01	H3931_104_0	2	1			2		0	08/02/2021	2022.01	08/02/2021 03:46:38 PM Eastern Daylight Time	08/02/2021 05:28:54 PM Eastern Daylight Time	08/02/2021 09:38:28 AM Eastern Daylight Time			08/04/2021 12:52:13 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite (HMO)	01	01		1			H3931	104	0	2022	New Castle, Kent and Sussex Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	105	0	1	01	01	H3931_105_0	2	1			2		0	08/02/2021	2022.01	08/02/2021 12:45:41 PM Eastern Daylight Time	08/02/2021 05:29:48 PM Eastern Daylight Time	08/02/2021 09:38:33 AM Eastern Daylight Time			08/04/2021 12:52:13 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Philly Suburban Value (HMO)	01	01		1			H3931	105	0	2022	Chester, Delaware and Montgomery counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	107	0	1	02	01	H3931_107_0	2	1			2		0	08/02/2021	2022.01	08/02/2021 04:21:01 PM Eastern Daylight Time	08/03/2021 12:41:21 PM Eastern Daylight Time	08/02/2021 09:38:37 AM Eastern Daylight Time			08/04/2021 12:52:13 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO-POS)	01	02		1			H3931	107	0	2022	Northeastern and Youngstown Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	108	0	1	01	01	H3931_108_0	2	1			2		0	08/02/2021	2022.01	08/02/2021 01:14:22 PM Eastern Daylight Time	08/03/2021 12:42:57 PM Eastern Daylight Time	08/02/2021 09:38:41 AM Eastern Daylight Time			08/04/2021 12:52:13 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H3931	108	0	2022	Central Ohio Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	109	0	1	02	01	H3931_109_0	3	1			2		0	08/02/2021	2022.01	08/02/2021 04:21:44 PM Eastern Daylight Time	08/03/2021 12:44:20 PM Eastern Daylight Time	08/02/2021 09:38:45 AM Eastern Daylight Time			08/04/2021 12:52:13 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value (HMO-POS)	01	02		1			H3931	109	0	2022	Toledo and Cincinnati Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	112	0	1	01	01	H3931_112_0	2	1			2		0	08/02/2021	2022.01	08/02/2021 12:46:32 PM Eastern Daylight Time	08/02/2021 05:30:41 PM Eastern Daylight Time	08/02/2021 09:38:49 AM Eastern Daylight Time			08/04/2021 12:52:13 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite (HMO)	01	01		1			H3931	112	0	2022	Southeastern and Central Pennsylvania		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	115	0	1	02	01	H3931_115_0	2	1					0	08/02/2021	2022.01	08/02/2021 01:42:35 PM Eastern Daylight Time	08/02/2021 03:11:33 PM Eastern Daylight Time	08/02/2021 09:38:53 AM Eastern Daylight Time			08/04/2021 01:38:04 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Platinum Plan (HMO-POS)	01	02		1			H3931	115	0	2022	Carson City, Douglas and Washoe Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	118	0	1	01	01	H3931_118_0	2	1			2		0	08/02/2021	2022.01	08/02/2021 01:15:55 PM Eastern Daylight Time	08/03/2021 12:45:41 PM Eastern Daylight Time	08/02/2021 09:38:58 AM Eastern Daylight Time			08/04/2021 12:52:13 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H3931	118	0	2022	Lexington Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	124	0	1	02	01	H3931_124_0	4	1					0	08/02/2021	2022.01	08/02/2021 03:30:18 PM Central Daylight Time	08/03/2021 12:50:11 PM Central Daylight Time	08/02/2021 08:39:02 AM Central Daylight Time			08/04/2021 02:07:30 PM Central Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare UVA Health System Prime (HMO-POS)	01	02		1			H3931	124	0	2022	Charlottesville and Surrounding area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	126	0	1	02	01	H3931_126_0	2	1					0	08/02/2021	2022.01	08/02/2021 01:31:58 PM Eastern Daylight Time	08/02/2021 02:53:10 PM Eastern Daylight Time	08/02/2021 09:39:06 AM Eastern Daylight Time			08/04/2021 01:38:04 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO-POS)	01	02		1			H3931	126	0	2022	Puget Sound Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	129	0	1	02	01	H3931_129_0	3	1			2		0	08/02/2021	2022.01	08/02/2021 11:16:31 AM Eastern Daylight Time	08/03/2021 01:17:20 PM Eastern Daylight Time	08/02/2021 09:39:10 AM Eastern Daylight Time			08/04/2021 03:43:15 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Platinum Plan (HMO-POS)	01	02		1			H3931	129	0	2022	Counties GIL, MAR, MOH, PIM, PIN, YAV		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	133	0	1	01	01	H3931_133_0	3	1			2		0	08/02/2021	2022.01	08/02/2021 01:16:28 PM Eastern Daylight Time	08/03/2021 12:47:04 PM Eastern Daylight Time	08/02/2021 09:39:15 AM Eastern Daylight Time			08/04/2021 12:52:13 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H3931	133	0	2022	Louisville Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	134	0	1	02	01	H3931_134_0	2	1			2		0	08/02/2021	2022.01	08/02/2021 01:17:01 PM Eastern Daylight Time	08/03/2021 12:49:19 PM Eastern Daylight Time	08/02/2021 09:39:19 AM Eastern Daylight Time			08/04/2021 12:52:13 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO-POS)	01	02		1			H3931	134	0	2022	Bowling Green/Southwest KY Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	140	0	1	01	01	H3931_140_0	2	1			2		0	08/02/2021	2022.01	08/02/2021 01:17:43 PM Eastern Daylight Time	08/03/2021 12:50:35 PM Eastern Daylight Time	08/02/2021 09:39:23 AM Eastern Daylight Time			08/04/2021 12:52:13 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H3931	140	0	2022	Ashland Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	143	0	1	02	01	H3931_143_0	3	1					0	08/02/2021	2022.01	08/02/2021 03:30:34 PM Central Daylight Time	08/03/2021 12:52:10 PM Central Daylight Time	08/02/2021 08:39:27 AM Central Daylight Time			08/04/2021 02:07:30 PM Central Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO-POS)	01	02		1			H3931	143	0	2022	Fairfax County and Surrounding Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		2					2					2	2			
H3931	801	0	1	01	01	H3931_801_0	1	1				0	0	05/27/2021	2022.01	05/27/2021 11:26:23 PM Eastern Daylight Time					06/03/2021 01:07:05 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (HMO)	01	01		1			H3931	801	0	2022	Pennsylvania		1	19900	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H3931	804	0	1	01	01	H3931_804_0	1	1						06/02/2021	2022.01	06/02/2021 09:23:03 PM Eastern Daylight Time					06/03/2021 01:07:05 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan w/Rx (HMO)	01	01		1			H3931	804	0	2022	Pennsylvania		1	26380	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H3942	001	0	1	20	08	H3942_001_0	1	1						06/07/2021	2022.01	06/07/2021 12:26:53 PM Eastern Daylight Time		06/07/2021 12:32:10 PM Eastern Daylight Time			06/07/2021 12:35:09 PM Eastern Daylight Time	ELDERHAUS INC.	Elderhaus PACE	www.elderhaus.com	Elderhaus PACE (PACE)	08	20		1			H3942	001	0	2022	Elderhaus PACE-New Hanover 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																
H3942	002	0	1	20	08	H3942_002_0	1	1						06/07/2021	2022.01	06/07/2021 12:28:07 PM Eastern Daylight Time		06/07/2021 12:32:40 PM Eastern Daylight Time			06/07/2021 12:35:09 PM Eastern Daylight Time	ELDERHAUS INC.	Elderhaus PACE	www.elderhaus.com	Elderhaus PACE (PACE)	08	20		1			H3942	002	0	2022	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	1		0	07/08/2021	2022.01	07/08/2021 03:15:18 PM Central Daylight Time	08/02/2021 12:42:29 PM Central Daylight Time	07/30/2021 11:33:27 AM Central Daylight Time			08/04/2021 10:27:29 AM Central Daylight Time	BRAVO HEALTH PENNSYLVANIA, INC.	Cigna	www.cignamedicare.com	Cigna TotalCare (HMO D-SNP)	01	01		1			H3949	009	0	2022	Philadelphia Area		2		2			1	3		2		2	www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.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	4	1			2		0	07/08/2021	2022.01	07/08/2021 03:16:12 PM Central Daylight Time	08/02/2021 12:39:33 PM Central Daylight Time	07/30/2021 11:33:51 AM Central Daylight Time			08/04/2021 10:27:29 AM Central Daylight Time	BRAVO HEALTH PENNSYLVANIA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Plus Medicare (HMO)	01	01		1			H3949	013	0	2022	Philadelphia Area		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.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	4	1		1	2		0	08/02/2021	2022.01	08/02/2021 05:15:58 PM Central Daylight Time	08/02/2021 12:38:27 PM Central Daylight Time	07/30/2021 11:34:15 AM Central Daylight Time			08/04/2021 10:27:29 AM Central Daylight Time	BRAVO HEALTH PENNSYLVANIA, INC.	Cigna	www.cignamedicare.com	Cigna Achieve Medicare (HMO C-SNP)	01	01		1			H3949	024	0	2022	Philadelphia Area		2		2			1	4			00000010000000000000		www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.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	3	1			2	0	0	07/08/2021	2022.01	07/08/2021 03:17:27 PM Central Daylight Time	05/31/2021 04:54:24 PM Central Daylight Time				07/19/2021 03:36:58 PM Central Daylight Time	BRAVO HEALTH PENNSYLVANIA, INC.	Cigna	www.cignamedicare.com	Cigna Fundamental Medicare (HMO)	01	01		1			H3949	026	0	2022	Philadelphia Area		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.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	4	1			2		0	07/08/2021	2022.01	07/08/2021 03:17:58 PM Central Daylight Time	08/02/2021 12:36:38 PM Central Daylight Time	07/30/2021 11:34:39 AM Central Daylight Time			08/04/2021 10:27:29 AM Central Daylight Time	BRAVO HEALTH PENNSYLVANIA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H3949	030	0	2022	Philadelphia Area		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.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	4	1			2		0	08/02/2021	2022.01	08/02/2021 05:19:00 PM Central Daylight Time	08/02/2021 12:35:36 PM Central Daylight Time	07/30/2021 11:35:03 AM Central Daylight Time			08/04/2021 10:27:29 AM Central Daylight Time	BRAVO HEALTH PENNSYLVANIA, INC.	Cigna	www.cignamedicare.com	Cigna Alliance Medicare (HMO)	01	01		1			H3949	031	0	2022	Philadelphia Area		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.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	032	0	1	01	01	H3949_032_0	4	1			2		0	08/02/2021	2022.01	08/02/2021 05:20:42 PM Central Daylight Time	08/02/2021 12:34:14 PM Central Daylight Time	07/30/2021 11:35:27 AM Central Daylight Time			08/04/2021 10:27:29 AM Central Daylight Time	BRAVO HEALTH PENNSYLVANIA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H3949	032	0	2022	Southern New Jersey		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.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	033	0	1	01	01	H3949_033_0	4	1			2		0	07/08/2021	2022.01	07/08/2021 03:19:57 PM Central Daylight Time	08/02/2021 12:32:49 PM Central Daylight Time	07/30/2021 11:35:51 AM Central Daylight Time			08/04/2021 10:27:29 AM Central Daylight Time	BRAVO HEALTH PENNSYLVANIA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Plus Medicare (HMO)	01	01		1			H3949	033	0	2022	Southern New Jersey		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.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	034	0	1	01	01	H3949_034_0	4	1			2		0	08/02/2021	2022.01	08/02/2021 06:08:06 PM Central Daylight Time	08/02/2021 12:31:21 PM Central Daylight Time	07/30/2021 11:36:14 AM Central Daylight Time			08/04/2021 10:27:29 AM Central Daylight Time	BRAVO HEALTH PENNSYLVANIA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H3949	034	0	2022	Central New Jersey		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.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	035	0	1	01	01	H3949_035_0	3	1			2		0	08/02/2021	2022.01	08/02/2021 05:24:23 PM Central Daylight Time	08/02/2021 12:29:33 PM Central Daylight Time	07/30/2021 11:36:37 AM Central Daylight Time			08/04/2021 10:27:29 AM Central Daylight Time	BRAVO HEALTH PENNSYLVANIA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H3949	035	0	2022	Central Pennsylvania		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.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	036	0	1	01	01	H3949_036_0	4	1	2	1	1		0	05/27/2021	2022.01	05/27/2021 09:49:17 AM Central Daylight Time	08/02/2021 12:28:11 PM Central Daylight Time	07/30/2021 11:37:02 AM Central Daylight Time			08/04/2021 10:27:29 AM Central Daylight Time	BRAVO HEALTH PENNSYLVANIA, INC.	Cigna	www.cignamedicare.com	Cigna TotalCare (HMO D-SNP)	01	01		1			H3949	036	0	2022	Central Pennsylvania		2		2			1	3		2		2	www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.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	037	0	1	01	01	H3949_037_0	7	1	2	1	1		0	08/17/2021	2022.01	08/17/2021 03:45:33 PM Central Daylight Time	08/02/2021 12:24:27 PM Central Daylight Time	07/30/2021 11:37:26 AM Central Daylight Time			08/17/2021 04:34:17 PM Central Daylight Time	BRAVO HEALTH PENNSYLVANIA, INC.	Cigna	www.cignamedicare.com	Cigna TotalCare Plus (HMO D-SNP)	01	01		1			H3949	037	0	2022	Pennsylvania		2		2			1	3		1		2	www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101		(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3949	804	0	1	01	01	H3949_804_0	2	1						05/10/2021	2022.01	05/10/2021 10:24:24 AM Central Daylight Time					06/02/2021 03:23:24 PM Central Daylight Time	BRAVO HEALTH PENNSYLVANIA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H3949	804	0	2022	Statewide NJ & PA		1	600	2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(888)281-7867		(888)281-7867		(888)281-7867		(888)281-7867		(888)281-7867		(888)281-7867		(888)281-7867		(888)281-7867		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H3952	008	0	1	01	01	H3952_008_0	2	1				0	0	05/24/2021	2022.01	05/24/2021 03:50:14 PM Eastern Daylight Time	06/07/2021 12:30:53 PM Eastern Daylight Time				06/07/2021 12:59:42 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN EAST, INC.	Independence Blue Cross	www.ibxmedicare.com	Keystone 65 Preferred Medical Only (HMO)	01	01		1			H3952	008	0	2022	Bucks, Philadelphia Counties		2	7959	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	2			
H3952	020	0	1	01	01	H3952_020_0	4	1					1	05/24/2021	2022.01	05/24/2021 03:48:15 PM Eastern Daylight Time	08/03/2021 03:09:12 PM Eastern Daylight Time	07/30/2021 11:07:58 AM Eastern Daylight Time			08/04/2021 05:31:49 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN EAST, INC.	Independence Blue Cross	www.ibxmedicare.com	Keystone 65 Preferred Rx (HMO)	01	01		1			H3952	020	0	2022	Bucks, Philadelphia Counties		2	48014	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	2			
H3952	044	0	1	01	01	H3952_044_0	4	1				0	0	05/24/2021	2022.01	05/24/2021 03:45:23 PM Eastern Daylight Time	07/07/2021 12:58:00 PM Eastern Daylight Time				07/19/2021 02:36:21 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN EAST, INC.	Independence Blue Cross	www.ibxmedicare.com	Keystone 65 Preferred Medical Only (HMO)	01	01		1			H3952	044	0	2022	Chester, Delaware, Montgomery Counties		2	4058	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	2			
H3952	045	0	1	01	01	H3952_045_0	3	1					1	05/24/2021	2022.01	05/24/2021 03:35:52 PM Eastern Daylight Time	08/03/2021 03:27:16 PM Eastern Daylight Time	07/30/2021 11:08:12 AM Eastern Daylight Time			08/04/2021 05:31:49 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN EAST, INC.	Independence Blue Cross	www.ibxmedicare.com	Keystone 65 Preferred Rx (HMO)	01	01		1			H3952	045	0	2022	Chester, Delaware, Montgomery Counties		2	27726	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	2			
H3952	048	0	1	01	01	H3952_048_0	1	1				0	0	05/26/2021	2022.01	05/26/2021 11:35:06 AM Eastern Daylight Time	06/04/2021 05:57:34 PM Eastern Daylight Time				06/04/2021 08:38:36 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN EAST, INC.	Independence Blue Cross	www.ibxmedicare.com	Keystone 65 Select Medical Only (HMO)	01	01		1			H3952	048	0	2022	Bucks, Philadelphia Counties		2	14673	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	2			
H3952	049	0	1	01	01	H3952_049_0	2	1					1	05/26/2021	2022.01	05/26/2021 11:23:28 AM Eastern Daylight Time	08/03/2021 03:43:08 PM Eastern Daylight Time	07/30/2021 11:08:24 AM Eastern Daylight Time			08/04/2021 05:31:49 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN EAST, INC.	Independence Blue Cross	www.ibxmedicare.com	Keystone 65 Select Rx (HMO)	01	01		1			H3952	049	0	2022	Bucks, Philadelphia Counties		2	150789	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	2			
H3952	050	0	1	01	01	H3952_050_0	3	1				0	0	05/26/2021	2022.01	05/26/2021 12:12:38 PM Eastern Daylight Time	06/04/2021 06:00:07 PM Eastern Daylight Time				06/04/2021 08:38:36 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN EAST, INC.	Independence Blue Cross	www.ibxmedicare.com	Keystone 65 Select Medical Only (HMO)	01	01		1			H3952	050	0	2022	Chester, Delaware, Montgomery Counties		2	13614	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	2			
H3952	051	0	1	01	01	H3952_051_0	2	1					1	08/02/2021	2022.01	08/02/2021 05:11:12 PM Eastern Daylight Time	08/04/2021 09:21:10 AM Eastern Daylight Time	07/30/2021 11:08:36 AM Eastern Daylight Time			08/04/2021 05:31:49 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN EAST, INC.	Independence Blue Cross	www.ibxmedicare.com	Keystone 65 Select Rx (HMO)	01	01		1			H3952	051	0	2022	Chester, Delaware, Montgomery Counties		2	107670	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	2			
H3952	053	0	1	02	01	H3952_053_0	3	1					1	08/02/2021	2022.01	08/02/2021 05:14:53 PM Eastern Daylight Time	08/04/2021 08:59:52 AM Eastern Daylight Time	07/30/2021 11:08:48 AM Eastern Daylight Time			08/04/2021 05:54:42 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN EAST, INC.	Independence Blue Cross	www.ibxmedicare.com	Keystone 65 Focus Rx (HMO-POS)	01	02		1			H3952	053	0	2022	Philadelphia, Bucks		2	100541	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	2			
H3952	054	0	1	02	01	H3952_054_0	2	1					1	08/02/2021	2022.01	08/02/2021 05:08:28 PM Eastern Daylight Time	08/04/2021 09:02:34 AM Eastern Daylight Time	07/30/2021 11:09:00 AM Eastern Daylight Time			08/04/2021 05:54:42 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN EAST, INC.	Independence Blue Cross	www.ibxmedicare.com	Keystone 65 Focus Rx (HMO-POS)	01	02		1			H3952	054	0	2022	Chester, Delaware, Montgomery		2	48180	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	2			
H3952	055	0	1	01	01	H3952_055_0	2	1					0	08/02/2021	2022.01	08/02/2021 04:39:20 PM Eastern Daylight Time	08/04/2021 09:04:14 AM Eastern Daylight Time	07/30/2021 11:09:12 AM Eastern Daylight Time			08/04/2021 05:54:42 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN EAST, INC.	Independence Blue Cross	www.ibxmedicare.com	Keystone 65 Basic Rx (HMO)	01	01		1			H3952	055	0	2022	Philadelphia, Bucks		2	243450	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	2			
H3952	056	0	1	01	01	H3952_056_0	3	1					0	08/03/2021	2022.01	08/03/2021 11:12:45 AM Eastern Daylight Time	08/04/2021 09:06:20 AM Eastern Daylight Time	07/30/2021 11:09:24 AM Eastern Daylight Time			08/04/2021 05:54:42 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN EAST, INC.	Independence Blue Cross	www.ibxmedicare.com	Keystone 65 Basic Rx (HMO)	01	01		1			H3952	056	0	2022	Chester, Delaware, Montgomery		2	187004	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	2			
H3952	802	0	1	01	01	H3952_802_0	1	1				0	0	05/25/2021	2022.01	05/25/2021 12:33:28 PM Eastern Daylight Time					06/04/2021 09:11:35 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN EAST, INC.	Independence Blue Cross	www.ibxmedicare.com	Keystone 65 Group Medical Only (HMO)	01	01		1			H3952	802	0	2022	Bucks,Chester,Delaware,Montgomery,Philadelphia Cty		1	12903	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;7c;7e;7i;8a;8b1;8b2;8b3;9a1;9b;10a;11a;11b;11c;14a;15;	2		1					1				
H3952	804	0	1	01	01	H3952_804_0	1	1						05/21/2021	2022.01	05/21/2021 03:04:23 PM Eastern Daylight Time					06/04/2021 09:11:35 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN EAST, INC.	Independence Blue Cross	www.ibxmedicare.com	Keystone 65 Group Rx (HMO)	01	01		1			H3952	804	0	2022	Bucks,Chester,Delaware,Montgomery,Philadelphia Cty		1	25700	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;7c;7e;7i;8a;8b1;8b2;8b3;9a1;9b;10a;11a;11b;11c;14a;15;	2		1					1				
H3954	097	0	1	01	01	H3954_097_0	7	1	2	1	1		0	08/05/2021	2022.01	08/05/2021 12:13:41 PM Eastern Daylight Time	08/04/2021 12:16:36 PM Eastern Daylight Time	07/29/2021 04:55:00 PM Eastern Daylight Time			08/05/2021 07:32:40 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Secure Rx (HMO D-SNP)	01	01		1			H3954	097	0	2022	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	21	1	01	01	H3954_156_21	5	1			2	0	0	07/20/2021	2022.01	07/20/2021 06:37:38 PM Eastern Daylight Time	07/09/2021 09:45:00 AM Eastern Daylight Time				07/21/2021 04:08:45 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Advantage (HMO)	01	01		1			H3954	156	21	2022	Pennsylvania	Central Pennsylvania	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	22	1	01	01	H3954_156_22	5	1			2	0	0	07/20/2021	2022.01	07/20/2021 06:36:23 PM Eastern Daylight Time	07/09/2021 09:45:00 AM Eastern Daylight Time				07/21/2021 04:08:45 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Advantage (HMO)	01	01		1			H3954	156	22	2022	Pennsylvania	Midstate Pennsylvania	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	23	1	01	01	H3954_156_23	5	1			2	0	0	07/20/2021	2022.01	07/20/2021 06:37:16 PM Eastern Daylight Time	07/09/2021 09:45:00 AM Eastern Daylight Time				07/21/2021 04:08:45 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Advantage (HMO)	01	01		1			H3954	156	23	2022	Pennsylvania	Midwest Pennsylvania	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	21	1	01	01	H3954_157_21	5	1			2		1	07/20/2021	2022.01	07/20/2021 06:42:43 PM Eastern Daylight Time	08/04/2021 12:27:36 PM Eastern Daylight Time	07/29/2021 04:56:54 PM Eastern Daylight Time			08/05/2021 07:32:40 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Advantage Rx (HMO)	01	01		1			H3954	157	21	2022	Pennsylvania	Central Pennsylvania	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	22	1	01	01	H3954_157_22	5	1			2		1	07/20/2021	2022.01	07/20/2021 06:42:26 PM Eastern Daylight Time	08/04/2021 12:30:24 PM Eastern Daylight Time	07/29/2021 04:58:18 PM Eastern Daylight Time			08/05/2021 07:32:40 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Advantage Rx (HMO)	01	01		1			H3954	157	22	2022	Pennsylvania	Midstate Pennsylvania	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	23	1	01	01	H3954_157_23	5	1			2		1	07/20/2021	2022.01	07/20/2021 06:45:52 PM Eastern Daylight Time	08/04/2021 12:33:12 PM Eastern Daylight Time	07/29/2021 04:59:50 PM Eastern Daylight Time			08/05/2021 07:32:40 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Advantage Rx (HMO)	01	01		1			H3954	157	23	2022	Pennsylvania	Midwest Pennsylvania	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	5	1			2		1	08/05/2021	2022.01	08/05/2021 02:33:55 PM Eastern Daylight Time	08/04/2021 12:36:16 PM Eastern Daylight Time	07/29/2021 05:01:44 PM Eastern Daylight Time			08/05/2021 07:32:40 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Complete Rx (HMO)	01	01		1			H3954	158	13	2022	Pennsylvania	Midstate Pennsylvania	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	5	1			2		1	08/05/2021	2022.01	08/05/2021 02:35:22 PM Eastern Daylight Time	08/04/2021 12:38:56 PM Eastern Daylight Time	07/29/2021 05:04:48 PM Eastern Daylight Time			08/05/2021 07:32:40 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Complete Rx (HMO)	01	01		1			H3954	158	14	2022	Pennsylvania	Central Pennsylvania	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	160	0	1	01	01	H3954_160_0	5	1					1	08/05/2021	2022.01	08/05/2021 02:37:01 PM Eastern Daylight Time	08/04/2021 12:41:54 PM Eastern Daylight Time	07/29/2021 05:06:12 PM Eastern Daylight Time			08/05/2021 07:32:40 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic 360 Rx (HMO)	01	01		1			H3954	160	0	2022	Pennsylvania		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	161	0	1	01	01	H3954_161_0	5	1					1	08/05/2021	2022.01	08/05/2021 10:03:13 AM Eastern Daylight Time	08/04/2021 12:45:02 PM Eastern Daylight Time	07/29/2021 05:08:18 PM Eastern Daylight Time			08/05/2021 07:32:40 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Essential Rx (HMO)	01	01		1			H3954	161	0	2022	Pennsylvania		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	3	1				0	0	05/24/2021	2022.01	05/24/2021 02:54:59 PM Eastern Daylight Time					06/04/2021 07:45:10 AM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic (Employer Group) (HMO)	01	01		1			H3954	801	0	2022	Pennsylvania		1	600	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	3	1						05/24/2021	2022.01	05/24/2021 02:53:45 PM Eastern Daylight Time					06/04/2021 07:45:10 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	2022	Pennsylvania		1	6547	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	3	1						05/24/2021	2022.01	05/24/2021 02:57:20 PM Eastern Daylight Time					06/04/2021 07:45:10 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	2022	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	031	0	1	02	01	H3957_031_0	7	1			1		0	08/04/2021	2022.01	08/04/2021 09:03:05 AM Eastern Daylight Time	08/03/2021 11:23:06 AM Eastern Daylight Time	07/30/2021 02:07:04 PM Eastern Daylight Time			08/05/2021 08:55:51 AM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Inc.	medicare.highmark.com	Security Blue HMO-POS ValueRx (HMO-POS)	01	02		1			H3957	031	0	2022	Southwestern PA		2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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	039	0	1	01	01	H3957_039_0	6	1			2		0	08/04/2021	2022.01	08/04/2021 08:48:55 AM Eastern Daylight Time	08/03/2021 11:24:06 AM Eastern Daylight Time	07/30/2021 02:08:13 PM Eastern Daylight Time			08/05/2021 08:55:51 AM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Inc.	medicare.highmark.com	Community Blue Medicare HMO Prestige (HMO)	01	01		1			H3957	039	0	2022	Western PA		2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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	6	1			2		1	07/16/2021	2022.01	07/16/2021 11:06:53 AM Eastern Daylight Time	08/03/2021 11:25:16 AM Eastern Daylight Time	07/30/2021 02:09:35 PM Eastern Daylight Time			08/05/2021 08:55:51 AM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Inc.	medicare.highmark.com	Community Blue Medicare HMO Signature (HMO)	01	01		1			H3957	042	1	2022	North Central PA	Lehigh Valley	2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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	6	1			2		1	07/16/2021	2022.01	07/16/2021 11:07:16 AM Eastern Daylight Time	08/03/2021 11:26:36 AM Eastern Daylight Time	07/30/2021 02:10:41 PM Eastern Daylight Time			08/05/2021 08:55:51 AM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Inc.	medicare.highmark.com	Community Blue Medicare HMO Signature (HMO)	01	01		1			H3957	042	2	2022	North Central PA	South Central PA	2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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		1	07/16/2021	2022.01	07/16/2021 11:07:26 AM Eastern Daylight Time	08/03/2021 11:27:36 AM Eastern Daylight Time	07/30/2021 02:12:06 PM Eastern Daylight Time			08/05/2021 08:55:51 AM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Inc.	medicare.highmark.com	Community Blue Medicare HMO Signature (HMO)	01	01		1			H3957	042	4	2022	North Central PA	North Central PA	2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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		1	07/16/2021	2022.01	07/16/2021 11:07:38 AM Eastern Daylight Time	08/03/2021 11:28:53 AM Eastern Daylight Time	07/30/2021 02:13:16 PM Eastern Daylight Time			08/05/2021 08:55:51 AM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Inc.	medicare.highmark.com	Community Blue Medicare HMO Signature (HMO)	01	01		1			H3957	042	5	2022	North Central PA	Lancaster PA	2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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	043	1	1	02	01	H3957_043_1	5	1			2	0	0	07/16/2021	2022.01	07/16/2021 10:18:20 AM Eastern Daylight Time	07/15/2021 03:38:31 PM Eastern Daylight Time				07/21/2021 10:23:53 AM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Inc.	medicare.highmark.com	Security Blue HMO-POS Basic (HMO-POS)	01	02		1			H3957	043	1	2022	Western PA	Southwest PA	2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(800)935-2583		(800)935-2583		(866)670-5844		(866)670-5844										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3957	043	2	1	02	01	H3957_043_2	5	1			2	0	0	07/16/2021	2022.01	07/16/2021 10:18:05 AM Eastern Daylight Time	07/20/2021 04:07:41 PM Eastern Daylight Time				07/22/2021 01:25:07 PM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Inc.	medicare.highmark.com	Security Blue HMO-POS Basic (HMO-POS)	01	02		1			H3957	043	2	2022	Western PA	West Central PA	2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(800)935-2583		(800)935-2583		(866)670-5844		(866)670-5844										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3957	044	1	1	02	01	H3957_044_1	6	1			2		0	07/20/2021	2022.01	07/20/2021 01:42:56 PM Eastern Daylight Time	08/03/2021 11:33:22 AM Eastern Daylight Time	07/30/2021 02:14:38 PM Eastern Daylight Time			08/05/2021 08:55:51 AM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Inc.	medicare.highmark.com	Security Blue HMO-POS ValueRx (HMO-POS)	01	02		1			H3957	044	1	2022	Western PA	West Central PA	2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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	044	4	1	02	01	H3957_044_4	6	1			2		0	08/04/2021	2022.01	08/04/2021 09:04:23 AM Eastern Daylight Time	08/03/2021 11:34:23 AM Eastern Daylight Time	07/30/2021 02:16:32 PM Eastern Daylight Time			08/05/2021 08:55:51 AM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Inc.	medicare.highmark.com	Security Blue HMO-POS ValueRx (HMO-POS)	01	02		1			H3957	044	4	2022	Western PA	Potter County	2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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	045	1	1	02	01	H3957_045_1	6	1			2		0	07/16/2021	2022.01	07/16/2021 09:52:36 AM Eastern Daylight Time	08/03/2021 11:35:23 AM Eastern Daylight Time	07/30/2021 02:17:55 PM Eastern Daylight Time			08/05/2021 08:55:51 AM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Inc.	medicare.highmark.com	Security Blue HMO-POS Standard (HMO-POS)	01	02		1			H3957	045	1	2022	Western PA	Southwest PA	2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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	045	2	1	02	01	H3957_045_2	6	1			2		0	07/16/2021	2022.01	07/16/2021 10:14:26 AM Eastern Daylight Time	08/03/2021 11:36:22 AM Eastern Daylight Time	07/30/2021 02:18:57 PM Eastern Daylight Time			08/05/2021 08:55:51 AM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Inc.	medicare.highmark.com	Security Blue HMO-POS Standard (HMO-POS)	01	02		1			H3957	045	2	2022	Western PA	West Central PA	2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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	046	1	1	02	01	H3957_046_1	6	1			2		0	07/16/2021	2022.01	07/16/2021 10:12:07 AM Eastern Daylight Time	08/03/2021 11:37:21 AM Eastern Daylight Time	07/30/2021 02:20:13 PM Eastern Daylight Time			08/05/2021 08:55:51 AM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Inc.	medicare.highmark.com	Security Blue HMO-POS Deluxe (HMO-POS)	01	02		1			H3957	046	1	2022	Western PA	Southwest PA	2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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	046	2	1	02	01	H3957_046_2	6	1			2		0	08/02/2021	2022.01	08/02/2021 10:35:56 AM Eastern Daylight Time	08/03/2021 11:38:24 AM Eastern Daylight Time	07/30/2021 02:55:28 PM Eastern Daylight Time			08/05/2021 08:55:51 AM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Inc.	medicare.highmark.com	Security Blue HMO-POS Deluxe (HMO-POS)	01	02		1			H3957	046	2	2022	Western PA	West Central PA	2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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	047	1	1	01	01	H3957_047_1	6	1			2		0	07/16/2021	2022.01	07/16/2021 10:20:35 AM Eastern Daylight Time	08/03/2021 11:39:35 AM Eastern Daylight Time	07/30/2021 03:29:50 PM Eastern Daylight Time			08/05/2021 08:55:51 AM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Inc.	medicare.highmark.com	Community Blue Medicare HMO Signature (HMO)	01	01		1			H3957	047	1	2022	Western PA	Southwest PA	2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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	047	2	1	01	01	H3957_047_2	6	1			2		0	07/16/2021	2022.01	07/16/2021 10:20:41 AM Eastern Daylight Time	08/03/2021 11:40:33 AM Eastern Daylight Time	07/30/2021 03:30:46 PM Eastern Daylight Time			08/05/2021 08:55:51 AM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Inc.	medicare.highmark.com	Community Blue Medicare HMO Signature (HMO)	01	01		1			H3957	047	2	2022	Western PA	West Central PA	2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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	2	1				0	0	05/03/2021	2022.01	05/03/2021 03:22:27 PM Eastern Daylight Time					06/04/2021 01:37:54 PM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Inc.	medicare.highmark.com	Security Blue HMO MA Calendar (HMO)	01	01		1			H3957	805	0	2022	Western PA		1	0	2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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;3-4;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;15;16b;	2		1					1				
H3957	806	0	1	01	01	H3957_806_0	2	1						05/03/2021	2022.01	05/03/2021 03:27:15 PM Eastern Daylight Time					06/04/2021 01:37:54 PM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Inc.	medicare.highmark.com	Security Blue HMO MA-PD Calendar (HMO)	01	01		1			H3957	806	0	2022	Western PA		1	0	2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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;3-4;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;15;16b;	2		1					1				
H3957	808	0	1	01	01	H3957_808_0	2	1						05/03/2021	2022.01	05/03/2021 03:23:31 PM Eastern Daylight Time					06/04/2021 01:37:54 PM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Inc.	medicare.highmark.com	Security Blue HMO MA-PD Non-Calendar (HMO)	01	01		1			H3957	808	0	2022	Western PA		1	8814	2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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;3-4;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;15;16b;	2		1					1				
H3957	810	0	1	01	01	H3957_810_0	2	1				0	0	05/03/2021	2022.01	05/03/2021 03:27:02 PM Eastern Daylight Time					06/04/2021 01:37:54 PM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Inc.	medicare.highmark.com	Community Blue Medicare HMO MA Calendar (HMO)	01	01		1			H3957	810	0	2022	Pennsylvania (Western and North Central)		1	0	2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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;3-4;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;15;16b;	2		1					1				
H3957	811	0	1	01	01	H3957_811_0	2	1						05/03/2021	2022.01	05/03/2021 03:30:27 PM Eastern Daylight Time					06/04/2021 01:37:54 PM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Inc.	medicare.highmark.com	Community Blue Medicare HMO MA-PD Calendar (HMO)	01	01		1			H3957	811	0	2022	Pennsylvania (Western and North Central)		1	7764	2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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;3-4;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;15;16b;	2		1					1				
H3957	812	0	1	01	01	H3957_812_0	2	1						05/03/2021	2022.01	05/03/2021 03:34:12 PM Eastern Daylight Time					06/04/2021 01:37:54 PM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Inc.	medicare.highmark.com	Community Blue Medicare HMO MA-PD Non-Calendar (HMO)	01	01		1			H3957	812	0	2022	Pennsylvania (Western and North Central)		1	0	2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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;3-4;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;15;16b;	2		1					1				
H3957	813	0	1	02	01	H3957_813_0	2	1				0	0	05/07/2021	2022.01	05/07/2021 09:38:29 AM Eastern Daylight Time					06/04/2021 01:37:54 PM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Inc.	medicare.highmark.com	Security Blue HMO-POS MA Calendar (HMO-POS)	01	02		1			H3957	813	0	2022	Western PA		1	10206	2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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;3-4;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;15;16b;	2		1	1	1a;1b;3-1;3-2;3-3;3-4;5;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;15;	2		1				
H3957	814	0	1	02	01	H3957_814_0	2	1						05/03/2021	2022.01	05/03/2021 03:45:59 PM Eastern Daylight Time					06/04/2021 01:37:54 PM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Inc.	medicare.highmark.com	Security Blue HMO-POS MA-PD Calendar (HMO-POS)	01	02		1			H3957	814	0	2022	Western PA		1	78558	2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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;3-4;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;15;16b;	2		1	1	1a;1b;3-1;3-2;3-3;3-4;5;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;15;	2		1				
H3957	815	0	1	02	01	H3957_815_0	2	1						05/14/2021	2022.01	05/14/2021 02:40:37 PM Eastern Daylight Time					06/04/2021 01:37:54 PM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Inc.	medicare.highmark.com	Security Blue HMO-POS MA-PD Non-Calendar (HMO-POS)	01	02		1			H3957	815	0	2022	Western PA		1	0	2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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;3-4;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;15;16b;	2		1	1	1a;1b;3-1;3-2;3-3;3-4;5;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;15;	2		1				
H3959	001	0	1	01	01	H3959_001_0	3	1			1		1	07/14/2021	2022.01	07/14/2021 12:37:01 PM Eastern Daylight Time	08/02/2021 05:31:34 PM Eastern Daylight Time	08/02/2021 09:39:31 AM Eastern Daylight Time			08/04/2021 12:52:13 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Gold (HMO)	01	01		1			H3959	001	0	2022	Allegheny County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3959	002	0	1	01	01	H3959_002_0	3	1			1		1	07/14/2021	2022.01	07/14/2021 12:37:45 PM Eastern Daylight Time	08/02/2021 05:32:30 PM Eastern Daylight Time	08/02/2021 09:39:36 AM Eastern Daylight Time			08/04/2021 12:52:13 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Gold (HMO)	01	01		1			H3959	002	0	2022	Western Pennsylvania		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3959	010	0	1	01	01	H3959_010_0	3	1			2		0	08/02/2021	2022.01	08/02/2021 12:47:35 PM Eastern Daylight Time	08/02/2021 05:33:28 PM Eastern Daylight Time	08/02/2021 09:39:40 AM Eastern Daylight Time			08/04/2021 12:52:13 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Silver (HMO)	01	01		1			H3959	010	0	2022	Allegheny County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3959	011	0	1	01	01	H3959_011_0	3	1			2		0	08/02/2021	2022.01	08/02/2021 12:48:00 PM Eastern Daylight Time	08/02/2021 05:34:26 PM Eastern Daylight Time	08/02/2021 09:39:44 AM Eastern Daylight Time			08/04/2021 12:52:13 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Silver (HMO)	01	01		1			H3959	011	0	2022	Western Pennsylvania		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3959	032	0	1	02	01	H3959_032_0	2	1			2		0	08/02/2021	2022.01	08/02/2021 04:13:00 PM Eastern Daylight Time	08/02/2021 05:35:24 PM Eastern Daylight Time	08/02/2021 09:39:48 AM Eastern Daylight Time			08/04/2021 12:52:13 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Premier (HMO-POS)	01	02		1			H3959	032	0	2022	Northwestern Pennsylvania		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3959	033	0	1	01	01	H3959_033_0	2	1			2		0	06/01/2021	2022.01	06/01/2021 04:43:11 PM Eastern Daylight Time	08/02/2021 05:36:18 PM Eastern Daylight Time	08/02/2021 09:39:52 AM Eastern Daylight Time			08/04/2021 12:52:13 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Premier (HMO)	01	01		1			H3959	033	0	2022	Southeastern Pennsylvania		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(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	1		0	07/08/2021	2022.01	07/08/2021 10:52:22 AM Eastern Daylight Time	08/02/2021 05:37:12 PM Eastern Daylight Time	08/02/2021 09:39:56 AM Eastern Daylight Time			08/04/2021 12:52:13 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Cares (HMO D-SNP)	01	01		1			H3959	035	0	2022	Southeastern Pennsylvania		2		2			1	3		1		1	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3959	036	0	1	01	01	H3959_036_0	3	1	2	1	1		0	07/08/2021	2022.01	07/08/2021 10:52:49 AM Eastern Daylight Time	08/02/2021 05:38:09 PM Eastern Daylight Time	08/02/2021 09:40:00 AM Eastern Daylight Time			08/04/2021 12:52:13 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Cares (HMO D-SNP)	01	01		1			H3959	036	0	2022	Central and Western Pennsylvania		2		2			1	3		1		1	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3959	037	0	1	02	01	H3959_037_0	3	1			2		0	08/02/2021	2022.01	08/02/2021 12:49:29 PM Eastern Daylight Time	08/02/2021 05:39:03 PM Eastern Daylight Time	08/02/2021 09:40:05 AM Eastern Daylight Time			08/04/2021 12:52:13 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Gold (HMO-POS)	01	02		1			H3959	037	0	2022	Northeastern Pennsylvania		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3959	039	0	1	02	01	H3959_039_0	2	1			1		0	06/02/2021	2022.01	06/02/2021 04:11:11 PM Eastern Daylight Time	08/02/2021 05:40:00 PM Eastern Daylight Time	08/02/2021 09:40:09 AM Eastern Daylight Time			08/04/2021 12:52:13 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Premier (HMO-POS)	01	02		1			H3959	039	0	2022	Central Pennsylvania		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3959	041	0	1	01	01	H3959_041_0	2	1			2	0	0	07/14/2021	2022.01	07/14/2021 12:41:44 PM Eastern Daylight Time	06/01/2021 05:30:04 PM Eastern Daylight Time				07/14/2021 01:03:56 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Eagle (HMO)	01	01		1			H3959	041	0	2022	Central and Western Pennsylvania		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3959	045	0	1	01	01	H3959_045_0	2	1			2		1	08/02/2021	2022.01	08/02/2021 12:50:27 PM Eastern Daylight Time	08/02/2021 05:41:51 PM Eastern Daylight Time	08/02/2021 09:40:13 AM Eastern Daylight Time			08/04/2021 12:52:13 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare PennHighlands Prime (HMO)	01	01		1			H3959	045	0	2022	Clearfield, Elk and Jefferson Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3959	046	0	1	01	01	H3959_046_0	3	1			1		0	08/02/2021	2022.01	08/02/2021 12:50:58 PM Eastern Daylight Time	08/02/2021 05:42:37 PM Eastern Daylight Time	08/02/2021 09:40:17 AM Eastern Daylight Time			08/04/2021 12:52:13 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Washington Prime (HMO)	01	01		1			H3959	046	0	2022	Greene and Washington Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3959	047	0	1	01	01	H3959_047_0	3	1			1		1	08/02/2021	2022.01	08/02/2021 12:51:38 PM Eastern Daylight Time	08/02/2021 05:43:23 PM Eastern Daylight Time	08/02/2021 09:40:22 AM Eastern Daylight Time			08/04/2021 12:52:13 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Butler Prime (HMO)	01	01		1			H3959	047	0	2022	Butler County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3959	049	0	1	01	01	H3959_049_0	3	1			1		0	08/02/2021	2022.01	08/02/2021 12:52:05 PM Eastern Daylight Time	08/02/2021 05:44:08 PM Eastern Daylight Time	08/02/2021 09:40:26 AM Eastern Daylight Time			08/04/2021 12:52:13 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Excela Prime (HMO)	01	01		1			H3959	049	0	2022	Westmoreland County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3959	051	0	1	01	01	H3959_051_0	3	1			2		1	08/02/2021	2022.01	08/02/2021 12:52:34 PM Eastern Daylight Time	08/02/2021 05:44:52 PM Eastern Daylight Time	08/02/2021 09:40:30 AM Eastern Daylight Time			08/04/2021 12:52:13 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Beaver Valley Prime (HMO)	01	01		1			H3959	051	0	2022	Beaver County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3959	052	0	1	01	01	H3959_052_0	2	1			2		0	08/02/2021	2022.01	08/02/2021 12:53:14 PM Eastern Daylight Time	08/02/2021 05:45:39 PM Eastern Daylight Time	08/02/2021 09:40:34 AM Eastern Daylight Time			08/04/2021 12:52:13 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Value (HMO)	01	01		1			H3959	052	0	2022	Southeastern Pennsylvania		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3959	053	0	1	01	01	H3959_053_0	3	1			2		1	08/02/2021	2022.01	08/02/2021 12:54:03 PM Eastern Daylight Time	08/02/2021 05:46:22 PM Eastern Daylight Time	08/02/2021 09:40:39 AM Eastern Daylight Time			08/04/2021 12:52:13 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Philly Prime (HMO)	01	01		1			H3959	053	0	2022	Philadelphia Metro Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3959	055	0	1	02	01	H3959_055_0	3	1			2		0	08/05/2021	2022.01	08/05/2021 06:21:09 PM Eastern Daylight Time	08/02/2021 05:47:09 PM Eastern Daylight Time	08/02/2021 09:40:43 AM Eastern Daylight Time			08/05/2021 06:23:10 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Value (HMO-POS)	01	02		1			H3959	055	0	2022	Kent, Sussex, New Castle counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3959	056	0	1	02	01	H3959_056_0	1	1			2	0	0	06/01/2021	2022.01	06/01/2021 04:44:31 PM Eastern Daylight Time	06/01/2021 05:37:26 PM Eastern Daylight Time				06/03/2021 11:34:22 AM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Eagle (HMO-POS)	01	02		1			H3959	056	0	2022	New Castle, Sussex, Kent counties		2		2			2						www.aetnamedicare.com/findpharmacy	http://www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3959	057	0	1	01	01	H3959_057_0	1	1			2	0	0	06/01/2021	2022.01	06/01/2021 04:44:48 PM Eastern Daylight Time	06/01/2021 05:38:21 PM Eastern Daylight Time				06/03/2021 11:34:22 AM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Eagle (HMO)	01	01		1			H3959	057	0	2022	Philadelphia Metro Area		2		2			2						www.aetnamedicare.com/findpharmacy	http://www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3959	058	0	1	01	01	H3959_058_0	2	1			2		0	08/02/2021	2022.01	08/02/2021 12:56:33 PM Eastern Daylight Time	08/02/2021 05:49:29 PM Eastern Daylight Time	08/02/2021 09:40:47 AM Eastern Daylight Time			08/04/2021 12:52:13 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Central Value (HMO)	01	01		1			H3959	058	0	2022	Altoona Johnstown Huntingdon State College area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3959	063	0	1	01	01	H3959_063_0	5	1	2	1	1		0	07/08/2021	2022.01	07/08/2021 10:53:26 AM Eastern Daylight Time	08/02/2021 05:50:15 PM Eastern Daylight Time	08/02/2021 09:40:51 AM Eastern Daylight Time			08/04/2021 12:52:13 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Cares (HMO D-SNP)	01	01		1			H3959	063	0	2022	Delaware		2		2			1	3		1		1	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3959	803	0	1	01	01	H3959_803_0	1	1				0	0	05/27/2021	2022.01	05/27/2021 11:27:58 PM Eastern Daylight Time					06/03/2021 01:24:36 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (HMO)	01	01		1			H3959	803	0	2022	Pennsylvania		1	120	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H3959	804	0	1	01	01	H3959_804_0	1	1						05/27/2021	2022.01	05/27/2021 11:28:37 PM Eastern Daylight Time					06/03/2021 01:24:36 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan w/Rx (HMO)	01	01		1			H3959	804	0	2022	Pennsylvania		1	113010	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H3962	001	0	1	01	01	H3962_001_0	4	1					1	07/16/2021	2022.01	07/16/2021 08:52:22 AM Eastern Daylight Time	08/03/2021 04:10:30 PM Eastern Daylight Time	08/03/2021 04:05:14 PM Eastern Daylight Time			08/04/2021 04:18:20 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	2022	21 Counties in Central PA		2		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					1	07/16/2021	2022.01	07/16/2021 08:53:00 AM Eastern Daylight Time	08/03/2021 04:13:48 PM Eastern Daylight Time	08/03/2021 04:02:36 PM Eastern Daylight Time			08/04/2021 04:21:18 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	2022	21 Counties in Central PA		2		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	4	1					1	08/03/2021	2022.01	08/03/2021 11:05:34 AM Eastern Daylight Time	08/03/2021 04:17:42 PM Eastern Daylight Time	08/03/2021 04:01:12 PM Eastern Daylight Time			08/04/2021 04:23:42 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	2022	21 Counties in Central PA		2		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	021	0	1	01	01	H3962_021_0	4	1					1	08/03/2021	2022.01	08/03/2021 02:31:46 PM Eastern Daylight Time	08/03/2021 04:19:44 PM Eastern Daylight Time	08/03/2021 03:58:58 PM Eastern Daylight Time			08/04/2021 04:26:22 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN CENTRAL, INC.	Keystone Health Plan Central, Inc.	www.capitalbluemedicare.com	Capital Blue Cross | WellSpan Health Inspire (HMO)	01	01		1			H3962	021	0	2022	6 County Central PA		2		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	801	0	1	01	01	H3962_801_0	1	1						06/03/2021	2022.01	06/03/2021 05:30:25 PM Eastern Daylight Time					06/04/2021 12:00:11 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN CENTRAL, INC.	Keystone Health Plan Central, Inc.	www.capitalbluemedicare.com	BlueJourney Group HMO Silver Rx (HMO)	01	01		1			H3962	801	0	2022	National		1	10680	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;3-4;5;6;7c;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;	2		1					1				
H3962	802	0	1	01	01	H3962_802_0	1	1				0	0	06/03/2021	2022.01	06/03/2021 02:11:53 PM Eastern Daylight Time					06/04/2021 12:00:11 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN CENTRAL, INC.	Keystone Health Plan Central, Inc.	www.capitalbluemedicare.com	BlueJourney Group HMO Without Rx (HMO)	01	01		1			H3962	802	0	2022	National		1	1464	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;3-4;5;6;7c;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;	2		1					1				
H3962	803	0	1	01	01	H3962_803_0	1	1						06/03/2021	2022.01	06/03/2021 01:42:05 PM Eastern Daylight Time					06/04/2021 12:00:11 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN CENTRAL, INC.	Keystone Health Plan Central, Inc.	www.capitalbluemedicare.com	BlueJourney Group HMO Bronze Rx FY (HMO)	01	01		1			H3962	803	0	2022	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;3-4;5;6;7c;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;	2		1					1				
H3962	813	0	1	01	01	H3962_813_0	1	1						06/03/2021	2022.01	06/03/2021 01:42:54 PM Eastern Daylight Time					06/04/2021 12:00:11 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN CENTRAL, INC.	Keystone Health Plan Central, Inc.	www.capitalbluemedicare.com	BlueJourney Group HMO Gold Rx (HMO)	01	01		1			H3962	813	0	2022	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;3-4;5;6;7c;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;	2		1					1				
H3962	814	0	1	01	01	H3962_814_0	1	1						06/03/2021	2022.01	06/03/2021 01:44:02 PM Eastern Daylight Time					06/04/2021 12:00:11 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN CENTRAL, INC.	Keystone Health Plan Central, Inc.	www.capitalbluemedicare.com	BlueJourney Group HMO Platinum Rx (HMO)	01	01		1			H3962	814	0	2022	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;3-4;5;6;7c;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;	2		1					1				
H3962	815	0	1	01	01	H3962_815_0	1	1						06/03/2021	2022.01	06/03/2021 01:45:22 PM Eastern Daylight Time					06/04/2021 12:00:11 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN CENTRAL, INC.	Keystone Health Plan Central, Inc.	www.capitalbluemedicare.com	BlueJourney Group HMO Bronze Rx (HMO)	01	01		1			H3962	815	0	2022	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;3-4;5;6;7c;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;	2		1					1				
H3962	816	0	1	01	01	H3962_816_0	1	1						06/03/2021	2022.01	06/03/2021 01:49:36 PM Eastern Daylight Time					06/04/2021 12:03:17 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN CENTRAL, INC.	Keystone Health Plan Central, Inc.	www.capitalbluemedicare.com	BlueJourney Group HMO Platinum Rx FY (HMO)	01	01		1			H3962	816	0	2022	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;3-4;5;6;7c;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;	2		1					1				
H3962	817	0	1	01	01	H3962_817_0	1	1						06/03/2021	2022.01	06/03/2021 02:00:18 PM Eastern Daylight Time					06/04/2021 12:03:17 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN CENTRAL, INC.	Keystone Health Plan Central, Inc.	www.capitalbluemedicare.com	BlueJourney Group HMO Silver Rx FY (HMO)	01	01		1			H3962	817	0	2022	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;3-4;5;6;7c;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;	2		1					1				
H3962	818	0	1	01	01	H3962_818_0	1	1						06/03/2021	2022.01	06/03/2021 01:58:40 PM Eastern Daylight Time					06/04/2021 12:03:17 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN CENTRAL, INC.	Keystone Health Plan Central, Inc.	www.capitalbluemedicare.com	BlueJourney Group HMO Gold Rx FY (HMO)	01	01		1			H3962	818	0	2022	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;3-4;5;6;7c;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;	2		1					1				
H3962	819	0	1	01	01	H3962_819_0	1	1				0	0	06/03/2021	2022.01	06/03/2021 02:11:01 PM Eastern Daylight Time					06/04/2021 12:03:17 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN CENTRAL, INC.	Keystone Health Plan Central, Inc.	www.capitalbluemedicare.com	Capital Blue Cross | WellSpan Health Without Rx (HMO)	01	01		1			H3962	819	0	2022	National		1	420	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;3-4;5;6;7c;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;	2		1					1				
H3962	820	0	1	01	01	H3962_820_0	1	1						06/03/2021	2022.01	06/03/2021 02:01:56 PM Eastern Daylight Time					06/04/2021 12:03:17 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN CENTRAL, INC.	Keystone Health Plan Central, Inc.	www.capitalbluemedicare.com	Capital Blue Cross | WellSpan Health Bronze (HMO)	01	01		1			H3962	820	0	2022	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;3-4;5;6;7c;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;	2		1					1				
H3962	821	0	1	01	01	H3962_821_0	1	1						06/03/2021	2022.01	06/03/2021 02:10:21 PM Eastern Daylight Time					06/04/2021 12:03:17 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN CENTRAL, INC.	Keystone Health Plan Central, Inc.	www.capitalbluemedicare.com	Capital Blue Cross | WellSpan Health Silver (HMO)	01	01		1			H3962	821	0	2022	National		1	1104	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;3-4;5;6;7c;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;	2		1					1				
H3962	822	0	1	01	01	H3962_822_0	1	1						06/03/2021	2022.01	06/03/2021 02:03:48 PM Eastern Daylight Time					06/04/2021 12:05:54 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN CENTRAL, INC.	Keystone Health Plan Central, Inc.	www.capitalbluemedicare.com	Capital Blue Cross | WellSpan Health Gold (HMO)	01	01		1			H3962	822	0	2022	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;3-4;5;6;7c;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;	2		1					1				
H3962	823	0	1	01	01	H3962_823_0	1	1						06/03/2021	2022.01	06/03/2021 02:05:11 PM Eastern Daylight Time					06/04/2021 12:05:54 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN CENTRAL, INC.	Keystone Health Plan Central, Inc.	www.capitalbluemedicare.com	Capital Blue Cross | WellSpan Health Platinum (HMO)	01	01		1			H3962	823	0	2022	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;3-4;5;6;7c;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;	2		1					1				
H3962	824	0	1	01	01	H3962_824_0	1	1						06/03/2021	2022.01	06/03/2021 02:07:17 PM Eastern Daylight Time					06/04/2021 12:05:54 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN CENTRAL, INC.	Keystone Health Plan Central, Inc.	www.capitalbluemedicare.com	Capital Blue Cross | WellSpan Health Bronze FY (HMO)	01	01		1			H3962	824	0	2022	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;3-4;5;6;7c;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;	2		1					1				
H3962	825	0	1	01	01	H3962_825_0	1	1						06/03/2021	2022.01	06/03/2021 02:08:01 PM Eastern Daylight Time					06/04/2021 12:05:54 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN CENTRAL, INC.	Keystone Health Plan Central, Inc.	www.capitalbluemedicare.com	Capital Blue Cross | WellSpan Health Silver FY (HMO)	01	01		1			H3962	825	0	2022	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;3-4;5;6;7c;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;	2		1					1				
H3962	826	0	1	01	01	H3962_826_0	1	1						06/03/2021	2022.01	06/03/2021 02:08:44 PM Eastern Daylight Time					06/04/2021 12:05:54 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN CENTRAL, INC.	Keystone Health Plan Central, Inc.	www.capitalbluemedicare.com	Capital Blue Cross | WellSpan Health Gold FY (HMO)	01	01		1			H3962	826	0	2022	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;3-4;5;6;7c;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;	2		1					1				
H3962	827	0	1	01	01	H3962_827_0	1	1						06/03/2021	2022.01	06/03/2021 02:09:25 PM Eastern Daylight Time					06/04/2021 12:05:54 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN CENTRAL, INC.	Keystone Health Plan Central, Inc.	www.capitalbluemedicare.com	Capital Blue Cross | WellSpan Health Platinum FY (HMO)	01	01		1			H3962	827	0	2022	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;3-4;5;6;7c;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;	2		1					1				
H3975	001	0	1	04	01	H3975_001_0	5	1					0	08/03/2021	2022.01	08/03/2021 10:39:57 AM Eastern Daylight Time	08/04/2021 12:09:41 AM Eastern Daylight Time	07/30/2021 11:19:16 AM Eastern Daylight Time			08/04/2021 10:34:28 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Wellcare	www.wellcare.com/medicare	Wellcare No Premium Open (PPO)	01	04		1			H3975	001	0	2022	All counties in KY		2	73669	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3975	002	0	1	04	01	H3975_002_0	4	1				0	0	07/19/2021	2022.01	07/19/2021 09:17:43 AM Eastern Daylight Time	06/04/2021 12:12:04 PM Eastern Daylight Time				07/19/2021 06:29:48 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Wellcare	www.wellcare.com/medicare	Wellcare Patriot Giveback Open (PPO)	01	04		1			H3975	002	0	2022	All counties in KY		2	2188	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175										(711)-		(711)-		(711)-		(711)-										2					2						2			
H3979	001	0	1	01	01	H3979_001_0	6	1					0	07/27/2021	2022.01	07/27/2021 03:40:37 PM Mountain Daylight Time	08/03/2021 09:37:38 AM Mountain Daylight Time	08/04/2021 04:04:08 PM Mountain Daylight Time			08/05/2021 04:53:55 PM Mountain Daylight Time	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Blue Cross and Blue Shield of Oklahoma	www.getblueok.com/mapd	Blue Cross Medicare Advantage Basic (HMO)	01	01		1			H3979	001	0	2022	Oklahoma City Metro Area		2	21468	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	2	1						05/25/2021	2022.01	05/25/2021 01:54:54 PM Central Daylight Time					06/03/2021 05:04:16 PM Central Daylight Time	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Blue Cross and Blue Shield of Oklahoma	www.getblueok.com/mapd	Blue Cross Group Medicare Advantage Plan (HMO)	01	01		1			H3979	801	0	2022	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)-		2					2					2	2			
H3979	803	0	1	01	01	H3979_803_0	2	1						05/25/2021	2022.01	05/25/2021 01:55:05 PM Central Daylight Time					06/03/2021 05:04:16 PM Central Daylight Time	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Blue Cross and Blue Shield of Oklahoma	www.getblueok.com/mapd	Blue Cross Group Medicare Advantage Plan (HMO)	01	01		1			H3979	803	0	2022	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)-		2					2					2	2			
H3979	805	0	1	01	01	H3979_805_0	2	1				0	0	05/25/2021	2022.01	05/25/2021 01:55:14 PM Central Daylight Time					06/03/2021 05:04:16 PM Central Daylight Time	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Blue Cross and Blue Shield of Oklahoma	www.getblueok.com/mapd	Blue Cross Group Medicare Advantage Plan (HMO)	01	01		1			H3979	805	0	2022	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)-										2					2					2	2			
H3991	001	0	1	20	08	H3991_001_0	1	1						09/16/2021	2022.01	09/16/2021 08:55:34 AM Cuba Daylight Time		09/16/2021 09:03:06 AM Cuba Daylight Time			09/16/2021 09:04:36 AM Cuba Daylight Time	CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC	Cherry Blossom PACE	WWW.cherryblossompace.com	Cherry Blossom PACE - Dual Eligible (PACE)	08	20		1			H3991	001	0	2022	Northern Virginia		2	781	2			2						www.carekinesses.com	www.cherryblossompace.com												(571)789-0770				(571)789-0770												(888)524-2060				(888)524-2060																
H3991	002	0	1	20	08	H3991_002_0	1	1						09/16/2021	2022.01	09/16/2021 08:56:20 AM Cuba Daylight Time		09/16/2021 09:03:09 AM Cuba Daylight Time			09/16/2021 09:04:36 AM Cuba Daylight Time	CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC	Cherry Blossom PACE	WWW.cherryblossompace.com	Cherry Blossom PACE - Medicare Only (PACE)	08	20		1			H3991	002	0	2022	Northern Virginia		2	50	2			2						www.carekinesses.com	www.cherryblossompace.com												(571)789-0770				(571)789-0770												(888)524-2060				(888)524-2060																
H4003	009	0	1	01	01	H4003_009_0	9	1		1	1		1	07/19/2021	2022.01	07/19/2021 08:00:44 PM SA Western Standard Time	08/03/2021 03:36:58 PM SA Western Standard Time	08/02/2021 03:11:10 PM SA Western Standard Time			08/04/2021 05:54:34 PM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Ms	www.mmmpr.com	MMM Supremo (HMO C-SNP)	01	01		1			H4003	009	0	2022	Puerto Rico		2	117703	2			1	4			00000000000000000010		www.mmmpr.com	www.mmmpr.com	www.mmmpr.com	(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		2					2					2	1	11	7b;7c;7e1;7e2;7g;7h1;7h2;7i;7k;8a2;8b1;9a2;9c;	7b1;
H4003	017	0	1	01	01	H4003_017_0	9	1	1	1	1		0	07/19/2021	2022.01	07/19/2021 08:04:27 PM SA Western Standard Time	08/03/2021 10:40:04 AM SA Western Standard Time	08/02/2021 03:11:08 PM SA Western Standard Time			08/04/2021 05:54:34 PM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Ms	www.mmmpr.com	MMM Diamante Platino (HMO D-SNP)	01	01		1			H4003	017	0	2022	Puerto Rico		2	872464	2		1	1	3		2		2	www.mmmpr.com	www.mmmpr.com	www.mmmpr.com	(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		2					2					2	2			
H4003	019	0	1	02	01	H4003_019_0	9	1			1		1	07/19/2021	2022.01	07/19/2021 05:08:05 PM SA Western Standard Time	08/03/2021 10:54:20 AM SA Western Standard Time	08/02/2021 03:11:08 PM SA Western Standard Time			08/04/2021 05:54:34 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	2022	Puerto Rico		2	17464	2			2						www.mmmpr.com	www.mmmpr.com	www.mmmpr.com	(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		2					2					2	1	01	7k;8a2;8b1;9a2;	
H4003	034	0	1	02	01	H4003_034_0	9	1			1		1	07/19/2021	2022.01	07/19/2021 08:03:27 PM SA Western Standard Time	08/03/2021 11:05:40 AM SA Western Standard Time	08/02/2021 03:11:06 PM SA Western Standard Time			08/04/2021 05:54:34 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	2022	Puerto Rico		2	849553	2			2						www.mmmpr.com	www.mmmpr.com	www.mmmpr.com	(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		2					2					2	1	11	3-1;3-2;3-3;3-4;7c;7g;7i;7k;8a2;8b1;9a2;	13a;
H4003	044	0	1	02	01	H4003_044_0	10	1			1		1	07/20/2021	2022.01	07/20/2021 06:15:21 PM SA Western Standard Time	08/05/2021 03:00:42 PM SA Western Standard Time	08/02/2021 03:11:04 PM SA Western Standard Time			08/05/2021 03:56:31 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	2022	Puerto Rico		2	993	2			2						www.mmmpr.com	www.mmmpr.com	www.mmmpr.com	(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		2					2					2	1	11	3-1;3-2;3-3;3-4;7b;7c;7d;7e1;7e2;7f;7g;7h1;7h2;7i;7k;8a2;8b1;9a2;9c;16b;18a;	7b1;7f;16b3;16b4;16b5;16b6;16b7;18a2;
H4003	047	0	1	01	01	H4003_047_0	11	1	1	1	1		0	07/19/2021	2022.01	07/19/2021 06:23:38 PM SA Western Standard Time	08/03/2021 03:29:22 PM SA Western Standard Time	08/02/2021 03:11:02 PM SA Western Standard Time			08/04/2021 05:54:34 PM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Ms	www.mmmpr.com	MMM Valor Platino (HMO D-SNP)	01	01		1			H4003	047	0	2022	Puerto Rico		2	344190	2		1	1	3		2		2	www.mmmpr.com	www.mmmpr.com	www.mmmpr.com	(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		2					2					2	2			
H4003	049	0	1	01	01	H4003_049_0	10	1	1	1	1		0	07/19/2021	2022.01	07/19/2021 07:14:17 PM SA Western Standard Time	08/03/2021 11:22:48 AM SA Western Standard Time	08/02/2021 03:11:00 PM SA Western Standard Time			08/04/2021 05:54:34 PM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Ms	www.mmmpr.com	MMM Grande Platino (HMO D-SNP)	01	01		1			H4003	049	0	2022	Puerto Rico		2	46939	2		1	1	3		2		2	www.mmmpr.com	www.mmmpr.com	www.mmmpr.com	(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		2					2					2	2			
H4003	051	0	1	02	01	H4003_051_0	12	1			1		1	07/19/2021	2022.01	07/19/2021 08:05:46 PM SA Western Standard Time	08/05/2021 03:00:43 PM SA Western Standard Time	08/03/2021 06:38:34 PM SA Western Standard Time			08/05/2021 03:56:31 PM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Ms	www.mmmpr.com	MMM Dinamico (HMO-POS)	01	02		1			H4003	051	0	2022	Puerto Rico		2	28848	2			2						www.mmmpr.com	www.mmmpr.com	www.mmmpr.com	(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		2					2					2	1	11	3-1;3-2;3-3;3-4;7b;7c;7d;7e1;7e2;7g;7h1;7h2;7i;7k;8a2;8b1;9a2;9c;	7b1;13a;
H4003	052	0	1	01	01	H4003_052_0	8	1		1	1		1	07/19/2021	2022.01	07/19/2021 08:08:36 PM SA Western Standard Time	08/03/2021 11:37:38 AM SA Western Standard Time	08/02/2021 03:11:02 PM SA Western Standard Time			08/04/2021 05:54:34 PM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Ms	www.mmmpr.com	MMM Integral (HMO C-SNP)	01	01		1			H4003	052	0	2022	Puerto Rico		2	17615	2			1	4			00000000000000000010		www.mmmpr.com	www.mmmpr.com	www.mmmpr.com	(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		2					2					2	1	11	7b;7c;7d;7e1;7e2;7g;7h1;7h2;7i;7k;8a2;8b1;9a2;9c;	7b1;
H4003	806	0	1	02	01	H4003_806_0	3	1						06/04/2021	2022.01	06/04/2021 05:35:57 PM SA Western Standard Time					06/07/2021 08:11:08 PM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Ms	www.mmmpr.com	MMM Group A Calendar (HMO-POS)	01	02		1			H4003	806	0	2022	Puerto Rico		1	383157	2			2						www.mmmpr.com	www.mmmpr.com	www.mmmpr.com	(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		1	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	2				
H4003	807	0	1	02	01	H4003_807_0	3	1						05/13/2021	2022.01	05/13/2021 11:48:16 AM Venezuela Standard Time					06/07/2021 08:11:08 PM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Ms	www.mmmpr.com	MMM Group B Calendar (HMO-POS)	01	02		1			H4003	807	0	2022	Puerto Rico		1	1200	2			2						www.mmmpr.com	www.mmmpr.com	www.mmmpr.com	(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		1	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	2				
H4003	820	0	1	02	01	H4003_820_0	3	1						06/04/2021	2022.01	06/04/2021 05:38:02 PM SA Western Standard Time					06/07/2021 08:11:08 PM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Ms	www.mmmpr.com	MMM Group C Calendar (HMO-POS)	01	02		1			H4003	820	0	2022	Puerto Rico		1	26719	2			2						www.mmmpr.com	www.mmmpr.com	www.mmmpr.com	(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		1	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	2				
H4003	821	0	1	02	01	H4003_821_0	3	1						06/04/2021	2022.01	06/04/2021 05:39:07 PM SA Western Standard Time					06/07/2021 08:11:08 PM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Ms	www.mmmpr.com	MMM Group D Calendar (HMO-POS)	01	02		1			H4003	821	0	2022	Puerto Rico		1	38445	2			2						www.mmmpr.com	www.mmmpr.com	www.mmmpr.com	(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		1	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	2				
H4003	822	0	1	02	01	H4003_822_0	3	1						06/04/2021	2022.01	06/04/2021 05:39:52 PM SA Western Standard Time					06/07/2021 08:11:08 PM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Ms	www.mmmpr.com	MMM Group A Non-Calendar (HMO-POS)	01	02		1			H4003	822	0	2022	Puerto Rico		1	1200	2			2						www.mmmpr.com	www.mmmpr.com	www.mmmpr.com	(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		1	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	2				
H4003	823	0	1	02	01	H4003_823_0	3	1						05/13/2021	2022.01	05/13/2021 12:07:30 PM Venezuela Standard Time					06/07/2021 08:11:08 PM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Ms	www.mmmpr.com	MMM Group B Non-Calendar (HMO-POS)	01	02		1			H4003	823	0	2022	Puerto Rico		1	1200	2			2						www.mmmpr.com	www.mmmpr.com	www.mmmpr.com	(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		1	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	2				
H4003	824	0	1	02	01	H4003_824_0	3	1						05/13/2021	2022.01	05/13/2021 12:12:50 PM Venezuela Standard Time					06/07/2021 08:11:08 PM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Ms	www.mmmpr.com	MMM Group C Non-Calendar (HMO-POS)	01	02		1			H4003	824	0	2022	Puerto Rico		1	1200	2			2						www.mmmpr.com	www.mmmpr.com	www.mmmpr.com	(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		1	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	2				
H4003	825	0	1	02	01	H4003_825_0	3	1						05/13/2021	2022.01	05/13/2021 12:18:18 PM Venezuela Standard Time					06/07/2021 08:11:08 PM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Ms	www.mmmpr.com	MMM Group D Non-Calendar (HMO-POS)	01	02		1			H4003	825	0	2022	Puerto Rico		1	1200	2			2						www.mmmpr.com	www.mmmpr.com	www.mmmpr.com	(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		1	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	2				
H4003	826	0	1	02	01	H4003_826_0	3	1						05/13/2021	2022.01	05/13/2021 12:24:04 PM Venezuela Standard Time					06/07/2021 08:11:08 PM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Ms	www.mmmpr.com	MMM Group E Calendar (HMO-POS)	01	02		1			H4003	826	0	2022	Puerto Rico		1	1200	2			2						www.mmmpr.com	www.mmmpr.com	www.mmmpr.com	(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		1	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	2				
H4003	827	0	1	02	01	H4003_827_0	3	1						05/13/2021	2022.01	05/13/2021 12:31:13 PM Venezuela Standard Time					06/07/2021 08:11:08 PM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Ms	www.mmmpr.com	MMM Group E Non-Calendar (HMO-POS)	01	02		1			H4003	827	0	2022	Puerto Rico		1	1200	2			2						www.mmmpr.com	www.mmmpr.com	www.mmmpr.com	(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		1	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	2				
H4004	048	0	1	01	01	H4004_048_0	11	1	1	1	1		0	07/19/2021	2022.01	07/19/2021 07:57:39 PM SA Western Standard Time	08/03/2021 11:47:42 AM SA Western Standard Time	08/02/2021 03:10:48 PM SA Western Standard Time			08/04/2021 05:54:34 PM SA Western Standard Time	MMM HEALTHCARE, LLC	PMC Medicare Choice	www.mmmpr.com	PMC Premier Platino (HMO D-SNP)	01	01		1			H4004	048	0	2022	Puerto Rico		2	103935	2		1	1	3		2		2	www.mmmpr.com	www.mmmpr.com	www.mmmpr.com	(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		2					2					2	2			
H4004	056	0	1	02	01	H4004_056_0	11	1			1		1	07/20/2021	2022.01	07/20/2021 04:21:03 PM SA Western Standard Time	08/03/2021 03:25:14 PM SA Western Standard Time	08/02/2021 03:10:46 PM SA Western Standard Time			08/04/2021 05:54:34 PM SA Western Standard Time	MMM HEALTHCARE, LLC	PMC Medicare Choice	www.mmmpr.com	PMC Max (HMO-POS)	01	02		1			H4004	056	0	2022	Puerto Rico		2	67862	2			2						www.mmmpr.com	www.mmmpr.com	www.mmmpr.com	(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		2					2					2	1	11	3-1;3-2;3-3;3-4;7b;7c;7d;7e1;7e2;7f;7g;7h1;7h2;7i;7k;8a2;8b1;9a2;9c;	7b1;7f;
H4004	061	0	1	01	01	H4004_061_0	11	1	1	1	1		0	07/19/2021	2022.01	07/19/2021 08:33:22 PM SA Western Standard Time	08/03/2021 03:22:24 PM SA Western Standard Time	08/02/2021 03:10:54 PM SA Western Standard Time			08/04/2021 05:54:34 PM SA Western Standard Time	MMM HEALTHCARE, LLC	PMC Medicare Choice	www.mmmpr.com	MMM Relax Platino (HMO D-SNP)	01	01		1			H4004	061	0	2022	Puerto Rico		2	288814	2		1	1	3		2		2	www.mmmpr.com	www.mmmpr.com	www.mmmpr.com	(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		2					2					2	2			
H4004	062	0	1	01	01	H4004_062_0	10	1	1	1	1		0	07/19/2021	2022.01	07/19/2021 08:38:32 PM SA Western Standard Time	08/03/2021 03:19:26 PM SA Western Standard Time	08/05/2021 03:34:00 PM SA Western Standard Time			08/05/2021 03:56:31 PM SA Western Standard Time	MMM HEALTHCARE, LLC	PMC Medicare Choice	www.mmmpr.com	MMM Bono Platino (HMO D-SNP)	01	01		1			H4004	062	0	2022	Puerto Rico		2	13583	2		1	1	3		2		2	www.mmmpr.com	www.mmmpr.com	www.mmmpr.com	(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		2					2					2	2			
H4004	063	0	1	02	01	H4004_063_0	9	1			1		1	07/20/2021	2022.01	07/20/2021 02:46:51 PM SA Western Standard Time	08/03/2021 03:14:46 PM SA Western Standard Time	08/02/2021 03:10:40 PM SA Western Standard Time			08/04/2021 05:54:34 PM SA Western Standard Time	MMM HEALTHCARE, LLC	PMC Medicare Choice	www.mmmpr.com	MMM Balance (HMO-POS)	01	02		1			H4004	063	0	2022	Puerto Rico		2	25590	2			2						www.mmmpr.com	www.mmmpr.com	www.mmmpr.com	(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		2					2					2	1	11	3-1;3-2;3-3;3-4;7b;7c;7d;7e1;7e2;7g;7h1;7h2;7i;7k;8a2;8b1;9a2;9c;	7b1;13a;
H4004	064	0	1	02	01	H4004_064_0	9	1			1		1	07/19/2021	2022.01	07/19/2021 09:06:22 PM SA Western Standard Time	08/03/2021 03:11:06 PM SA Western Standard Time	08/02/2021 03:10:36 PM SA Western Standard Time			08/04/2021 05:54:34 PM SA Western Standard Time	MMM HEALTHCARE, LLC	PMC Medicare Choice	www.mmmpr.com	MMM Poderoso (HMO-POS)	01	02		1			H4004	064	0	2022	Puerto Rico		2	4832	2			2						www.mmmpr.com	www.mmmpr.com	www.mmmpr.com	(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		2					2					2	1	11	3-1;3-2;3-3;3-4;7b;7d;7e1;7e2;7f;7g;7h1;7h2;7i;7k;8a2;8b1;9a2;9c;	7b1;7f;
H4004	065	0	1	02	01	H4004_065_0	8	1			1		1	07/19/2021	2022.01	07/19/2021 09:17:21 PM SA Western Standard Time	08/03/2021 03:04:28 PM SA Western Standard Time	08/02/2021 03:10:34 PM SA Western Standard Time			08/04/2021 05:54:34 PM SA Western Standard Time	MMM HEALTHCARE, LLC	PMC Medicare Choice	www.mmmpr.com	MMM Plenitud (HMO-POS)	01	02		1			H4004	065	0	2022	Puerto Rico		2	79036	2			2						www.mmmpr.com	www.mmmpr.com	www.mmmpr.com	(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		2					2					2	1	11	3-1;3-2;3-3;3-4;7c;7g;7i;7k;8a2;8b1;9a2;	13a;
H4004	817	0	1	02	01	H4004_817_0	3	1						05/20/2021	2022.01	05/20/2021 11:34:10 AM SA Western Standard Time					06/07/2021 08:11:08 PM SA Western Standard Time	MMM HEALTHCARE, LLC	PMC Medicare Choice	www.mmmpr.com	PMC Group A Calendar (HMO-POS)	01	02		1			H4004	817	0	2022	Puerto Rico		1	0	2			2						www.mmmpr.com	www.mmmpr.com	www.mmmpr.com	(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		1	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	2				
H4004	818	0	1	02	01	H4004_818_0	3	1						05/13/2021	2022.01	05/13/2021 01:44:45 PM Venezuela Standard Time					06/07/2021 08:11:08 PM SA Western Standard Time	MMM HEALTHCARE, LLC	PMC Medicare Choice	www.mmmpr.com	PMC Group B Calendar (HMO-POS)	01	02		1			H4004	818	0	2022	Puerto Rico		1	0	2			2						www.mmmpr.com	www.mmmpr.com	www.mmmpr.com	(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		1	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	2				
H4004	819	0	1	02	01	H4004_819_0	3	1						05/13/2021	2022.01	05/13/2021 01:48:34 PM Venezuela Standard Time					06/07/2021 08:11:08 PM SA Western Standard Time	MMM HEALTHCARE, LLC	PMC Medicare Choice	www.mmmpr.com	PMC Group C Calendar (HMO-POS)	01	02		1			H4004	819	0	2022	Puerto Rico		1	0	2			2						www.mmmpr.com	www.mmmpr.com	www.mmmpr.com	(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		1	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	2				
H4004	820	0	1	02	01	H4004_820_0	3	1						05/13/2021	2022.01	05/13/2021 03:54:05 PM Venezuela Standard Time					06/07/2021 08:11:08 PM SA Western Standard Time	MMM HEALTHCARE, LLC	PMC Medicare Choice	www.mmmpr.com	PMC Group D Calendar (HMO-POS)	01	02		1			H4004	820	0	2022	Puerto Rico		1	0	2			2						www.mmmpr.com	www.mmmpr.com	www.mmmpr.com	(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		1	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	2				
H4004	822	0	1	02	01	H4004_822_0	3	1						06/04/2021	2022.01	06/04/2021 05:51:57 PM SA Western Standard Time					06/07/2021 08:11:08 PM SA Western Standard Time	MMM HEALTHCARE, LLC	PMC Medicare Choice	www.mmmpr.com	PMC Group A Non-Calendar (HMO-POS)	01	02		1			H4004	822	0	2022	Puerto Rico		1	0	2			2						www.mmmpr.com	www.mmmpr.com	www.mmmpr.com	(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		1	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	2				
H4004	823	0	1	02	01	H4004_823_0	3	1						05/18/2021	2022.01	05/18/2021 03:25:37 PM SA Western Standard Time					06/07/2021 08:11:08 PM SA Western Standard Time	MMM HEALTHCARE, LLC	PMC Medicare Choice	www.mmmpr.com	PMC Group B Non-Calendar (HMO-POS)	01	02		1			H4004	823	0	2022	Puerto Rico		1	0	2			2						www.mmmpr.com	www.mmmpr.com	www.mmmpr.com	(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		1	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	2				
H4004	824	0	1	02	01	H4004_824_0	3	1						05/18/2021	2022.01	05/18/2021 03:25:55 PM SA Western Standard Time					06/07/2021 08:11:08 PM SA Western Standard Time	MMM HEALTHCARE, LLC	PMC Medicare Choice	www.mmmpr.com	PMC Group C Non-Calendar (HMO-POS)	01	02		1			H4004	824	0	2022	Puerto Rico		1	0	2			2						www.mmmpr.com	www.mmmpr.com	www.mmmpr.com	(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		1	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	2				
H4004	825	0	1	02	01	H4004_825_0	3	1						06/04/2021	2022.01	06/04/2021 05:50:09 PM SA Western Standard Time					06/07/2021 08:11:08 PM SA Western Standard Time	MMM HEALTHCARE, LLC	PMC Medicare Choice	www.mmmpr.com	PMC Group D Non-Calendar (HMO-POS)	01	02		1			H4004	825	0	2022	Puerto Rico		1	0	2			2						www.mmmpr.com	www.mmmpr.com	www.mmmpr.com	(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		1	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	2				
H4004	826	0	1	02	01	H4004_826_0	3	1						05/14/2021	2022.01	05/14/2021 04:48:40 PM Venezuela Standard Time					06/07/2021 08:11:08 PM SA Western Standard Time	MMM HEALTHCARE, LLC	PMC Medicare Choice	www.mmmpr.com	PMC Group E Calendar (HMO-POS)	01	02		1			H4004	826	0	2022	Puerto Rico		1	0	2			2						www.mmmpr.com	www.mmmpr.com	www.mmmpr.com	(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		1	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	2				
H4004	827	0	1	02	01	H4004_827_0	3	1						05/18/2021	2022.01	05/18/2021 03:29:39 PM SA Western Standard Time					06/07/2021 08:11:08 PM SA Western Standard Time	MMM HEALTHCARE, LLC	PMC Medicare Choice	www.mmmpr.com	PMC Group E Non-Calendar (HMO-POS)	01	02		1			H4004	827	0	2022	Puerto Rico		1	0	2			2						www.mmmpr.com	www.mmmpr.com	www.mmmpr.com	(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		1	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	2				
H4005	001	0	1	04	01	H4005_001_0	7	1			1	0	0	07/10/2021	2022.01	07/10/2021 04:32:32 PM SA Western Standard Time	06/07/2021 03:48:52 PM SA Western Standard Time				07/11/2021 01:30:01 PM SA Western Standard Time	TRIPLE S ADVANTAGE, INC.	Triple-S Advantage	www.sssadvantage.com	ptimo (PPO)	01	04		1			H4005	001	0	2022	Puerto Rico		2	5844	2			2						www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(833)221-2234		(833)221-2234										(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520										2					2						1	11	7d;7f;7g;8a1;8a2;8b1;8b2;8b3;	7f;
H4005	004	0	1	04	01	H4005_004_0	8	1			1		1	08/04/2021	2022.01	08/04/2021 10:20:50 AM SA Western Standard Time	08/04/2021 10:31:53 AM SA Western Standard Time	07/30/2021 11:15:56 AM SA Western Standard Time			08/05/2021 09:01:04 AM SA Western Standard Time	TRIPLE S ADVANTAGE, INC.	Triple-S Advantage	www.sssadvantage.com	ptimo Plus (PPO)	01	04		1			H4005	004	0	2022	Puerto Rico		2	36984	2			2						www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(833)221-2234		(833)221-2234		(888)620-1919		(888)620-1919		(833)221-2234		(833)221-2234		(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;8b1;8b2;8b3;	7f;
H4005	801	0	1	04	01	H4005_801_0	5	1				0	0	05/20/2021	2022.01	05/20/2021 01:46:14 PM SA Western Standard Time					06/07/2021 04:51:39 PM SA Western Standard Time	TRIPLE S ADVANTAGE, INC.	Triple-S Advantage	www.sssadvantage.com	ptimo (PPO)	01	04		1			H4005	801	0	2022	Puerto Rico		1	120	2			2						www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(833)221-2234		(833)221-2234										(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520										1	1	2;3-1;3-2;3-3;3-4;5;6;7c;7d;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;16b;	2		1									
H4005	802	0	1	04	01	H4005_802_0	5	1						05/21/2021	2022.01	05/21/2021 11:48:23 AM SA Western Standard Time					06/07/2021 04:51:39 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	2022	Puerto Rico		1	73800	2			2						www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(833)221-2234		(833)221-2234		(888)620-1919		(888)620-1919		(833)221-2234		(833)221-2234		(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;3-4;5;6;7c;7d;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;16b;	2		1									
H4005	804	0	1	04	01	H4005_804_0	5	1						05/17/2021	2022.01	05/17/2021 10:11:27 AM SA Western Standard Time					06/07/2021 04:51:39 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	2022	Puerto Rico		1	1440	2			2						www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(833)221-2234		(833)221-2234		(888)620-1919		(888)620-1919		(833)221-2234		(833)221-2234		(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;3-4;5;6;7c;7d;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;15;16b;	2		1									
H4005	807	0	1	04	01	H4005_807_0	5	1						05/17/2021	2022.01	05/17/2021 10:18:40 AM SA Western Standard Time					06/07/2021 04:51:39 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	2022	Puerto Rico		1	120	2			2						www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(833)221-2234		(833)221-2234		(888)620-1919		(888)620-1919		(833)221-2234		(833)221-2234		(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;3-4;5;7c;7d;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;16b;	2		1									
H4005	808	0	1	04	01	H4005_808_0	5	1						05/17/2021	2022.01	05/17/2021 10:28:37 AM SA Western Standard Time					06/07/2021 04:51:39 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	2022	Puerto Rico		1	120	2			2						www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(833)221-2234		(833)221-2234		(888)620-1919		(888)620-1919		(833)221-2234		(833)221-2234		(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;3-4;5;6;7c;7d;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;16b;	2		1									
H4007	012	0	1	01	01	H4007_012_0	7	1			1		1	08/11/2021	2022.01	08/11/2021 02:43:21 PM Eastern Daylight Time	08/03/2021 07:50:46 PM Eastern Daylight Time	07/30/2021 10:40:00 AM Eastern Daylight Time			08/11/2021 05:40:55 PM 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	2022	Puerto Rico Island Wide		2		2			2						https://www.humana.com/pharmacy/	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	7	1	1	1	1		0	08/11/2021	2022.01	08/11/2021 05:05:17 PM Eastern Daylight Time	08/03/2021 07:49:28 PM Eastern Daylight Time	07/30/2021 10:40:12 AM Eastern Daylight Time			08/11/2021 05:40:55 PM Eastern Daylight Time	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H4007-016 (HMO D-SNP)	01	01		1			H4007	016	0	2022	Puerto Rico Island Wide		2		2		1	1	3		2		2	https://www.humana.com/pharmacy/	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	7	1	1	1	1		0	07/15/2021	2022.01	07/15/2021 11:07:15 AM Eastern Daylight Time	08/03/2021 07:50:09 PM Eastern Daylight Time	07/30/2021 10:40:24 AM Eastern Daylight Time			08/04/2021 01:25:17 PM Eastern Daylight Time	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H4007-018 (HMO D-SNP)	01	01		1			H4007	018	0	2022	Puerto Rico Island Wide		2		2		1	1	3		2		2	https://www.humana.com/pharmacy/	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	6	1	1	1	1		0	08/01/2021	2022.01	08/01/2021 10:20:58 AM Eastern Daylight Time	08/03/2021 07:51:23 PM Eastern Daylight Time	07/30/2021 10:40:36 AM Eastern Daylight Time			08/04/2021 01:25:17 PM Eastern Daylight Time	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H4007-019 (HMO D-SNP)	01	01		1			H4007	019	0	2022	Puerto Rico Island Wide		2		2		1	1	3		2		2	https://www.humana.com/pharmacy/	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	3	1			2		1	08/01/2021	2022.01	08/01/2021 10:21:16 AM Eastern Daylight Time	08/03/2021 07:52:06 PM Eastern Daylight Time	07/30/2021 10:40:48 AM Eastern Daylight Time			08/04/2021 01:25:17 PM 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	2022	Puerto Rico Island Wide		2		2			2						https://www.humana.com/pharmacy/	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	021	0	1	01	01	H4007_021_0	6	1			1		1	07/15/2021	2022.01	07/15/2021 11:07:56 AM Eastern Daylight Time	08/03/2021 07:52:50 PM Eastern Daylight Time	07/30/2021 10:41:00 AM Eastern Daylight Time			08/04/2021 01:25:17 PM Eastern Daylight Time	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H4007-021 (HMO)	01	01		1			H4007	021	0	2022	Puerto Rico Island Wide		2		2			2						https://www.humana.com/pharmacy/	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	022	0	1	01	01	H4007_022_0	4	1	1	1	1		0	07/08/2021	2022.01	07/08/2021 04:28:28 PM Eastern Daylight Time	08/03/2021 07:53:29 PM Eastern Daylight Time	07/30/2021 10:41:12 AM Eastern Daylight Time			08/04/2021 01:25:17 PM Eastern Daylight Time	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H4007-022 (HMO D-SNP)	01	01		1			H4007	022	0	2022	Puerto Rico Island Wide		2		2		1	1	3		2		2	https://www.humana.com/pharmacy/	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						05/25/2021	2022.01	05/25/2021 02:45:30 PM Eastern Daylight Time					06/04/2021 08:33:40 AM 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	2022	Puerto Rico - Island Wide		1	1200	2			2						https://www.humana.com/pharmacy/	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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H4007	802	0	1	01	01	H4007_802_0	1	1				0	0	05/25/2021	2022.01	05/25/2021 02:47:42 PM Eastern Daylight Time					06/04/2021 08:33:40 AM 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	2022	Puerto Rico - Island Wide		1	1200	2			2						https://www.humana.com/pharmacy/	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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H4007	811	0	1	01	01	H4007_811_0	1	1						05/27/2021	2022.01	05/27/2021 03:38:19 PM Eastern Daylight Time					06/04/2021 08:33:40 AM Eastern Daylight Time	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H4007	811	0	2022	Puerto Rico - Island Wide		1	1200	2			2						https://www.humana.com/pharmacy/	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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					2				
H4007	812	0	1	01	01	H4007_812_0	1	1				0	0	05/27/2021	2022.01	05/27/2021 03:39:46 PM Eastern Daylight Time					06/04/2021 08:33:40 AM Eastern Daylight Time	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H4007	812	0	2022	Puerto Rico - Island Wide		1	1200	2			2						https://www.humana.com/pharmacy/	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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					2				
H4007	813	0	1	01	01	H4007_813_0	1	1						05/27/2021	2022.01	05/27/2021 03:41:17 PM Eastern Daylight Time					06/04/2021 08:33:40 AM Eastern Daylight Time	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H4007	813	0	2022	Puerto Rico - Island Wide		1	24393	2			2						https://www.humana.com/pharmacy/	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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					2				
H4007	814	0	1	01	01	H4007_814_0	1	1				0	0	05/27/2021	2022.01	05/27/2021 03:43:18 PM Eastern Daylight Time					06/04/2021 08:33:40 AM Eastern Daylight Time	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H4007	814	0	2022	Puerto Rico - Island Wide		1	1200	2			2						https://www.humana.com/pharmacy/	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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					2				
H4007	815	0	1	01	01	H4007_815_0	1	1						05/27/2021	2022.01	05/27/2021 03:45:13 PM Eastern Daylight Time					06/04/2021 08:33:40 AM Eastern Daylight Time	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H4007	815	0	2022	Puerto Rico - Island Wide		1	1200	2			2						https://www.humana.com/pharmacy/	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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					2				
H4007	816	0	1	01	01	H4007_816_0	1	1				0	0	05/27/2021	2022.01	05/27/2021 03:47:11 PM Eastern Daylight Time					06/04/2021 08:33:40 AM Eastern Daylight Time	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H4007	816	0	2022	Puerto Rico - Island Wide		1	1200	2			2						https://www.humana.com/pharmacy/	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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					2				
H4007	817	0	1	01	01	H4007_817_0	1	1						06/03/2021	2022.01	06/03/2021 03:17:44 PM Eastern Daylight Time					06/04/2021 08:33:40 AM Eastern Daylight Time	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H4007	817	0	2022	Puerto Rico - Island Wide		1	1200	2			2						https://www.humana.com/pharmacy/	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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					2				
H4007	818	0	1	01	01	H4007_818_0	1	1				0	0	06/03/2021	2022.01	06/03/2021 03:18:05 PM Eastern Daylight Time					06/04/2021 08:33:40 AM Eastern Daylight Time	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H4007	818	0	2022	Puerto Rico - Island Wide		1	1200	2			2						https://www.humana.com/pharmacy/	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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					2				
H4007	819	0	1	01	01	H4007_819_0	1	1						06/03/2021	2022.01	06/03/2021 03:18:25 PM Eastern Daylight Time					06/04/2021 08:33:40 AM Eastern Daylight Time	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H4007	819	0	2022	Puerto Rico - Island Wide		1	1200	2			2						https://www.humana.com/pharmacy/	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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					2				
H4007	820	0	1	01	01	H4007_820_0	1	1				0	0	06/03/2021	2022.01	06/03/2021 03:18:43 PM Eastern Daylight Time					06/04/2021 08:33:40 AM Eastern Daylight Time	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H4007	820	0	2022	Puerto Rico - Island Wide		1	1200	2			2						https://www.humana.com/pharmacy/	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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					2				
H4007	821	0	1	01	01	H4007_821_0	1	1						06/03/2021	2022.01	06/03/2021 03:20:49 PM Eastern Daylight Time					06/04/2021 08:33:40 AM Eastern Daylight Time	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H4007	821	0	2022	Puerto Rico - Island Wide		1	1200	2			2						https://www.humana.com/pharmacy/	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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					2				
H4007	822	0	1	01	01	H4007_822_0	1	1				0	0	06/03/2021	2022.01	06/03/2021 03:23:16 PM Eastern Daylight Time					06/04/2021 08:33:40 AM Eastern Daylight Time	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H4007	822	0	2022	Puerto Rico - Island Wide		1	1200	2			2						https://www.humana.com/pharmacy/	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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					2				
H4007	823	0	1	01	01	H4007_823_0	1	1						06/03/2021	2022.01	06/03/2021 03:25:54 PM Eastern Daylight Time					06/04/2021 08:33:40 AM Eastern Daylight Time	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H4007	823	0	2022	Puerto Rico - Island Wide		1	1200	2			2						https://www.humana.com/pharmacy/	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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					2				
H4007	824	0	1	01	01	H4007_824_0	1	1				0	0	06/03/2021	2022.01	06/03/2021 03:28:04 PM Eastern Daylight Time					06/04/2021 08:33:40 AM Eastern Daylight Time	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H4007	824	0	2022	Puerto Rico - Island Wide		1	1200	2			2						https://www.humana.com/pharmacy/	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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					2				
H4007	825	0	1	01	01	H4007_825_0	1	1						06/03/2021	2022.01	06/03/2021 03:30:08 PM Eastern Daylight Time					06/04/2021 08:33:40 AM Eastern Daylight Time	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H4007	825	0	2022	Puerto Rico - Island Wide		1	1200	2			2						https://www.humana.com/pharmacy/	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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					2				
H4007	826	0	1	01	01	H4007_826_0	1	1				0	0	06/03/2021	2022.01	06/03/2021 03:32:16 PM Eastern Daylight Time					06/04/2021 08:33:40 AM Eastern Daylight Time	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H4007	826	0	2022	Puerto Rico - Island Wide		1	1200	2			2						https://www.humana.com/pharmacy/	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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					2				
H4036	008	0	1	04	01	H4036_008_0	7	1					0	08/03/2021	2022.01	08/03/2021 02:41:13 PM Eastern Daylight Time	08/03/2021 06:04:00 PM Eastern Daylight Time	08/03/2021 06:04:00 PM Eastern Daylight Time			08/04/2021 02:28:17 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	2022	Select Counties in Wisconsin		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(855)690-7802		(855)690-7802		(855)679-0545		(855)679-0545		(833)339-3521		(833)339-3521		(855)485-0961		(855)485-0961		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4036	009	0	1	04	01	H4036_009_0	9	1					0	08/02/2021	2022.01	08/02/2021 02:22:34 PM Eastern Daylight Time	08/03/2021 06:04:00 PM Eastern Daylight Time	08/03/2021 06:04:00 PM Eastern Daylight Time			08/04/2021 02:28:17 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	2022	Select Counties in Wisconsin		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(855)690-7802		(855)690-7802		(855)679-0545		(855)679-0545		(833)339-3521		(833)339-3521		(855)485-0961		(855)485-0961		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4036	017	0	1	04	01	H4036_017_0	7	1					0	08/02/2021	2022.01	08/02/2021 12:35:21 PM Eastern Daylight Time	08/03/2021 06:03:59 PM Eastern Daylight Time	08/03/2021 06:03:59 PM Eastern Daylight Time			08/04/2021 02:00:52 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	2022	Select Counties in Ohio		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(855)690-7801		(855)690-7801		(855)679-0545		(855)679-0545		(833)339-3520		(833)339-3520		(855)485-0961		(855)485-0961		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4036	020	0	1	04	01	H4036_020_0	7	1					0	08/03/2021	2022.01	08/03/2021 02:41:29 PM Eastern Daylight Time	08/03/2021 06:04:00 PM Eastern Daylight Time	08/03/2021 06:04:00 PM Eastern Daylight Time			08/04/2021 02:28:17 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	020	0	2022	Select Counties in Wisconsin		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(855)690-7802		(855)690-7802		(855)679-0545		(855)679-0545		(833)339-3521		(833)339-3521		(855)485-0961		(855)485-0961		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4036	022	0	1	04	01	H4036_022_0	6	1				0	0	07/16/2021	2022.01	07/16/2021 04:16:13 PM Eastern Daylight Time	07/16/2021 06:58:49 PM Eastern Daylight Time				07/19/2021 05:00:56 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Service (PPO)	01	04		1			H4036	022	0	2022	Select counties in OH		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(855)690-7802		(855)690-7802		(855)679-0545		(855)679-0545										(711)-		(711)-		(711)-		(711)-										2					2						2			
H4036	023	0	1	04	01	H4036_023_0	7	1					0	08/04/2021	2022.01	08/04/2021 02:52:09 PM Eastern Daylight Time	08/04/2021 03:44:03 PM Eastern Daylight Time	07/29/2021 07:17:10 PM Eastern Daylight Time			08/04/2021 07:08:57 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue + Kroger Access (PPO)	01	04		1			H4036	023	0	2022	Select counties in OH		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(855)690-7801		(855)690-7801		(855)679-0545		(855)679-0545		(833)339-3520		(833)339-3520		(855)485-0961		(855)485-0961		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4036	024	0	1	04	01	H4036_024_0	6	1				0	0	07/15/2021	2022.01	07/15/2021 10:37:01 AM Eastern Daylight Time	07/16/2021 06:58:51 PM Eastern Daylight Time				07/19/2021 04:21:07 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Service (PPO)	01	04		1			H4036	024	0	2022	Select counties in Wisconsin		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(855)690-7802		(855)690-7802		(855)679-0545		(855)679-0545										(711)-		(711)-		(711)-		(711)-										2					2						2			
H4036	025	0	1	04	01	H4036_025_0	8	1					0	08/02/2021	2022.01	08/02/2021 12:35:37 PM Eastern Daylight Time	08/03/2021 06:03:59 PM Eastern Daylight Time	08/03/2021 06:03:59 PM Eastern Daylight Time			08/04/2021 02:00:52 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	025	0	2022	Select counties in OH		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(855)690-7801		(855)690-7801		(855)679-0545		(855)679-0545		(833)339-3520		(833)339-3520		(855)485-0961		(855)485-0961		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4036	801	0	1	04	01	H4036_801_0	1	1						06/02/2021	2022.01	06/02/2021 04:13:28 PM Pacific Daylight Time					06/04/2021 09:11:13 AM Pacific Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H4036	801	0	2022	National		1	914010	2			2						www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)360-3662		(833)360-3662		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1									
H4036	802	0	1	04	01	H4036_802_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 04:13:45 PM Pacific Daylight Time					06/04/2021 09:11:13 AM Pacific Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H4036	802	0	2022	National		1	1374321	2			2						www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1									
H4036	805	0	1	04	01	H4036_805_0	1	1						06/02/2021	2022.01	06/02/2021 04:14:00 PM Pacific Daylight Time					06/04/2021 09:11:13 AM Pacific Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H4036	805	0	2022	National		1	12	2			2						www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)360-3662		(833)360-3662		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1									
H4036	806	0	2	04	01	H4036_806_0	1	1						06/02/2021	2022.01	06/02/2021 04:14:09 PM Pacific Daylight Time					06/04/2021 09:11:13 AM Pacific Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		2	1		H4036	806	0	2022	National		1	1698	2			2						www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)360-3662		(833)360-3662		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1									
H4036	807	0	1	04	01	H4036_807_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 04:14:29 PM Pacific Daylight Time					06/04/2021 09:11:13 AM Pacific Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H4036	807	0	2022	National		1	9513	2			2						www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1									
H4036	809	0	2	04	01	H4036_809_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 04:14:43 PM Pacific Daylight Time					06/04/2021 09:11:13 AM Pacific Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		2	1		H4036	809	0	2022	National		1	35673	2			2						www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1									
H4036	810	0	2	04	01	H4036_810_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 04:15:06 PM Pacific Daylight Time					06/04/2021 09:11:13 AM Pacific Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		2	1		H4036	810	0	2022	National		1	600	2			2						www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1									
H4036	812	0	1	04	01	H4036_812_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 04:15:16 PM Pacific Daylight Time					06/04/2021 09:11:13 AM Pacific Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H4036	812	0	2022	National		1	600	2			2						www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1									
H4036	813	0	1	04	01	H4036_813_0	1	1				0	0	06/03/2021	2022.01	06/03/2021 11:40:44 AM Pacific Daylight Time					06/04/2021 09:11:13 AM Pacific Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H4036	813	0	2022	National		1	600	2			2						www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1									
H4036	814	0	1	04	01	H4036_814_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 04:15:38 PM Pacific Daylight Time					06/04/2021 09:11:13 AM Pacific Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H4036	814	0	2022	National		1	600	2			2						www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(833)498-1581		(833)498-1581		(833)498-1580		(833)498-1580										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1									
H4036	815	0	1	04	01	H4036_815_0	1	1						06/03/2021	2022.01	06/03/2021 11:40:40 AM Pacific Daylight Time					06/04/2021 09:11:13 AM Pacific Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H4036	815	0	2022	National		1	600	2			2						www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)360-3662		(833)360-3662		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1									
H4036	816	0	1	04	01	H4036_816_0	1	1				0	0	06/03/2021	2022.01	06/03/2021 11:40:53 AM Pacific Daylight Time					06/04/2021 09:11:13 AM Pacific Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H4036	816	0	2022	National		1	240000	2			2						www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1									
H4036	817	0	2	04	01	H4036_817_0	1	1						06/03/2021	2022.01	06/03/2021 11:41:01 AM Pacific Daylight Time					06/04/2021 09:11:13 AM Pacific Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		2	1		H4036	817	0	2022	National		1	600	2			2						www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)360-3662		(833)360-3662		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1									
H4036	818	0	2	04	01	H4036_818_0	1	1				0	0	06/03/2021	2022.01	06/03/2021 11:41:08 AM Pacific Daylight Time					06/04/2021 09:11:13 AM Pacific Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		2	1		H4036	818	0	2022	National		1	600	2			2						www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1									
H4036	819	0	1	04	01	H4036_819_0	1	1						06/03/2021	2022.01	06/03/2021 11:41:16 AM Pacific Daylight Time					06/04/2021 09:11:13 AM Pacific Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H4036	819	0	2022	National		1	1000	2			2						www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)360-3662		(833)360-3662		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1									
H4036	820	0	1	04	01	H4036_820_0	1	1				0	0	06/03/2021	2022.01	06/03/2021 11:41:23 AM Pacific Daylight Time					06/04/2021 09:11:13 AM Pacific Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H4036	820	0	2022	National		1	600	2			2						www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1									
H4036	821	0	2	04	01	H4036_821_0	1	1						06/03/2021	2022.01	06/03/2021 11:41:29 AM Pacific Daylight Time					06/04/2021 09:11:13 AM Pacific Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		2	1		H4036	821	0	2022	National		1	600	2			2						www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)360-3662		(833)360-3662		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1									
H4036	822	0	2	04	01	H4036_822_0	1	1				0	0	06/03/2021	2022.01	06/03/2021 11:41:35 AM Pacific Daylight Time					06/04/2021 09:11:13 AM Pacific Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		2	1		H4036	822	0	2022	National		1	600	2			2						www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1									
H4053	001	0	1	20	08	H4053_001_0	1	1						06/04/2021	2022.01	06/04/2021 10:37:28 AM Eastern Daylight Time		06/04/2021 09:53:06 AM Eastern Daylight Time			06/04/2021 12:28:45 PM Eastern Daylight Time	PRISMA HEALTH-UPSTATE	Prisma Health SeniorCare PACE-Upstate	https://www.ghs.org/healthcareservices/seniorcare/	Prisma Health PACE-Upstate - Dual Eligible (PACE)	08	20		1			H4053	001	0	2022	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						06/04/2021	2022.01	06/04/2021 10:38:00 AM Eastern Daylight Time		06/04/2021 09:53:22 AM Eastern Daylight Time			06/04/2021 12:28:45 PM Eastern Daylight Time	PRISMA HEALTH-UPSTATE	Prisma Health SeniorCare PACE-Upstate	https://www.ghs.org/healthcareservices/seniorcare/	Prisma Health PACE-Upstate - Medicare Only (PACE)	08	20		1			H4053	002	0	2022	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)-																
H4054	001	0	1	01	01	H4054_001_0	17	1		1			0	08/05/2021	2022.01	08/05/2021 05:22:38 PM Eastern Daylight Time	08/05/2021 07:33:37 PM Eastern Daylight Time	08/05/2021 07:33:37 PM Eastern Daylight Time			08/05/2021 07:41:08 PM Eastern Daylight Time	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Provider Partners Health Plans	www.pphealthplan.com	Provider Partners Texas Advantage Plan (HMO I-SNP)	01	01		1			H4054	001	0	2022	Texas (Partial)		2		2			1	1	1				www.pphealthplan.com	www.pphealthplan.com	www.pphealthplan.com	(800)405-9681		(800)405-9681		(800)405-9681		(800)405-9681		(844)846-8007		(844)846-8007		(800)405-9681		(800)405-9681		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4054	002	0	1	01	01	H4054_002_0	18	1		1			0	08/05/2021	2022.01	08/05/2021 05:23:28 PM Eastern Daylight Time	08/05/2021 07:33:37 PM Eastern Daylight Time	08/05/2021 07:33:37 PM Eastern Daylight Time			08/05/2021 07:41:08 PM Eastern Daylight Time	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Provider Partners Health Plans	www.pphealthplan.com	Provider Partners Texas Community Plan (HMO I-SNP)	01	01		1			H4054	002	0	2022	Texas (Partial)		2		2			1	1	2				www.pphealthplan.com	www.pphealthplan.com	www.pphealthplan.com	(800)405-9681		(800)405-9681		(800)405-9681		(800)405-9681		(844)846-8007		(844)846-8007		(800)405-9681		(800)405-9681		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4073	001	0	1	01	01	H4073_001_0	5	1					0	08/03/2021	2022.01	08/03/2021 12:04:53 PM Eastern Daylight Time	08/04/2021 12:10:38 AM Eastern Daylight Time	07/30/2021 11:19:40 AM Eastern Daylight Time			08/04/2021 10:12:55 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO)	01	01		1			H4073	001	0	2022	Select counties in NC		2	9594	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4073	002	0	1	01	01	H4073_002_0	5	1	2	1			0	06/02/2021	2022.01	06/02/2021 05:06:46 PM Eastern Daylight Time	08/04/2021 12:11:06 AM Eastern Daylight Time	07/30/2021 11:20:18 AM Eastern Daylight Time			08/04/2021 10:12:55 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Access (HMO D-SNP)	01	01		1			H4073	002	0	2022	Select counties in NC		2	5165	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4074	001	0	1	20	08	H4074_001_0	1	1						05/27/2021	2022.01	05/27/2021 01:32:41 PM Eastern Daylight Time		05/27/2021 01:26:21 PM Eastern Daylight Time			05/27/2021 01:35:55 PM Eastern Daylight Time	MERCY LIFE OF ALABAMA	Mercy LIFE of Alabama	https://www.trinityhealthpace.org	Mercy LIFE of Alabama (PACE)	08	20		1			H4074	001	0	2022	Mercy LIFE of Alabama Baldwin and Mobile counties		2		2			2						https://pharmastar.com	www.mercylifeal.com	https://www.trinityhealthpace.org									(855)367-6562		(251)287-8478		(855)367-6562		(251)287-8478										(855)212-1552		(855)212-1552		(855)212-1552		(855)212-1552																
H4074	002	0	1	20	08	H4074_002_0	1	1						05/27/2021	2022.01	05/27/2021 01:33:31 PM Eastern Daylight Time		05/27/2021 01:26:21 PM Eastern Daylight Time			05/27/2021 01:35:55 PM Eastern Daylight Time	MERCY LIFE OF ALABAMA	Mercy LIFE of Alabama	https://www.trinityhealthpace.org	Mercy LIFE of Alabama (PACE)	08	20		1			H4074	002	0	2022	Mercy LIFE of Alabama Baldwin and Mobile counties		2		2			2						https://pharmastar.com	www.mercylifeal.com	https://www.trinityhealthpace.org									(855)367-6562		(251)287-8478		(855)367-6562		(251)287-8478										(855)212-1552		(855)212-1552		(855)212-1552		(855)212-1552																
H4091	001	0	1	04	01	H4091_001_0	6	1		1			0	08/04/2021	2022.01	08/04/2021 08:37:16 AM Central Daylight Time	08/04/2021 11:43:55 AM Central Daylight Time	08/02/2021 12:16:50 PM Central Daylight Time			08/05/2021 11:18:13 AM Central Daylight Time	SIMPRA ADVANTAGE, INC.	Simpra Advantage	www.simpra.com	Simpra Advantage (PPO I-SNP)	01	04		1			H4091	001	0	2022	Alabama statewide		2		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	6	1	2	1			0	08/04/2021	2022.01	08/04/2021 08:37:43 AM Central Daylight Time	08/04/2021 11:46:51 AM Central Daylight Time	08/02/2021 12:09:18 PM Central Daylight Time			08/05/2021 11:18:13 AM Central Daylight Time	SIMPRA ADVANTAGE, INC.	Simpra Advantage	www.simpra.com	Simpra Advantage (PPO D-SNP)	01	04		1			H4091	002	0	2022	Alabama statewide		2		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			
H4091	003	0	1	04	01	H4091_003_0	7	1		1			0	08/04/2021	2022.01	08/04/2021 08:39:24 AM Central Daylight Time	08/04/2021 11:49:49 AM Central Daylight Time	08/02/2021 11:24:36 AM Central Daylight Time			08/05/2021 11:18:13 AM Central Daylight Time	SIMPRA ADVANTAGE, INC.	Simpra Advantage	www.simpra.com	Simpra Advantage Premier (PPO I-SNP)	01	04		1			H4091	003	0	2022	Alabama statewide		2		2			1	1	3				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	19	1		1			0	08/09/2021	2022.01	08/09/2021 12:36:31 PM Eastern Daylight Time	08/05/2021 07:33:37 PM Eastern Daylight Time	08/05/2021 07:33:37 PM Eastern Daylight Time			08/09/2021 01:29:05 PM Eastern Daylight Time	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Provider Partners Health Plans	www.pphealthplan.com	Provider Partners Pennsylvania Advantage Plan (HMO I-SNP)	01	01		1			H4093	001	0	2022	PA East & West Borders		2		2			1	1	1				www.pphealthplan.com	www.pphealthplan.com	www.pphealthplan.com	(800)405-9681		(800)405-9681		(800)405-9681		(800)405-9681		(844)846-8007		(844)846-8007		(800)405-9681		(800)405-9681		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4093	004	0	1	01	01	H4093_004_0	19	1		1			0	08/05/2021	2022.01	08/05/2021 05:29:36 PM Eastern Daylight Time	08/05/2021 07:33:37 PM Eastern Daylight Time	08/05/2021 07:33:37 PM Eastern Daylight Time			08/05/2021 07:41:08 PM Eastern Daylight Time	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Provider Partners Health Plans	www.pphealthplan.com	Provider Partners Pennsylvania Community Plan (HMO I-SNP)	01	01		1			H4093	004	0	2022	PA East & West Borders		2		2			1	1	2				www.pphealthplan.com	www.pphealthplan.com	www.pphealthplan.com	(800)405-9681		(800)405-9681		(800)405-9681		(800)405-9681		(844)846-8007		(844)846-8007		(800)405-9681		(800)405-9681		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4094	001	0	1	02	01	H4094_001_0	4	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 09:43:19 AM Central Daylight Time	08/03/2021 01:42:12 PM Central Daylight Time	07/29/2021 08:37:02 PM Central Daylight Time			08/04/2021 04:26:06 PM Central Daylight Time	OPTIMUM CHOICE, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Plan 2 (HMO-POS D-SNP)	01	02		1			H4094	001	0	2022	Montgomery County		2		2			1	3		1		1	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(844)855-9776		(844)855-9776		(888)834-3721		(888)834-3721		(844)855-9776		(844)855-9776		(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						06/03/2021	2022.01	06/03/2021 02:03:12 PM Eastern Daylight Time		05/27/2021 09:37:54 AM Eastern Daylight Time			06/03/2021 02:05:29 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	2022	Most 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						06/03/2021	2022.01	06/03/2021 02:03:38 PM Eastern Daylight Time		05/27/2021 09:47:54 AM Eastern Daylight Time			06/03/2021 02:05:29 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	2022	Most 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						06/01/2021	2022.01	06/01/2021 12:23:27 PM Eastern Daylight Time		05/26/2021 08:27:24 AM Eastern Daylight Time			06/01/2021 12:25:09 PM Eastern Daylight Time	THE WASHTENAW PACE	Huron Valley PACE	www.huronvalleypace.org	Huron Valley PACE - Dual Eligible (PACE)	08	20		1			H4118	001	0	2022	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						06/01/2021	2022.01	06/01/2021 12:23:55 PM Eastern Daylight Time		05/26/2021 08:28:00 AM Eastern Daylight Time			06/01/2021 12:25:09 PM Eastern Daylight Time	THE WASHTENAW PACE	Huron Valley PACE	www.huronvalleypace.org	Huron Valley PACE - Medicare Only (PACE)	08	20		1			H4118	002	0	2022	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	8	1					1	07/02/2021	2022.01	07/02/2021 11:30:37 AM Central Daylight Time	08/04/2021 03:57:48 PM Central Daylight Time	08/04/2021 08:59:47 AM Central Daylight Time			08/05/2021 06:26:51 PM Central Daylight Time	DOCTORS HEALTHCARE PLANS, INC.	Doctors HealthCare Plans, Inc.	www.doctorshcp.com	DrMax (HMO-POS)	01	02		1			H4140	001	0	2022	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	8	1	2	1			0	07/07/2021	2022.01	07/07/2021 11:35:20 AM Central Daylight Time	08/04/2021 03:59:11 PM Central Daylight Time	08/04/2021 09:04:44 AM Central Daylight Time			08/05/2021 06:26:51 PM Central Daylight Time	DOCTORS HEALTHCARE PLANS, INC.	Doctors HealthCare Plans, Inc.	www.doctorshcp.com	DrPlus (HMO-POS D-SNP)	01	02		1			H4140	002	0	2022	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	004	0	1	02	01	H4140_004_0	8	1		1			1	07/02/2021	2022.01	07/02/2021 11:31:01 AM Central Daylight Time	08/04/2021 04:00:33 PM Central Daylight Time	08/04/2021 09:05:41 AM Central Daylight Time			08/05/2021 06:26:51 PM Central Daylight Time	DOCTORS HEALTHCARE PLANS, INC.	Doctors HealthCare Plans, Inc.	www.doctorshcp.com	DrExtraCare (HMO-POS C-SNP)	01	02		1			H4140	004	0	2022	Miami-Dade County		2		2			1	4			00000000000000000100		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	005	0	1	02	01	H4140_005_0	8	1					0	07/02/2021	2022.01	07/02/2021 11:31:17 AM Central Daylight Time	08/04/2021 04:04:50 PM Central Daylight Time	08/04/2021 09:08:12 AM Central Daylight Time			08/05/2021 06:26:51 PM Central Daylight Time	DOCTORS HEALTHCARE PLANS, INC.	Doctors HealthCare Plans, Inc.	www.doctorshcp.com	DrValue (HMO-POS)	01	02		1			H4140	005	0	2022	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	006	0	1	02	01	H4140_006_0	7	1					0	07/02/2021	2022.01	07/02/2021 11:31:54 AM Central Daylight Time	08/04/2021 04:07:14 PM Central Daylight Time	08/04/2021 09:09:18 AM Central Daylight Time			08/05/2021 06:26:51 PM Central Daylight Time	DOCTORS HEALTHCARE PLANS, INC.	Doctors HealthCare Plans, Inc.	www.doctorshcp.com	DrFirst (HMO-POS)	01	02		1			H4140	006	0	2022	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	007	0	1	02	01	H4140_007_0	7	1					0	07/02/2021	2022.01	07/02/2021 11:32:06 AM Central Daylight Time	08/04/2021 04:09:36 PM Central Daylight Time	08/04/2021 09:10:11 AM Central Daylight Time			08/05/2021 06:26:51 PM Central Daylight Time	DOCTORS HEALTHCARE PLANS, INC.	Doctors HealthCare Plans, Inc.	www.doctorshcp.com	DrChoice (HMO-POS)	01	02		1			H4140	007	0	2022	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	009	0	1	02	01	H4140_009_0	7	1					1	07/02/2021	2022.01	07/02/2021 11:32:28 AM Central Daylight Time	08/04/2021 04:13:00 PM Central Daylight Time	08/04/2021 09:13:03 AM Central Daylight Time			08/05/2021 06:26:51 PM Central Daylight Time	DOCTORS HEALTHCARE PLANS, INC.	Doctors HealthCare Plans, Inc.	www.doctorshcp.com	DrMax-B (HMO-POS)	01	02		1			H4140	009	0	2022	Broward 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	010	0	1	02	01	H4140_010_0	7	1	2	1			0	07/02/2021	2022.01	07/02/2021 12:01:36 PM Central Daylight Time	08/04/2021 04:14:11 PM Central Daylight Time	08/04/2021 09:14:25 AM Central Daylight Time			08/05/2021 06:26:51 PM Central Daylight Time	DOCTORS HEALTHCARE PLANS, INC.	Doctors HealthCare Plans, Inc.	www.doctorshcp.com	DrPlus-B (HMO-POS D-SNP)	01	02		1			H4140	010	0	2022	Broward 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	011	0	1	02	01	H4140_011_0	7	1					0	08/04/2021	2022.01	08/04/2021 03:32:11 PM Central Daylight Time	08/04/2021 04:15:51 PM Central Daylight Time	08/04/2021 09:15:26 AM Central Daylight Time			08/05/2021 06:26:51 PM Central Daylight Time	DOCTORS HEALTHCARE PLANS, INC.	Doctors HealthCare Plans, Inc.	www.doctorshcp.com	DrValue-B (HMO-POS)	01	02		1			H4140	011	0	2022	Broward 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			
H4141	003	0	1	01	01	H4141_003_0	4	1	2	1	1		0	07/22/2021	2022.01	07/22/2021 04:10:13 PM Eastern Daylight Time	08/03/2021 05:33:03 PM Eastern Daylight Time	07/30/2021 10:41:24 AM Eastern Daylight Time			08/04/2021 02:06:50 PM Eastern Daylight Time	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H4141-003 (HMO D-SNP)	01	01		1			H4141	003	0	2022	Greater Georgia Area		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		1	08/02/2021	2022.01	08/02/2021 12:03:28 PM Eastern Daylight Time	08/03/2021 05:29:48 PM Eastern Daylight Time	07/30/2021 10:41:36 AM Eastern Daylight Time			08/04/2021 02:06:50 PM 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	2022	Atlanta Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			2		1	07/31/2021	2022.01	07/31/2021 02:58:15 PM Eastern Daylight Time	08/03/2021 05:32:43 PM Eastern Daylight Time	08/03/2021 09:59:54 AM Eastern Daylight Time			08/04/2021 01:38:25 PM 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	2022	Select counties in Georgia	Select counties in Georgia	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			2		1	07/22/2021	2022.01	07/22/2021 04:55:41 PM Eastern Daylight Time	08/03/2021 05:31:25 PM Eastern Daylight Time	08/03/2021 10:01:58 AM Eastern Daylight Time			08/04/2021 01:38:25 PM 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	2022	Select counties in Georgia	Select counties in Georgia	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1	01	01	H4141_017_5	3	1			2		1	07/31/2021	2022.01	07/31/2021 02:58:47 PM Eastern Daylight Time	08/03/2021 05:48:25 PM Eastern Daylight Time	08/03/2021 10:04:34 AM Eastern Daylight Time			08/04/2021 01:38:25 PM 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	5	2022	Select counties in Georgia	Select counties in Georgia	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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						05/25/2021	2022.01	05/25/2021 03:11:52 PM Eastern Daylight Time					06/04/2021 08:33:40 AM 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	2022	Select counties in Georgia		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242		(866)396-8810		(866)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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H4141	802	0	1	01	01	H4141_802_0	1	1				0	0	05/25/2021	2022.01	05/25/2021 03:14:06 PM Eastern Daylight Time					06/04/2021 08:33:40 AM 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	2022	Select counties in Georgia		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H4141	805	0	1	01	01	H4141_805_0	1	1						05/27/2021	2022.01	05/27/2021 03:55:47 PM Eastern Daylight Time					06/04/2021 08:33:40 AM Eastern Daylight Time	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H4141	805	0	2022	Select counties in Georgia		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242		(866)396-8810		(866)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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					2				
H4141	806	0	1	01	01	H4141_806_0	1	1				0	0	05/27/2021	2022.01	05/27/2021 03:57:53 PM Eastern Daylight Time					06/04/2021 08:33:40 AM Eastern Daylight Time	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H4141	806	0	2022	Select counties in Georgia		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					2				
H4142	001	0	1	20	08	H4142_001_0	1	1						06/02/2021	2022.01	06/02/2021 09:22:40 AM Central Daylight Time		06/02/2021 09:17:59 AM Central Daylight Time			06/02/2021 09:24:28 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	2022	Cherokee and surrounding counties		2		2			2						N/A	N/A										(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						06/02/2021	2022.01	06/02/2021 09:23:05 AM Central Daylight Time		06/02/2021 09:18:15 AM Central Daylight Time			06/02/2021 09:24:28 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	2022	Cherokee and surrounding counties		2		2			2						N/A	N/A										(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	8	1			2	0	0	07/22/2021	2022.01	07/22/2021 09:14:49 AM Eastern Daylight Time	07/22/2021 09:09:48 AM Eastern Daylight Time				07/22/2021 09:24:58 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 Core (HMO)	01	01		1			H4152	004	0	2022	State of Rhode Island		2	7759	2			2						www.BCBSRI.com/Medicare	www.BCBSRI.com/Medicare	https://www.bcbsri.com/finddoctor	(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	10	1			2		1	08/06/2021	2022.01	08/06/2021 12:11:31 PM Eastern Daylight Time	08/06/2021 02:29:02 PM Eastern Daylight Time	08/05/2021 08:54:16 AM Eastern Daylight Time			08/06/2021 03:57:28 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 Plus (HMO)	01	01		1			H4152	005	0	2022	State of Rhode Island		2	21375	2			2						www.BCBSRI.com/Medicare	www.BCBSRI.com/Medicare	https://www.bcbsri.com/finddoctor	(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	10	1			2		1	07/15/2021	2022.01	07/15/2021 11:15:28 AM Eastern Daylight Time	08/06/2021 02:29:04 PM Eastern Daylight Time	08/05/2021 08:54:19 AM Eastern Daylight Time			08/06/2021 03:57:28 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 Preferred (HMO-POS)	01	02		1			H4152	007	0	2022	State of Rhode Island		2	8184	2			2						www.BCBSRI.com/Medicare	www.BCBSRI.com/Medicare	https://www.bcbsri.com/finddoctor	(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	10	1			2		1	07/22/2021	2022.01	07/22/2021 09:18:23 AM Eastern Daylight Time	08/06/2021 02:28:58 PM Eastern Daylight Time	08/05/2021 08:54:24 AM Eastern Daylight Time			08/06/2021 03:57:28 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 Standard with Drugs (HMO)	01	01		1			H4152	013	0	2022	State of Rhode Island		2	35089	2			2						www.BCBSRI.com/Medicare	www.BCBSRI.com/Medicare	https://www.bcbsri.com/finddoctor	(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	9	1			2		1	07/22/2021	2022.01	07/22/2021 09:18:02 AM Eastern Daylight Time	08/05/2021 08:54:26 AM Eastern Daylight Time	08/05/2021 08:53:58 AM Eastern Daylight Time			08/05/2021 01:26:32 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 Advance (HMO)	01	01		1			H4152	017	0	2022	State of Rhode Island		2	21255	2			2						www.BCBSRI.com/Medicare	www.BCBSRI.com/Medicare	https://www.bcbsri.com/finddoctor	(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	9	1			2		1	07/15/2021	2022.01	07/15/2021 11:24:55 AM Eastern Daylight Time	08/05/2021 08:54:00 AM Eastern Daylight Time	08/05/2021 08:54:01 AM Eastern Daylight Time			08/05/2021 01:26:32 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 Extra (HMO-POS)	01	02		1			H4152	018	0	2022	State of Rhode Island		2	28377	2			2						www.BCBSRI.com/Medicare	www.BCBSRI.com/Medicare	https://www.bcbsri.com/finddoctor	(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	020	0	1	02	01	H4152_020_0	11	1			1		1	07/21/2021	2022.01	07/21/2021 08:43:53 AM Eastern Daylight Time	08/05/2021 08:54:03 AM Eastern Daylight Time	08/05/2021 08:54:05 AM Eastern Daylight Time			08/05/2021 01:26:32 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 Value (HMO-POS)	01	02		1			H4152	020	0	2022	State of Rhode Island		2	463610	2			2						www.BCBSRI.com/Medicare	www.BCBSRI.com/Medicare	https://www.bcbsri.com/finddoctor	(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	021	0	1	01	01	H4152_021_0	7	1	2	1	2		0	08/03/2021	2022.01	08/03/2021 02:42:17 PM Eastern Daylight Time	08/05/2021 08:54:07 AM Eastern Daylight Time	08/05/2021 08:54:09 AM Eastern Daylight Time			08/05/2021 01:26:32 PM Eastern Daylight Time	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Blue Cross & Blue Shield of Rhode Island	www.BCBSRI.com/Medicare	BlueRI for Duals (HMO D-SNP)	01	01		1			H4152	021	0	2022	State of Rhode Island		2	37320	2			1	3		1		2	www.BCBSRI.com/Medicare	www.BCBSRI.com/Medicare	https://www.bcbsri.com/finddoctor	(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	815	0	1	02	01	H4152_815_0	6	1						06/07/2021	2022.01	06/07/2021 01:31:54 PM Eastern Daylight Time					06/07/2021 04:58:56 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	2022	RI, Bristol Cty MA, Partial New London Cty CT		1	33985	2			2						www.BCBSRI.com/Medicare	www.BCBSRI.com/Medicare	https://www.bcbsri.com/finddoctor	(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	817	0	1	01	01	H4152_817_0	6	1						06/07/2021	2022.01	06/07/2021 11:30:01 AM Eastern Daylight Time					06/07/2021 04:58:56 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	2022	RI, Bristol Cty MA, Partial New London Cty CT		1	5548	2			2						www.BCBSRI.com/Medicare	www.BCBSRI.com/Medicare	https://www.bcbsri.com/finddoctor	(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			
H4172	001	0	1	01	01	H4172_001_0	7	1		1			0	08/04/2021	2022.01	08/04/2021 08:35:48 AM Central Daylight Time	08/04/2021 11:52:36 AM Central Daylight Time	08/02/2021 12:21:57 PM Central Daylight Time			08/05/2021 11:18:13 AM Central Daylight Time	NHC ADVANTAGE, LLC	NHC Advantage	www.nhcadvantageplan.com	NHC Advantage (HMO I-SNP)	01	01		1			H4172	001	0	2022	Missouri (partial) Tennessee (partial)		2		2			1	1	3				www.nhcadvantageplan.com	www.nhcadvantageplan.com	www.nhcadvantageplan.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			
H4185	001	0	1	20	08	H4185_001_0	1	1						06/15/2021	2022.01	06/15/2021 12:23:12 PM Pacific Daylight Time		06/15/2021 12:22:11 PM Pacific Daylight Time			06/15/2021 12:24:22 PM Pacific Daylight Time	NEIGHBORHOOD HEALTHCARE	Neighborhood Healthcare PACE	www.nhcarepace.org	Neighborhood Healthcare PACE Dual Eligible (PACE)	08	20		1			H4185	001	0	2022	Riverside and San Bernardino Counties		2		2			2						www.nhcarepace.org	https://www.Nhcarepace.org	www.nhcarepace.org											(844)642-7223				(844)642-7223												(711)-				(711)-																
H4185	002	0	1	20	08	H4185_002_0	1	1						06/15/2021	2022.01	06/15/2021 12:23:32 PM Pacific Daylight Time		06/15/2021 12:22:11 PM Pacific Daylight Time			06/15/2021 12:24:22 PM Pacific Daylight Time	NEIGHBORHOOD HEALTHCARE	Neighborhood Healthcare PACE	www.nhcarepace.org	Neighborhood Healthcare PACE Medicare Only (PACE)	08	20		1			H4185	002	0	2022	Riverside and San Bernardino Counties		2		2			2						www.nhcarepace.org	https://www.Nhcarepace.org	www.nhcarepace.org											(844)642-7223				(844)642-7223												(711)-				(711)-																
H4198	007	0	1	01	01	H4198_007_0	6	1				0	0	07/12/2021	2022.01	07/12/2021 04:21:27 PM Central Daylight Time	06/07/2021 03:06:00 PM Central Daylight Time				07/13/2021 12:34:54 PM Central Daylight Time	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	CommunityCare Advantage Medicare Plan (HMO)	www.ccokadvantage.com/2022/Integris	Integris Health Partners+ Choice (HMO)	01	01		1			H4198	007	0	2022	Select Oklahoma counties		2		2			2						www.ccokadvantage.com/2022/AMP/Pharmacy-and-Rx-Inf	www.medicareplanrx.com/jccf/ccok_amp_formulary_22.html	www.ccokadvantage.com/2022/Integris	(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	008	0	1	01	01	H4198_008_0	8	1					1	08/04/2021	2022.01	08/04/2021 08:46:21 AM Central Daylight Time	08/05/2021 04:37:12 PM Central Daylight Time	08/05/2021 04:38:41 PM Central Daylight Time			08/05/2021 04:41:48 PM Central Daylight Time	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	CommunityCare Advantage Medicare Plan (HMO)	www.ccokadvantage.com/2022/Integris	Integris Health Partners+ Deluxe (HMO)	01	01		1			H4198	008	0	2022	Select Oklahoma counties		2		2			2						www.ccokadvantage.com/2022/AMP/Pharmacy-and-Rx-Info.asp	www.medicareplanrx.com/jccf/ccok_amp_formulary_22.html	www.ccokadvantage.com/2022/Integris	(800)333-3275		(918)594-5202		(800)333-3275		(918)594-5202		(877)293-8628		(918)594-5211		(800)333-3275		(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		2					2					2	2			
H4198	009	0	1	01	01	H4198_009_0	10	1					1	08/04/2021	2022.01	08/04/2021 08:46:44 AM Central Daylight Time	08/05/2021 04:37:21 PM Central Daylight Time	08/05/2021 04:38:50 PM Central Daylight Time			08/05/2021 04:41:48 PM Central Daylight Time	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	CommunityCare Advantage Medicare Plan (HMO)	www.ccokadvantage.com/2022/Integris	Integris Health Partners+ Premier (HMO)	01	01		1			H4198	009	0	2022	Select Oklahoma counties		2		2			2						www.ccokadvantage.com/2022/AMP/Pharmacy-and-Rx-Info.asp	www.medicareplanrx.com/jccf/ccok_amp_formulary_22.html	www.ccokadvantage.com/2022/Integris	(800)333-3275		(918)594-5202		(800)333-3275		(918)594-5202		(877)293-8628		(918)594-5202		(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			
H4203	001	0	1	20	08	H4203_001_0	1	1						06/04/2021	2022.01	06/04/2021 10:38:24 AM Eastern Daylight Time		06/04/2021 09:52:06 AM Eastern Daylight Time			06/04/2021 12:57:37 PM Eastern Daylight Time	PRISMA HEALTH-MIDLANDS	Palmetto SeniorCare PACE	Palmettohealth.org	Prisma Health PACE-Midlands - Dual Eligible (PACE)	08	20		1			H4203	001	0	2022	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						06/04/2021	2022.01	06/04/2021 10:38:34 AM Eastern Daylight Time		06/04/2021 09:52:27 AM Eastern Daylight Time			06/04/2021 12:57:37 PM Eastern Daylight Time	PRISMA HEALTH-MIDLANDS	Palmetto SeniorCare PACE	Palmettohealth.org	Prisma Health PACE-Midlands - Medicare Only (PACE)	08	20		1			H4203	002	0	2022	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	3	1				0	0	07/14/2021	2022.01	07/14/2021 02:26:03 PM Central Daylight Time	06/04/2021 10:44:26 AM Central Daylight Time				07/14/2021 02:50:02 PM Central Daylight Time	USABLE MUTUAL INSURANCE COMPANY	Arkansas Blue Medicare	www.arkansasbluecross.com/medicare	BlueMedicare Value (PFFS)	04	09	1	1			H4213	016	1	2022	State of Arkansas	Northern, Western and South Central AR counties	2	20790	2			2						www.arkansasbluecross.com/medicare	www.arkansasbluecross.com/medicare	www.arkansasbluecross.com	(877)233-7022		(877)233-7022		(888)605-0322		(888)605-0322										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H4213	016	3	1	09	04	H4213_016_3	3	1				0	0	07/14/2021	2022.01	07/14/2021 02:28:06 PM Central Daylight Time	06/04/2021 10:44:56 AM Central Daylight Time				07/14/2021 02:50:02 PM Central Daylight Time	USABLE MUTUAL INSURANCE COMPANY	Arkansas Blue Medicare	www.arkansasbluecross.com/medicare	BlueMedicare Value (PFFS)	04	09	1	1			H4213	016	3	2022	State of Arkansas	Northwest, Western and Central AR counties	2	5985	2			2						www.arkansasbluecross.com/medicare	www.arkansasbluecross.com/medicare	www.arkansasbluecross.com	(877)233-7022		(877)233-7022		(888)605-0322		(888)605-0322										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H4213	016	4	1	09	04	H4213_016_4	3	1				0	0	07/14/2021	2022.01	07/14/2021 02:29:59 PM Central Daylight Time	06/04/2021 10:45:36 AM Central Daylight Time				07/14/2021 02:50:02 PM Central Daylight Time	USABLE MUTUAL INSURANCE COMPANY	Arkansas Blue Medicare	www.arkansasbluecross.com/medicare	BlueMedicare Value (PFFS)	04	09	1	1			H4213	016	4	2022	State of Arkansas	East Central AR counties	2	3929	2			2						www.arkansasbluecross.com/medicare	www.arkansasbluecross.com/medicare	www.arkansasbluecross.com	(877)233-7022		(877)233-7022		(888)605-0322		(888)605-0322										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H4213	017	1	1	09	04	H4213_017_1	5	1						07/14/2021	2022.01	07/14/2021 02:31:26 PM Central Daylight Time	08/04/2021 05:13:08 PM Central Daylight Time	08/04/2021 05:18:18 PM Central Daylight Time			08/04/2021 05:33:00 PM Central Daylight Time	USABLE MUTUAL INSURANCE COMPANY	Arkansas Blue Medicare	www.arkansasbluecross.com/medicare	BlueMedicare Preferred (PFFS)	04	09	1	1			H4213	017	1	2022	State of Arkansas	Northern, Western and South Central AR counties	2	10512	2			2						www.arkansasbluecross.com/medicare	www.arkansasbluecross.com/medicare	www.arkansasbluecross.com	(877)233-7022		(877)233-7022		(888)605-0322		(888)605-0322		(877)233-7022		(877)233-7022		(888)605-0322		(888)605-0322		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4213	017	5	1	09	04	H4213_017_5	5	1						07/14/2021	2022.01	07/14/2021 02:32:20 PM Central Daylight Time	08/04/2021 05:13:13 PM Central Daylight Time	08/04/2021 05:18:22 PM Central Daylight Time			08/04/2021 05:33:00 PM Central Daylight Time	USABLE MUTUAL INSURANCE COMPANY	Arkansas Blue Medicare	www.arkansasbluecross.com/medicare	BlueMedicare Preferred (PFFS)	04	09	1	1			H4213	017	5	2022	State of Arkansas	Northwest, Western and Central AR counties	2	10290	2			2						www.arkansasbluecross.com/medicare	www.arkansasbluecross.com/medicare	www.arkansasbluecross.com	(877)233-7022		(877)233-7022		(888)605-0322		(888)605-0322		(877)233-7022		(877)233-7022		(888)605-0322		(888)605-0322		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4213	017	6	1	09	04	H4213_017_6	5	1						07/14/2021	2022.01	07/14/2021 02:33:20 PM Central Daylight Time	08/04/2021 05:13:17 PM Central Daylight Time	08/04/2021 05:18:26 PM Central Daylight Time			08/04/2021 05:33:00 PM Central Daylight Time	USABLE MUTUAL INSURANCE COMPANY	Arkansas Blue Medicare	www.arkansasbluecross.com/medicare	BlueMedicare Preferred (PFFS)	04	09	1	1			H4213	017	6	2022	State of Arkansas	East Central AR counties	2	3026	2			2						www.arkansasbluecross.com/medicare	www.arkansasbluecross.com/medicare	www.arkansasbluecross.com	(877)233-7022		(877)233-7022		(888)605-0322		(888)605-0322		(877)233-7022		(877)233-7022		(888)605-0322		(888)605-0322		(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			0	08/04/2021	2022.01	08/04/2021 04:19:45 PM Central Daylight Time	08/04/2021 12:05:57 PM Central Daylight Time	08/04/2021 12:03:38 PM Central Daylight Time			08/05/2021 12:11:22 PM Central Daylight Time	VISTA HEALTH PLAN, INC.	VISTA Health Plan Inc.	www.keystonefirstvipchoice.com	Keystone First VIP Choice (HMO D-SNP)	01	01		1			H4227	001	0	2022	Southeastern 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			0	08/04/2021	2022.01	08/04/2021 04:34:37 PM Central Daylight Time	08/04/2021 12:06:57 PM Central Daylight Time	08/04/2021 12:04:19 PM Central Daylight Time			08/05/2021 12:11:22 PM Central Daylight Time	VISTA HEALTH PLAN, INC.	VISTA Health Plan Inc.	www.amerihealthcaritasvipcare.com	AmeriHealth Caritas VIP Care (HMO D-SNP)	01	01		1			H4227	002	0	2022	Northeast, Central and Western 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			
H4232	001	0	1	01	01	H4232_001_0	2	1		1			0	08/03/2021	2022.01	08/03/2021 11:18:36 AM Central Daylight Time	08/05/2021 08:08:03 AM Central Daylight Time	08/05/2021 08:08:21 AM Central Daylight Time			08/05/2021 08:38:26 AM Central Daylight Time	AMERICAN HEALTH PLAN OF UT, INC.	American Health Advantage of Utah	ut.amhealthplans.com	American Health Advantage of Utah (HMO I-SNP)	01	01		1			H4232	001	0	2022	North and Central Utah		2	2413	2			1	1	3				ut.amhealthplans.com	ut.amhealthplans.com	ut.amhealthplans.com	(855)521-0627		(855)521-0627		(855)521-0627		(855)521-0627		(855)521-0627		(855)521-0627		(855)521-0627		(855)521-0627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4232	002	0	1	01	01	H4232_002_0	2	1		1			0	08/03/2021	2022.01	08/03/2021 11:19:26 AM Central Daylight Time	08/05/2021 08:08:03 AM Central Daylight Time	08/05/2021 08:08:22 AM Central Daylight Time			08/05/2021 08:38:26 AM Central Daylight Time	AMERICAN HEALTH PLAN OF UT, INC.	American Health Advantage of Utah	ut.amhealthplans.com	American Health Advantage of Utah Gold (HMO I-SNP)	01	01		1			H4232	002	0	2022	Utah		2		2			1	1	3				ut.amhealthplans.com	ut.amhealthplans.com	ut.amhealthplans.com	(855)521-0627		(855)521-0627		(855)521-0627		(855)521-0627		(855)521-0627		(855)521-0627		(855)521-0627		(855)521-0627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4232	003	0	1	01	01	H4232_003_0	2	1		1			0	08/03/2021	2022.01	08/03/2021 11:20:11 AM Central Daylight Time	08/05/2021 08:08:03 AM Central Daylight Time	08/05/2021 08:08:22 AM Central Daylight Time			08/05/2021 08:38:26 AM Central Daylight Time	AMERICAN HEALTH PLAN OF UT, INC.	American Health Advantage of Utah	ID.Amhealthplans.com	American Health Advantage of Idaho (HMO I-SNP)	01	01		1			H4232	003	0	2022	South Idaho		2		2			1	1	3				ID.Amhealthplans.com	ID.Amhealthplans.com	ID.Amhealthplans.com	(855)521-0627		(855)521-0627		(855)521-0627		(855)521-0627		(855)521-0627		(855)521-0627		(855)521-0627		(855)521-0627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4235	001	0	1	20	08	H4235_001_0	1	1						06/03/2021	2022.01	06/03/2021 10:59:54 AM Eastern Daylight Time		06/03/2021 10:55:06 AM Eastern Daylight Time			06/03/2021 11:08:20 AM 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	2022	Gaston County and Parts of Cleveland and Lincoln		2		2			2						n/a	n/a	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						06/02/2021	2022.01	06/02/2021 04:54:40 PM Eastern Daylight Time		06/03/2021 10:55:06 AM Eastern Daylight Time			06/03/2021 11:08:20 AM 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	2022	Gaston, Lincoln and Cleveland Counties in NC		2		2			2						n/a	n/a	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																
H4256	001	0	1	20	08	H4256_001_0	1	1						06/02/2021	2022.01	06/02/2021 02:37:55 PM Eastern Daylight Time		06/02/2021 02:36:56 PM Eastern Daylight Time			06/02/2021 02:43:41 PM Eastern Daylight Time	PACE NORTH, INC.	PACE North	www.pacenorth.org	PACE North, Inc (PACE)	08	20		1			H4256	001	0	2022	Grand Traverse, Benz, Leel,Wexf, Kalk, Antr, Mani		2		2			2						KalamazooLTCPharmacy.com	N/A												(231)252-2767				(231)252-2767										(833)410-2082		(833)410-2082				(833)410-2082																
H4256	002	0	1	20	08	H4256_002_0	1	1						06/02/2021	2022.01	06/02/2021 02:38:10 PM Eastern Daylight Time		06/02/2021 02:36:55 PM Eastern Daylight Time			06/02/2021 02:43:41 PM Eastern Daylight Time	PACE NORTH, INC.	PACE North	www.pacenorth.org	PACE North, Inc (PACE)	08	20		1			H4256	002	0	2022	Grand Traverse, Benz, Leel,Wexf, Kalk, Antr, Mani		2		2			2						KalamazooLTCPharmacy.com	N/A												(231)252-2767				(231)252-2767												(833)410-2082				(833)410-2082																
H4279	001	0	1	01	01	H4279_001_0	7	1	2	1			0	08/04/2021	2022.01	08/04/2021 02:50:27 PM Eastern Daylight Time	08/05/2021 08:15:05 AM Eastern Daylight Time	08/05/2021 12:27:15 PM Eastern Daylight Time			08/05/2021 01:57:30 PM Eastern Daylight Time	UPMC FOR YOU, INC	UPMC for Life Complete Care	https://www.upmchealthplan.com/snp/	UPMC for Life Complete Care (HMO D-SNP)	01	01		1			H4279	001	0	2022	Western Pennsylvania		2	479675	2			1	3		1		1	https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/	https://findcare.upmchealthplan.com/browse?caretype=Medical	(800)606-8648		(800)606-8648		(866)405-8762		(866)405-8762		(800)606-8648		(800)606-8648		(866)405-8762		(866)405-8762		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4279	004	0	1	01	01	H4279_004_0	6	1	2	1			0	08/04/2021	2022.01	08/04/2021 02:50:49 PM Eastern Daylight Time	08/05/2021 08:15:08 AM Eastern Daylight Time	08/05/2021 12:27:17 PM Eastern Daylight Time			08/05/2021 01:57:30 PM Eastern Daylight Time	UPMC FOR YOU, INC	UPMC for Life Complete Care	https://www.upmchealthplan.com/snp/	UPMC for Life Complete Care (HMO D-SNP)	01	01		1			H4279	004	0	2022	Eastern Pennsylvania		2	3768	2			1	3		1		1	https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/	https://findcare.upmchealthplan.com/browse?caretype=Medical	(800)606-8648		(800)606-8648		(866)405-8762		(866)405-8762		(800)606-8648		(800)606-8648		(866)405-8762		(866)405-8762		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4286	001	0	1	01	01	H4286_001_0	6	1					0	08/03/2021	2022.01	08/03/2021 04:34:46 PM Mountain Daylight Time	08/03/2021 04:20:56 PM Central Daylight Time	08/09/2021 10:36:32 AM Central Daylight Time			08/10/2021 10:00:12 AM Central Daylight Time	LEON HEALTH PLANS, INC.	Leon Health Plans	www.leonhealth.com	Leon MediExtra (HMO)	01	01		1			H4286	001	0	2022	Leon MediExtra Miami Dade		2	208501	2			2						www.leonhealth.com	www.leonhealth.com	www.leonhealth.com	(844)969-5366		(305)541-5366		(844)969-5366		(305)541-5366		(844)969-5366		(305)541-5366		(844)969-5366		(305)541-5366		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4286	002	0	1	01	01	H4286_002_0	9	1	2	1			0	08/03/2021	2022.01	08/03/2021 04:32:18 PM Mountain Daylight Time	08/03/2021 02:45:51 PM Central Daylight Time	07/30/2021 08:51:04 AM Central Daylight Time			08/04/2021 02:04:53 PM Central Daylight Time	LEON HEALTH PLANS, INC.	Leon Health Plans	www.leonhealth.com	Leon MediDual (HMO D-SNP)	01	01		1			H4286	002	0	2022	Leon MediDual Miami Dade		2	230000	2			1	3		2		2	www.leonhealth.com	www.leonhealth.com	www.leonhealth.com	(844)969-5366		(305)541-5366		(844)969-5366		(305)541-5366		(844)969-5366		(305)541-5366		(844)969-5366		(305)541-5366		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4286	003	0	1	01	01	H4286_003_0	4	1					0	08/03/2021	2022.01	08/03/2021 04:34:28 PM Mountain Daylight Time	08/03/2021 04:25:41 PM Central Daylight Time	07/30/2021 09:01:27 AM Central Daylight Time			08/04/2021 02:04:53 PM Central Daylight Time	LEON HEALTH PLANS, INC.	Leon Health Plans	www.leonhealth.com	Leon MediMore (HMO)	01	01		1			H4286	003	0	2022	Leon MediMore Miami Dade		2	10999	2			2						www.leonhealth.com	www.leonhealth.com	www.leonhealth.com	(844)969-5366		(305)541-5366		(844)969-5366		(305)541-5366		(844)969-5366		(305)541-5366		(844)969-5366		(305)541-5366		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4304	001	0	1	04	01	H4304_001_0	7	1					1	08/05/2021	2022.01	08/05/2021 11:06:41 AM Mountain Daylight Time	08/05/2021 11:00:29 AM Mountain Daylight Time	08/05/2021 11:00:00 AM Mountain Daylight Time			08/05/2021 11:56:56 AM Mountain Daylight Time	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Advantage U	www.AdvantageUMedicare.com	Advantage U Signature (PPO)	01	04		1			H4304	001	0	2022	Davis, Salt Lake, Tooele, Utah and Weber Counties		2		2			2						www.AdvantageUMedicare.com	www.AdvantageUMedicare.com	www.AdvantageUMedicare.com	(855)275-0374		(855)275-0374		(855)275-0374		(855)275-0374		(888)970-0851		(888)970-0851		(855)275-0374		(855)275-0374		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4304	801	0	1	04	01	H4304_801_0	5	1						06/07/2021	2022.01	06/07/2021 07:52:46 AM Mountain Daylight Time					07/20/2021 08:17:21 PM Mountain Daylight Time	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Advantage U	www.AdvantageUMedicare.com	Advantage U CY EWGP (PPO)	01	04		1			H4304	801	0	2022	Davis, Salt Lake, Tooele, Utah and Weber Counties		1	100	2			2						www.AdvantageUMedicare.com	www.AdvantageUMedicare.com	www.AdvantageUMedicare.com	(855)275-0374		(855)275-0374		(855)275-0374		(855)275-0374		(855)275-0374		(855)275-0374		(855)275-0374		(855)275-0374		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H4304	802	0	1	04	01	H4304_802_0	5	1						06/07/2021	2022.01	06/07/2021 07:55:03 AM Mountain Daylight Time					07/20/2021 08:17:21 PM Mountain Daylight Time	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Advantage U	www.AdvantageUMedicare.com	Advantage U BY EWGP (PPO)	01	04		1			H4304	802	0	2022	Davis, Salt Lake, Tooele, Utah and Davis Counties		1	100	2			2						www.AdvantageUMedicare.com	www.AdvantageUMedicare.com	www.AdvantageUMedicare.com	(855)275-0374		(855)275-0374		(855)275-0374		(855)275-0374		(855)275-0374		(855)275-0374		(855)275-0374		(855)275-0374		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					2				
H4304	803	0	1	04	01	H4304_803_0	5	1				0	0	06/07/2021	2022.01	06/07/2021 07:56:31 AM Mountain Daylight Time					07/20/2021 08:17:21 PM Mountain Daylight Time	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Advantage U	www.AdvantageUMedicare.com	Advantage U EWGP MA ONLY (PPO)	01	04		1			H4304	803	0	2022	Davis, Salt Lake, Tooele, Utah and Weber Counties		1	100	2			2						www.AdvantageUMedicare.com	www.AdvantageUMedicare.com	www.AdvantageUMedicare.com	(855)275-0374		(855)275-0374		(855)275-0374		(855)275-0374										(711)-		(711)-		(711)-		(711)-										1	2		2		1					2				
H4305	001	0	1	20	08	H4305_001_0	1	1						06/02/2021	2022.01	06/02/2021 12:31:07 PM Central Daylight Time		05/28/2021 01:01:41 PM Central Daylight Time			06/02/2021 12:33:51 PM Central Daylight Time	TOTAL LIFE HEALTHCARE	Total Life Healthcare	www.stbernards.info/	Total Life Healthcare Dual (PACE)	08	20		1			H4305	001	0	2022	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						06/02/2021	2022.01	06/02/2021 12:31:20 PM Central Daylight Time		05/28/2021 01:01:51 PM Central Daylight Time			06/02/2021 12:33:51 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	2022	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						06/03/2021	2022.01	06/03/2021 01:07:42 PM Eastern Daylight Time		06/03/2021 01:05:09 PM Eastern Daylight Time			06/03/2021 01:09:57 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	2022	Catawba Co. and Surrounding Select Zip Codes		2		2			2						www.carekinesis.com	www.pace-at-home.org										(828)468-3980		(828)468-3980		(828)468-3980		(828)468-3980										(180)073-5296		(180)073-5296		(180)073-5296		(180)073-5296																
H4326	002	0	1	20	08	H4326_002_0	1	1						06/03/2021	2022.01	06/03/2021 01:08:03 PM Eastern Daylight Time		06/03/2021 01:05:09 PM Eastern Daylight Time			06/03/2021 01:09:57 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	2022	Catawba Co. and Surrounding Select Zip Codes		2		2			2						www.carekinesis.com	www.pace-at-home.org										(828)468-3980		(828)468-3980		(828)468-3980		(828)468-3980										(180)073-5296		(180)073-5296		(180)073-5296		(180)073-5296																
H4343	001	0	1	01	01	H4343_001_0	4	1					0	08/02/2021	2022.01	08/02/2021 04:06:03 PM Central Daylight Time	08/03/2021 11:11:35 PM Central Daylight Time	07/30/2021 10:20:38 AM Central Daylight Time			08/04/2021 10:17:29 PM Central Daylight Time	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Ascension Complete	ascensioncomplete.com	Ascension Complete St. Vincent's Reward (HMO)	01	01		1			H4343	001	0	2022	Birmingham & Surrounding Counties in Alabama		2	598	2			2						ascensioncomplete.com/findadoctor	ascensioncomplete.com/formulary	ascensioncomplete.com/findadoctor	(833)623-0771		(833)623-0771		(844)578-1926		(844)578-1926		(833)623-0771		(833)623-0771		(844)578-1926		(844)578-1926		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4343	002	0	1	01	01	H4343_002_0	4	1					0	08/02/2021	2022.01	08/02/2021 04:06:19 PM Central Daylight Time	08/03/2021 11:12:04 PM Central Daylight Time	07/30/2021 10:21:00 AM Central Daylight Time			08/04/2021 10:17:29 PM Central Daylight Time	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Ascension Complete	ascensioncomplete.com	Ascension Complete Providence Reward (HMO)	01	01		1			H4343	002	0	2022	Mobile area in Alabama		2	133	2			2						ascensioncomplete.com/findadoctor	ascensioncomplete.com/formulary	ascensioncomplete.com/findadoctor	(833)623-0771		(833)623-0771		(844)578-1926		(844)578-1926		(833)623-0771		(833)623-0771		(844)578-1926		(844)578-1926		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4343	003	0	1	01	01	H4343_003_0	4	1					0	08/02/2021	2022.01	08/02/2021 04:07:24 PM Central Daylight Time	08/03/2021 11:12:32 PM Central Daylight Time	07/30/2021 10:21:22 AM Central Daylight Time			08/04/2021 10:17:29 PM Central Daylight Time	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Ascension Complete	ascensioncomplete.com	Ascension Complete St. Vincent's Secure (HMO)	01	01		1			H4343	003	0	2022	Birmingham surrounding counties in Alabama		2	4331	2			2						ascensioncomplete.com/findadoctor	ascensioncomplete.com/formulary	ascensioncomplete.com/findadoctor	(833)623-0771		(833)623-0771		(844)578-1926		(844)578-1926		(833)623-0771		(833)623-0771		(844)578-1926		(844)578-1926		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4343	004	0	1	01	01	H4343_004_0	4	1					0	08/02/2021	2022.01	08/02/2021 04:07:43 PM Central Daylight Time	08/03/2021 11:13:01 PM Central Daylight Time	07/30/2021 10:21:40 AM Central Daylight Time			08/04/2021 10:17:29 PM Central Daylight Time	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Ascension Complete	ascensioncomplete.com	Ascension Complete Providence Secure (HMO)	01	01		1			H4343	004	0	2022	Mobile area in Alabama		2	2041	2			2						ascensioncomplete.com/findadoctor	ascensioncomplete.com/formulary	ascensioncomplete.com/findadoctor	(833)623-0771		(833)623-0771		(844)578-1926		(844)578-1926		(833)623-0771		(833)623-0771		(844)578-1926		(844)578-1926		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4343	005	0	1	01	01	H4343_005_0	4	1	2	1			0	08/02/2021	2022.01	08/02/2021 10:10:45 AM Central Daylight Time	08/03/2021 11:13:31 PM Central Daylight Time	07/30/2021 10:22:00 AM Central Daylight Time			08/04/2021 10:17:29 PM Central Daylight Time	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Ascension Complete	ascensioncomplete.com	Ascension Complete St. Vincent's DSNP (HMO D-SNP)	01	01		1			H4343	005	0	2022	Birmingham & Surrounding  Counties in Alabama		2	4364	2			1	3		1		1	ascensioncomplete.com/findadoctor	ascensioncomplete.com/formulary	ascensioncomplete.com/findadoctor	(833)623-0771		(833)623-0771		(844)578-1926		(844)578-1926		(833)623-0771		(833)623-0771		(844)578-1926		(844)578-1926		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4343	006	0	1	01	01	H4343_006_0	4	1	2	1			0	08/02/2021	2022.01	08/02/2021 10:11:30 AM Central Daylight Time	08/03/2021 11:14:00 PM Central Daylight Time	07/30/2021 10:22:22 AM Central Daylight Time			08/04/2021 10:17:29 PM Central Daylight Time	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Ascension Complete	ascensioncomplete.com	Ascension Complete Providence DSNP (HMO D-SNP)	01	01		1			H4343	006	0	2022	Mobile area in Alabama		2	1925	2			1	3		1		1	ascensioncomplete.com/findadoctor	ascensioncomplete.com/formulary	ascensioncomplete.com/findadoctor	(833)623-0771		(833)623-0771		(844)578-1926		(844)578-1926		(833)623-0771		(833)623-0771		(844)578-1926		(844)578-1926		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4346	001	0	1	01	01	H4346_001_0	7	1					0	07/18/2021	2022.01	07/18/2021 03:21:55 PM Pacific Daylight Time	08/03/2021 06:04:08 PM Eastern Daylight Time	08/03/2021 06:04:08 PM Eastern Daylight Time			08/04/2021 01:51:40 PM Eastern Daylight Time	HMO COLORADO, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Value Plus (HMO)	01	01		1			H4346	001	0	2022	Clark County		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com/medicare	(800)499-2793		(800)499-2793		(855)679-0546		(855)679-0546		(833)341-4604		(833)341-4604		(855)485-0962		(855)485-0962		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4346	005	0	1	01	01	H4346_005_0	6	1		1			0	07/18/2021	2022.01	07/18/2021 03:43:30 PM Pacific Daylight Time	08/03/2021 06:04:08 PM Eastern Daylight Time	08/03/2021 06:04:08 PM Eastern Daylight Time			08/04/2021 01:51:40 PM Eastern Daylight Time	HMO COLORADO, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Lung Care (HMO C-SNP)	01	01		1			H4346	005	0	2022	Clark County		2		2			1	4			00000000000100000000		https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com/medicare	(800)499-2793		(800)499-2793		(855)679-0547		(855)679-0547		(833)341-4604		(833)341-4604		(855)485-0963		(855)485-0963		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4346	006	0	1	01	01	H4346_006_0	6	1		1			1	07/18/2021	2022.01	07/18/2021 03:48:43 PM Pacific Daylight Time	08/03/2021 06:04:08 PM Eastern Daylight Time	08/03/2021 06:04:08 PM Eastern Daylight Time			08/04/2021 01:51:40 PM Eastern Daylight Time	HMO COLORADO, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Diabetes Care (HMO C-SNP)	01	01		1			H4346	006	0	2022	Clark County		2		2			1	4			00000010000000000000		https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com/medicare	(800)499-2793		(800)499-2793		(855)679-0547		(855)679-0547		(833)341-4604		(833)341-4604		(855)485-0963		(855)485-0963		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4346	008	0	1	01	01	H4346_008_0	6	1		1			0	07/18/2021	2022.01	07/18/2021 03:43:43 PM Pacific Daylight Time	08/03/2021 06:04:09 PM Eastern Daylight Time	08/03/2021 06:04:09 PM Eastern Daylight Time			08/04/2021 01:51:40 PM Eastern Daylight Time	HMO COLORADO, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Heart Care (HMO C-SNP)	01	01		1			H4346	008	0	2022	Clark County		2		2			1	4			00000000000000000010		https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com/medicare	(800)499-2793		(800)499-2793		(855)679-0547		(855)679-0547		(833)341-4604		(833)341-4604		(855)485-0963		(855)485-0963		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4346	009	0	1	01	01	H4346_009_0	6	1					0	07/16/2021	2022.01	07/16/2021 05:12:44 PM Pacific Daylight Time	08/03/2021 06:04:09 PM Eastern Daylight Time	08/03/2021 06:04:09 PM Eastern Daylight Time			08/04/2021 01:51:40 PM Eastern Daylight Time	HMO COLORADO, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue StartSmart Plus (HMO)	01	01		1			H4346	009	0	2022	Clark County		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com/medicare	(800)499-2793		(800)499-2793		(855)679-0546		(855)679-0546		(833)341-4604		(833)341-4604		(855)485-0962		(855)485-0962		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4346	010	0	1	01	01	H4346_010_0	7	1		1			0	06/04/2021	2022.01	06/04/2021 03:36:13 PM Eastern Daylight Time	08/03/2021 06:04:09 PM Eastern Daylight Time	08/03/2021 06:04:09 PM Eastern Daylight Time			08/04/2021 01:51:40 PM Eastern Daylight Time	HMO COLORADO, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Care On Site (HMO I-SNP)	01	01		1			H4346	010	0	2022	Clark County		2		2			1	1	3				https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com/medicare	(800)499-2793		(800)499-2793		(855)679-0548		(855)679-0548		(833)341-4604		(833)341-4604		(855)485-0964		(855)485-0964		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4346	012	0	1	01	01	H4346_012_0	8	1					0	08/02/2021	2022.01	08/02/2021 02:53:51 PM Pacific Daylight Time	08/03/2021 03:04:03 PM Pacific Daylight Time	08/03/2021 03:04:03 PM Pacific Daylight Time			08/04/2021 12:07:42 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	2022	Denver Metro Area		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com/medicare	(888)346-0095		(888)346-0095		(855)679-0546		(855)679-0546		(833)341-4608		(833)341-4608		(855)485-0962		(855)485-0962		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4346	014	0	1	01	01	H4346_014_0	6	1	2	1			0	08/04/2021	2022.01	08/04/2021 12:47:35 PM Eastern Daylight Time	08/04/2021 02:10:14 PM Eastern Daylight Time	08/03/2021 06:03:58 PM Eastern Daylight Time			08/04/2021 04:38:04 PM Eastern Daylight Time	HMO COLORADO, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Dual Advantage (HMO D-SNP)	01	01		1			H4346	014	0	2022	Greater Denver Area		2		2			1	3		2		2	https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com/medicare	(844)664-7175		(844)664-7175		(855)679-0549		(855)679-0549		(833)341-4607		(833)341-4607		(855)485-0965		(855)485-0965		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4346	017	0	1	01	01	H4346_017_0	9	1					0	07/18/2021	2022.01	07/18/2021 03:56:50 PM Pacific Daylight Time	08/03/2021 03:04:03 PM Pacific Daylight Time	08/03/2021 03:04:03 PM Pacific Daylight Time			08/04/2021 12:07:42 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	2022	Clark County		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com/medicare	(844)469-1759		(844)469-1759		(855)679-0546		(855)679-0546		(833)341-4605		(833)341-4605		(855)485-0962		(855)485-0962		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4346	019	0	1	01	01	H4346_019_0	8	1					0	06/03/2021	2022.01	06/03/2021 05:34:23 PM Pacific Daylight Time	08/03/2021 03:04:03 PM Pacific Daylight Time	08/03/2021 03:04:03 PM Pacific Daylight Time			08/04/2021 12:07:42 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	019	0	2022	Washoe County		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com/medicare	(844)469-1759		(844)469-1759		(855)679-0546		(855)679-0546		(833)341-4605		(833)341-4605		(855)485-0962		(855)485-0962		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4346	022	0	1	01	01	H4346_022_0	9	1		1			1	08/10/2021	2022.01	08/10/2021 11:47:12 AM Pacific Daylight Time	08/10/2021 09:03:15 AM Pacific Daylight Time	08/03/2021 03:04:03 PM Pacific Daylight Time			08/10/2021 11:56:30 AM Pacific Daylight Time	HMO COLORADO, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Diabetes Care (HMO C-SNP)	01	01		1			H4346	022	0	2022	Denver Metro Area		2		2			1	4			00000010000000000000		https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com/medicare	(844)286-1319		(844)286-1319		(855)679-0547		(855)679-0547		(833)341-4608		(833)341-4608		(855)485-0963		(855)485-0963		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4346	023	0	1	01	01	H4346_023_0	9	1		1			0	08/10/2021	2022.01	08/10/2021 09:21:07 AM Pacific Daylight Time	08/10/2021 09:04:44 AM Pacific Daylight Time	08/03/2021 03:04:03 PM Pacific Daylight Time			08/10/2021 11:56:30 AM Pacific Daylight Time	HMO COLORADO, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Care On Site (HMO I-SNP)	01	01		1			H4346	023	0	2022	Denver Metro Area		2		2			1	1	3				https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com/medicare	(844)209-6346		(844)209-6346		(855)679-0548		(855)679-0548		(833)341-4608		(833)341-4608		(855)485-0964		(855)485-0964		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4346	024	0	1	01	01	H4346_024_0	8	1					0	07/31/2021	2022.01	07/31/2021 05:05:30 PM Pacific Daylight Time	08/03/2021 03:04:04 PM Pacific Daylight Time	08/03/2021 03:04:04 PM Pacific Daylight Time			08/04/2021 12:07:42 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	024	0	2022	Nye County		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com/medicare	(844)469-1759		(844)469-1759		(855)679-0546		(855)679-0546		(833)341-4606		(833)341-4606		(855)485-0962		(855)485-0962		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4346	025	0	1	01	01	H4346_025_0	6	1	2	1			0	07/19/2021	2022.01	07/19/2021 03:30:49 PM Eastern Daylight Time	08/03/2021 06:03:58 PM Eastern Daylight Time	08/03/2021 06:03:58 PM Eastern Daylight Time			08/04/2021 03:50:55 PM Eastern Daylight Time	HMO COLORADO, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Dual Advantage (HMO D-SNP)	01	01		1			H4346	025	0	2022	Clark,Nye, and Washoe Counties		2		2			1	3		1		1	https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com/medicare	(833)713-1303		(833)713-1303		(855)679-0549		(855)679-0549		(833)341-4605		(833)341-4605		(855)485-0965		(855)485-0965		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4346	026	0	1	01	01	H4346_026_0	6	1	2	1			0	07/29/2021	2022.01	07/29/2021 04:22:14 PM Eastern Daylight Time	08/03/2021 06:03:58 PM Eastern Daylight Time	08/03/2021 06:03:58 PM Eastern Daylight Time			08/04/2021 03:50:55 PM Eastern Daylight Time	HMO COLORADO, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Connect (HMO D-SNP)	01	01		1			H4346	026	0	2022	Clark County		2		2			1	3		1		1	https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com/medicare	(844)469-1759		(844)469-1759		(855)679-0549		(855)679-0549		(833)341-4605		(833)341-4605		(855)485-0965		(855)485-0965		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4346	029	0	1	01	01	H4346_029_0	8	1		1			0	06/04/2021	2022.01	06/04/2021 07:59:31 AM Pacific Daylight Time		08/03/2021 03:04:04 PM Pacific Daylight Time		08/03/2021 03:04:04 PM Pacific Daylight Time	08/04/2021 12:07:42 PM Pacific Daylight Time	HMO COLORADO, INC.	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue ESRD Care (HMO C-SNP)	01	01		1			H4346	029	0	2022	Select Counties in CO		2		2			1	4			00000000100000000000		https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com/medicare	(844)286-1319		(844)286-1319		(855)679-0547		(855)679-0547		(833)341-4608		(833)341-4608		(855)485-0963		(855)485-0963		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4346	802	0	1	01	01	H4346_802_0	1	1						06/02/2021	2022.01	06/02/2021 10:52:58 AM Pacific Daylight Time					06/04/2021 10:32:44 AM Pacific Daylight Time	HMO COLORADO, INC.	Anthem Blue Cross and Blue Shield	caremore.com	Anthem EGWP MAPD (HMO)	01	01		1			H4346	802	0	2022	Nevada		1	600	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)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1					1				
H4346	805	0	1	01	01	H4346_805_0	1	1						06/02/2021	2022.01	06/02/2021 03:53:07 PM Pacific Daylight Time					06/04/2021 10:32:44 AM 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	2022	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		(833)848-8729		(833)848-8729		(833)360-3663		(833)360-3663		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1					1				
H4346	806	0	2	01	01	H4346_806_0	1	1						06/02/2021	2022.01	06/02/2021 03:53:14 PM Pacific Daylight Time					06/04/2021 10:32:44 AM 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	2022	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		(833)848-8729		(833)848-8729		(833)360-3663		(833)360-3663		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1					1				
H4346	809	0	1	01	01	H4346_809_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 03:53:21 PM Pacific Daylight Time					06/04/2021 10:32:44 AM 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	2022	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		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1					1				
H4346	810	0	2	01	01	H4346_810_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 03:53:30 PM Pacific Daylight Time					06/04/2021 10:32:44 AM 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	2022	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		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1					1				
H4346	812	0	1	01	01	H4346_812_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 03:53:41 PM Pacific Daylight Time					06/04/2021 10:32:44 AM 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	2022	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		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1					1				
H4346	821	0	2	01	01	H4346_821_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 03:54:11 PM Pacific Daylight Time					06/04/2021 10:32:44 AM 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	2022	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		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1					1				
H4346	823	0	1	01	01	H4346_823_0	1	1						06/02/2021	2022.01	06/02/2021 03:54:20 PM Pacific Daylight Time					06/04/2021 10:32:44 AM Pacific Daylight Time	HMO COLORADO, INC.	Anthem Blue Cross and Blue Shield	www.Anthem.com/Medicare	Anthem MediBlue (HMO)	01	01		1			H4346	823	0	2022	Nevada Select Counties		1	600	2			2						www.Anthem.com/Medicare	www.Anthem.com/Medicare	www.Anthem.com/Medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)360-3663		(833)360-3663		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1					1				
H4346	824	0	1	01	01	H4346_824_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 03:54:30 PM Pacific Daylight Time					06/04/2021 10:32:44 AM Pacific Daylight Time	HMO COLORADO, INC.	Anthem Blue Cross and Blue Shield	www.Anthem.com/Medicare	Anthem MediBlue (HMO)	01	01		1			H4346	824	0	2022	Nevada select counties		1	600	2			2						www.Anthem.com/Medicare	www.Anthem.com/Medicare	www.Anthem.com/Medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1					1				
H4346	826	0	1	01	01	H4346_826_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 03:54:41 PM Pacific Daylight Time					06/04/2021 10:32:44 AM Pacific Daylight Time	HMO COLORADO, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/Medicare	Anthem MediBlue (HMO)	01	01		1			H4346	826	0	2022	Nevada select counties		1	600	2			2						www.anthem.com/Medicare	www.anthem.com/Medicare	www.anthem.com/Medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1					1				
H4346	827	0	2	01	01	H4346_827_0	1	1						06/02/2021	2022.01	06/02/2021 03:54:51 PM Pacific Daylight Time					06/04/2021 10:32:44 AM Pacific Daylight Time	HMO COLORADO, INC.	Anthem Blue Cross and Blue Shield	www.Anthem.com/Medicare	Anthem MediBlue (HMO)	01	01		2	1		H4346	827	0	2022	Nevada select counties		1	600	2			2						www.Anthem.com/Medicare	www.Anthem.com/Medicare	www.Anthem.com/Medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)360-3663		(833)360-3663		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1					1				
H4346	828	0	2	01	01	H4346_828_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 03:55:04 PM Pacific Daylight Time					06/04/2021 10:32:44 AM Pacific Daylight Time	HMO COLORADO, INC.	Anthem Blue Cross and Blue Shield	www.Anthem.com/Medicare	Anthem MediBlue (HMO)	01	01		2	1		H4346	828	0	2022	Nevada select counties		1	600	2			2						www.Anthem.com/Medicare	www.Anthem.com/Medicare	www.Anthem.com/Medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1					1				
H4346	830	0	2	01	01	H4346_830_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 03:55:13 PM Pacific Daylight Time					06/04/2021 10:32:44 AM Pacific Daylight Time	HMO COLORADO, INC.	Anthem Blue Cross and Blue Shield	www.Anthem.com/Medicare	Anthem MediBlue (HMO)	01	01		2	1		H4346	830	0	2022	Nevada select counties		1	600	2			2						www.Anthem.com/Medicare	www.Anthem.com/Medicare	www.Anthem.com/Medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1					1				
H4388	001	0		07	02	H4388_001_0	5	2				0	0	06/04/2021	2022.01	06/04/2021 11:19:34 AM Central Daylight Time			06/04/2021 10:38:31 AM Central Daylight Time		06/04/2021 01:55:28 PM 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	2022	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						06/04/2021	2022.01	06/04/2021 09:19:05 AM Eastern Daylight Time		05/27/2021 08:42:56 AM Eastern Daylight Time			06/04/2021 09:25:14 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	2022	New York, Bronx, Richmond and Westchester counties		2		2			2						www.archcareseniorlife.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						06/04/2021	2022.01	06/04/2021 09:19:16 AM Eastern Daylight Time		05/27/2021 08:43:32 AM Eastern Daylight Time			06/04/2021 09:25:14 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	2022	New York, Bronx, Richmond and Westchester counties		2		2			2						www.archcareseniorlife.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						06/02/2021	2022.01	06/02/2021 12:24:17 PM Central Daylight Time		05/28/2021 12:53:49 PM Central Daylight Time			06/02/2021 12:27:30 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	2022	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						06/02/2021	2022.01	06/02/2021 12:24:36 PM Central Daylight Time		05/28/2021 12:54:17 PM Central Daylight Time			06/02/2021 12:27:30 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	2022	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	5	1	2	1	1		0	07/08/2021	2022.01	07/08/2021 03:30:01 PM Central Daylight Time	08/01/2021 09:57:42 PM Central Daylight Time	07/30/2021 11:37:50 AM Central Daylight Time			08/04/2021 10:48:45 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna TotalCare (HMO D-SNP)	01	01		1			H4407	004	0	2022	Southern Mississippi		2		2			1	3		2		2	www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)707-7116		(855)707-7116		(800)668-3813		(800)668-3813		(855)707-7116		(855)707-7116		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4407	011	0	1	01	01	H4407_011_0	3	1			2	0	0	07/08/2021	2022.01	07/08/2021 03:30:30 PM Central Daylight Time	05/31/2021 08:14:42 PM Central Daylight Time				07/19/2021 03:55:41 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Fundamental Medicare (HMO)	01	01		1			H4407	011	0	2022	Southern Mississippi		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)707-7116		(855)707-7116										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H4407	026	0	1	01	01	H4407_026_0	4	1			2		0	08/02/2021	2022.01	08/02/2021 06:55:09 PM Central Daylight Time	08/01/2021 10:00:55 PM Central Daylight Time	07/30/2021 11:38:13 AM Central Daylight Time			08/04/2021 10:48:45 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H4407	026	0	2022	Southern Mississippi		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)707-7116		(855)707-7116		(800)668-3813		(800)668-3813		(855)707-7116		(855)707-7116		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4407	027	0	1	01	01	H4407_027_0	4	1			2		0	07/08/2021	2022.01	07/08/2021 03:31:29 PM Central Daylight Time	08/03/2021 04:05:23 PM Central Daylight Time	07/30/2021 11:38:37 AM Central Daylight Time			08/04/2021 10:48:45 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Plus Medicare (HMO)	01	01		1			H4407	027	0	2022	Southern Mississippi		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)707-7116		(855)707-7116		(800)668-3813		(800)668-3813		(855)707-7116		(855)707-7116		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4407	028	0	1	01	01	H4407_028_0	4	1			2		0	08/02/2021	2022.01	08/02/2021 04:40:36 PM Central Daylight Time	08/02/2021 05:14:11 PM Central Daylight Time	07/30/2021 11:39:00 AM Central Daylight Time			08/04/2021 10:48:45 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H4407	028	0	2022	North Mississippi		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101		(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4461	004	0	1	01	01	H4461_004_0	4	1			2	0	0	07/19/2021	2022.01	07/19/2021 11:53:51 AM Eastern Daylight Time	07/22/2021 08:37:43 AM Eastern Daylight Time				07/22/2021 02:05:06 PM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Humana	www.humana.com/medicare	Humana Honor (HMO)	01	01		1			H4461	004	0	2022	Greater Tennessee		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_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	9	1	2	1	1		0	08/01/2021	2022.01	08/01/2021 12:49:15 PM Eastern Daylight Time	08/03/2021 06:40:27 PM Eastern Daylight Time	07/30/2021 10:42:02 AM Eastern Daylight Time			08/04/2021 01:29:26 PM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H4461-022 (HMO D-SNP)	01	01		1			H4461	022	0	2022	Greater Tennessee		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			2		1	08/01/2021	2022.01	08/01/2021 12:50:55 PM Eastern Daylight Time	08/03/2021 06:39:52 PM Eastern Daylight Time	07/30/2021 10:42:12 AM Eastern Daylight Time			08/04/2021 01:54:40 PM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Humana	www.humana.com/medicare	Humana Gold Plus H4461-025 (HMO)	01	01		1			H4461	025	0	2022	Memphis Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			2		1	08/01/2021	2022.01	08/01/2021 12:51:13 PM Eastern Daylight Time	08/03/2021 06:40:56 PM Eastern Daylight Time	07/30/2021 10:42:24 AM Eastern Daylight Time			08/04/2021 01:54:40 PM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Humana	www.humana.com/medicare	Humana Gold Plus H4461-029 (HMO)	01	01		1			H4461	029	0	2022	Nashville Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			2		1	08/01/2021	2022.01	08/01/2021 12:51:31 PM Eastern Daylight Time	08/03/2021 06:41:28 PM Eastern Daylight Time	07/30/2021 10:42:38 AM Eastern Daylight Time			08/04/2021 01:54:40 PM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Humana	www.humana.com/medicare	Humana Gold Plus H4461-030 (HMO)	01	01		1			H4461	030	1	2022	East Tennessee	East Tennessee	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			2		1	08/01/2021	2022.01	08/01/2021 12:51:43 PM Eastern Daylight Time	08/03/2021 06:42:00 PM Eastern Daylight Time	07/30/2021 10:42:48 AM Eastern Daylight Time			08/04/2021 01:54:40 PM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Humana	www.humana.com/medicare	Humana Gold Plus H4461-030 (HMO)	01	01		1			H4461	030	2	2022	East Tennessee	East Tennessee	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			2		1	08/01/2021	2022.01	08/01/2021 12:51:59 PM Eastern Daylight Time	08/03/2021 06:42:32 PM Eastern Daylight Time	07/30/2021 10:43:00 AM Eastern Daylight Time			08/04/2021 01:54:40 PM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Humana	www.humana.com/medicare	Humana Gold Plus H4461-030 (HMO)	01	01		1			H4461	030	3	2022	East Tennessee	East Tennessee	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			2		1	08/01/2021	2022.01	08/01/2021 12:53:02 PM Eastern Daylight Time	08/03/2021 07:01:26 PM Eastern Daylight Time	07/30/2021 10:43:12 AM Eastern Daylight Time			08/04/2021 01:54:40 PM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Humana	www.humana.com/medicare	Humana Gold Plus H4461-031 (HMO)	01	01		1			H4461	031	1	2022	East Tennessee	East Tennessee	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			2		1	07/31/2021	2022.01	07/31/2021 01:42:04 PM Eastern Daylight Time	08/03/2021 06:43:07 PM Eastern Daylight Time	07/30/2021 10:43:24 AM Eastern Daylight Time			08/04/2021 01:54:40 PM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Humana	www.humana.com/medicare	Humana Gold Plus H4461-031 (HMO)	01	01		1			H4461	031	2	2022	East Tennessee	East Tennessee	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			2		1	06/03/2021	2022.01	06/03/2021 02:15:28 PM Eastern Daylight Time	08/03/2021 06:43:36 PM Eastern Daylight Time	07/30/2021 10:43:36 AM Eastern Daylight Time			08/04/2021 01:54:40 PM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Humana	www.humana.com/medicare	Humana Gold Plus H4461-031 (HMO)	01	01		1			H4461	031	3	2022	East Tennessee	East Tennessee	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			2		1	08/01/2021	2022.01	08/01/2021 12:53:27 PM Eastern Daylight Time	08/03/2021 06:44:35 PM Eastern Daylight Time	07/30/2021 10:43:48 AM Eastern Daylight Time			08/04/2021 01:54:40 PM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Humana	www.humana.com/medicare	Humana Gold Plus H4461-034 (HMO)	01	01		1			H4461	034	0	2022	East Tennessee		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			2		1	07/31/2021	2022.01	07/31/2021 01:45:15 PM Eastern Daylight Time	08/03/2021 06:51:11 PM Eastern Daylight Time	07/30/2021 10:44:00 AM Eastern Daylight Time			08/04/2021 01:54:40 PM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Humana	www.humana.com/medicare	Humana Gold Plus H4461-035 (HMO)	01	01		1			H4461	035	0	2022	East Tennessee		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			2		1	07/31/2021	2022.01	07/31/2021 01:46:45 PM Eastern Daylight Time	08/03/2021 07:02:12 PM Eastern Daylight Time	07/30/2021 10:44:12 AM Eastern Daylight Time			08/04/2021 02:00:40 PM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Humana	www.humana.com/medicare	Humana Gold Plus H4461-036 (HMO)	01	01		1			H4461	036	0	2022	East Tennessee		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	037	0	1	01	01	H4461_037_0	3	1			2		1	08/01/2021	2022.01	08/01/2021 12:53:49 PM Eastern Daylight Time	08/03/2021 06:55:28 PM Eastern Daylight Time	07/30/2021 10:44:24 AM Eastern Daylight Time			08/04/2021 02:00:40 PM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Humana	www.humana.com/medicare	Humana Gold Plus H4461-037 (HMO)	01	01		1			H4461	037	0	2022	Rural Tennessee		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	038	0	1	01	01	H4461_038_0	6	1	2	1	1		0	08/01/2021	2022.01	08/01/2021 12:54:10 PM Eastern Daylight Time	08/03/2021 06:57:32 PM Eastern Daylight Time	07/30/2021 10:44:36 AM Eastern Daylight Time			08/04/2021 02:00:40 PM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H4461-038 (HMO D-SNP)	01	01		1			H4461	038	0	2022	Greater Tennessee		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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						05/25/2021	2022.01	05/25/2021 03:21:21 PM Eastern Daylight Time					06/04/2021 08:33:40 AM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H4461	806	0	2022	Select counties in East Tennessee area		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242		(866)396-8810		(866)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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H4461	807	0	1	01	01	H4461_807_0	1	1				0	0	05/25/2021	2022.01	05/25/2021 03:24:58 PM Eastern Daylight Time					06/04/2021 08:33:40 AM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H4461	807	0	2022	Select counties in East Tennessee area		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H4461	810	0	1	01	01	H4461_810_0	1	1						05/27/2021	2022.01	05/27/2021 03:59:41 PM Eastern Daylight Time					06/04/2021 08:33:40 AM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H4461	810	0	2022	Select counties in East Tennessee area		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242		(866)396-8810		(866)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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					2				
H4461	811	0	1	01	01	H4461_811_0	1	1				0	0	05/27/2021	2022.01	05/27/2021 04:01:42 PM Eastern Daylight Time					06/04/2021 08:33:40 AM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H4461	811	0	2022	Select counties in East Tennessee area		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					2				
H4490	001	0	1	01	01	H4490_001_0	2	1		1			0	08/03/2021	2022.01	08/03/2021 11:21:39 AM Central Daylight Time	08/05/2021 08:08:03 AM Central Daylight Time	08/05/2021 08:08:22 AM Central Daylight Time			08/05/2021 08:40:42 AM Central Daylight Time	MISSOURI MEDICARE SELECT, LLC	American Health Advantage of Missouri	mo.AmHealthPlans.com	American Health Advantage of Missouri (HMO I-SNP)	01	01		1			H4490	001	0	2022	Missouri (partial)		2		2			1	1	3				mo.AmHealthPlans.com	mo.AmHealthPlans.com	mo.AmHealthPlans.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			
H4490	002	0	1	01	01	H4490_002_0	2	1		1			0	08/03/2021	2022.01	08/03/2021 11:26:26 AM Central Daylight Time	08/05/2021 08:08:03 AM Central Daylight Time	08/05/2021 08:08:22 AM Central Daylight Time			08/05/2021 08:40:42 AM Central Daylight Time	MISSOURI MEDICARE SELECT, LLC	American Health Advantage of Missouri	mo.AmHealthPlans.com	American Health Advantage of Missouri Gold (HMO I-SNP)	01	01		1			H4490	002	0	2022	Missouri (partial)		2		2			1	1	3				mo.AmHealthPlans.com	mo.AmHealthPlans.com	mo.AmHealthPlans.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			
H4490	003	0	1	01	01	H4490_003_0	2	1		1			0	08/03/2021	2022.01	08/03/2021 11:26:56 AM Central Daylight Time	08/05/2021 08:08:03 AM Central Daylight Time	08/05/2021 08:08:22 AM Central Daylight Time			08/05/2021 08:40:42 AM Central Daylight Time	MISSOURI MEDICARE SELECT, LLC	American Health Advantage of Missouri	mo.AmHealthPlans.com	American Health Advantage of Missouri Silver (HMO I-SNP)	01	01		1			H4490	003	0	2022	Missouri (partial)		2		2			1	1	3				mo.AmHealthPlans.com	mo.AmHealthPlans.com	mo.AmHealthPlans.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	9	1					0	08/04/2021	2022.01	08/04/2021 08:44:07 AM Eastern Daylight Time	08/02/2021 08:16:50 PM Eastern Daylight Time	08/02/2021 08:08:22 PM Eastern Daylight Time			08/05/2021 11:37:29 AM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/planfinder	MedMutual Advantage Select (PPO)	01	04		1			H4497	001	1	2022	Ohio Regions	Northeast Ohio	2		2			2						medmutual.com/maplaninfo	medmutual.com/maplaninfo	providersearch.medmutual.com	(800)982-3117		(800)982-3117		(877)368-0081		(877)368-0081		(800)982-3117		(800)982-3117		(877)368-0081		(877)368-0081		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4497	001	2	1	04	01	H4497_001_2	9	1					0	07/16/2021	2022.01	07/16/2021 12:00:46 PM Eastern Daylight Time	08/02/2021 08:31:14 PM Eastern Daylight Time	08/02/2021 08:05:06 PM Eastern Daylight Time			08/05/2021 11:37:29 AM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/planfinder	MedMutual Advantage Select (PPO)	01	04		1			H4497	001	2	2022	Ohio Regions	Select Ohio Counties	2		2			2						medmutual.com/maplaninfo	medmutual.com/maplaninfo	providersearch.medmutual.com	(800)982-3117		(800)982-3117		(877)368-0081		(877)368-0081		(800)982-3117		(800)982-3117		(877)368-0081		(877)368-0081		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4497	001	3	1	04	01	H4497_001_3	9	1					0	07/16/2021	2022.01	07/16/2021 12:00:08 PM Eastern Daylight Time	08/02/2021 08:26:16 PM Eastern Daylight Time	08/02/2021 08:07:00 PM Eastern Daylight Time			08/05/2021 11:37:29 AM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/planfinder	MedMutual Advantage Select (PPO)	01	04		1			H4497	001	3	2022	Ohio Regions	Central Ohio, Cincinnati/Dayton and Toledo	2		2			2						medmutual.com/maplaninfo	medmutual.com/maplaninfo	providersearch.medmutual.com	(800)982-3117		(800)982-3117		(877)368-0081		(877)368-0081		(800)982-3117		(800)982-3117		(877)368-0081		(877)368-0081		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4497	002	1	1	04	01	H4497_002_1	9	1					0	07/16/2021	2022.01	07/16/2021 11:59:46 AM Eastern Daylight Time	08/02/2021 08:22:28 PM Eastern Daylight Time	08/02/2021 08:06:28 PM Eastern Daylight Time			08/05/2021 11:37:29 AM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/planfinder	MedMutual Advantage Preferred (PPO)	01	04		1			H4497	002	1	2022	Ohio Regions	Northeast Ohio	2		2			2						medmutual.com/maplaninfo	medmutual.com/maplaninfo	providersearch.medmutual.com	(800)982-3117		(800)982-3117		(877)368-0081		(877)368-0081		(800)982-3117		(800)982-3117		(877)368-0081		(877)368-0081		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4497	002	2	1	04	01	H4497_002_2	9	1					0	07/16/2021	2022.01	07/16/2021 11:59:27 AM Eastern Daylight Time	08/02/2021 08:20:32 PM Eastern Daylight Time	08/02/2021 08:04:18 PM Eastern Daylight Time			08/05/2021 11:37:29 AM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/planfinder	MedMutual Advantage Preferred (PPO)	01	04		1			H4497	002	2	2022	Ohio Regions	Select Ohio Counties	2		2			2						medmutual.com/maplaninfo	medmutual.com/maplaninfo	providersearch.medmutual.com	(800)982-3117		(800)982-3117		(877)368-0081		(877)368-0081		(800)982-3117		(800)982-3117		(877)368-0081		(877)368-0081		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4497	002	3	1	04	01	H4497_002_3	9	1					0	07/16/2021	2022.01	07/16/2021 11:59:08 AM Eastern Daylight Time	08/02/2021 08:39:14 PM Eastern Daylight Time	08/02/2021 08:03:20 PM Eastern Daylight Time			08/05/2021 11:37:29 AM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/planfinder	MedMutual Advantage Preferred (PPO)	01	04		1			H4497	002	3	2022	Ohio Regions	Central Ohio, Cincinnati/Dayton and Toledo	2		2			2						medmutual.com/maplaninfo	medmutual.com/maplaninfo	providersearch.medmutual.com	(800)982-3117		(800)982-3117		(877)368-0081		(877)368-0081		(800)982-3117		(800)982-3117		(877)368-0081		(877)368-0081		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4497	003	1	1	04	01	H4497_003_1	9	1					0	07/16/2021	2022.01	07/16/2021 11:58:42 AM Eastern Daylight Time	08/02/2021 08:38:06 PM Eastern Daylight Time	08/02/2021 08:01:10 PM Eastern Daylight Time			08/05/2021 11:37:29 AM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/planfinder	MedMutual Advantage Premium (PPO)	01	04		1			H4497	003	1	2022	Ohio Regions	Northeast Ohio	2		2			2						medmutual.com/maplaninfo	medmutual.com/maplaninfo	providersearch.medmutual.com	(800)982-3117		(800)982-3117		(877)368-0081		(877)368-0081		(800)982-3117		(800)982-3117		(877)368-0081		(877)368-0081		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4497	003	2	1	04	01	H4497_003_2	9	1					0	07/16/2021	2022.01	07/16/2021 11:58:18 AM Eastern Daylight Time	08/02/2021 08:37:10 PM Eastern Daylight Time	08/02/2021 08:13:52 PM Eastern Daylight Time			08/05/2021 11:37:29 AM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/planfinder	MedMutual Advantage Premium (PPO)	01	04		1			H4497	003	2	2022	Ohio Regions	Select Ohio Counties	2		2			2						medmutual.com/maplaninfo	medmutual.com/maplaninfo	providersearch.medmutual.com	(800)982-3117		(800)982-3117		(877)368-0081		(877)368-0081		(800)982-3117		(800)982-3117		(877)368-0081		(877)368-0081		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4497	003	3	1	04	01	H4497_003_3	9	1					0	07/16/2021	2022.01	07/16/2021 11:57:53 AM Eastern Daylight Time	08/03/2021 10:02:50 AM Eastern Daylight Time	08/02/2021 08:12:12 PM Eastern Daylight Time			08/05/2021 11:37:29 AM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/planfinder	MedMutual Advantage Premium (PPO)	01	04		1			H4497	003	3	2022	Ohio Regions	Central Ohio, Cincinnati/Dayton and Toledo	2		2			2						medmutual.com/maplaninfo	medmutual.com/maplaninfo	providersearch.medmutual.com	(800)982-3117		(800)982-3117		(877)368-0081		(877)368-0081		(800)982-3117		(800)982-3117		(877)368-0081		(877)368-0081		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4497	005	1	1	04	01	H4497_005_1	10	1					0	08/11/2021	2022.01	08/11/2021 10:51:45 AM Eastern Daylight Time	08/02/2021 08:34:24 PM Eastern Daylight Time	08/02/2021 08:13:14 PM Eastern Daylight Time			08/11/2021 12:32:08 PM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/planfinder	MedMutual Advantage Access (PPO)	01	04		1			H4497	005	1	2022	Ohio Regions	Northeast Ohio	2		2			2						medmutual.com/maplaninfo	medmutual.com/maplaninfo	providersearch.medmutual.com	(800)982-3117		(800)982-3117		(877)368-0081		(877)368-0081		(800)982-3117		(800)982-3117		(877)368-0081		(877)368-0081		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4497	005	2	1	04	01	H4497_005_2	11	1					0	08/12/2021	2022.01	08/12/2021 10:57:33 AM Eastern Daylight Time	08/02/2021 08:32:12 PM Eastern Daylight Time	08/02/2021 08:14:18 PM Eastern Daylight Time			08/12/2021 11:51:40 AM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/planfinder	MedMutual Advantage Access (PPO)	01	04		1			H4497	005	2	2022	Ohio Regions	Central Ohio, Cincinnati/Dayton and Toledo	2		2			2						medmutual.com/maplaninfo	medmutual.com/maplaninfo	providersearch.medmutual.com	(800)982-3117		(800)982-3117		(877)368-0081		(877)368-0081		(800)982-3117		(800)982-3117		(877)368-0081		(877)368-0081		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4497	801	0	1	04	01	H4497_801_0	3	1						05/18/2021	2022.01	05/18/2021 02:09:10 PM Eastern Daylight Time					07/19/2021 06:27:36 PM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/magroup	MedMutual Advantage EGWP (Calendar Year) (PPO)	01	04		1			H4497	801	0	2022	Ohio Regions		1	17600	2			2						medmutual.com/magroup	medmutual.com/magroup	providersearch.medmutual.com	(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;3-2;6;8a;8b1;8b2;9a1;9b;10a;11a;11b;15;	2		1									
H4497	802	0	1	04	01	H4497_802_0	3	1						05/18/2021	2022.01	05/18/2021 02:09:22 PM Eastern Daylight Time					07/19/2021 06:27:36 PM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/magroup	MedMutual Advantage EGWP (Non-Calendar Year) (PPO)	01	04		1			H4497	802	0	2022	Ohio Regions		1	100	2			2						medmutual.com/magroup	medmutual.com/magroup	providersearch.medmutual.com	(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;3-2;6;8a;8b1;8b2;9a1;9b;10a;11a;11b;15;	2		1									
H4497	803	0	1	04	01	H4497_803_0	3	1				0	0	05/18/2021	2022.01	05/18/2021 02:09:35 PM Eastern Daylight Time					07/19/2021 06:27:36 PM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/magroup	MedMutual Advantage EGWP (MA-Only) (PPO)	01	04		1			H4497	803	0	2022	Ohio Regions		1	100	2			2						medmutual.com/magroup	medmutual.com/magroup	providersearch.medmutual.com	(800)801-4823		(800)801-4823		(866)406-8777		(866)406-8777										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;6;8a;8b1;8b2;9a1;9b;10a;11a;11b;15;	2		1									
H4506	003	0	1	01	01	H4506_003_0	4	1					1	07/31/2021	2022.01	07/31/2021 03:37:55 PM Pacific Daylight Time	08/04/2021 12:14:28 AM Eastern Daylight Time	07/30/2021 11:22:42 AM Eastern Daylight Time			08/04/2021 10:52:49 PM Eastern Daylight Time	SELECTCARE OF TEXAS, INC.	Wellcare	www.wellcare.com/medicare	Wellcare TexanPlus Classic No Premium (HMO)	01	01		1			H4506	003	0	2022	Select counties in TX		2	550863	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4506	010	0	1	01	01	H4506_010_0	4	1				0	0	05/30/2021	2022.01	05/30/2021 10:33:09 PM Pacific Daylight Time	06/06/2021 12:48:27 PM Eastern Daylight Time				07/19/2021 05:55:30 PM Eastern Daylight Time	SELECTCARE OF TEXAS, INC.	Wellcare	www.wellcare.com/medicare	Wellcare TexanPlus Patriot Giveback (HMO)	01	01		1			H4506	010	0	2022	Select counties in TX		2	12763	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H4506	029	0	1	02	01	H4506_029_0	4	1					0	07/31/2021	2022.01	07/31/2021 03:40:10 PM Pacific Daylight Time	08/04/2021 03:22:52 PM Eastern Daylight Time	07/30/2021 11:23:38 AM Eastern Daylight Time			08/04/2021 10:52:49 PM Eastern Daylight Time	SELECTCARE OF TEXAS, INC.	Wellcare	www.wellcare.com/medicare	Wellcare TexanPlus No Premium (HMO-POS)	01	02		1			H4506	029	0	2022	Select counties in TX		2	9578	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4506	801	0	1	01	01	H4506_801_0	2	1						05/03/2021	2022.01	05/03/2021 01:38:10 PM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	SELECTCARE OF TEXAS, INC.	Wellcare	www.wellcare.com/medicare	H4506 - Retiree - MA-PD non-CY (HMO)	01	01		1			H4506	801	0	2022	Select counties in TX		1	100	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H4506	806	0	1	01	01	H4506_806_0	2	1						05/03/2021	2022.01	05/03/2021 01:38:18 PM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	SELECTCARE OF TEXAS, INC.	Wellcare	www.wellcare.com/medicare	City of Houston Group Retirees (HMO)	01	01		1			H4506	806	0	2022	Select counties in TX		1	100	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)530-9495		(866)230-2513		(866)527-0056		(866)527-0056		(866)530-9495		(866)230-2513		(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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H4506	808	0	1	01	01	H4506_808_0	2	1				0	0	05/03/2021	2022.01	05/03/2021 01:38:25 PM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	SELECTCARE OF TEXAS, INC.	Wellcare	www.wellcare.com/medicare	H4506 - Retiree - MA (HMO)	01	01		1			H4506	808	0	2022	Select counties in TX		1	100	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H4506	810	0	1	02	01	H4506_810_0	2	1						05/03/2021	2022.01	05/03/2021 01:39:57 PM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	SELECTCARE OF TEXAS, INC.	Wellcare	www.wellcare.com/medicare	City of Houston Group Retirees (HMO-POS)	01	02		1			H4506	810	0	2022	Select counties in TX		1	100	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1				
H4513	009	0	1	01	01	H4513_009_0	2	1			2	0	0	05/24/2021	2022.01	05/24/2021 11:28:00 AM Central Daylight Time	06/01/2021 12:23:35 AM Central Daylight Time				06/02/2021 04:05:19 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Fundamental Medicare (HMO)	01	01		1			H4513	009	0	2022	Houston & Valley		2		2			2						www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)982-6174		(855)982-6174										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H4513	026	0	1	01	01	H4513_026_0	3	1			2		0	08/02/2021	2022.01	08/02/2021 05:33:20 PM Central Daylight Time	08/02/2021 05:21:15 PM Central Daylight Time	07/30/2021 11:39:24 AM Central Daylight Time			08/04/2021 10:48:45 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H4513	026	0	2022	East Texas		2		2			2						www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)982-6174		(855)982-6174		(800)668-3813		(800)668-3813		(855)982-6174		(855)982-6174		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	027	0	1	01	01	H4513_027_0	5	1	2	1	1		0	07/08/2021	2022.01	07/08/2021 03:32:35 PM Central Daylight Time	08/02/2021 05:23:10 PM Central Daylight Time	07/30/2021 11:39:51 AM Central Daylight Time			08/04/2021 10:48:45 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna TotalCare (HMO D-SNP)	01	01		1			H4513	027	0	2022	East Texas		2		2			1	3		2		2	www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)982-6174		(855)982-6174		(800)668-3813		(800)668-3813		(855)982-6174		(855)982-6174		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	028	0	1	01	01	H4513_028_0	6	1			2		0	08/02/2021	2022.01	08/02/2021 05:34:49 PM Central Daylight Time	08/02/2021 05:24:18 PM Central Daylight Time	07/30/2021 11:40:15 AM Central Daylight Time			08/04/2021 10:48:45 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H4513	028	0	2022	North Texas & San Antonio		2		2			2						www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)982-6174		(855)982-6174		(800)668-3813		(800)668-3813		(855)982-6174		(855)982-6174		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	029	0	1	01	01	H4513_029_0	6	1	2	1	1		0	07/08/2021	2022.01	07/08/2021 03:09:33 PM Central Daylight Time	08/02/2021 05:25:28 PM Central Daylight Time	07/30/2021 11:40:40 AM Central Daylight Time			08/04/2021 10:48:45 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna TotalCare (HMO D-SNP)	01	01		1			H4513	029	0	2022	North Texas & San Antonio		2		2			1	3		2		2	www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)982-6174		(855)982-6174		(800)668-3813		(800)668-3813		(855)982-6174		(855)982-6174		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	030	0	1	01	01	H4513_030_0	4	1			2		0	08/02/2021	2022.01	08/02/2021 04:41:42 PM Central Daylight Time	08/02/2021 05:16:23 PM Central Daylight Time	07/30/2021 11:41:03 AM Central Daylight Time			08/04/2021 10:48:45 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H4513	030	0	2022	Northwest Georgia		2		2			2						www.cigna.com/medicare	www.cignamedicare.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			2	0	0	07/08/2021	2022.01	07/08/2021 03:33:37 PM Central Daylight Time	05/28/2021 11:07:36 AM Central Daylight Time				07/19/2021 03:55:41 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Fundamental Medicare (HMO)	01	01		1			H4513	033	0	2022	Tennessee		2		2			2						www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(866)593-4468		(866)593-4468										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H4513	034	0	1	01	01	H4513_034_0	5	1	2	1	2		0	08/17/2021	2022.01	08/17/2021 03:45:48 PM Central Daylight Time	08/02/2021 05:22:26 PM Central Daylight Time	07/30/2021 11:41:27 AM Central Daylight Time			08/17/2021 04:34:17 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna TotalCare Plus (HMO D-SNP)	01	01		1			H4513	034	0	2022	Middle and West Tennessee		2		2			1	3		1		2	www.cigna.com/medicare	www.cignamedicare.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	035	0	1	01	01	H4513_035_0	4	1			2		0	07/08/2021	2022.01	07/08/2021 03:34:33 PM Central Daylight Time	08/02/2021 05:34:16 PM Central Daylight Time	07/30/2021 11:41:51 AM Central Daylight Time			08/04/2021 10:48:45 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Primary Medicare (HMO)	01	01		1			H4513	035	0	2022	East Tennessee		2		2			2						www.cigna.com/medicare	www.cignamedicare.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	036	0	1	02	01	H4513_036_0	5	1			2		0	07/08/2021	2022.01	07/08/2021 03:35:02 PM Central Daylight Time	08/02/2021 05:35:54 PM Central Daylight Time	07/30/2021 11:42:14 AM Central Daylight Time			08/04/2021 10:48:45 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Premier Medicare (HMO-POS)	01	02		1			H4513	036	0	2022	Tennessee		2		2			2						www.cigna.com/medicare	www.cignamedicare.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	037	0	1	01	01	H4513_037_0	4	1			2		0	08/02/2021	2022.01	08/02/2021 04:42:38 PM Central Daylight Time	08/02/2021 05:37:03 PM Central Daylight Time	07/30/2021 11:42:37 AM Central Daylight Time			08/04/2021 10:48:45 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H4513	037	0	2022	East Tennessee		2		2			2						www.cigna.com/medicare	www.cignamedicare.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	038	0	1	01	01	H4513_038_0	4	1			2		0	08/02/2021	2022.01	08/02/2021 04:43:41 PM Central Daylight Time	08/02/2021 05:38:16 PM Central Daylight Time	07/30/2021 11:43:01 AM Central Daylight Time			08/04/2021 10:48:45 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H4513	038	0	2022	East Arkansas		2		2			2						www.cigna.com/medicare	www.cignamedicare.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	039	0	1	01	01	H4513_039_0	5	1	2	1	2		0	08/17/2021	2022.01	08/17/2021 03:46:00 PM Central Daylight Time	08/02/2021 05:39:22 PM Central Daylight Time	07/30/2021 11:43:25 AM Central Daylight Time			08/17/2021 04:34:17 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna TotalCare Plus (HMO D-SNP)	01	01		1			H4513	039	0	2022	East Arkansas		2		2			1	3		1		2	www.cigna.com/medicare	www.cignamedicare.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	040	0	1	01	01	H4513_040_0	5	1	2	1	2		0	08/17/2021	2022.01	08/17/2021 03:48:34 PM Central Daylight Time	08/02/2021 05:40:59 PM Central Daylight Time	07/30/2021 11:43:49 AM Central Daylight Time			08/17/2021 04:34:17 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna TotalCare Plus (HMO D-SNP)	01	01		1			H4513	040	0	2022	East Tennessee		2		2			1	3		1		2	www.cigna.com/medicare	www.cignamedicare.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	045	0	1	01	01	H4513_045_0	3	1			2	0	0	07/08/2021	2022.01	07/08/2021 03:37:34 PM Central Daylight Time	05/31/2021 08:36:53 PM Central Daylight Time				07/19/2021 03:55:41 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Fundamental Medicare (HMO)	01	01		1			H4513	045	0	2022	Alabama		2		2			2						www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)707-7116		(855)707-7116										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H4513	046	1	1	01	01	H4513_046_1	4	1			2		0	08/02/2021	2022.01	08/02/2021 06:55:42 PM Central Daylight Time	08/01/2021 10:07:31 PM Central Daylight Time	07/30/2021 11:44:12 AM Central Daylight Time			08/04/2021 10:48:45 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Preferred AL Medicare (HMO)	01	01		1			H4513	046	1	2022	Alabama	South Alabama	2		2			2						www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)707-7116		(855)707-7116		(800)668-3813		(800)668-3813		(855)707-7116		(855)707-7116		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	046	2	1	01	01	H4513_046_2	3	1			2		0	08/02/2021	2022.01	08/02/2021 06:56:02 PM Central Daylight Time	08/01/2021 10:21:27 PM Central Daylight Time	07/30/2021 11:44:36 AM Central Daylight Time			08/04/2021 10:48:45 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Preferred AL Medicare (HMO)	01	01		1			H4513	046	2	2022	Alabama	North Alabama	2		2			2						www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)707-7116		(855)707-7116		(800)668-3813		(800)668-3813		(855)707-7116		(855)707-7116		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	047	0	1	01	01	H4513_047_0	4	1			2		0	07/08/2021	2022.01	07/08/2021 03:38:39 PM Central Daylight Time	08/03/2021 04:08:33 PM Central Daylight Time	07/30/2021 11:45:00 AM Central Daylight Time			08/04/2021 10:48:45 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Plus Medicare (HMO)	01	01		1			H4513	047	0	2022	Alabama		2		2			2						www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)707-7116		(855)707-7116		(800)668-3813		(800)668-3813		(855)707-7116		(855)707-7116		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	048	0	1	01	01	H4513_048_0	4	1			2		0	07/08/2021	2022.01	07/08/2021 03:39:02 PM Central Daylight Time	08/03/2021 04:11:17 PM Central Daylight Time	07/30/2021 11:45:25 AM Central Daylight Time			08/04/2021 10:48:45 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Plus Medicare (HMO)	01	01		1			H4513	048	0	2022	Alabama		2		2			2						www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)707-7116		(855)707-7116		(800)668-3813		(800)668-3813		(855)707-7116		(855)707-7116		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	049	1	1	01	01	H4513_049_1	4	1			2		0	08/02/2021	2022.01	08/02/2021 04:44:18 PM Central Daylight Time	08/02/2021 05:42:48 PM Central Daylight Time	07/30/2021 11:45:51 AM Central Daylight Time			08/04/2021 10:48:45 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H4513	049	1	2022	Tennessee	Tennessee Preferred	2		2			2						www.cigna.com/medicare	www.cignamedicare.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	049	2	1	01	01	H4513_049_2	4	1			2		0	08/02/2021	2022.01	08/02/2021 04:44:57 PM Central Daylight Time	08/02/2021 05:45:05 PM Central Daylight Time	07/30/2021 11:46:15 AM Central Daylight Time			08/04/2021 10:48:45 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H4513	049	2	2022	Tennessee	Tennessee Preferred Select Counties	2		2			2						www.cigna.com/medicare	www.cignamedicare.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	050	0	1	01	01	H4513_050_0	4	1			2		0	08/02/2021	2022.01	08/02/2021 04:45:59 PM Central Daylight Time	08/02/2021 05:46:51 PM Central Daylight Time	07/30/2021 11:46:39 AM Central Daylight Time			08/04/2021 10:48:45 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H4513	050	0	2022	Central Arkansas		2		2			2						www.cigna.com/medicare	www.cignamedicare.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	051	0	1	01	01	H4513_051_0	4	1			2		0	08/02/2021	2022.01	08/02/2021 04:48:27 PM Central Daylight Time	08/02/2021 05:49:13 PM Central Daylight Time	07/30/2021 11:47:02 AM Central Daylight Time			08/04/2021 10:48:45 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H4513	051	0	2022	West Arkansas		2		2			2						www.cigna.com/medicare	www.cignamedicare.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	052	0	1	01	01	H4513_052_0	4	1			2		0	08/02/2021	2022.01	08/02/2021 04:50:20 PM Central Daylight Time	08/02/2021 05:50:22 PM Central Daylight Time	07/30/2021 11:47:25 AM Central Daylight Time			08/04/2021 10:48:45 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H4513	052	0	2022	Northwest Arkansas		2		2			2						www.cigna.com/medicare	www.cignamedicare.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	053	0	1	01	01	H4513_053_0	4	1			2		0	07/08/2021	2022.01	07/08/2021 03:42:09 PM Central Daylight Time	08/02/2021 05:51:30 PM Central Daylight Time	07/30/2021 11:47:51 AM Central Daylight Time			08/04/2021 10:48:45 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Primary Medicare (HMO)	01	01		1			H4513	053	0	2022	West Tennessee		2		2			2						www.cigna.com/medicare	www.cignamedicare.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	054	0	1	01	01	H4513_054_0	4	1			2		0	08/03/2021	2022.01	08/03/2021 10:38:48 AM Central Daylight Time	08/01/2021 10:31:06 PM Central Daylight Time	07/30/2021 11:48:22 AM Central Daylight Time			08/04/2021 10:48:45 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H4513	054	0	2022	Alabama		2		2			2						www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)707-7116		(855)707-7116		(800)668-3813		(800)668-3813		(855)707-7116		(855)707-7116		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	055	0	1	01	01	H4513_055_0	4	1	2	1	2		0	07/08/2021	2022.01	07/08/2021 03:43:05 PM Central Daylight Time	08/01/2021 10:35:23 PM Central Daylight Time	07/30/2021 11:48:46 AM Central Daylight Time			08/04/2021 10:48:45 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna TotalCare (HMO D-SNP)	01	01		1			H4513	055	0	2022	Alabama		2		2			1	3		2		2	www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)707-7116		(855)707-7116		(800)668-3813		(800)668-3813		(855)707-7116		(855)707-7116		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	056	1	1	01	01	H4513_056_1	4	1	2	1	2		0	07/08/2021	2022.01	07/08/2021 03:43:35 PM Central Daylight Time	08/01/2021 10:39:18 PM Central Daylight Time	07/30/2021 11:49:10 AM Central Daylight Time			08/04/2021 10:48:45 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna TotalCare AL (HMO D-SNP)	01	01		1			H4513	056	1	2022	Alabama	South Alabama	2		2			1	3		2		2	www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)707-7116		(855)707-7116		(800)668-3813		(800)668-3813		(855)707-7116		(855)707-7116		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	056	2	1	01	01	H4513_056_2	4	1	2	1	2		0	07/08/2021	2022.01	07/08/2021 03:44:00 PM Central Daylight Time	08/01/2021 10:43:54 PM Central Daylight Time	07/30/2021 11:49:34 AM Central Daylight Time			08/04/2021 10:48:45 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna TotalCare AL (HMO D-SNP)	01	01		1			H4513	056	2	2022	Alabama	North Alabama	2		2			1	3		2		2	www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)707-7116		(855)707-7116		(800)668-3813		(800)668-3813		(855)707-7116		(855)707-7116		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	057	0	1	01	01	H4513_057_0	4	1			2		0	08/02/2021	2022.01	08/02/2021 06:57:20 PM Central Daylight Time	08/01/2021 10:46:45 PM Central Daylight Time	07/30/2021 11:49:59 AM Central Daylight Time			08/04/2021 10:48:45 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H4513	057	0	2022	Alabama		2		2			2						www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)707-7116		(855)707-7116		(800)668-3813		(800)668-3813		(855)707-7116		(855)707-7116		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	059	0	1	01	01	H4513_059_0	4	1			2		0	08/02/2021	2022.01	08/02/2021 04:52:02 PM Central Daylight Time	08/02/2021 05:52:31 PM Central Daylight Time	07/30/2021 11:50:23 AM Central Daylight Time			08/04/2021 10:48:45 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H4513	059	0	2022	Tri Cities		2		2			2						www.cigna.com/medicare	www.cignamedicare.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	060	1	1	01	01	H4513_060_1	4	1	2	1	2		0	07/08/2021	2022.01	07/08/2021 03:45:18 PM Central Daylight Time	08/02/2021 05:26:33 PM Central Daylight Time	07/30/2021 11:50:49 AM Central Daylight Time			08/04/2021 10:48:45 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna TotalCare (HMO D-SNP)	01	01		1			H4513	060	1	2022	Houston, Valley, El Paso & San Antonio	Houston & San Antonio	2		2			1	3		2		2	www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)982-6174		(855)982-6174		(800)668-3813		(800)668-3813		(855)982-6174		(855)982-6174		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	060	2	1	01	01	H4513_060_2	4	1	2	1	2		0	07/08/2021	2022.01	07/08/2021 03:45:50 PM Central Daylight Time	08/02/2021 05:27:31 PM Central Daylight Time	07/30/2021 11:51:13 AM Central Daylight Time			08/04/2021 10:48:45 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna TotalCare (HMO D-SNP)	01	01		1			H4513	060	2	2022	Houston, Valley, El Paso & San Antonio	Valley	2		2			1	3		2		2	www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)982-6174		(855)982-6174		(800)668-3813		(800)668-3813		(855)982-6174		(855)982-6174		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	060	3	1	01	01	H4513_060_3	4	1	2	1	2		0	07/08/2021	2022.01	07/08/2021 03:11:38 PM Central Daylight Time	08/02/2021 05:28:37 PM Central Daylight Time	07/30/2021 11:51:38 AM Central Daylight Time			08/04/2021 10:48:45 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna TotalCare (HMO D-SNP)	01	01		1			H4513	060	3	2022	Houston, Valley, El Paso & San Antonio	El Paso	2		2			1	3		2		2	www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)982-6174		(855)982-6174		(800)668-3813		(800)668-3813		(855)982-6174		(855)982-6174		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	061	1	1	01	01	H4513_061_1	3	1			2		0	08/02/2021	2022.01	08/02/2021 05:36:09 PM Central Daylight Time	08/02/2021 05:29:35 PM Central Daylight Time	07/30/2021 11:52:02 AM Central Daylight Time			08/04/2021 10:48:45 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H4513	061	1	2022	Houston, Valley, El Paso & San Antonio	Houston & San Antonio	2		2			2						www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)982-6174		(855)982-6174		(800)668-3813		(800)668-3813		(855)982-6174		(855)982-6174		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	061	2	1	01	01	H4513_061_2	3	1			2		0	08/02/2021	2022.01	08/02/2021 05:37:41 PM Central Daylight Time	08/02/2021 05:30:42 PM Central Daylight Time	07/30/2021 11:52:26 AM Central Daylight Time			08/04/2021 10:48:45 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H4513	061	2	2022	Houston, Valley, El Paso & San Antonio	Valley	2		2			2						www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)982-6174		(855)982-6174		(800)668-3813		(800)668-3813		(855)982-6174		(855)982-6174		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	061	3	1	01	01	H4513_061_3	3	1			2		0	08/02/2021	2022.01	08/02/2021 05:39:01 PM Central Daylight Time	08/02/2021 05:32:09 PM Central Daylight Time	07/30/2021 11:52:50 AM Central Daylight Time			08/04/2021 10:48:45 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H4513	061	3	2022	Houston, Valley, El Paso & San Antonio	El Paso	2		2			2						www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)982-6174		(855)982-6174		(800)668-3813		(800)668-3813		(855)982-6174		(855)982-6174		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	062	0	1	01	01	H4513_062_0	2	1			2	0	0	05/24/2021	2022.01	05/24/2021 09:31:01 AM Central Daylight Time	06/01/2021 12:36:32 AM Central Daylight Time				06/02/2021 04:05:19 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Fundamental Medicare (HMO)	01	01		1			H4513	062	0	2022	El Paso & San Antonio		2		2			2						www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)982-6174		(855)982-6174										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H4513	063	0	1	01	01	H4513_063_0	4	1	2	1	2		0	07/08/2021	2022.01	07/08/2021 03:46:22 PM Central Daylight Time	08/01/2021 10:49:13 PM Central Daylight Time	07/30/2021 11:53:15 AM Central Daylight Time			08/04/2021 10:48:45 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna TotalCare Plus (HMO D-SNP)	01	01		1			H4513	063	0	2022	Alabama		2		2			1	3		1		2	www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101		(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	064	0	1	01	01	H4513_064_0	4	1			2		0	08/02/2021	2022.01	08/02/2021 05:40:18 PM Central Daylight Time	08/02/2021 05:33:31 PM Central Daylight Time	07/30/2021 11:53:38 AM Central Daylight Time			08/04/2021 10:48:45 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Alliance Medicare (HMO)	01	01		1			H4513	064	0	2022	Houston		2		2			2						www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)982-6174		(855)982-6174		(800)668-3813		(800)668-3813		(855)982-6174		(855)982-6174		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	066	0	1	01	01	H4513_066_0	3	1			2		0	08/02/2021	2022.01	08/02/2021 05:41:39 PM Central Daylight Time	08/02/2021 05:34:41 PM Central Daylight Time	07/30/2021 11:54:01 AM Central Daylight Time			08/04/2021 10:48:45 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Savings Medicare (HMO)	01	01		1			H4513	066	0	2022	Houston & San Antonio		2		2			2						www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)982-6174		(855)982-6174		(800)668-3813		(800)668-3813		(855)982-6174		(855)982-6174		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	804	0	1	01	01	H4513_804_0	2	1						05/10/2021	2022.01	05/10/2021 10:26:25 AM Central Daylight Time					06/02/2021 04:05:19 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignahealthspring.com	Cigna Preferred Medicare (HMO)	01	01		1			H4513	804	0	2022	Statewide TX		1	600	2			2						www.cigna.com/medicare	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)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H4513	815	0	1	01	01	H4513_815_0	2	1						05/10/2021	2022.01	05/10/2021 10:27:58 AM Central Daylight Time					06/02/2021 04:05:19 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H4513	815	0	2022	Statewide TN, MS & IL		1	8531	2			2						www.cigna.com/medicare	www.cignamedicare.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)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H4513	817	0	1	01	01	H4513_817_0	2	1						05/10/2021	2022.01	05/10/2021 10:29:04 AM Central Daylight Time					06/02/2021 04:05:19 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H4513	817	0	2022	Statewide AL		1	600	2			2						www.cigna.com/medicare	www.cignamedicare.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)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H4513	819	0	1	01	01	H4513_819_0	2	1						05/10/2021	2022.01	05/10/2021 10:32:02 AM Central Daylight Time					06/02/2021 04:05:19 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H4513	819	0	2022	Statewide AR		1	24	2			2						www.cigna.com/medicare	www.cignamedicare.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)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H4513	820	0	1	01	01	H4513_820_0	2	1						05/10/2021	2022.01	05/10/2021 10:32:40 AM Central Daylight Time					06/02/2021 04:05:19 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H4513	820	0	2022	Statewide VA		1	600	2			2						www.cigna.com/medicare	www.cignamedicare.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)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H4513	821	0	1	01	01	H4513_821_0	2	1						05/10/2021	2022.01	05/10/2021 10:34:52 AM Central Daylight Time					06/02/2021 04:05:19 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H4513	821	0	2022	Nationwide		1	600	2			2						www.cigna.com/medicare	www.cignamedicare.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)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H4514	007	0	1	01	01	H4514_007_0	2	1			2		1	08/04/2021	2022.01	08/04/2021 08:55:41 AM Central Daylight Time	08/03/2021 12:38:04 PM Central Daylight Time	07/29/2021 08:37:17 PM Central Daylight Time			08/04/2021 03:17:59 PM Central Daylight Time	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO)	01	01		1			H4514	007	0	2022	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	013	1	1	01	01	H4514_013_1	5	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 09:01:40 AM Central Daylight Time	08/03/2021 12:16:32 PM Central Daylight Time	07/29/2021 08:37:32 PM Central Daylight Time			08/04/2021 03:17:59 PM Central Daylight Time	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO D-SNP)	01	01		1			H4514	013	1	2022	Houston, Austin, and Outer Dallas Metro Areas	Houston Metro Area	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	013	2	1	01	01	H4514_013_2	5	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 09:03:07 AM Central Daylight Time	08/03/2021 12:16:55 PM Central Daylight Time	07/29/2021 08:37:47 PM Central Daylight Time			08/04/2021 03:17:59 PM Central Daylight Time	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO D-SNP)	01	01		1			H4514	013	2	2022	Houston, Austin, and Outer Dallas Metro Areas	Austin Metro Area	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	013	3	1	01	01	H4514_013_3	5	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 09:04:43 AM Central Daylight Time	08/03/2021 12:17:20 PM Central Daylight Time	07/29/2021 08:38:02 PM Central Daylight Time			08/04/2021 03:17:59 PM Central Daylight Time	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO D-SNP)	01	01		1			H4514	013	3	2022	Houston, Austin, and Outer Dallas Metro Areas	Outer Dallas Metro Area	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	014	0	1	02	01	H4514_014_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 09:06:53 AM Central Daylight Time	08/03/2021 12:17:43 PM Central Daylight Time	07/29/2021 08:38:17 PM Central Daylight Time			08/04/2021 03:17:59 PM Central Daylight Time	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Ally (HMO-POS)	01	02		1			H4514	014	0	2022	Fort Bend and Harris 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			
H4514	015	0	1	02	01	H4514_015_0	4	1		1	2		1	08/04/2021	2022.01	08/04/2021 09:09:01 AM Central Daylight Time	08/03/2021 08:48:38 PM Central Daylight Time	07/29/2021 08:38:32 PM Central Daylight Time			08/04/2021 03:17:59 PM Central Daylight Time	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Chronic Complete Ally (HMO-POS C-SNP)	01	02		1			H4514	015	0	2022	Fort Bend and Harris counties		2		2			1	4			00000000000000000010		www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.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			
H4514	016	0	1	01	01	H4514_016_0	4	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 09:10:33 AM Central Daylight Time	08/03/2021 12:18:31 PM Central Daylight Time	07/29/2021 08:38:47 PM Central Daylight Time			08/04/2021 03:17:59 PM Central Daylight Time	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Ally (HMO D-SNP)	01	01		1			H4514	016	0	2022	Fort Bend and Harris counties		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	801	0	1	01	01	H4514_801_0	1	1						05/24/2021	2022.01	05/24/2021 12:38:08 PM Eastern Daylight Time					06/03/2021 09:56:57 AM Eastern 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	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1					1				
H4514	803	0	1	01	01	H4514_803_0	1	1				0	0	06/03/2021	2022.01	06/03/2021 09:44:18 AM Eastern Daylight Time					06/03/2021 09:56:57 AM Eastern 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	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1					1				
H4514	806	0	1	01	01	H4514_806_0	1	1						05/24/2021	2022.01	05/24/2021 12:38:46 PM Eastern Daylight Time					06/03/2021 09:56:57 AM Eastern 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	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1					1				
H4517	001	0	1	20	08	H4517_001_0	1	1						06/02/2021	2022.01	06/02/2021 12:53:34 PM Central Daylight Time		06/02/2021 12:48:01 PM Central Daylight Time			06/02/2021 12:54:57 PM 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	2022	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						06/02/2021	2022.01	06/02/2021 12:53:45 PM Central Daylight Time		06/02/2021 12:49:17 PM Central Daylight Time			06/02/2021 12:54:57 PM 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	2022	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	1	1						06/03/2021	2022.01	06/03/2021 03:23:00 PM Mountain Daylight Time		06/02/2021 02:07:31 PM Mountain Daylight Time			06/03/2021 03:33:04 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	2022	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	1	1						06/03/2021	2022.01	06/03/2021 03:23:29 PM Mountain Daylight Time		06/02/2021 02:07:28 PM Mountain Daylight Time			06/03/2021 03:33:04 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	2022	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	2	1					0	08/02/2021	2022.01	08/02/2021 03:15:42 PM Eastern Daylight Time	08/02/2021 03:25:00 PM Eastern Daylight Time	08/02/2021 09:40:56 AM Eastern Daylight Time			08/04/2021 02:44:24 PM Eastern Daylight Time	AETNA HEALTH INC. (TX)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (HMO)	01	01		1			H4523	001	0	2022	San Antonio and Austin Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4523	015	0	1	01	01	H4523_015_0	2	1					0	08/02/2021	2022.01	08/02/2021 03:22:38 PM Eastern Daylight Time	08/02/2021 03:26:14 PM Eastern Daylight Time	08/02/2021 09:41:00 AM Eastern Daylight Time			08/04/2021 02:44:24 PM Eastern Daylight Time	AETNA HEALTH INC. (TX)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (HMO)	01	01		1			H4523	015	0	2022	Houston and Surrounding Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4523	020	0	1	01	01	H4523_020_0	2	1					0	08/02/2021	2022.01	08/02/2021 03:23:08 PM Eastern Daylight Time	08/02/2021 03:27:21 PM Eastern Daylight Time	08/02/2021 09:41:04 AM Eastern Daylight Time			08/04/2021 02:44:24 PM Eastern Daylight Time	AETNA HEALTH INC. (TX)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime Plan (HMO)	01	01		1			H4523	020	0	2022	Bexar and Comal counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4523	021	0	1	01	01	H4523_021_0	2	1					0	08/02/2021	2022.01	08/02/2021 03:23:36 PM Eastern Daylight Time	08/02/2021 03:28:52 PM Eastern Daylight Time	08/02/2021 09:41:09 AM Eastern Daylight Time			08/04/2021 02:44:24 PM Eastern Daylight Time	AETNA HEALTH INC. (TX)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime Plan (HMO)	01	01		1			H4523	021	0	2022	Dallas and Surrounding Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4523	024	0	1	01	01	H4523_024_0	3	1					0	08/02/2021	2022.01	08/02/2021 03:24:47 PM Eastern Daylight Time	08/02/2021 03:29:57 PM Eastern Daylight Time	08/02/2021 09:41:13 AM Eastern Daylight Time			08/04/2021 02:44:24 PM Eastern Daylight Time	AETNA HEALTH INC. (TX)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime Plan (HMO)	01	01		1			H4523	024	0	2022	Harris County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4523	801	0	1	01	01	H4523_801_0	1	1				0	0	05/27/2021	2022.01	05/27/2021 11:29:00 PM Eastern Daylight Time					06/03/2021 01:24:36 PM Eastern Daylight Time	AETNA HEALTH INC. (TX)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (HMO)	01	01		1			H4523	801	0	2022	Texas		1	660	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H4523	802	0	1	01	01	H4523_802_0	1	1						06/02/2021	2022.01	06/02/2021 10:01:26 PM Eastern Daylight Time					06/03/2021 01:24:36 PM Eastern Daylight Time	AETNA HEALTH INC. (TX)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan w/Rx (HMO)	01	01		1			H4523	802	0	2022	Texas		1	4390	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H4527	001	0	1	01	01	H4527_001_0	4	1			1		1	08/04/2021	2022.01	08/04/2021 11:17:40 AM Central Daylight Time	08/03/2021 11:53:05 AM Central Daylight Time	07/29/2021 08:39:01 PM Central Daylight Time			08/04/2021 03:37:54 PM Central Daylight Time	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO)	01	01		1			H4527	001	0	2022	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			2		1	08/04/2021	2022.01	08/04/2021 09:13:38 AM Central Daylight Time	08/03/2021 11:53:30 AM Central Daylight Time	07/29/2021 08:39:16 PM Central Daylight Time			08/04/2021 03:37:54 PM Central Daylight Time	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO)	01	01		1			H4527	002	0	2022	Austin 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	003	0	1	01	01	H4527_003_0	4	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 09:15:25 AM Central Daylight Time	08/03/2021 11:53:54 AM Central Daylight Time	07/29/2021 08:39:31 PM Central Daylight Time			08/04/2021 03:37:54 PM Central Daylight Time	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Focus (HMO D-SNP)	01	01		1			H4527	003	0	2022	Hays, Travis, and Williamson 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			
H4527	004	0	1	01	01	H4527_004_0	4	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 09:16:49 AM Central Daylight Time	08/03/2021 11:54:17 AM Central Daylight Time	07/29/2021 08:39:47 PM Central Daylight Time			08/04/2021 03:37:54 PM Central Daylight Time	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Plan 1 (HMO D-SNP)	01	01		1			H4527	004	0	2022	Aransas, Kleberg, Nueces, San Patricio 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			
H4527	005	0	1	01	01	H4527_005_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 09:18:12 AM Central Daylight Time	08/03/2021 11:54:43 AM Central Daylight Time	07/29/2021 08:40:02 PM Central Daylight Time			08/04/2021 03:37:54 PM Central Daylight Time	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO)	01	01		1			H4527	005	0	2022	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	4	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 09:19:24 AM Central Daylight Time	08/03/2021 11:55:07 AM Central Daylight Time	07/29/2021 08:40:17 PM Central Daylight Time			08/04/2021 03:37:54 PM Central Daylight Time	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO D-SNP)	01	01		1			H4527	006	0	2022	El Paso County		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			
H4527	013	0	1	01	01	H4527_013_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 09:27:30 AM Central Daylight Time	08/03/2021 11:55:31 AM Central Daylight Time	07/29/2021 08:40:32 PM Central Daylight Time			08/04/2021 03:37:54 PM Central Daylight Time	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO)	01	01		1			H4527	013	0	2022	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	4	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 09:28:41 AM Central Daylight Time	08/03/2021 11:55:56 AM Central Daylight Time	07/29/2021 08:40:47 PM Central Daylight Time			08/04/2021 03:37:54 PM Central Daylight Time	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Plan 1 (HMO D-SNP)	01	01		1			H4527	015	0	2022	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			
H4527	024	0	1	02	01	H4527_024_0	3	1			2	0	0	07/14/2021	2022.01	07/14/2021 05:01:40 PM Central Daylight Time	06/03/2021 03:36:00 PM Central Daylight Time				07/15/2021 12:54:22 PM Central Daylight Time	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (HMO-POS)	01	02		1			H4527	024	0	2022	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	02	01	H4527_037_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 10:21:57 AM Central Daylight Time	08/03/2021 11:56:20 AM Central Daylight Time	07/29/2021 08:41:02 PM Central Daylight Time			08/04/2021 03:37:54 PM Central Daylight Time	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO-POS)	01	02		1			H4527	037	0	2022	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	039	0	1	01	01	H4527_039_0	3	1		1	2		1	08/04/2021	2022.01	08/04/2021 10:23:06 AM Central Daylight Time	08/03/2021 11:56:45 AM Central Daylight Time	07/29/2021 08:41:17 PM Central Daylight Time			08/04/2021 03:37:54 PM Central Daylight Time	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Chronic Complete (HMO C-SNP)	01	01		1			H4527	039	0	2022	Bastrop, Hays, Travis, and Williamson counties		2		2			1	4			00000000000000000010		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			
H4527	040	0	1	01	01	H4527_040_0	3	1		1	2		1	08/04/2021	2022.01	08/04/2021 10:24:14 AM Central Daylight Time	08/03/2021 11:57:10 AM Central Daylight Time	07/29/2021 08:41:31 PM Central Daylight Time			08/04/2021 03:37:54 PM Central Daylight Time	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Chronic Complete (HMO C-SNP)	01	01		1			H4527	040	0	2022	El Paso County		2		2			1	4			00000000000000000010		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			
H4527	041	0	1	01	01	H4527_041_0	3	1		1	2		1	08/04/2021	2022.01	08/04/2021 10:26:55 AM Central Daylight Time	08/03/2021 11:57:34 AM Central Daylight Time	07/29/2021 08:41:46 PM Central Daylight Time			08/04/2021 03:37:54 PM Central Daylight Time	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Chronic Complete (HMO C-SNP)	01	01		1			H4527	041	0	2022	Corpus Christi Metro Area		2		2			1	4			00000000000000000010		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			
H4527	042	0	1	01	01	H4527_042_0	3	1		1	2		1	08/04/2021	2022.01	08/04/2021 10:28:00 AM Central Daylight Time	08/03/2021 11:57:59 AM Central Daylight Time	07/29/2021 08:42:00 PM Central Daylight Time			08/04/2021 03:37:54 PM Central Daylight Time	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Chronic Complete (HMO C-SNP)	01	01		1			H4527	042	0	2022	Cameron, Hidalgo, Starr, and Willacy Counties		2		2			1	4			00000000000000000010		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			
H4527	801	0	1	01	01	H4527_801_0	1	1						05/24/2021	2022.01	05/24/2021 12:39:10 PM Eastern Daylight Time					06/03/2021 09:58:51 AM Eastern Daylight Time	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H4527	801	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;17a;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H4527	802	0	1	01	01	H4527_802_0	1	1				0	0	06/03/2021	2022.01	06/03/2021 09:44:58 AM Eastern Daylight Time					06/03/2021 09:58:51 AM Eastern Daylight Time	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H4527	802	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;17a;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H4527	803	0	1	01	01	H4527_803_0	1	1						05/24/2021	2022.01	05/24/2021 12:39:42 PM Eastern Daylight Time					06/03/2021 09:58:51 AM Eastern Daylight Time	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H4527	803	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;17a;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H4537	001	0	1	04	01	H4537_001_0	5	1					0	08/01/2021	2022.01	08/01/2021 03:34:35 PM Eastern Daylight Time	08/04/2021 12:15:57 AM Eastern Daylight Time	07/30/2021 11:23:58 AM Eastern Daylight Time			08/04/2021 08:53:46 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC	Wellcare	www.wellcare.com/medicare	Wellcare No Premium Open (PPO)	01	04		1			H4537	001	0	2022	Select counties in OK		2	629	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)853-0865		(833)853-0865		(844)917-0175		(844)917-0175		(833)853-0865		(833)853-0865		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4537	002	0	1	04	01	H4537_002_0	5	1					0	08/01/2021	2022.01	08/01/2021 03:35:34 PM Eastern Daylight Time	08/04/2021 12:16:25 AM Eastern Daylight Time	07/30/2021 11:24:32 AM Eastern Daylight Time			08/04/2021 08:53:46 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC	Wellcare	www.wellcare.com/medicare	Wellcare No Premium Open (PPO)	01	04		1			H4537	002	0	2022	Select counties in OK		2	629	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)853-0865		(833)853-0865		(844)917-0175		(844)917-0175		(833)853-0865		(833)853-0865		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4544	001	0	1	04	01	H4544_001_0	3	1					1	08/04/2021	2022.01	08/04/2021 04:17:20 PM Central Daylight Time	08/03/2021 01:22:16 PM Central Daylight Time	07/29/2021 08:42:15 PM Central Daylight Time			08/04/2021 07:39:56 PM Central Daylight Time	PEOPLES HEALTH, INC.	Peoples Health	www.peopleshealth.com	Peoples Health Choices (PPO)	01	04		1			H4544	001	0	2022	Select Counties in Louisiana		2		2			2						www.peopleshealth.com/pharmacies	www.peopleshealth.com/formulary	www.peopleshealth.com/physicians	(800)222-8600		(800)222-8600		(800)555-5757		(800)555-5757		(800)222-8600		(800)222-8600		(800)555-5757		(800)555-5757		(800)846-5277		(800)846-5277		(711)-		(711)-		(800)846-5277		(800)846-5277		(711)-		(711)-		2					2						2			
H4544	002	0	1	04	01	H4544_002_0	3	1				0	0	08/04/2021	2022.01	08/04/2021 04:17:42 PM Central Daylight Time	06/03/2021 03:40:56 PM Central Daylight Time				08/04/2021 07:39:56 PM Central Daylight Time	PEOPLES HEALTH, INC.	Peoples Health	www.peopleshealth.com	Peoples Health Patriot (PPO)	01	04		1			H4544	002	0	2022	Select Counties in Louisiana		2		2			2						www.peopleshealth.com/pharmacies	www.peopleshealth.com/formulary	www.peopleshealth.com/physicians	(800)222-8600		(800)222-8600		(800)555-5757		(800)555-5757										(800)846-5277		(800)846-5277		(711)-		(711)-										2					2						2			
H4590	010	0	1	01	01	H4590_010_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 10:30:36 AM Central Daylight Time	08/03/2021 02:15:28 PM Central Daylight Time	07/29/2021 08:42:30 PM Central Daylight Time			08/04/2021 03:52:34 PM Central Daylight Time	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons (HMO)	01	01		1			H4590	010	0	2022	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	02	01	H4590_012_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 10:31:52 AM Central Daylight Time	08/03/2021 02:15:58 PM Central Daylight Time	07/29/2021 08:42:44 PM Central Daylight Time			08/04/2021 03:52:34 PM Central Daylight Time	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Plan 1 (HMO-POS)	01	02		1			H4590	012	0	2022	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	4	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 11:20:35 AM Central Daylight Time	08/03/2021 02:16:29 PM Central Daylight Time	07/29/2021 08:42:59 PM Central Daylight Time			08/04/2021 03:52:34 PM Central Daylight Time	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO D-SNP)	01	01		1			H4590	020	0	2022	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	4	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 10:34:45 AM Central Daylight Time	08/03/2021 02:16:59 PM Central Daylight Time	07/29/2021 08:43:14 PM Central Daylight Time			08/04/2021 03:52:34 PM Central Daylight Time	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO D-SNP)	01	01		1			H4590	022	0	2022	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			2		1	08/04/2021	2022.01	08/04/2021 10:35:58 AM Central Daylight Time	08/03/2021 02:17:30 PM Central Daylight Time	07/29/2021 08:43:29 PM Central Daylight Time			08/04/2021 03:52:34 PM Central Daylight Time	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons (HMO)	01	01		1			H4590	025	0	2022	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	02	01	H4590_027_0	2	1			2	0	0	07/14/2021	2022.01	07/14/2021 05:28:21 PM Central Daylight Time	06/03/2021 04:00:51 PM Central Daylight Time				07/15/2021 01:03:35 PM Central Daylight Time	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (HMO-POS)	01	02		1			H4590	027	0	2022	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	2	1			2	0	0	07/14/2021	2022.01	07/14/2021 05:31:35 PM Central Daylight Time	06/03/2021 04:01:15 PM Central Daylight Time				07/15/2021 01:03:35 PM Central Daylight Time	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (HMO)	01	01		1			H4590	029	0	2022	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	4	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 10:41:09 AM Central Daylight Time	08/03/2021 02:18:01 PM Central Daylight Time	07/29/2021 08:43:44 PM Central Daylight Time			08/04/2021 03:52:34 PM Central Daylight Time	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Plan 2 (HMO D-SNP)	01	01		1			H4590	033	0	2022	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	2		1	08/04/2021	2022.01	08/04/2021 10:42:42 AM Central Daylight Time	08/03/2021 02:18:32 PM Central Daylight Time	07/29/2021 08:43:59 PM Central Daylight Time			08/04/2021 03:52:34 PM Central Daylight Time	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Chronic Complete (HMO C-SNP)	01	01		1			H4590	037	0	2022	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	02	01	H4590_041_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 10:43:54 AM Central Daylight Time	08/03/2021 02:19:02 PM Central Daylight Time	07/29/2021 08:44:13 PM Central Daylight Time			08/04/2021 03:52:34 PM Central Daylight Time	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Plan 2 (HMO-POS)	01	02		1			H4590	041	0	2022	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	02	01	H4590_042_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 10:45:30 AM Central Daylight Time	08/03/2021 02:19:33 PM Central Daylight Time	07/29/2021 08:44:28 PM Central Daylight Time			08/04/2021 03:52:34 PM Central Daylight Time	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	01	02		1			H4590	042	0	2022	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	043	0	1	02	01	H4590_043_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 10:46:44 AM Central Daylight Time	08/03/2021 02:20:04 PM Central Daylight Time	07/29/2021 08:44:42 PM Central Daylight Time			08/04/2021 03:52:34 PM Central Daylight Time	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	01	02		1			H4590	043	0	2022	Dallas 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	044	0	1	02	01	H4590_044_0	3	1		1	2		1	08/04/2021	2022.01	08/04/2021 10:48:04 AM Central Daylight Time	08/03/2021 02:20:34 PM Central Daylight Time	07/29/2021 08:44:58 PM Central Daylight Time			08/04/2021 03:52:34 PM Central Daylight Time	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Ally (HMO-POS C-SNP)	01	02		1			H4590	044	0	2022	Dallas Metro Area		2		2			1	4			00011010000000000000		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			
H4590	045	0	1	01	01	H4590_045_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 10:49:22 AM Central Daylight Time	08/03/2021 02:21:05 PM Central Daylight Time	07/29/2021 08:45:12 PM Central Daylight Time			08/04/2021 03:52:34 PM Central Daylight Time	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO)	01	01		1			H4590	045	0	2022	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	801	0	1	01	01	H4590_801_0	1	1				0	0	06/03/2021	2022.01	06/03/2021 09:45:44 AM Eastern Daylight Time					06/03/2021 10:01:09 AM Eastern Daylight Time	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H4590	801	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H4590	803	0	1	01	01	H4590_803_0	1	1						05/24/2021	2022.01	05/24/2021 12:40:20 PM Eastern Daylight Time					06/03/2021 10:01:09 AM Eastern Daylight Time	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H4590	803	0	2022	TX Employer Sponsored Plan Service Area		1	14400	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H4590	804	0	1	01	01	H4590_804_0	1	1						05/24/2021	2022.01	05/24/2021 12:40:36 PM Eastern Daylight Time					06/03/2021 10:01:09 AM Eastern Daylight Time	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H4590	804	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H4604	003	0	1	01	01	H4604_003_0	3	1					1	08/04/2021	2022.01	08/04/2021 01:41:15 PM Central Daylight Time	08/03/2021 12:40:18 PM Central Daylight Time	07/29/2021 08:45:27 PM Central Daylight Time			08/04/2021 09:58:39 PM Central Daylight Time	UNITEDHEALTHCARE OF UTAH, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO)	01	01		1			H4604	003	0	2022	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	2	1				0	0	07/15/2021	2022.01	07/15/2021 09:41:31 AM Central Daylight Time	06/03/2021 03:05:23 PM Central Daylight Time				07/16/2021 01:27:07 PM Central Daylight Time	UNITEDHEALTHCARE OF UTAH, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (HMO)	01	01		1			H4604	005	0	2022	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					1	08/04/2021	2022.01	08/04/2021 01:45:00 PM Central Daylight Time	08/03/2021 12:40:50 PM Central Daylight Time	07/29/2021 08:45:41 PM Central Daylight Time			08/04/2021 09:58:39 PM Central Daylight Time	UNITEDHEALTHCARE OF UTAH, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO)	01	01		1			H4604	011	0	2022	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	3	1					1	08/04/2021	2022.01	08/04/2021 01:46:51 PM Central Daylight Time	08/03/2021 12:41:23 PM Central Daylight Time	07/29/2021 08:45:56 PM Central Daylight Time			08/04/2021 09:58:39 PM Central Daylight Time	UNITEDHEALTHCARE OF UTAH, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO)	01	01		1			H4604	012	0	2022	Select Counties in Idaho		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					1	08/04/2021	2022.01	08/04/2021 01:48:35 PM Central Daylight Time	08/03/2021 12:41:58 PM Central Daylight Time	07/29/2021 08:46:11 PM Central Daylight Time			08/04/2021 09:58:39 PM Central Daylight Time	UNITEDHEALTHCARE OF UTAH, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO)	01	01		1			H4604	013	0	2022	Select Counties in Idaho		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					1	08/04/2021	2022.01	08/04/2021 01:50:44 PM Central Daylight Time	08/03/2021 12:42:34 PM Central Daylight Time	07/29/2021 08:46:26 PM Central Daylight Time			08/04/2021 09:58:39 PM Central Daylight Time	UNITEDHEALTHCARE OF UTAH, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO)	01	01		1			H4604	014	0	2022	Select Counties in Idaho		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	015	0	1	01	01	H4604_015_0	3	1					1	08/04/2021	2022.01	08/04/2021 01:53:09 PM Central Daylight Time	08/03/2021 12:43:09 PM Central Daylight Time	07/29/2021 08:46:40 PM Central Daylight Time			08/04/2021 09:58:39 PM Central Daylight Time	UNITEDHEALTHCARE OF UTAH, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Focus (HMO)	01	01		1			H4604	015	0	2022	Select Counties in Idaho		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	016	0	1	01	01	H4604_016_0	3	1					1	08/04/2021	2022.01	08/04/2021 01:54:44 PM Central Daylight Time	08/03/2021 12:43:45 PM Central Daylight Time	07/29/2021 08:46:54 PM Central Daylight Time			08/04/2021 09:58:39 PM Central Daylight Time	UNITEDHEALTHCARE OF UTAH, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO)	01	01		1			H4604	016	0	2022	Iron and Washington 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			
H4604	017	0	1	01	01	H4604_017_0	3	1		1			1	08/04/2021	2022.01	08/04/2021 01:56:23 PM Central Daylight Time	08/03/2021 12:44:20 PM Central Daylight Time	07/29/2021 08:47:09 PM Central Daylight Time			08/04/2021 09:58:39 PM Central Daylight Time	UNITEDHEALTHCARE OF UTAH, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Assist (HMO C-SNP)	01	01		1			H4604	017	0	2022	Select Counties in Utah		2		2			1	4			00000000000000000010		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			
H4604	018	0	1	01	01	H4604_018_0	3	1					1	08/04/2021	2022.01	08/04/2021 01:58:03 PM Central Daylight Time	08/03/2021 12:44:56 PM Central Daylight Time	07/29/2021 08:47:24 PM Central Daylight Time			08/04/2021 09:58:39 PM Central Daylight Time	UNITEDHEALTHCARE OF UTAH, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Walgreens (HMO)	01	01		1			H4604	018	0	2022	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	019	0	1	01	01	H4604_019_0	2	1				0	0	07/15/2021	2022.01	07/15/2021 10:04:05 AM Central Daylight Time	06/03/2021 03:09:18 PM Central Daylight Time				07/16/2021 01:36:12 PM Central Daylight Time	UNITEDHEALTHCARE OF UTAH, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (HMO)	01	01		1			H4604	019	0	2022	Select counties in Idaho		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	020	0	1	01	01	H4604_020_0	3	1					1	08/04/2021	2022.01	08/04/2021 02:07:10 PM Central Daylight Time	08/03/2021 12:45:33 PM Central Daylight Time	07/29/2021 08:47:39 PM Central Daylight Time			08/04/2021 09:58:39 PM Central Daylight Time	UNITEDHEALTHCARE OF UTAH, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO)	01	01		1			H4604	020	0	2022	Select counties in Idaho		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	022	0	1	01	01	H4604_022_0	3	1					1	08/04/2021	2022.01	08/04/2021 02:09:18 PM Central Daylight Time	08/03/2021 12:46:07 PM Central Daylight Time	07/29/2021 08:47:53 PM Central Daylight Time			08/04/2021 09:58:39 PM Central Daylight Time	UNITEDHEALTHCARE OF UTAH, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO)	01	01		1			H4604	022	0	2022	Select Counties in Idaho		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	023	0	1	01	01	H4604_023_0	3	1					1	08/04/2021	2022.01	08/04/2021 02:11:08 PM Central Daylight Time	08/03/2021 12:46:41 PM Central Daylight Time	07/29/2021 08:48:07 PM Central Daylight Time			08/04/2021 09:58:39 PM Central Daylight Time	UNITEDHEALTHCARE OF UTAH, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO)	01	01		1			H4604	023	0	2022	Iron and Washington 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						06/02/2021	2022.01	06/02/2021 04:00:52 PM Central Daylight Time					06/02/2021 04:24:52 PM Central Daylight Time	UNITEDHEALTHCARE OF UTAH, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H4604	801	0	2022	Salt Lake and Surrounding Counties		1	3000	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1					1				
H4604	803	0	1	01	01	H4604_803_0	1	1						06/02/2021	2022.01	06/02/2021 04:01:14 PM Central Daylight Time					06/02/2021 04:24:52 PM Central Daylight Time	UNITEDHEALTHCARE OF UTAH, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H4604	803	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1					1				
H4604	805	0	1	01	01	H4604_805_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 04:03:56 PM Central Daylight Time					06/02/2021 04:24:52 PM Central Daylight Time	UNITEDHEALTHCARE OF UTAH, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H4604	805	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1					1				
H4605	001	0	1	04	01	H4605_001_0	4	1			2	0	0	07/07/2021	2022.01	07/07/2021 10:26:16 AM Pacific Daylight Time	07/01/2021 02:18:31 PM Pacific Daylight Time				07/07/2021 03:24:11 PM Pacific Daylight Time	REGENCE BLUECROSS BLUESHIELD OF UTAH	Regence BlueCross BlueShield of Utah	www.regence.com/medicare	Regence Valiance (PPO)	01	04		1			H4605	001	0	2022	Select Counties in Utah		2	5635	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	7	1			1		1	08/03/2021	2022.01	08/03/2021 12:52:57 PM Pacific Daylight Time	08/04/2021 01:07:38 PM Pacific Daylight Time	08/06/2021 10:14:08 AM Pacific Daylight Time			08/09/2021 09:46:09 AM Pacific 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	2022	Select Counties in Utah		2	53755	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	7	1			1		1	07/07/2021	2022.01	07/07/2021 10:41:05 AM Pacific Daylight Time	08/04/2021 12:54:59 PM Pacific Daylight Time	08/06/2021 10:18:07 AM Pacific Daylight Time			08/09/2021 09:46:09 AM Pacific 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	2022	Davis, Salt Lake, Utah, and Weber counties		2	15988	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	7	1			1		1	08/03/2021	2022.01	08/03/2021 12:52:14 PM Pacific Daylight Time	08/04/2021 01:09:27 PM Pacific Daylight Time	08/06/2021 10:20:29 AM Pacific Daylight Time			08/09/2021 09:46:09 AM Pacific 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	2022	Select Counties in Utah		2	37165	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	008	0	1	04	01	H4605_008_0	7	1			1		1	08/03/2021	2022.01	08/03/2021 12:52:32 PM Pacific Daylight Time	08/04/2021 01:10:17 PM Pacific Daylight Time	08/06/2021 10:22:48 AM Pacific Daylight Time			08/09/2021 09:46:09 AM Pacific 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	008	0	2022	Iron and Washington Counties		2	7480	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	009	0	1	04	01	H4605_009_0	7	1			1		1	08/03/2021	2022.01	08/03/2021 12:53:46 PM Pacific Daylight Time	08/04/2021 01:08:32 PM Pacific Daylight Time	08/06/2021 10:16:12 AM Pacific Daylight Time			08/09/2021 09:46:09 AM Pacific 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	009	0	2022	Iron and Washington Counties		2	621	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	4	1				0	0	06/02/2021	2022.01	06/02/2021 10:53:47 AM Pacific Daylight Time					06/03/2021 11:12:52 AM Pacific 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	2022	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										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7c;7e;7h;7i;7k;8a;8b1;8b2;9a1;9a2;9b;9c;10a;11a;11b;11c;15;	2		1									
H4605	802	0	1	04	01	H4605_802_0	4	1						06/02/2021	2022.01	06/02/2021 10:54:11 AM Pacific Daylight Time					06/03/2021 11:12:52 AM Pacific 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	2022	Nationwide except territories		1	5280	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;7k;8a;8b1;8b2;9a1;9a2;9b;9c;10a;11a;11b;11c;15;	2		1									
H4605	803	0	1	04	01	H4605_803_0	4	1						06/02/2021	2022.01	06/02/2021 10:54:38 AM Pacific Daylight Time					06/03/2021 11:12:52 AM Pacific 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	2022	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;7e;7h;7i;7k;8a;8b1;8b2;9a1;9a2;9b;9c;10a;11a;11b;11c;15;	2		1									
H4605	804	0	1	04	01	H4605_804_0	4	1						06/02/2021	2022.01	06/02/2021 10:55:00 AM Pacific Daylight Time					06/03/2021 11:12:52 AM Pacific 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	2022	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;7e;7h;7i;7k;8a;8b1;8b2;9a1;9a2;9b;9c;10a;11a;11b;11c;15;	2		1									
H4623	001	0	1	01	01	H4623_001_0	4	1					1	08/01/2021	2022.01	08/01/2021 01:28:20 PM Eastern Daylight Time	08/03/2021 05:46:40 PM Eastern Daylight Time	07/30/2021 10:44:48 AM Eastern Daylight Time			08/04/2021 01:40:20 PM 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	2022	Southwest Missouri		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4623	002	0	1	01	01	H4623_002_0	7	1					1	08/01/2021	2022.01	08/01/2021 01:29:14 PM Eastern Daylight Time	08/03/2021 06:00:11 PM Eastern Daylight Time	07/30/2021 10:45:00 AM Eastern Daylight Time			08/04/2021 01:40:20 PM Eastern Daylight Time	HUMANA REGIONAL HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Community HMO H4623-002 (HMO)	01	01		1			H4623	002	0	2022	Select Counties in Southwest Missouri		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4624	001	0	1	01	01	H4624_001_0	8	1					1	08/10/2021	2022.01	08/10/2021 09:17:12 AM Central Daylight Time	08/05/2021 12:16:38 PM Central Daylight Time	08/05/2021 12:16:38 PM Central Daylight Time			08/10/2021 09:33:48 AM Central Daylight Time	ZING HEALTH OF MICHIGAN, INC.	Zing Health	myzinghealth.com	Zing Choice IL (HMO)	01	01		1			H4624	001	0	2022	Kane & Will Counties & Rockford Area		2		2			2						myzinghealth.com	myzinghealth.com	myzinghealth.com	(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4624	002	0	1	02	01	H4624_002_0	8	1					1	08/10/2021	2022.01	08/10/2021 09:17:38 AM Central Daylight Time	08/05/2021 12:16:38 PM Central Daylight Time	08/05/2021 12:16:38 PM Central Daylight Time			08/10/2021 09:33:48 AM Central Daylight Time	ZING HEALTH OF MICHIGAN, INC.	Zing Health	myzinghealth.com	Zing Open Access IL (HMO-POS)	01	02		1			H4624	002	0	2022	Kane & Will Counties & Rockford Area		2		2			2						myzinghealth.com	myzinghealth.com	myzinghealth.com	(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4624	003	0	1	01	01	H4624_003_0	8	1					1	08/10/2021	2022.01	08/10/2021 09:17:57 AM Central Daylight Time	08/05/2021 12:16:38 PM Central Daylight Time	08/05/2021 12:16:38 PM Central Daylight Time			08/10/2021 09:33:48 AM Central Daylight Time	ZING HEALTH OF MICHIGAN, INC.	Zing Health	myzinghealth.com	Zing Choice IN (HMO)	01	01		1			H4624	003	0	2022	Allen, Lake & Marion Counties		2		2			2						myzinghealth.com	myzinghealth.com	myzinghealth.com	(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4624	006	0	1	01	01	H4624_006_0	8	1					1	08/10/2021	2022.01	08/10/2021 09:20:01 AM Central Daylight Time	08/05/2021 12:16:38 PM Central Daylight Time	08/05/2021 12:16:38 PM Central Daylight Time			08/10/2021 09:33:48 AM Central Daylight Time	ZING HEALTH OF MICHIGAN, INC.	Zing Health	myzinghealth.com	Zing Choice MI (HMO)	01	01		1			H4624	006	0	2022	Genesee, Oakland & Wayne Counties		2		2			2						myzinghealth.com	myzinghealth.com	myzinghealth.com	(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4624	007	0	1	02	01	H4624_007_0	8	1					1	08/10/2021	2022.01	08/10/2021 09:20:18 AM Central Daylight Time	08/05/2021 12:16:38 PM Central Daylight Time	08/05/2021 12:16:38 PM Central Daylight Time			08/10/2021 09:33:48 AM Central Daylight Time	ZING HEALTH OF MICHIGAN, INC.	Zing Health	myzinghealth.com	Zing Open Access MI (HMO-POS)	01	02		1			H4624	007	0	2022	Genesee, Oakland & Wayne Counties		2		2			2						myzinghealth.com	myzinghealth.com	myzinghealth.com	(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4624	010	0	1	01	01	H4624_010_0	8	1		1			1	08/10/2021	2022.01	08/10/2021 09:18:35 AM Central Daylight Time	08/05/2021 12:16:38 PM Central Daylight Time	08/05/2021 12:16:38 PM Central Daylight Time			08/10/2021 09:33:48 AM Central Daylight Time	ZING HEALTH OF MICHIGAN, INC.	Zing Health	myzinghealth.com	Zing Essential Wellness IL (HMO C-SNP)	01	01		1			H4624	010	0	2022	Cook, Kane & Will Counties & Rockford Area		2		2			1	4			00000000000000000010		myzinghealth.com	myzinghealth.com	myzinghealth.com	(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4624	011	0	1	01	01	H4624_011_0	8	1		1			1	08/10/2021	2022.01	08/10/2021 09:18:54 AM Central Daylight Time	08/05/2021 12:16:38 PM Central Daylight Time	08/05/2021 12:16:38 PM Central Daylight Time			08/10/2021 09:33:48 AM Central Daylight Time	ZING HEALTH OF MICHIGAN, INC.	Zing Health	myzinghealth.com	Zing Essential Wellness IN (HMO C-SNP)	01	01		1			H4624	011	0	2022	Allen, Lake & Marion Counties		2		2			1	4			00000000000000000010		myzinghealth.com	myzinghealth.com	myzinghealth.com	(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4624	012	0	1	01	01	H4624_012_0	8	1		1			1	08/10/2021	2022.01	08/10/2021 09:20:39 AM Central Daylight Time	08/05/2021 12:16:39 PM Central Daylight Time	08/05/2021 12:16:39 PM Central Daylight Time			08/10/2021 09:33:48 AM Central Daylight Time	ZING HEALTH OF MICHIGAN, INC.	Zing Health	myzinghealth.com	Zing Essential Wellness MI (HMO C-SNP)	01	01		1			H4624	012	0	2022	Genesee, Oakland & Wayne Counties		2		2			1	4			00000000000000000010		myzinghealth.com	myzinghealth.com	myzinghealth.com	(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4624	015	0	1	02	01	H4624_015_0	8	1					1	08/10/2021	2022.01	08/10/2021 09:19:15 AM Central Daylight Time	08/05/2021 12:16:39 PM Central Daylight Time	08/05/2021 12:16:39 PM Central Daylight Time			08/10/2021 09:33:48 AM Central Daylight Time	ZING HEALTH OF MICHIGAN, INC.	Zing Health	myzinghealth.com	Zing Open Access IN (HMO-POS)	01	02		1			H4624	015	0	2022	Allen, Lake & Marion Counties		2		2			2						myzinghealth.com	myzinghealth.com	myzinghealth.com	(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4624	016	0	1	02	01	H4624_016_0	9	1	2	1			0	08/10/2021	2022.01	08/10/2021 09:21:00 AM Central Daylight Time	08/05/2021 12:16:39 PM Central Daylight Time	08/05/2021 12:16:39 PM Central Daylight Time			08/10/2021 09:33:48 AM Central Daylight Time	ZING HEALTH OF MICHIGAN, INC.	Zing Health	myzinghealth.com	Zing Complete Plus IN (HMO-POS D-SNP)	01	02		1			H4624	016	0	2022	Allen, Lake & Marion Counties		2		2			1	3		1		2	myzinghealth.com	myzinghealth.com	myzinghealth.com	(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4624	017	0	1	02	01	H4624_017_0	8	1					1	08/10/2021	2022.01	08/10/2021 09:19:38 AM Central Daylight Time	08/05/2021 12:16:39 PM Central Daylight Time	08/05/2021 12:16:39 PM Central Daylight Time			08/10/2021 09:33:48 AM Central Daylight Time	ZING HEALTH OF MICHIGAN, INC.	Zing Health	myzinghealth.com	Zing Signature Care (HMO-POS)	01	02		1			H4624	017	0	2022	Marion County		2		2			2						myzinghealth.com	myzinghealth.com	myzinghealth.com	(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4624	018	0	1	02	01	H4624_018_0	9	1	2	1			0	08/10/2021	2022.01	08/10/2021 09:21:21 AM Central Daylight Time	08/05/2021 12:16:39 PM Central Daylight Time	08/05/2021 12:16:39 PM Central Daylight Time			08/10/2021 09:33:48 AM Central Daylight Time	ZING HEALTH OF MICHIGAN, INC.	Zing Health	myzinghealth.com	Zing Dual Platinum Plus (HMO-POS D-SNP)	01	02		1			H4624	018	0	2022	Marion County		2		2			1	3		1		2	myzinghealth.com	myzinghealth.com	myzinghealth.com	(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4624	019	0	1	01	01	H4624_019_0	8	1	2	1			0	08/05/2021	2022.01	08/05/2021 12:45:53 PM Central Daylight Time	08/05/2021 12:16:39 PM Central Daylight Time	08/05/2021 12:16:39 PM Central Daylight Time			08/05/2021 03:31:37 PM Central Daylight Time	ZING HEALTH OF MICHIGAN, INC.	Zing Health	myzinghealth.com	Zing Complete Plus MI (HMO D-SNP)	01	01		1			H4624	019	0	2022	Genesee, Oakland & Wayne Counties		2		2			1	3		1		2	myzinghealth.com	myzinghealth.com	myzinghealth.com	(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4624	801	0	1	01	01	H4624_801_0	6	1						07/14/2021	2022.01	07/14/2021 01:06:56 PM Central Daylight Time					07/14/2021 01:13:17 PM Central Daylight Time	ZING HEALTH OF MICHIGAN, INC.	Zing Health	myzinghealth.com	Zing EGWP CY (HMO)	01	01		1			H4624	801	0	2022	Counties in IL, IN, MI		1	12000	2			2						myzinghealth.com	myzinghealth.com	myzinghealth.com	(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4624	802	0	1	01	01	H4624_802_0	6	1						07/14/2021	2022.01	07/14/2021 01:06:44 PM Central Daylight Time					07/14/2021 01:13:17 PM Central Daylight Time	ZING HEALTH OF MICHIGAN, INC.	Zing Health	myzinghealth.com	Zing EGWP NCY (HMO)	01	01		1			H4624	802	0	2022	Counties in IL, IN, MI		1	12000	2			2						myzinghealth.com	myzinghealth.com	myzinghealth.com	(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4624	803	0	1	01	01	H4624_803_0	6	1				0	0	07/14/2021	2022.01	07/14/2021 01:06:31 PM Central Daylight Time					07/14/2021 01:13:17 PM Central Daylight Time	ZING HEALTH OF MICHIGAN, INC.	Zing Health	myzinghealth.com	Zing EGWP MA Only CY (HMO)	01	01		1			H4624	803	0	2022	Counties in IL, IN, MI		1	12000	2			2						myzinghealth.com	myzinghealth.com	myzinghealth.com	(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H4624	804	0	1	01	01	H4624_804_0	6	1				0	0	07/14/2021	2022.01	07/14/2021 01:06:20 PM Central Daylight Time					07/14/2021 01:13:17 PM Central Daylight Time	ZING HEALTH OF MICHIGAN, INC.	Zing Health	myzinghealth.com	Zing EGWP MA Only NCY (HMO)	01	01		1			H4624	804	0	2022	Counties in IL, IN, MI		1	12000	2			2						myzinghealth.com	myzinghealth.com	myzinghealth.com	(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H4675	001	0	1	01	01	H4675_001_0	6	1					1	07/14/2021	2022.01	07/14/2021 12:52:16 PM Central Daylight Time	08/05/2021 03:52:12 PM Central Daylight Time	08/05/2021 03:54:39 PM Central Daylight Time			08/05/2021 04:16:56 PM Central Daylight Time	HEALTHIER NEW JERSEY INSURANCE COMPANY	Braven Health	www.bravenhealth.com	Braven Medicare Plus (HMO)	01	01		1			H4675	001	0	2022	Eastern New Jersey		2		2			2						https://www.bravenhealth.com	https://www.bravenhealth.com	www.bravenhealth.com	(833)272-8360		(833)272-8360		(833)713-1313		(833)713-1313		(855)457-0222		(855)457-0222		(833)713-1313		(833)713-1313		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4675	801	0	1	02	01	H4675_801_0	2	1				0	0	06/03/2021	2022.01	06/03/2021 12:24:25 PM Central Daylight Time					06/06/2021 08:10:18 PM Central Daylight Time	HEALTHIER NEW JERSEY INSURANCE COMPANY	Braven Health	www.bravenhealth.com	Braven Medicare Access Group (HMO-POS)	01	02		1			H4675	801	0	2022	New Jersey		1	120	2			2						https://www.bravenhealth.com	https://www.bravenhealth.com	www.bravenhealth.com	(833)272-8360		(833)272-8360		(833)713-1313		(833)713-1313										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7c;7d;7i;8a;8b1;8b2;9a1;9b;9c;10a;11a;11b;11c;15;	2		1	1	1a;1b;2;5;6;7c;7d;7i;8a;8b1;8b2;9a1;9b;9c;10a;11a;11b;11c;15;	2		2				
H4675	802	0	1	02	01	H4675_802_0	2	1						06/03/2021	2022.01	06/03/2021 12:24:38 PM Central Daylight Time					06/06/2021 08:10:18 PM Central Daylight Time	HEALTHIER NEW JERSEY INSURANCE COMPANY	Braven Health	www.bravenhealth.com	Braven Medicare Access Group w/Rx (HMO-POS)	01	02		1			H4675	802	0	2022	New Jersey		1	590	2			2						https://www.bravenhealth.com	https://www.bravenhealth.com	www.bravenhealth.com	(833)272-8360		(833)272-8360		(833)713-1313		(833)713-1313		(855)457-0222		(855)457-0222		(833)713-1313		(833)713-1313		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7c;7d;7i;8a;8b1;8b2;9a1;9b;9c;10a;11a;11b;11c;15;	2		1	1	1a;1b;2;5;6;7c;7d;7i;8a;8b1;8b2;9a1;9b;9c;10a;11a;11b;11c;15;	2		2				
H4675	803	0	1	02	01	H4675_803_0	2	1						06/03/2021	2022.01	06/03/2021 01:11:05 PM Central Daylight Time					06/06/2021 08:10:18 PM Central Daylight Time	HEALTHIER NEW JERSEY INSURANCE COMPANY	Braven Health	www.bravenhealth.com	Braven Medicare Access Group w/Rx Value (HMO-POS)	01	02		1			H4675	803	0	2022	New Jersey		1	120	2			2						https://www.bravenhealth.com	https://www.bravenhealth.com	www.bravenhealth.com	(833)272-8360		(833)272-8360		(833)713-1313		(833)713-1313		(855)457-0222		(855)457-0222		(833)713-1313		(833)713-1313		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7c;7d;7i;8a;8b1;8b2;9a1;9b;9c;10a;11a;11b;11c;15;	2		1	1	1a;1b;2;5;6;7c;7d;7i;8a;8b1;8b2;9a1;9b;9c;10a;11a;11b;11c;15;	2		2				
H4676	001	0	1	01	01	H4676_001_0	6	1			2		1	08/05/2021	2022.01	08/05/2021 01:13:56 PM Eastern Daylight Time	08/05/2021 02:10:45 PM Eastern Daylight Time	08/05/2021 02:10:45 PM Eastern Daylight Time			08/05/2021 02:12:56 PM Eastern Daylight Time	TROY HEALTH, INC.	Troy Medicare	www.troymedicare.com	Troy Medicare (HMO)	01	01		1			H4676	001	0	2022	Fayetteville and Mooresville Regions		2	3400	2			2						www.troymedicare.com	www.troymedicare.com	www.troymedicare.com	(888)494-8769		(888)494-8769		(888)494-8769		(888)494-8769		(866)423-8065		(866)423-8065		(888)494-8769		(888)494-8769		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4676	002	0	1	01	01	H4676_002_0	7	1	2	1	1		0	08/05/2021	2022.01	08/05/2021 01:11:35 PM Eastern Daylight Time	08/05/2021 02:10:46 PM Eastern Daylight Time	08/05/2021 02:10:46 PM Eastern Daylight Time			08/05/2021 02:12:56 PM Eastern Daylight Time	TROY HEALTH, INC.	Troy Medicare	www.troymedicare.com	Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)	01	01		1			H4676	002	0	2022	Fayetteville and Mooresville Regions		2	3600	2			1	3		1		1	www.troymedicare.com	www.troymedicare.com	www.troymedicare.com	(888)494-8769		(888)494-8769		(888)494-8769		(888)494-8769		(866)423-8065		(866)423-8065		(888)494-8769		(888)494-8769		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					1					2	2			
H4699	001	0	1	04	01	H4699_001_0	5	1					0	08/03/2021	2022.01	08/03/2021 10:22:08 AM Eastern Daylight Time	08/04/2021 12:16:55 AM Eastern Daylight Time	07/30/2021 11:24:52 AM Eastern Daylight Time			08/04/2021 11:21:47 PM Eastern Daylight Time	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium Open (PPO)	01	04		1			H4699	001	0	2022	All counties in RI		2	4402	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4699	002	0	1	04	01	H4699_002_0	6	1					0	08/03/2021	2022.01	08/03/2021 09:16:30 AM Eastern Daylight Time	08/04/2021 12:17:23 AM Eastern Daylight Time	07/30/2021 11:25:24 AM Eastern Daylight Time			08/04/2021 11:21:47 PM Eastern Daylight Time	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Giveback Open (PPO)	01	04		1			H4699	002	0	2022	All counties in RI		2	6527	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4699	003	0	1	04	01	H4699_003_0	6	1	2	1			0	06/06/2021	2022.01	06/06/2021 11:57:16 PM Eastern Daylight Time	08/04/2021 12:17:51 AM Eastern Daylight Time	07/30/2021 11:25:46 AM Eastern Daylight Time			08/04/2021 11:21:47 PM Eastern Daylight Time	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Access Open (PPO D-SNP)	01	04		1			H4699	003	0	2022	All counties in RI		2	6267	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4699	004	0	1	04	01	H4699_004_0	6	1					0	06/07/2021	2022.01	06/07/2021 12:09:11 AM Eastern Daylight Time	08/04/2021 12:18:20 AM Eastern Daylight Time	07/30/2021 11:26:06 AM Eastern Daylight Time			08/04/2021 11:21:47 PM Eastern Daylight Time	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Assist Open (PPO)	01	04		1			H4699	004	0	2022	All counties in RI		2	1184	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4699	005	0	1	04	01	H4699_005_0	6	1	2	1			0	06/07/2021	2022.01	06/07/2021 12:11:48 AM Eastern Daylight Time	08/04/2021 12:18:50 AM Eastern Daylight Time	07/30/2021 11:26:26 AM Eastern Daylight Time			08/04/2021 11:21:47 PM Eastern Daylight Time	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Liberty Open (PPO D-SNP)	01	04		1			H4699	005	0	2022	All counties in RI		2	1171	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4699	006	0	1	04	01	H4699_006_0	5	1				0	0	06/07/2021	2022.01	06/07/2021 12:15:03 AM Eastern Daylight Time	06/04/2021 01:39:22 PM Eastern Daylight Time				07/19/2021 04:18:34 PM Eastern Daylight Time	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Patriot No Premium Open (PPO)	01	04		1			H4699	006	0	2022	All counties in RI		2	189	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175										(711)-		(711)-		(711)-		(711)-										2					2						2			
H4709	001	0	1	01	01	H4709_001_0	6	1					0	09/28/2021	2022.01	09/28/2021 04:50:19 PM Central Daylight Time	08/05/2021 05:33:36 PM Central Daylight Time	08/05/2021 05:34:57 PM Central Daylight Time			09/28/2021 04:55:13 PM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY OF FLORIDA	Bright Health	brighthealthcare.com/medicare	Bright Advantage Health Dollars Plan (HMO)	01	01		1			H4709	001	0	2022	Daytona, Orlando, and Southwest Florida		2	14155	2			2						brighthealthcare.com/madoctors	brighthealthcare.com/drug-search/ma	brighthealthcare.com/madoctors	(844)926-4521		(844)926-4521		(844)679-2028		(844)679-2028		(844)926-4521		(844)926-4521		(844)679-2028		(844)679-2028		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4709	011	0	1	01	01	H4709_011_0	6	1					0	09/28/2021	2022.01	09/28/2021 04:50:40 PM Central Daylight Time	08/05/2021 05:33:36 PM Central Daylight Time	08/05/2021 05:34:57 PM Central Daylight Time			09/28/2021 04:55:13 PM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY OF FLORIDA	Bright Health	brighthealthcare.com/medicare	Bright Advantage Health Dollars Plan (HMO)	01	01		1			H4709	011	0	2022	Fort Lauderdale and Palm Beach Areas		2	10584	2			2						brighthealthcare.com/madoctors	brighthealthcare.com/drug-search/ma	brighthealthcare.com/madoctors	(844)926-4521		(844)926-4521		(844)679-2028		(844)679-2028		(844)926-4521		(844)926-4521		(844)679-2028		(844)679-2028		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4709	025	0	1	01	01	H4709_025_0	6	1					0	09/28/2021	2022.01	09/28/2021 04:50:56 PM Central Daylight Time	08/05/2021 05:33:37 PM Central Daylight Time	08/05/2021 05:34:57 PM Central Daylight Time			09/28/2021 04:55:13 PM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY OF FLORIDA	Bright Health	brighthealthcare.com/medicare	Bright Advantage Health Dollars Plan (HMO)	01	01		1			H4709	025	0	2022	Central Florida		2	12829	2			2						brighthealthcare.com/madoctors	brighthealthcare.com/drug-search/ma	brighthealthcare.com/madoctors	(844)926-4521		(844)926-4521		(844)679-2028		(844)679-2028		(844)926-4521		(844)926-4521		(844)679-2028		(844)679-2028		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4709	026	0	1	01	01	H4709_026_0	5	1					0	08/03/2021	2022.01	08/03/2021 03:51:07 PM Central Daylight Time	08/05/2021 05:33:37 PM Central Daylight Time	08/05/2021 05:34:57 PM Central Daylight Time			08/05/2021 06:16:05 PM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY OF FLORIDA	Bright Health	brighthealthcare.com/medicare	Bright Advantage Part B Savings Plan (HMO)	01	01		1			H4709	026	0	2022	Central Florida		2	1234	2			2						brighthealthcare.com/madoctors	brighthealthcare.com/drug-search/ma	brighthealthcare.com/madoctors	(844)926-4521		(844)926-4521		(844)679-2028		(844)679-2028		(844)926-4521		(844)926-4521		(844)679-2028		(844)679-2028		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4709	027	0	1	01	01	H4709_027_0	5	1		1			1	08/03/2021	2022.01	08/03/2021 03:51:31 PM Central Daylight Time	08/05/2021 05:33:37 PM Central Daylight Time	08/05/2021 05:34:57 PM Central Daylight Time			08/05/2021 06:16:05 PM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY OF FLORIDA	Bright Health	brighthealthcare.com/medicare	Bright Advantage Embrace Care Plan (HMO C-SNP)	01	01		1			H4709	027	0	2022	Central Florida		2	6341	2			1	4			00000000000000000010		brighthealthcare.com/madoctors	brighthealthcare.com/drug-search/ma	brighthealthcare.com/madoctors	(844)926-4521		(844)926-4521		(844)679-2028		(844)679-2028		(844)926-4521		(844)926-4521		(844)679-2028		(844)679-2028		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4709	029	0	1	01	01	H4709_029_0	5	1					0	08/03/2021	2022.01	08/03/2021 03:52:09 PM Central Daylight Time	08/05/2021 05:33:37 PM Central Daylight Time	08/05/2021 05:34:57 PM Central Daylight Time			08/05/2021 06:16:05 PM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY OF FLORIDA	Bright Health	brighthealthcare.com/medicare	Bright Advantage Part B Savings Plan (HMO)	01	01		1			H4709	029	0	2022	Daytona, Orlando, and Southwest Florida		2	833	2			2						brighthealthcare.com/madoctors	brighthealthcare.com/drug-search/ma	brighthealthcare.com/madoctors	(844)926-4521		(844)926-4521		(844)679-2028		(844)679-2028		(844)926-4521		(844)926-4521		(844)679-2028		(844)679-2028		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4709	031	0	1	01	01	H4709_031_0	5	1		1			0	08/03/2021	2022.01	08/03/2021 03:26:41 PM Central Daylight Time	08/05/2021 05:33:37 PM Central Daylight Time	08/05/2021 05:34:58 PM Central Daylight Time			08/05/2021 06:16:05 PM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY OF FLORIDA	Bright Health	brighthealthcare.com/medicare	Bright Advantage Embrace Choice Plan (HMO C-SNP)	01	01		1			H4709	031	0	2022	Broward, Lake, Miami-Dade, Palm Beach and Sumter		2	3390	2			1	4			00000000000000000010		brighthealthcare.com/madoctors	brighthealthcare.com/drug-search/ma	brighthealthcare.com/madoctors	(844)926-4521		(844)926-4521		(844)679-2028		(844)679-2028		(844)926-4521		(844)926-4521		(844)679-2028		(844)679-2028		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4709	032	0	1	01	01	H4709_032_0	5	1					0	08/03/2021	2022.01	08/03/2021 03:52:48 PM Central Daylight Time	08/05/2021 05:33:37 PM Central Daylight Time	08/05/2021 05:34:58 PM Central Daylight Time			08/05/2021 06:16:05 PM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY OF FLORIDA	Bright Health	brighthealthcare.com/medicare	Bright Advantage Part B Savings Plan (HMO)	01	01		1			H4709	032	0	2022	Fort Lauderdale and Palm Beach Areas		2	1018	2			2						brighthealthcare.com/madoctors	brighthealthcare.com/drug-search/ma	brighthealthcare.com/madoctors	(844)926-4521		(844)926-4521		(844)679-2028		(844)679-2028		(844)926-4521		(844)926-4521		(844)679-2028		(844)679-2028		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4709	033	0	1	01	01	H4709_033_0	5	1		1			1	08/03/2021	2022.01	08/03/2021 03:53:20 PM Central Daylight Time	08/05/2021 05:33:37 PM Central Daylight Time	08/05/2021 05:34:58 PM Central Daylight Time			08/05/2021 06:16:05 PM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY OF FLORIDA	Bright Health	brighthealthcare.com/medicare	Bright Advantage Embrace Care Plan (HMO C-SNP)	01	01		1			H4709	033	0	2022	Fort Lauderdale and Palm Beach Areas		2	5232	2			1	4			00000000000000000010		brighthealthcare.com/madoctors	brighthealthcare.com/drug-search/ma	brighthealthcare.com/madoctors	(844)926-4521		(844)926-4521		(844)679-2028		(844)679-2028		(844)926-4521		(844)926-4521		(844)679-2028		(844)679-2028		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4709	035	0	1	01	01	H4709_035_0	6	1					0	09/28/2021	2022.01	09/28/2021 04:51:25 PM Central Daylight Time	08/05/2021 05:33:37 PM Central Daylight Time	08/05/2021 05:34:58 PM Central Daylight Time			09/28/2021 04:55:13 PM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY OF FLORIDA	Bright Health	brighthealthcare.com/medicare	Bright Advantage Classic Care Plan (HMO)	01	01		1			H4709	035	0	2022	Miami Area		2	9622	2			2						brighthealthcare.com/madoctors	brighthealthcare.com/drug-search/ma	brighthealthcare.com/madoctors	(844)926-4521		(844)926-4521		(844)679-2028		(844)679-2028		(844)926-4521		(844)926-4521		(844)679-2028		(844)679-2028		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4709	036	0	1	01	01	H4709_036_0	5	1					0	08/03/2021	2022.01	08/03/2021 03:54:06 PM Central Daylight Time	08/05/2021 03:37:48 PM Central Daylight Time	08/05/2021 03:37:51 PM Central Daylight Time			08/05/2021 06:16:05 PM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY OF FLORIDA	Bright Health	brighthealthcare.com/medicare	Bright Advantage Part B Savings Plan (HMO)	01	01		1			H4709	036	0	2022	Miami Area		2	1234	2			2						brighthealthcare.com/madoctors	brighthealthcare.com/drug-search/ma	brighthealthcare.com/madoctors	(844)926-4521		(844)926-4521		(844)679-2028		(844)679-2028		(844)926-4521		(844)926-4521		(844)679-2028		(844)679-2028		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4709	037	0	1	01	01	H4709_037_0	5	1		1			1	08/03/2021	2022.01	08/03/2021 03:54:24 PM Central Daylight Time	08/05/2021 03:37:48 PM Central Daylight Time	08/05/2021 03:37:51 PM Central Daylight Time			08/05/2021 06:16:05 PM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY OF FLORIDA	Bright Health	brighthealthcare.com/medicare	Bright Advantage Embrace Care Plan (HMO C-SNP)	01	01		1			H4709	037	0	2022	Miami Area		2	6341	2			1	4			00000000000000000010		brighthealthcare.com/madoctors	brighthealthcare.com/drug-search/ma	brighthealthcare.com/madoctors	(844)926-4521		(844)926-4521		(844)679-2028		(844)679-2028		(844)926-4521		(844)926-4521		(844)679-2028		(844)679-2028		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4709	039	0	1	01	01	H4709_039_0	5	1		1			0	08/03/2021	2022.01	08/03/2021 03:27:20 PM Central Daylight Time	08/05/2021 03:37:48 PM Central Daylight Time	08/05/2021 03:37:51 PM Central Daylight Time			08/05/2021 06:16:05 PM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY OF FLORIDA	Bright Health	brighthealthcare.com/medicare	Bright Advantage Embrace Assist Plan (HMO C-SNP)	01	01		1			H4709	039	0	2022	Broward, Lake, Miami-Dade, Palm Beach and Sumter		2	678	2			1	4			00000000000000000010		brighthealthcare.com/madoctors	brighthealthcare.com/drug-search/ma	brighthealthcare.com/madoctors	(844)926-4521		(844)926-4521		(844)679-2028		(844)679-2028		(844)926-4521		(844)926-4521		(844)679-2028		(844)679-2028		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4709	040	0	1	02	01	H4709_040_0	6	1					0	08/03/2021	2022.01	08/03/2021 03:54:44 PM Central Daylight Time	08/05/2021 03:37:48 PM Central Daylight Time	08/05/2021 03:37:51 PM Central Daylight Time			08/05/2021 06:16:05 PM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY OF FLORIDA	Bright Health	brighthealthcare.com/medicare	Bright New Day (HMO-POS)	01	02		1			H4709	040	0	2022	Miami Area		2	3701	2			2						brighthealthcare.com/madoctors	brighthealthcare.com/drug-search/ma	brighthealthcare.com/madoctors	(844)926-4521		(844)926-4521		(844)679-2028		(844)679-2028		(844)926-4521		(844)926-4521		(844)679-2028		(844)679-2028		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4711	001	0	1	02	01	H4711_001_0	2	1					0	08/02/2021	2022.01	08/02/2021 05:26:38 PM Eastern Daylight Time	08/02/2021 03:12:25 PM Eastern Daylight Time	08/02/2021 09:41:17 AM Eastern Daylight Time			08/04/2021 01:48:44 PM Eastern Daylight Time	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (HMO-POS)	01	02		1			H4711	001	0	2022	Clark and Nye Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4711	002	0	1	02	01	H4711_002_0	2	1					0	08/02/2021	2022.01	08/02/2021 05:27:04 PM Eastern Daylight Time	08/02/2021 03:13:17 PM Eastern Daylight Time	08/02/2021 09:41:21 AM Eastern Daylight Time			08/04/2021 01:48:44 PM Eastern Daylight Time	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime Plan (HMO-POS)	01	02		1			H4711	002	0	2022	Clark and Nye Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4711	005	0	1	02	01	H4711_005_0	2	1					0	08/02/2021	2022.01	08/02/2021 05:27:51 PM Eastern Daylight Time	08/02/2021 03:14:10 PM Eastern Daylight Time	08/02/2021 09:41:26 AM Eastern Daylight Time			08/04/2021 01:48:44 PM Eastern Daylight Time	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (HMO-POS)	01	02		1			H4711	005	0	2022	Northern Nevada		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4711	006	0	1	02	01	H4711_006_0	2	1			2		0	08/02/2021	2022.01	08/02/2021 03:13:50 PM Central Daylight Time	08/03/2021 01:14:22 PM Central Daylight Time	08/02/2021 08:41:30 AM Central Daylight Time			08/04/2021 01:00:17 PM Central Daylight Time	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite Prime (HMO-POS)	01	02		1			H4711	006	0	2022	Denver Metro & Northern Colorado		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4711	007	0	1	02	01	H4711_007_0	2	1			2		0	08/02/2021	2022.01	08/02/2021 03:14:04 PM Central Daylight Time	08/03/2021 01:15:23 PM Central Daylight Time	08/02/2021 08:41:34 AM Central Daylight Time			08/04/2021 01:00:17 PM Central Daylight Time	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite Prime (HMO-POS)	01	02		1			H4711	007	0	2022	Southern & Western Colorado		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4711	008	0	1	02	01	H4711_008_0	2	1			2		0	08/02/2021	2022.01	08/02/2021 03:14:19 PM Central Daylight Time	08/03/2021 01:16:21 PM Central Daylight Time	08/02/2021 08:41:38 AM Central Daylight Time			08/04/2021 01:00:17 PM Central Daylight Time	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime 1 (HMO-POS)	01	02		1			H4711	008	0	2022	Denver Metro & Northern Colorado		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4711	009	0	1	02	01	H4711_009_0	2	1			2		0	08/02/2021	2022.01	08/02/2021 03:14:42 PM Central Daylight Time	08/03/2021 01:17:19 PM Central Daylight Time	08/02/2021 08:41:43 AM Central Daylight Time			08/04/2021 01:00:17 PM Central Daylight Time	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime 1 (HMO-POS)	01	02		1			H4711	009	0	2022	Southern & Western Colorado		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4711	010	0	1	02	01	H4711_010_0	1	1			2	0	0	06/01/2021	2022.01	06/01/2021 03:44:37 PM Central Daylight Time	06/01/2021 04:00:36 PM Central Daylight Time				06/03/2021 11:18:51 AM Central Daylight Time	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Eagle Prime (HMO-POS)	01	02		1			H4711	010	0	2022	Colorado		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H4711	011	0	1	01	01	H4711_011_0	5	1	2	1	1		0	07/08/2021	2022.01	07/08/2021 11:21:25 AM Eastern Daylight Time	08/02/2021 03:15:03 PM Eastern Daylight Time	08/02/2021 09:41:47 AM Eastern Daylight Time			08/04/2021 05:00:46 PM Eastern Daylight Time	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Dual Prime Plan (HMO D-SNP)	01	01		1			H4711	011	0	2022	Clark and Nye Counties		2		2			1	3		1		1	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4711	012	0	1	01	01	H4711_012_0	3	1	2	1	1		0	07/08/2021	2022.01	07/08/2021 11:28:55 AM Eastern Daylight Time	08/03/2021 01:19:23 PM Central Daylight Time	08/02/2021 08:41:51 AM Central Daylight Time			08/04/2021 01:00:17 PM Central Daylight Time	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Assure Premier Prime (HMO D-SNP)	01	01		1			H4711	012	0	2022	Colorado		2		2			1	3		1		1	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		2					2					2	2			
H4711	013	0	1	01	01	H4711_013_0	6	1	2	1	1		0	07/08/2021	2022.01	07/08/2021 11:22:12 AM Eastern Daylight Time	08/02/2021 03:15:53 PM Eastern Daylight Time	08/02/2021 09:41:55 AM Eastern Daylight Time			08/04/2021 05:00:46 PM Eastern Daylight Time	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Dual Preferred Plan (HMO D-SNP)	01	01		1			H4711	013	0	2022	Northern Nevada		2		2			1	3		1		1	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4711	801	0	1	01	01	H4711_801_0	1	1				0	0	05/27/2021	2022.01	05/27/2021 11:30:56 PM Eastern Daylight Time					06/03/2021 01:24:36 PM Eastern Daylight Time	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (HMO)	01	01		1			H4711	801	0	2022	Colorado and Nevada		1	120	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H4711	802	0	1	01	01	H4711_802_0	1	1						05/27/2021	2022.01	05/27/2021 11:31:15 PM Eastern Daylight Time					06/03/2021 01:24:36 PM Eastern Daylight Time	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan w/Rx (HMO)	01	01		1			H4711	802	0	2022	Colorado and Nevada		1	120	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H4714	001	0	1	20	08	H4714_001_0	1	1						06/04/2021	2022.01	06/04/2021 08:49:31 AM Eastern Daylight Time		06/03/2021 02:18:32 PM Eastern Daylight Time			06/04/2021 08:53:16 AM Eastern Daylight Time	PACE OF THE SOUTHERN PIEDMONT, INC.	PACE of the Southern Piedmont	www.pacesp.com	PACE of the Southern Piedmont - Dual (PACE)	08	20		1			H4714	001	0	2022	PACE of the Southern Piedmont - Dual		2		2			2						http://pharmastarpbm.com	Not applicable										(704)887-3840		(704)887-3840		(704)887-3840		(704)887-3840										(704)887-3840	8000	(704)887-3840	8000	(704)887-3840	8000	(704)887-3840	8000															
H4714	002	0	1	20	08	H4714_002_0	1	1						06/04/2021	2022.01	06/04/2021 08:50:36 AM Eastern Daylight Time		06/03/2021 02:18:36 PM Eastern Daylight Time			06/04/2021 08:53:16 AM Eastern Daylight Time	PACE OF THE SOUTHERN PIEDMONT, INC.	PACE of the Southern Piedmont	www.pacesp.com	PACE of the Southern Piedmont - Medicare only (PACE)	08	20		1			H4714	002	0	2022	PACE of the Southern Piedmont - Medicare only		2		2			2						http://pharmastarpbm.com	Not applicable										(704)887-3840		(704)887-3840		(704)887-3840		(704)887-3840										(704)887-3840	8000	(704)887-3840	8000	(704)887-3840	8000	(704)887-3840	8000															
H4739	001	0	1	01	01	H4739_001_0	4	1	2	1			0	08/04/2021	2022.01	08/04/2021 04:37:24 PM Central Daylight Time	08/04/2021 12:08:20 PM Central Daylight Time	08/04/2021 12:05:01 PM Central Daylight Time			08/05/2021 12:21:10 PM Central Daylight Time	SELECT HEALTH OF SOUTH CAROLINA, INC.	First Choice VIP Care	www.firstchoicevipcare.com	First Choice VIP Care (HMO D-SNP)	01	01		1			H4739	001	0	2022	Majority of SC Counties		2		2			1	3		1		1	www.firstchoicevipcare.com	www.firstchoicevipcare.com	www.firstchoicevipcare.com	(888)978-0862		(888)978-0862		(888)978-0862		(888)978-0862		(888)978-0862		(888)978-0862		(888)978-0862		(888)978-0862		(888)978-0862		(888)978-0862		(888)978-0862		(888)978-0862		(888)978-0862		(888)978-0862		(888)978-0862		(888)978-0862		2					2					2	2			
H4754	004	0	1	04	01	H4754_004_0	4	1					0	08/05/2021	2022.01	08/05/2021 08:14:52 AM Pacific Daylight Time	08/03/2021 09:01:56 AM Pacific Daylight Time	07/30/2021 02:12:10 PM Pacific Daylight Time			08/05/2021 02:34:04 PM 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	2022	Lane County		2		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	3	1				0	0	07/20/2021	2022.01	07/20/2021 04:37:10 PM Pacific Daylight Time	06/06/2021 01:16:37 PM Pacific Daylight Time				07/21/2021 01:22:29 PM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Explorer 6 (PPO)	01	04		1			H4754	006	0	2022	Southwest and Southern Idaho		2		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	4	1					0	08/05/2021	2022.01	08/05/2021 08:14:41 AM Pacific Daylight Time	08/03/2021 09:03:33 AM Pacific Daylight Time	07/30/2021 02:12:28 PM Pacific Daylight Time			08/05/2021 02:34:04 PM 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	2022	Coos and Curry Counties		2		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	3	1				0	0	07/21/2021	2022.01	07/21/2021 09:49:29 AM Pacific Daylight Time	06/06/2021 01:17:36 PM Pacific Daylight Time				07/21/2021 01:22:29 PM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Explorer 8 (PPO)	01	04		1			H4754	008	0	2022	Coos, Curry and Lane Counties		2		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	4	1					0	08/05/2021	2022.01	08/05/2021 08:14:26 AM Pacific Daylight Time	08/03/2021 09:04:48 AM Pacific Daylight Time	07/30/2021 02:12:48 PM Pacific Daylight Time			08/05/2021 02:34:04 PM 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	2022	Eastern Idaho		2		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	4	1					0	08/05/2021	2022.01	08/05/2021 08:14:21 AM Pacific Daylight Time	08/03/2021 09:06:11 AM Pacific Daylight Time	07/30/2021 02:13:06 PM Pacific Daylight Time			08/05/2021 02:34:04 PM 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	2022	North Idaho		2		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	3	1				0	0	07/20/2021	2022.01	07/20/2021 04:48:36 PM Pacific Daylight Time	06/06/2021 01:19:02 PM Pacific Daylight Time				07/21/2021 01:22:29 PM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Explorer 12 (PPO)	01	04		1			H4754	012	0	2022	North and Eastern Idaho		2		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	016	0	1	04	01	H4754_016_0	3	1				0	0	07/20/2021	2022.01	07/20/2021 04:51:39 PM Pacific Daylight Time	06/06/2021 03:18:46 PM Pacific Daylight Time				07/21/2021 01:22:29 PM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Explorer 16 (PPO)	01	04		1			H4754	016	0	2022	Missoula County		2		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			
H4754	017	0	1	04	01	H4754_017_0	6	1					0	08/05/2021	2022.01	08/05/2021 08:14:02 AM Pacific Daylight Time	08/05/2021 10:16:32 AM Pacific Daylight Time	07/30/2021 02:13:24 PM Pacific Daylight Time			08/05/2021 02:34:04 PM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Explorer Rx 17 (PPO)	01	04		1			H4754	017	0	2022	Missoula County		2		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	801	0	1	04	01	H4754_801_0	2	1				0	0	06/05/2021	2022.01	06/05/2021 07:30:10 PM Pacific Daylight Time					06/06/2021 05:13:19 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	2022	Statewide - Idaho, Montana 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										2					2						2			
H4754	802	0	1	04	01	H4754_802_0	3	1						06/05/2021	2022.01	06/05/2021 07:53:58 PM Pacific Daylight Time					06/06/2021 05:13:19 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	2022	Statewide - Idaho, Montana 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		2					2						2			
H4801	001	0	1	04	01	H4801_001_0	3	1					0	06/03/2021	2022.01	06/03/2021 01:44:13 PM Central Daylight Time	08/03/2021 10:38:04 AM Central Daylight Time	08/04/2021 05:04:28 PM Central Daylight Time			08/05/2021 05:38:13 PM Central Daylight Time	GHS INSURANCE COMPANY	Blue Cross and Blue Shield of OK, TX	www.hcsc.com	Blue Cross Medicare Advantage Classic (PPO)	01	04		1			H4801	001	0	2022	Dallas Market		2	13741	2			2						www.myprime.com	www.myprime.com	www.hcsc.com	(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			
H4801	002	0	1	04	01	H4801_002_0	3	1					0	06/03/2021	2022.01	06/03/2021 01:44:44 PM Central Daylight Time	08/03/2021 10:38:28 AM Central Daylight Time	08/04/2021 05:04:46 PM Central Daylight Time			08/05/2021 05:38:13 PM Central Daylight Time	GHS INSURANCE COMPANY	Blue Cross and Blue Shield of OK, TX	www.hcsc.com	Blue Cross Medicare Advantage Classic (PPO)	01	04		1			H4801	002	0	2022	Houston Market		2	26179	2			2						www.myprime.com	www.myprime.com	www.hcsc.com	(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			
H4801	003	0	1	04	01	H4801_003_0	3	1					0	06/03/2021	2022.01	06/03/2021 01:45:13 PM Central Daylight Time	08/03/2021 10:38:54 AM Central Daylight Time	08/04/2021 05:05:04 PM Central Daylight Time			08/05/2021 05:38:13 PM Central Daylight Time	GHS INSURANCE COMPANY	Blue Cross and Blue Shield of OK, TX	www.hcsc.com	Blue Cross Medicare Advantage Classic (PPO)	01	04		1			H4801	003	0	2022	Austin Market		2	9299	2			2						www.myprime.com	www.myprime.com	www.hcsc.com	(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			
H4801	004	0	1	04	01	H4801_004_0	3	1					0	06/03/2021	2022.01	06/03/2021 03:31:00 PM Central Daylight Time	08/03/2021 10:39:18 AM Central Daylight Time	08/04/2021 05:05:24 PM Central Daylight Time			08/05/2021 05:38:13 PM Central Daylight Time	GHS INSURANCE COMPANY	Blue Cross and Blue Shield of OK, TX	www.hcsc.com	Blue Cross Medicare Advantage Classic (PPO)	01	04		1			H4801	004	0	2022	San Antonio Market		2	5317	2			2						www.myprime.com	www.myprime.com	www.hcsc.com	(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			
H4801	005	0	1	04	01	H4801_005_0	3	1					0	06/03/2021	2022.01	06/03/2021 01:46:50 PM Central Daylight Time	08/03/2021 10:39:44 AM Central Daylight Time	08/04/2021 05:05:42 PM Central Daylight Time			08/05/2021 05:38:13 PM Central Daylight Time	GHS INSURANCE COMPANY	Blue Cross and Blue Shield of OK, TX	www.hcsc.com	Blue Cross Medicare Advantage Classic (PPO)	01	04		1			H4801	005	0	2022	El Paso Market		2	4908	2			2						www.myprime.com	www.myprime.com	www.hcsc.com	(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			
H4801	006	0	1	04	01	H4801_006_0	3	1					0	06/03/2021	2022.01	06/03/2021 01:47:21 PM Central Daylight Time	08/03/2021 10:40:08 AM Central Daylight Time	08/04/2021 05:06:00 PM Central Daylight Time			08/05/2021 05:38:13 PM Central Daylight Time	GHS INSURANCE COMPANY	Blue Cross and Blue Shield of OK, TX	www.hcsc.com	Blue Cross Medicare Advantage Classic (PPO)	01	04		1			H4801	006	0	2022	South Texas Market		2	7694	2			2						www.myprime.com	www.myprime.com	www.hcsc.com	(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			
H4801	007	0	1	04	01	H4801_007_0	5	1					0	06/03/2021	2022.01	06/03/2021 11:02:00 AM Mountain Daylight Time	08/03/2021 09:40:34 AM Mountain Daylight Time	08/04/2021 04:06:18 PM Mountain Daylight Time			08/05/2021 04:53:55 PM Mountain Daylight Time	GHS INSURANCE COMPANY	Blue Cross and Blue Shield of OK, TX	www.hcsc.com	Blue Cross Medicare Advantage Classic (PPO)	01	04		1			H4801	007	0	2022	Oklahoma Counties		2	8118	2			2						www.myprime.com	www.myprime.com	www.hcsc.com	(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			
H4801	008	0	1	04	01	H4801_008_0	5	1					0	07/15/2021	2022.01	07/15/2021 09:45:42 AM Mountain Daylight Time	08/03/2021 09:41:00 AM Mountain Daylight Time	08/04/2021 04:06:38 PM Mountain Daylight Time			08/05/2021 04:53:55 PM Mountain Daylight Time	GHS INSURANCE COMPANY	Blue Cross and Blue Shield of OK, TX	www.hcsc.com	Blue Cross Medicare Advantage Classic (PPO)	01	04		1			H4801	008	0	2022	Tulsa Counties		2	7571	2			2						www.myprime.com	www.myprime.com	www.hcsc.com	(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			
H4801	009	0	1	04	01	H4801_009_0	3	1					0	06/03/2021	2022.01	06/03/2021 05:13:21 PM Central Daylight Time	08/03/2021 10:41:26 AM Central Daylight Time	08/04/2021 05:06:56 PM Central Daylight Time			08/05/2021 05:38:13 PM Central Daylight Time	GHS INSURANCE COMPANY	Blue Cross and Blue Shield of OK, TX	www.hcsc.com	Blue Cross Medicare Advantage Classic (PPO)	01	04		1			H4801	009	0	2022	North Texas Market		2	2653	2			2						www.myprime.com	www.myprime.com	www.hcsc.com	(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			
H4801	010	0	1	04	01	H4801_010_0	3	1					0	06/03/2021	2022.01	06/03/2021 01:48:27 PM Central Daylight Time	08/03/2021 10:41:52 AM Central Daylight Time	08/04/2021 05:07:16 PM Central Daylight Time			08/05/2021 05:38:13 PM Central Daylight Time	GHS INSURANCE COMPANY	Blue Cross and Blue Shield of OK, TX	www.hcsc.com	Blue Cross Medicare Advantage Classic (PPO)	01	04		1			H4801	010	0	2022	Southeast Texas Market		2	4377	2			2						www.myprime.com	www.myprime.com	www.hcsc.com	(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			
H4801	011	0	1	04	01	H4801_011_0	3	1					0	06/03/2021	2022.01	06/03/2021 01:48:54 PM Central Daylight Time	08/03/2021 10:42:18 AM Central Daylight Time	08/04/2021 05:07:34 PM Central Daylight Time			08/05/2021 05:38:13 PM Central Daylight Time	GHS INSURANCE COMPANY	Blue Cross and Blue Shield of OK, TX	www.hcsc.com	Blue Cross Medicare Advantage Classic (PPO)	01	04		1			H4801	011	0	2022	Central Texas Market		2	5571	2			2						www.myprime.com	www.myprime.com	www.hcsc.com	(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			
H4801	012	0	1	04	01	H4801_012_0	3	1					0	06/03/2021	2022.01	06/03/2021 01:49:25 PM Central Daylight Time	08/03/2021 10:42:44 AM Central Daylight Time	08/04/2021 05:07:52 PM Central Daylight Time			08/05/2021 05:38:13 PM Central Daylight Time	GHS INSURANCE COMPANY	Blue Cross and Blue Shield of OK, TX	www.hcsc.com	Blue Cross Medicare Advantage Classic (PPO)	01	04		1			H4801	012	0	2022	Northeast Texas Market		2	2587	2			2						www.myprime.com	www.myprime.com	www.hcsc.com	(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			
H4801	013	0	1	04	01	H4801_013_0	3	1					0	07/15/2021	2022.01	07/15/2021 09:43:24 AM Mountain Daylight Time	08/03/2021 09:43:10 AM Mountain Daylight Time	08/04/2021 04:08:10 PM Mountain Daylight Time			08/05/2021 04:53:55 PM Mountain Daylight Time	GHS INSURANCE COMPANY	Blue Cross and Blue Shield of OK, TX	www.hcsc.com	Blue Cross Medicare Advantage Flex (PPO)	01	04		1			H4801	013	0	2022	Oklahoma		2	1974	2			2						www.myprime.com	www.myprime.com	www.hcsc.com	(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			
H4801	014	0	1	04	01	H4801_014_0	3	1					0	06/03/2021	2022.01	06/03/2021 01:49:57 PM Central Daylight Time	08/03/2021 10:43:42 AM Central Daylight Time	08/04/2021 05:08:28 PM Central Daylight Time			08/05/2021 05:38:13 PM Central Daylight Time	GHS INSURANCE COMPANY	Blue Cross and Blue Shield of OK, TX	www.hcsc.com	Blue Cross Medicare Advantage Flex (PPO)	01	04		1			H4801	014	0	2022	Texas Market		2	7980	2			2						www.myprime.com	www.myprime.com	www.hcsc.com	(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			
H4829	002	0	1	04	01	H4829_002_0	3	1					1	08/04/2021	2022.01	08/04/2021 08:32:29 AM Central Daylight Time	08/03/2021 11:51:13 AM Central Daylight Time	07/29/2021 08:48:21 PM Central Daylight Time			08/04/2021 07:05:02 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H4829	002	0	2022	Napa and Sonoma counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4829	003	0	1	04	01	H4829_003_0	3	1					1	08/04/2021	2022.01	08/04/2021 08:26:11 AM Central Daylight Time	08/03/2021 11:51:48 AM Central Daylight Time	07/29/2021 08:48:36 PM Central Daylight Time			08/04/2021 07:05:02 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H4829	003	0	2022	Select Counties in California		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4829	004	0	1	04	01	H4829_004_0	3	1					1	08/04/2021	2022.01	08/04/2021 08:23:44 AM Central Daylight Time	08/03/2021 11:52:21 AM Central Daylight Time	07/29/2021 08:48:51 PM Central Daylight Time			08/04/2021 07:05:02 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H4829	004	0	2022	Marin and Solano counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4829	005	0	1	04	01	H4829_005_0	4	1					1	08/17/2021	2022.01	08/17/2021 11:06:11 AM Central Daylight Time	08/03/2021 11:52:53 AM Central Daylight Time	07/29/2021 08:49:05 PM Central Daylight Time			08/17/2021 11:07:42 AM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H4829	005	0	2022	Santa Barbara county		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4829	006	0	1	04	01	H4829_006_0	3	1					1	08/04/2021	2022.01	08/04/2021 08:18:35 AM Central Daylight Time	08/03/2021 11:53:24 AM Central Daylight Time	07/29/2021 08:49:21 PM Central Daylight Time			08/04/2021 07:05:02 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H4829	006	0	2022	Placer, Sacramento and Yolo counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4829	007	0	1	04	01	H4829_007_0	3	1					1	08/04/2021	2022.01	08/04/2021 08:15:53 AM Central Daylight Time	08/03/2021 11:53:54 AM Central Daylight Time	07/29/2021 08:49:35 PM Central Daylight Time			08/04/2021 07:05:02 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H4829	007	0	2022	Santa Cruz and Santa Clara counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4829	008	0	1	04	01	H4829_008_0	3	1					1	08/04/2021	2022.01	08/04/2021 08:06:35 AM Central Daylight Time	08/03/2021 11:54:23 AM Central Daylight Time	07/29/2021 08:49:50 PM Central Daylight Time			08/04/2021 07:05:02 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H4829	008	0	2022	San Joaquin and Stanislaus counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(844)808-4553		(844)808-4553		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4835	001	0	1	02	01	H4835_001_0	2	1					0	08/02/2021	2022.01	08/02/2021 11:18:28 AM Eastern Daylight Time	08/03/2021 01:18:10 PM Eastern Daylight Time	08/02/2021 09:41:59 AM Eastern Daylight Time			08/04/2021 03:54:17 PM Eastern Daylight Time	AETNA BETTER HEALTH OF OKLAHOMA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime Plus Plan (HMO-POS)	01	02		1			H4835	001	0	2022	Maricopa County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4835	002	0	1	02	01	H4835_002_0	2	1					0	08/02/2021	2022.01	08/02/2021 11:19:29 AM Eastern Daylight Time	08/03/2021 01:19:01 PM Eastern Daylight Time	08/02/2021 09:42:04 AM Eastern Daylight Time			08/04/2021 03:54:17 PM Eastern Daylight Time	AETNA BETTER HEALTH OF OKLAHOMA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (HMO-POS)	01	02		1			H4835	002	0	2022	Maricopa County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4835	003	0	1	02	01	H4835_003_0	2	1					0	08/02/2021	2022.01	08/02/2021 11:26:34 AM Eastern Daylight Time	08/03/2021 01:19:53 PM Eastern Daylight Time	08/02/2021 09:42:08 AM Eastern Daylight Time			08/04/2021 03:54:17 PM Eastern Daylight Time	AETNA BETTER HEALTH OF OKLAHOMA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (HMO-POS)	01	02		1			H4835	003	0	2022	Pinal County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4835	004	0	1	02	01	H4835_004_0	2	1					0	08/02/2021	2022.01	08/02/2021 11:30:08 AM Eastern Daylight Time	08/03/2021 01:20:44 PM Eastern Daylight Time	08/02/2021 09:42:12 AM Eastern Daylight Time			08/04/2021 03:54:17 PM Eastern Daylight Time	AETNA BETTER HEALTH OF OKLAHOMA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (HMO-POS)	01	02		1			H4835	004	0	2022	Pima County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4835	005	0	1	02	01	H4835_005_0	2	1					0	08/02/2021	2022.01	08/02/2021 11:39:02 AM Eastern Daylight Time	08/03/2021 01:21:38 PM Eastern Daylight Time	08/02/2021 09:42:16 AM Eastern Daylight Time			08/04/2021 03:54:17 PM Eastern Daylight Time	AETNA BETTER HEALTH OF OKLAHOMA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (HMO-POS)	01	02		1			H4835	005	0	2022	Coconino, Mohave and Yavapai Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4835	006	0	1	02	01	H4835_006_0	3	1					0	08/02/2021	2022.01	08/02/2021 11:42:05 AM Eastern Daylight Time	08/03/2021 01:22:30 PM Eastern Daylight Time	08/02/2021 09:42:20 AM Eastern Daylight Time			08/04/2021 03:54:17 PM Eastern Daylight Time	AETNA BETTER HEALTH OF OKLAHOMA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (HMO-POS)	01	02		1			H4835	006	0	2022	Counties COH, GIL, GRA, SC		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4835	801	0	1	01	01	H4835_801_0	1	1				0	0	05/27/2021	2022.01	05/27/2021 11:31:45 PM Eastern Daylight Time					06/03/2021 01:24:36 PM Eastern Daylight Time	AETNA BETTER HEALTH OF OKLAHOMA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (HMO)	01	01		1			H4835	801	0	2022	Arizona		1	120	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H4835	802	0	1	01	01	H4835_802_0	1	1						05/27/2021	2022.01	05/27/2021 11:32:04 PM Eastern Daylight Time					06/03/2021 01:24:36 PM Eastern Daylight Time	AETNA BETTER HEALTH OF OKLAHOMA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan w/Rx (HMO)	01	01		1			H4835	802	0	2022	Arizona		1	120	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H4847	001	0	1	01	01	H4847_001_0	4	1					0	08/03/2021	2022.01	08/03/2021 11:28:34 AM Eastern Daylight Time	08/04/2021 12:19:48 AM Eastern Daylight Time	07/30/2021 11:26:46 AM Eastern Daylight Time			08/04/2021 09:57:30 PM Eastern Daylight Time	WELLCARE OF SOUTH CAROLINA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO)	01	01		1			H4847	001	0	2022	Select counties in SC		2	43406	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4847	002	0	1	01	01	H4847_002_0	4	1					0	08/03/2021	2022.01	08/03/2021 11:46:54 AM Eastern Daylight Time	08/04/2021 12:20:17 AM Eastern Daylight Time	07/30/2021 11:27:06 AM Eastern Daylight Time			08/04/2021 09:57:30 PM Eastern Daylight Time	WELLCARE OF SOUTH CAROLINA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO)	01	01		1			H4847	002	0	2022	Select counties in SC		2	17876	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4847	004	0	1	01	01	H4847_004_0	4	1	2	1			0	07/19/2021	2022.01	07/19/2021 12:38:54 PM Eastern Daylight Time	08/04/2021 12:20:45 AM Eastern Daylight Time	07/30/2021 11:27:30 AM Eastern Daylight Time			08/04/2021 09:57:30 PM Eastern Daylight Time	WELLCARE OF SOUTH CAROLINA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Liberty (HMO D-SNP)	01	01		1			H4847	004	0	2022	Select counties in SC		2	29734	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4847	005	0	1	01	01	H4847_005_0	4	1					0	07/19/2021	2022.01	07/19/2021 12:42:07 PM Eastern Daylight Time	08/04/2021 03:23:17 PM Eastern Daylight Time	07/30/2021 11:27:52 AM Eastern Daylight Time			08/04/2021 09:57:30 PM Eastern Daylight Time	WELLCARE OF SOUTH CAROLINA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Assist (HMO)	01	01		1			H4847	005	0	2022	All counties in SC		2	33522	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4847	006	0	1	02	01	H4847_006_0	3	1				0	0	07/19/2021	2022.01	07/19/2021 12:45:18 PM Eastern Daylight Time	06/04/2021 12:48:54 PM Eastern Daylight Time				07/19/2021 06:42:26 PM Eastern Daylight Time	WELLCARE OF SOUTH CAROLINA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Patriot Giveback (HMO-POS)	01	02		1			H4847	006	0	2022	All counties in SC		2	5185	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H4853	001	0	1	01	01	H4853_001_0	6	1					0	08/03/2021	2022.01	08/03/2021 02:00:24 PM Central Daylight Time	08/05/2021 03:37:48 PM Central Daylight Time	08/05/2021 03:37:52 PM Central Daylight Time			08/05/2021 06:26:50 PM Central Daylight Time	BRIGHT HEALTH COMPANY OF ARIZONA	Bright Health	brighthealthcare.com/medicare	Bright Advantage Classic Care Plan (HMO)	01	01		1			H4853	001	0	2022	Phoenix and Tucson Area		2	26151	2			2						brighthealthcare.com/madoctors	brighthealthcare.com/drug-search/ma	brighthealthcare.com/madoctors	(844)926-4521		(844)926-4521		(844)679-2028		(844)679-2028		(844)926-4521		(844)926-4521		(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	6	1					0	08/05/2021	2022.01	08/05/2021 08:02:26 AM Central Daylight Time	08/05/2021 03:37:48 PM Central Daylight Time	08/05/2021 03:37:52 PM Central Daylight Time			08/05/2021 06:26:50 PM Central Daylight Time	BRIGHT HEALTH COMPANY OF ARIZONA	Bright Health	brighthealthcare.com/medicare	Bright Advantage Classic Choice Plan (HMO)	01	01		1			H4853	002	0	2022	Phoenix and Tucson Area		2	4934	2			2						brighthealthcare.com/madoctors	brighthealthcare.com/drug-search/ma	brighthealthcare.com/madoctors	(844)926-4521		(844)926-4521		(844)679-2028		(844)679-2028		(844)926-4521		(844)926-4521		(844)679-2028		(844)679-2028		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4853	016	0	1	01	01	H4853_016_0	6	1		1			1	08/03/2021	2022.01	08/03/2021 02:05:09 PM Central Daylight Time	08/05/2021 03:37:48 PM Central Daylight Time	08/05/2021 03:37:52 PM Central Daylight Time			08/05/2021 06:26:50 PM Central Daylight Time	BRIGHT HEALTH COMPANY OF ARIZONA	Bright Health	brighthealthcare.com/medicare	Bright Advantage Embrace Care Plan (HMO C-SNP)	01	01		1			H4853	016	0	2022	Phoenix and Tucson Area		2	12683	2			1	4			00000000000000000010		brighthealthcare.com/madoctors	brighthealthcare.com/drug-search/ma	brighthealthcare.com/madoctors	(844)926-4521		(844)926-4521		(844)679-2028		(844)679-2028		(844)926-4521		(844)926-4521		(844)679-2028		(844)679-2028		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4853	017	0	1	01	01	H4853_017_0	7	1		1			0	08/03/2021	2022.01	08/03/2021 02:11:30 PM Central Daylight Time	08/05/2021 03:37:48 PM Central Daylight Time	08/05/2021 03:37:52 PM Central Daylight Time			08/05/2021 06:26:50 PM Central Daylight Time	BRIGHT HEALTH COMPANY OF ARIZONA	Bright Health	brighthealthcare.com/medicare	Bright Advantage Embrace Choice Plan (HMO C-SNP)	01	01		1			H4853	017	0	2022	Phoenix and Tucson Area		2	2537	2			1	4			00000000000000000010		brighthealthcare.com/madoctors	brighthealthcare.com/drug-search/ma	brighthealthcare.com/madoctors	(844)926-4521		(844)926-4521		(844)679-2028		(844)679-2028		(844)926-4521		(844)926-4521		(844)679-2028		(844)679-2028		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4853	018	0	1	01	01	H4853_018_0	6	1		1			0	08/03/2021	2022.01	08/03/2021 02:07:02 PM Central Daylight Time	08/05/2021 03:37:48 PM Central Daylight Time	08/05/2021 03:37:52 PM Central Daylight Time			08/05/2021 06:26:50 PM Central Daylight Time	BRIGHT HEALTH COMPANY OF ARIZONA	Bright Health	brighthealthcare.com/medicare	Bright Advantage Harmony Choice Plan (HMO C-SNP)	01	01		1			H4853	018	0	2022	Phoenix and Tucson Area		2	507	2			1	4			00000000000010000000		brighthealthcare.com/madoctors	brighthealthcare.com/drug-search/ma	brighthealthcare.com/madoctors	(844)926-4521		(844)926-4521		(844)679-2028		(844)679-2028		(844)926-4521		(844)926-4521		(844)679-2028		(844)679-2028		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4853	020	0	1	01	01	H4853_020_0	6	1		1			0	08/03/2021	2022.01	08/03/2021 02:12:43 PM Central Daylight Time	08/05/2021 03:37:48 PM Central Daylight Time	08/05/2021 03:37:52 PM Central Daylight Time			08/05/2021 06:26:50 PM Central Daylight Time	BRIGHT HEALTH COMPANY OF ARIZONA	Bright Health	brighthealthcare.com/medicare	Bright Advantage Embrace Assist Plan (HMO C-SNP)	01	01		1			H4853	020	0	2022	Phoenix and Tucson Area		2	507	2			1	4			00000000000000000010		brighthealthcare.com/madoctors	brighthealthcare.com/drug-search/ma	brighthealthcare.com/madoctors	(844)926-4521		(844)926-4521		(844)679-2028		(844)679-2028		(844)926-4521		(844)926-4521		(844)679-2028		(844)679-2028		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4868	003	0	1	01	01	H4868_003_0	6	1				0	0	06/01/2021	2022.01	06/01/2021 12:29:55 PM Eastern Daylight Time	06/06/2021 12:50:04 PM Eastern Daylight Time				07/19/2021 04:15:23 PM Eastern Daylight Time	WELLCARE OF NEW YORK, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Patriot No Premium (HMO)	01	01		1			H4868	003	0	2022	Select counties in NY		2	3085	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H4868	004	0	1	01	01	H4868_004_0	5	1	2	1			0	06/02/2021	2022.01	06/02/2021 07:42:35 PM Eastern Daylight Time	08/04/2021 12:22:39 AM Eastern Daylight Time	07/30/2021 11:28:12 AM Eastern Daylight Time			08/04/2021 11:02:27 PM Eastern Daylight Time	WELLCARE OF NEW YORK, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Access (HMO D-SNP)	01	01		1			H4868	004	0	2022	Select counties in NY		2	44291	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4868	014	0	1	01	01	H4868_014_0	5	1	2	1			0	06/02/2021	2022.01	06/02/2021 07:41:06 PM Eastern Daylight Time	08/04/2021 12:23:10 AM Eastern Daylight Time	07/30/2021 11:28:30 AM Eastern Daylight Time			08/04/2021 11:02:27 PM Eastern Daylight Time	WELLCARE OF NEW YORK, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Access (HMO D-SNP)	01	01		1			H4868	014	0	2022	Select counties in NY		2	229900	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4868	016	0	1	01	01	H4868_016_0	5	1					0	06/01/2021	2022.01	06/01/2021 10:10:37 AM Eastern Daylight Time	08/04/2021 03:23:42 PM Eastern Daylight Time	07/30/2021 11:28:50 AM Eastern Daylight Time			08/04/2021 11:02:27 PM Eastern Daylight Time	WELLCARE OF NEW YORK, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Assist (HMO)	01	01		1			H4868	016	0	2022	Select counties in NY		2	20380	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4868	019	0	1	01	01	H4868_019_0	5	1					0	08/02/2021	2022.01	08/02/2021 05:07:35 PM Eastern Daylight Time	08/04/2021 12:24:10 AM Eastern Daylight Time	07/30/2021 11:29:08 AM Eastern Daylight Time			08/04/2021 11:02:27 PM Eastern Daylight Time	WELLCARE OF NEW YORK, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO)	01	01		1			H4868	019	0	2022	Select counties in NY		2	155469	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4875	016	1	1	04	01	H4875_016_1	9	1					0	07/19/2021	2022.01	07/19/2021 02:52:44 PM Eastern Daylight Time	08/03/2021 11:45:32 PM Eastern Daylight Time	07/30/2021 02:27:58 PM Eastern Daylight Time			08/05/2021 11:58:59 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Merit (PPO)	01	04		1			H4875	016	1	2022	68 lower peninsula Michigan counties	Region 3	2	13816	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)384-1695		(616)464-8850		(888)389-6648		(616)464-8820		(888)384-1695		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4875	016	2	1	04	01	H4875_016_2	9	1					0	07/19/2021	2022.01	07/19/2021 03:00:40 PM Eastern Daylight Time	08/03/2021 11:46:06 PM Eastern Daylight Time	07/30/2021 02:28:14 PM Eastern Daylight Time			08/05/2021 11:58:59 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Merit (PPO)	01	04		1			H4875	016	2	2022	68 lower peninsula Michigan counties	Region 4	2	6226	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)384-1695		(616)464-8850		(888)389-6648		(616)464-8820		(888)384-1695		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4875	016	3	1	04	01	H4875_016_3	9	1					0	07/19/2021	2022.01	07/19/2021 03:26:11 PM Eastern Daylight Time	08/03/2021 11:46:42 PM Eastern Daylight Time	07/30/2021 02:28:30 PM Eastern Daylight Time			08/05/2021 11:58:59 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Merit (PPO)	01	04		1			H4875	016	3	2022	68 lower peninsula Michigan counties	Region 5	2	22019	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)384-1695		(616)464-8850		(888)389-6648		(616)464-8820		(888)384-1695		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4875	016	4	1	04	01	H4875_016_4	9	1					0	07/19/2021	2022.01	07/19/2021 03:01:05 PM Eastern Daylight Time	08/03/2021 11:47:18 PM Eastern Daylight Time	07/30/2021 02:28:46 PM Eastern Daylight Time			08/05/2021 11:58:59 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Merit (PPO)	01	04		1			H4875	016	4	2022	68 lower peninsula Michigan counties	Region 1	2	56324	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)384-1695		(616)464-8850		(888)389-6648		(616)464-8820		(888)384-1695		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4875	016	5	1	04	01	H4875_016_5	9	1					0	07/19/2021	2022.01	07/19/2021 03:01:13 PM Eastern Daylight Time	08/03/2021 11:47:56 PM Eastern Daylight Time	07/30/2021 02:29:00 PM Eastern Daylight Time			08/05/2021 11:58:59 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Merit (PPO)	01	04		1			H4875	016	5	2022	68 lower peninsula Michigan counties	Region 2	2	30833	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)384-1695		(616)464-8850		(888)389-6648		(616)464-8820		(888)384-1695		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4875	017	1	1	04	01	H4875_017_1	9	1					0	07/19/2021	2022.01	07/19/2021 02:53:51 PM Eastern Daylight Time	08/03/2021 11:48:30 PM Eastern Daylight Time	07/30/2021 02:29:18 PM Eastern Daylight Time			08/05/2021 11:58:59 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Select (PPO)	01	04		1			H4875	017	1	2022	68 lower peninsula Michigan counties	Region 1	2	18046	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)384-1695		(616)464-8850		(888)389-6648		(616)464-8820		(888)384-1695		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4875	017	2	1	04	01	H4875_017_2	9	1					0	07/19/2021	2022.01	07/19/2021 03:14:11 PM Eastern Daylight Time	08/03/2021 11:49:06 PM Eastern Daylight Time	07/30/2021 02:29:32 PM Eastern Daylight Time			08/05/2021 11:58:59 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Select (PPO)	01	04		1			H4875	017	2	2022	68 lower peninsula Michigan counties	Region 2	2	10409	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)384-1695		(616)464-8850		(888)389-6648		(616)464-8820		(888)384-1695		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4875	017	3	1	04	01	H4875_017_3	9	1					0	07/19/2021	2022.01	07/19/2021 03:19:54 PM Eastern Daylight Time	08/03/2021 11:49:42 PM Eastern Daylight Time	07/30/2021 02:29:48 PM Eastern Daylight Time			08/05/2021 11:58:59 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Select (PPO)	01	04		1			H4875	017	3	2022	68 lower peninsula Michigan counties	Region 3	2	4541	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)384-1695		(616)464-8850		(888)389-6648		(616)464-8820		(888)384-1695		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4875	017	4	1	04	01	H4875_017_4	9	1					0	07/19/2021	2022.01	07/19/2021 03:25:02 PM Eastern Daylight Time	08/03/2021 11:50:18 PM Eastern Daylight Time	07/30/2021 02:30:04 PM Eastern Daylight Time			08/05/2021 11:58:59 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Select (PPO)	01	04		1			H4875	017	4	2022	68 lower peninsula Michigan counties	Region 4	2	2273	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)384-1695		(616)464-8850		(888)389-6648		(616)464-8820		(888)384-1695		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4875	017	5	1	04	01	H4875_017_5	9	1					0	07/19/2021	2022.01	07/19/2021 03:01:58 PM Eastern Daylight Time	08/03/2021 11:50:54 PM Eastern Daylight Time	07/30/2021 02:30:18 PM Eastern Daylight Time			08/05/2021 11:58:59 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Select (PPO)	01	04		1			H4875	017	5	2022	68 lower peninsula Michigan counties	Region 5	2	5827	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)384-1695		(616)464-8850		(888)389-6648		(616)464-8820		(888)384-1695		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4875	018	1	1	04	01	H4875_018_1	9	1					0	07/19/2021	2022.01	07/19/2021 02:54:46 PM Eastern Daylight Time	08/03/2021 11:51:28 PM Eastern Daylight Time	07/30/2021 02:30:34 PM Eastern Daylight Time			08/05/2021 11:58:59 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Ideal (PPO)	01	04		1			H4875	018	1	2022	68 lower peninsula Michigan counties	Region 1	2	8585	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)384-1695		(616)464-8850		(888)389-6648		(616)464-8820		(888)384-1695		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4875	018	2	1	04	01	H4875_018_2	9	1					0	07/19/2021	2022.01	07/19/2021 03:20:07 PM Eastern Daylight Time	08/03/2021 11:52:06 PM Eastern Daylight Time	07/30/2021 02:30:50 PM Eastern Daylight Time			08/05/2021 11:58:59 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Ideal (PPO)	01	04		1			H4875	018	2	2022	68 lower peninsula Michigan counties	Region 2	2	19719	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)384-1695		(616)464-8850		(888)389-6648		(616)464-8820		(888)384-1695		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4875	018	3	1	04	01	H4875_018_3	9	1					0	07/19/2021	2022.01	07/19/2021 03:23:39 PM Eastern Daylight Time	08/03/2021 11:52:42 PM Eastern Daylight Time	07/30/2021 02:31:08 PM Eastern Daylight Time			08/05/2021 11:58:59 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Ideal (PPO)	01	04		1			H4875	018	3	2022	68 lower peninsula Michigan counties	Region 3	2	18009	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)384-1695		(616)464-8850		(888)389-6648		(616)464-8820		(888)384-1695		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4875	018	4	1	04	01	H4875_018_4	9	1					0	07/19/2021	2022.01	07/19/2021 03:10:54 PM Eastern Daylight Time	08/03/2021 11:53:20 PM Eastern Daylight Time	07/30/2021 02:31:22 PM Eastern Daylight Time			08/05/2021 11:58:59 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Ideal (PPO)	01	04		1			H4875	018	4	2022	68 lower peninsula Michigan counties	Region 4	2	11525	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)384-1695		(616)464-8850		(888)389-6648		(616)464-8820		(888)384-1695		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4875	018	5	1	04	01	H4875_018_5	9	1					0	07/19/2021	2022.01	07/19/2021 03:02:41 PM Eastern Daylight Time	08/03/2021 11:53:56 PM Eastern Daylight Time	07/30/2021 02:31:38 PM Eastern Daylight Time			08/05/2021 11:58:59 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Ideal (PPO)	01	04		1			H4875	018	5	2022	68 lower peninsula Michigan counties	Region 5	2	20615	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)384-1695		(616)464-8850		(888)389-6648		(616)464-8820		(888)384-1695		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4875	020	1	1	04	01	H4875_020_1	10	1					0	08/05/2021	2022.01	08/05/2021 09:05:41 AM Eastern Daylight Time	08/03/2021 11:54:30 PM Eastern Daylight Time	07/30/2021 02:31:56 PM Eastern Daylight Time			08/05/2021 11:58:59 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Edge (PPO)	01	04		1			H4875	020	1	2022	West, SW, & SE counties, lower MI	Region 1	2	220659	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)384-1695		(616)464-8850		(888)389-6648		(616)464-8820		(888)384-1695		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4875	020	2	1	04	01	H4875_020_2	10	1					0	08/05/2021	2022.01	08/05/2021 11:15:45 AM Eastern Daylight Time	08/03/2021 11:55:06 PM Eastern Daylight Time	07/30/2021 02:32:10 PM Eastern Daylight Time			08/05/2021 11:58:59 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Edge (PPO)	01	04		1			H4875	020	2	2022	West, SW, & SE counties, lower MI	Region 2	2	168297	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)384-1695		(616)464-8850		(888)389-6648		(616)464-8820		(888)384-1695		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4875	020	3	1	04	01	H4875_020_3	10	1					0	08/05/2021	2022.01	08/05/2021 09:11:14 AM Eastern Daylight Time	08/03/2021 11:55:42 PM Eastern Daylight Time	07/30/2021 02:32:26 PM Eastern Daylight Time			08/05/2021 11:58:59 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Edge (PPO)	01	04		1			H4875	020	3	2022	West, SW, & SE counties, lower MI	Region 5	2	234113	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)384-1695		(616)464-8850		(888)389-6648		(616)464-8820		(888)384-1695		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4875	021	1	1	04	01	H4875_021_1	9	1					0	08/05/2021	2022.01	08/05/2021 11:16:14 AM Eastern Daylight Time	08/03/2021 11:56:18 PM Eastern Daylight Time	07/30/2021 02:32:42 PM Eastern Daylight Time			08/05/2021 11:58:59 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Compass (PPO)	01	04		1			H4875	021	1	2022	North counties, lower MI	Region 3	2	29112	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)384-1695		(616)464-8850		(888)389-6648		(616)464-8820		(888)384-1695		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4875	021	2	1	04	01	H4875_021_2	9	1					0	08/05/2021	2022.01	08/05/2021 11:16:54 AM Eastern Daylight Time	08/03/2021 11:56:54 PM Eastern Daylight Time	07/30/2021 02:32:56 PM Eastern Daylight Time			08/05/2021 11:58:59 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Compass (PPO)	01	04		1			H4875	021	2	2022	North counties, lower MI	Region 4	2	29366	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)384-1695		(616)464-8850		(888)389-6648		(616)464-8820		(888)384-1695		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4875	022	1	1	04	01	H4875_022_1	9	1					0	08/05/2021	2022.01	08/05/2021 11:17:57 AM Eastern Daylight Time	08/03/2021 11:57:30 PM Eastern Daylight Time	07/30/2021 02:33:12 PM Eastern Daylight Time			08/05/2021 11:58:59 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Vital (PPO)	01	04		1			H4875	022	1	2022	68 lower peninsula Michigan counties	Region 1	2	4665	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)384-1695		(616)464-8850		(888)389-6648		(616)464-8820		(888)384-1695		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4875	022	2	1	04	01	H4875_022_2	9	1					0	08/05/2021	2022.01	08/05/2021 11:19:06 AM Eastern Daylight Time	08/03/2021 11:58:06 PM Eastern Daylight Time	07/30/2021 02:33:28 PM Eastern Daylight Time			08/05/2021 11:58:59 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Vital (PPO)	01	04		1			H4875	022	2	2022	68 lower peninsula Michigan counties	Region 2	2	4922	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)384-1695		(616)464-8850		(888)389-6648		(616)464-8820		(888)384-1695		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4875	022	5	1	04	01	H4875_022_5	9	1					0	08/05/2021	2022.01	08/05/2021 09:57:08 AM Eastern Daylight Time	08/03/2021 11:58:48 PM Eastern Daylight Time	07/30/2021 02:33:42 PM Eastern Daylight Time			08/05/2021 11:58:59 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Vital (PPO)	01	04		1			H4875	022	5	2022	68 lower peninsula Michigan counties	Region 5	2	6193	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)384-1695		(616)464-8850		(888)389-6648		(616)464-8820		(888)384-1695		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4875	803	0	1	04	01	H4875_803_0	8	1						06/18/2021	2022.01	06/18/2021 02:14:17 PM Eastern Daylight Time					06/18/2021 02:24:10 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare PPO EG Non-Calendar Year (PPO)	01	04		1			H4875	803	0	2022	National		1	912	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4875	804	0	1	04	01	H4875_804_0	8	1						06/18/2021	2022.01	06/18/2021 02:14:27 PM Eastern Daylight Time					06/18/2021 02:24:10 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare PPO EG Calendar Year (PPO)	01	04		1			H4875	804	0	2022	National		1	57576	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4875	805	0	1	04	01	H4875_805_0	7	1				0	0	06/07/2021	2022.01	06/07/2021 01:29:08 PM Eastern Daylight Time					06/07/2021 11:18:26 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	2022	National		1	20	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850										(711)-		(711)-		(711)-		(711)-										2					2						2			
H4875	806	0	1	04	01	H4875_806_0	7	1				0	0	06/07/2021	2022.01	06/07/2021 01:29:20 PM Eastern Daylight Time					06/07/2021 11:18:26 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	2022	National		1	20	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850										(711)-		(711)-		(711)-		(711)-										2					2						2			
H4882	001	0	1	04	01	H4882_001_0	7	1					1	07/20/2021	2022.01	07/20/2021 08:54:01 AM Central Daylight Time	08/04/2021 08:58:45 AM Central Daylight Time	08/02/2021 12:16:18 PM Central Daylight Time			08/05/2021 11:10:18 AM Central Daylight Time	HEALTHPARTNERS, INC.	HealthPartners	healthpartners.com/medicare	HealthPartners Journey Stride (PPO)	01	04		1			H4882	001	0	2022	Metro and Central MN Counties		2	141254	2			2						healthpartners.com/partdpharmacy	healthpartners.com/medicarerx	healthpartners.com/medicarenetworks	(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					1	07/15/2021	2022.01	07/15/2021 06:03:44 PM Central Daylight Time	08/04/2021 08:42:22 AM Central Daylight Time	08/02/2021 12:16:32 PM Central Daylight Time			08/05/2021 11:43:02 AM Central Daylight Time	HEALTHPARTNERS, INC.	HealthPartners	healthpartners.com/medicare	HealthPartners Journey Pace (PPO)	01	04		1			H4882	002	0	2022	Metro and Central MN Counties		2	15312	2			2						healthpartners.com/partdpharmacy	healthpartners.com/medicarerx	healthpartners.com/medicarenetworks	(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	5	1					1	07/15/2021	2022.01	07/15/2021 06:09:32 PM Central Daylight Time	08/04/2021 09:05:42 AM Central Daylight Time	08/02/2021 12:16:46 PM Central Daylight Time			08/05/2021 11:43:02 AM Central Daylight Time	HEALTHPARTNERS, INC.	HealthPartners	healthpartners.com/medicare	HealthPartners Journey Steady (PPO)	01	04		1			H4882	003	0	2022	Metro and Central MN Counties		2	95703	2			2						healthpartners.com/partdpharmacy	healthpartners.com/medicarerx	healthpartners.com/medicarenetworks	(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	5	1					1	07/15/2021	2022.01	07/15/2021 06:14:14 PM Central Daylight Time	08/02/2021 07:26:48 PM Central Daylight Time	08/02/2021 12:17:02 PM Central Daylight Time			08/05/2021 12:03:53 PM Central Daylight Time	HEALTHPARTNERS, INC.	HealthPartners	healthpartners.com/medicare	HealthPartners Robin Birch (PPO)	01	04		1			H4882	004	0	2022	NE WI - Brown, Outagamie: 13 additional counties		2	4727	2			2						healthpartners.com/partdpharmacy	healthpartners.com/medicarerx	healthpartners.com/medicarenetworks	(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	5	1					1	07/15/2021	2022.01	07/15/2021 06:21:57 PM Central Daylight Time	08/02/2021 07:27:16 PM Central Daylight Time	08/02/2021 12:17:16 PM Central Daylight Time			08/05/2021 12:03:53 PM Central Daylight Time	HEALTHPARTNERS, INC.	HealthPartners	healthpartners.com/medicare	HealthPartners Robin Maple (PPO)	01	04		1			H4882	005	0	2022	NE WI - Brown, Outagamie: 13 additional counties		2	9889	2			2						healthpartners.com/partdpharmacy	healthpartners.com/medicarerx	healthpartners.com/medicarenetworks	(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	006	0	1	04	01	H4882_006_0	5	1					1	07/16/2021	2022.01	07/16/2021 12:07:34 PM Central Daylight Time	08/04/2021 09:02:45 AM Central Daylight Time	08/02/2021 12:17:30 PM Central Daylight Time			08/05/2021 11:43:02 AM Central Daylight Time	HEALTHPARTNERS, INC.	HealthPartners	healthpartners.com/medicare	HealthPartners Journey Dash (PPO)	01	04		1			H4882	006	0	2022	Metro and Central MN Counties		2	5684	2			2						healthpartners.com/partdpharmacy	healthpartners.com/medicarerx	healthpartners.com/medicarenetworks	(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	007	0	1	04	01	H4882_007_0	6	1					1	07/15/2021	2022.01	07/15/2021 06:27:50 PM Central Daylight Time	08/04/2021 09:11:40 AM Central Daylight Time	08/02/2021 12:17:44 PM Central Daylight Time			08/05/2021 12:18:37 PM Central Daylight Time	HEALTHPARTNERS, INC.	HealthPartners	healthpartners.com/medicare	HealthPartners Journey Pace (PPO)	01	04		1			H4882	007	0	2022	Greater MN: North, West, Southwest Counties		2		2			2						healthpartners.com/partdpharmacy	healthpartners.com/medicarerx	healthpartners.com/medicarenetworks	(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	008	0	1	04	01	H4882_008_0	6	1					1	07/15/2021	2022.01	07/15/2021 06:30:10 PM Central Daylight Time	08/04/2021 09:15:42 AM Central Daylight Time	08/02/2021 12:17:58 PM Central Daylight Time			08/05/2021 12:18:37 PM Central Daylight Time	HEALTHPARTNERS, INC.	HealthPartners	healthpartners.com/medicare	HealthPartners Journey Dash (PPO)	01	04		1			H4882	008	0	2022	Greater MN: North, West, Southwest Counties		2		2			2						healthpartners.com/partdpharmacy	healthpartners.com/medicarerx	healthpartners.com/medicarenetworks	(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	801	0	1	04	01	H4882_801_0	1	1						06/07/2021	2022.01	06/07/2021 08:35:48 AM Central Daylight Time					06/07/2021 08:47:27 AM Central Daylight Time	HEALTHPARTNERS, INC.	HealthPartners	healthpartners.com/medicare	HealthPartners Group MAPD Calendar Year (PPO)	01	04		1			H4882	801	0	2022	All States Excluding Cost Counties		1	204120	2			2						healthpartners.com/partdpharmacy	healthpartners.com/medicarerx	healthpartners.com/medicarenetworks	(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				0	0	06/07/2021	2022.01	06/07/2021 08:45:17 AM Central Daylight Time					06/07/2021 08:47:27 AM Central Daylight Time	HEALTHPARTNERS, INC.	HealthPartners	healthpartners.com/medicare	HealthPartners Group MA Only (PPO)	01	04		1			H4882	803	0	2022	All States Excluding Cost Counties		1	0	2			2						healthpartners.com/partdpharmacy	healthpartners.com/medicarerx	healthpartners.com/medicarenetworks	(866)233-8734		(952)883-6655		(844)363-8979		(952)883-5090										(711)-		(711)-		(711)-		(711)-										2					2						2			
H4882	804	0	1	04	01	H4882_804_0	1	1						06/07/2021	2022.01	06/07/2021 08:44:37 AM Central Daylight Time					06/07/2021 08:47:27 AM Central Daylight Time	HEALTHPARTNERS, INC.	HealthPartners	healthpartners.com/medicare	HealthPartners Group II MAPD Calendar Year (PPO)	01	04		1			H4882	804	0	2022	All States Excluding Cost Counties		1	0	2			2						healthpartners.com/partdpharmacy	healthpartners.com/medicarerx	healthpartners.com/medicarenetworks	(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	805	0	1	04	01	H4882_805_0	1	1				0	0	06/07/2021	2022.01	06/07/2021 08:43:53 AM Central Daylight Time					06/07/2021 08:47:27 AM Central Daylight Time	HEALTHPARTNERS, INC.	HealthPartners	healthpartners.com/medicare	HealthPartners Group II MA Only (PPO)	01	04		1			H4882	805	0	2022	All States Excluding Cost Counties		1	0	2			2						healthpartners.com/partdpharmacy	healthpartners.com/medicarerx	healthpartners.com/medicarenetworks	(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			2		0	07/15/2021	2022.01	07/15/2021 01:26:51 PM Eastern Daylight Time	08/03/2021 06:04:05 PM Eastern Daylight Time	08/03/2021 06:04:05 PM Eastern Daylight Time			08/04/2021 02:27:41 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	shop.anthem.com/medicare	Anthem MediBlue Access (PPO)	01	04		1			H4909	014	0	2022	Select Counties in Virginia		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(866)827-9866		(866)827-9866		(855)679-0550		(855)679-0550		(833)341-4610		(833)341-4610		(855)485-0966		(855)485-0966		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4909	015	0	1	04	01	H4909_015_0	7	1			2		0	08/02/2021	2022.01	08/02/2021 02:27:10 PM Eastern Daylight Time	08/03/2021 06:04:00 PM Eastern Daylight Time	08/03/2021 06:04:00 PM Eastern Daylight Time			08/04/2021 02:28:17 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	shop.anthem.com/medicare	Anthem MediBlue Access (PPO)	01	04		1			H4909	015	0	2022	Select Counties in Missouri		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(855)690-7798		(855)690-7798		(855)679-0550		(855)679-0550		(833)341-4609		(833)341-4609		(855)485-0966		(855)485-0966		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4909	016	0	1	04	01	H4909_016_0	8	1			2		0	08/02/2021	2022.01	08/02/2021 02:28:28 PM Eastern Daylight Time	08/03/2021 06:04:00 PM Eastern Daylight Time	08/03/2021 06:04:00 PM Eastern Daylight Time			08/04/2021 02:28:17 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	shop.anthem.com/medicare	Anthem MediBlue Access Basic (PPO)	01	04		1			H4909	016	0	2022	Select Counties in Missouri		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(855)690-7798		(855)690-7798		(855)679-0550		(855)679-0550		(833)341-4609		(833)341-4609		(855)485-0966		(855)485-0966		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4909	018	0	1	04	01	H4909_018_0	6	1	2	1	1		0	08/02/2021	2022.01	08/02/2021 11:31:13 AM Eastern Daylight Time	08/03/2021 06:04:05 PM Eastern Daylight Time	08/03/2021 06:04:05 PM Eastern Daylight Time			08/04/2021 02:27:41 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	shop.anthem.com/medicare	Anthem MediBlue Dual Access (PPO D-SNP)	01	04		1			H4909	018	0	2022	Select Counties in Virginia		2		2			1	3		1		1	https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(833)713-1081		(833)713-1081		(855)679-0551		(855)679-0551		(833)341-4610		(833)341-4610		(855)485-0967		(855)485-0967		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4909	020	0	1	04	01	H4909_020_0	5	1			2	0	0	06/03/2021	2022.01	06/03/2021 08:58:43 PM Eastern Daylight Time	07/16/2021 06:59:00 PM Eastern Daylight Time				07/19/2021 03:23:11 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	shop.anthem.com/medicare	Anthem MediBlue Service (PPO)	01	04		1			H4909	020	0	2022	Select counties in Virginia		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(833)713-1081		(833)713-1081		(855)679-0551		(855)679-0551										(711)-		(711)-		(711)-		(711)-										2					2						2			
H4909	021	0	1	04	01	H4909_021_0	6	1			2	0	0	07/15/2021	2022.01	07/15/2021 10:37:31 AM Eastern Daylight Time	07/16/2021 06:58:51 PM Eastern Daylight Time				07/19/2021 04:21:07 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	shop.anthem.com/medicare	Anthem MediBlue Service (PPO)	01	04		1			H4909	021	0	2022	Select counties in Missouri		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(855)690-7798		(855)690-7798		(855)679-0550		(855)679-0550										(711)-		(711)-		(711)-		(711)-										2					2						2			
H4909	022	0	1	04	01	H4909_022_0	12	1			2		0	07/31/2021	2022.01	07/31/2021 05:09:16 PM Pacific Daylight Time	08/03/2021 03:04:04 PM Pacific Daylight Time	08/03/2021 03:04:04 PM Pacific Daylight Time			08/04/2021 12:07:42 PM Pacific Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	shop.anthem.com/medicare	Anthem MediBlue Access (PPO)	01	04		1			H4909	022	0	2022	Select Counties in CO		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(888)346-0095		(888)346-0095		(855)679-0546		(855)679-0546		(833)341-4608		(833)341-4608		(855)485-0962		(855)485-0962		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4909	023	0	1	04	01	H4909_023_0	6	1			2	0	0	07/16/2021	2022.01	07/16/2021 05:32:00 PM Eastern Daylight Time	07/16/2021 06:58:49 PM Eastern Daylight Time				07/19/2021 05:00:56 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	shop.anthem.com/medicare	Anthem MediBlue Service (PPO)	01	04		1			H4909	023	0	2022	Kentucky		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(855)690-7795		(855)690-7795		(855)768-1041		(855)768-1041										(711)-		(711)-		(711)-		(711)-										2					2						2			
H4909	024	0	1	04	01	H4909_024_0	7	1			2		0	08/02/2021	2022.01	08/02/2021 12:43:38 PM Eastern Daylight Time	08/03/2021 06:03:59 PM Eastern Daylight Time	08/03/2021 06:03:59 PM Eastern Daylight Time			08/04/2021 02:00:52 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	shop.anthem.com/medicare	Anthem MediBlue Access Preferred (PPO)	01	04		1			H4909	024	0	2022	Select counties in KY		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(855)690-7795		(855)690-7795		(855)768-1041		(855)768-1041		(833)343-4761		(833)343-4761		(855)499-1091		(855)499-1091		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4909	025	0	1	04	01	H4909_025_0	7	1			2		0	08/04/2021	2022.01	08/04/2021 02:56:24 PM Eastern Daylight Time	08/04/2021 03:55:13 PM Eastern Daylight Time	07/29/2021 07:29:40 PM Eastern Daylight Time			08/04/2021 07:08:57 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	shop.anthem.com/medicare	Anthem MediBlue + Kroger Access (PPO)	01	04		1			H4909	025	0	2022	Select counties in KY		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(855)690-7795		(855)690-7795		(855)768-1041		(855)768-1041		(833)343-4761		(833)343-4761		(855)499-1091		(855)499-1091		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4909	026	0	1	04	01	H4909_026_0	6	1			2		0	08/04/2021	2022.01	08/04/2021 02:50:02 PM Eastern Daylight Time	08/04/2021 03:56:33 PM Eastern Daylight Time	07/29/2021 07:30:16 PM Eastern Daylight Time			08/04/2021 07:09:46 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	shop.anthem.com/medicare	Anthem MediBlue + Kroger Access (PPO)	01	04		1			H4909	026	0	2022	Select counties in Virginia		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(866)827-9866		(866)827-9866		(855)679-0550		(855)679-0550		(833)341-4610		(833)341-4610		(855)485-0966		(855)485-0966		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4909	804	0	1	04	01	H4909_804_0	1	1						06/02/2021	2022.01	06/02/2021 04:16:42 PM Pacific Daylight Time					06/04/2021 09:15:55 AM Pacific Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H4909	804	0	2022	National		1	72	2			2						www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)285-4630		(833)285-4630		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1									
H4909	805	0	1	04	01	H4909_805_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 04:16:50 PM Pacific Daylight Time					06/04/2021 09:15:55 AM Pacific Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H4909	805	0	2022	National		1	2010	2			2						www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1									
H4909	810	0	2	04	01	H4909_810_0	1	1						06/02/2021	2022.01	06/02/2021 04:16:57 PM Pacific Daylight Time					06/04/2021 09:15:55 AM Pacific Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		2	1		H4909	810	0	2022	National		1	600	2			2						www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)285-4630		(833)285-4630		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1									
H4909	811	0	1	04	01	H4909_811_0	1	1						06/02/2021	2022.01	06/02/2021 04:17:09 PM Pacific Daylight Time					06/04/2021 09:15:55 AM Pacific Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H4909	811	0	2022	National		1	600	2			2						www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)285-4630		(833)285-4630		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1									
H4909	812	0	1	04	01	H4909_812_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 04:17:15 PM Pacific Daylight Time					06/04/2021 09:15:55 AM Pacific Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H4909	812	0	2022	National		1	600	2			2						www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1									
H4909	814	0	2	04	01	H4909_814_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 04:17:21 PM Pacific Daylight Time					06/04/2021 09:15:55 AM Pacific Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		2	1		H4909	814	0	2022	National		1	600	2			2						www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1									
H4909	815	0	2	04	01	H4909_815_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 04:17:27 PM Pacific Daylight Time					06/04/2021 09:15:55 AM Pacific Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		2	1		H4909	815	0	2022	National		1	600	2			2						www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1									
H4909	817	0	1	04	01	H4909_817_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 04:17:35 PM Pacific Daylight Time					06/04/2021 09:15:55 AM Pacific Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H4909	817	0	2022	National		1	600	2			2						www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1									
H4909	818	0	1	04	01	H4909_818_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 04:17:44 PM Pacific Daylight Time					06/04/2021 09:15:55 AM Pacific Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H4909	818	0	2022	National		1	600	2			2						www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1									
H4922	003	0	1	01	01	H4922_003_0	5	1	2	1			0	08/04/2021	2022.01	08/04/2021 05:16:48 PM Eastern Daylight Time	08/04/2021 10:47:44 AM Eastern Daylight Time	07/30/2021 02:09:34 PM Eastern Daylight Time			08/05/2021 01:42:42 PM Eastern Daylight Time	AGEWELL NEW YORK, LLC	AgeWell New York	www.agewellnewyork.com	AgeWell New York FeelWell (HMO D-SNP)	01	01		1			H4922	003	0	2022	New York City Metro Area, Nassau, Westchester		2	5760	2			1	3		1		1	www.agewellnewyork.com	www.agewellnewyork.com	www.agewellnewyork.com	(866)237-3210		(866)237-3210		(866)237-3210		(866)237-3210		(844)782-7670		(844)782-7670		(866)237-3210		(866)237-3210		(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					2	2			
H4922	004	0	1	01	01	H4922_004_0	5	1		1			0	08/04/2021	2022.01	08/04/2021 05:20:44 PM Eastern Daylight Time	08/04/2021 03:11:28 PM Eastern Daylight Time	07/30/2021 02:14:07 PM Eastern Daylight Time			08/05/2021 01:42:42 PM Eastern Daylight Time	AGEWELL NEW YORK, LLC	AgeWell New York	www.agewellnewyork.com	AgeWell New York CareWell (HMO I-SNP)	01	01		1			H4922	004	0	2022	New York City Metro Area, Long Island, Westchester		2	6244	2			1	1	1				www.agewellnewyork.com	www.agewellnewyork.com	www.agewellnewyork.com	(866)237-3210		(866)237-3210		(866)237-3210		(866)237-3210		(844)782-7670		(844)782-7670		(866)237-3210		(866)237-3210		(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					2	2			
H4922	010	0	1	01	01	H4922_010_0	7	1	2	1			0	08/04/2021	2022.01	08/04/2021 05:17:25 PM Eastern Daylight Time	08/04/2021 10:51:19 AM Eastern Daylight Time	07/30/2021 02:16:36 PM Eastern Daylight Time			08/05/2021 01:42:42 PM Eastern Daylight Time	AGEWELL NEW YORK, LLC	AgeWell New York	www.agewellnewyork.com	AgeWell New York Advantage Plus (HMO D-SNP)	01	01		1			H4922	010	0	2022	New York City Metro Area, Nassau, Westchester		2	4261	2			1	3		1		1	www.agewellnewyork.com	www.agewellnewyork.com	www.agewellnewyork.com	(866)237-3210		(866)237-3210		(866)237-3210		(866)237-3210		(844)782-7670		(844)782-7670		(866)237-3210		(866)237-3210		(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					2	2			
H4922	011	0	1	01	01	H4922_011_0	6	1					0	08/04/2021	2022.01	08/04/2021 05:23:25 PM Eastern Daylight Time	08/04/2021 10:53:57 AM Eastern Daylight Time	07/30/2021 02:19:02 PM Eastern Daylight Time			08/05/2021 01:42:42 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	2022	New York City Metro Area, Nassau, Westchester		2	7384	2			2						www.agewellnewyork.com	www.agewellnewyork.com	www.agewellnewyork.com	(866)237-3210		(866)237-3210		(866)237-3210		(866)237-3210		(844)782-7670		(844)782-7670		(866)237-3210		(866)237-3210		(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					2	2			
H4931	001	0	1	01	01	H4931_001_0	11	1	2	1	1		0	07/09/2021	2022.01	07/09/2021 02:12:30 PM US Mountain Standard Time	08/03/2021 03:28:30 PM US Mountain Standard Time	08/03/2021 02:57:36 PM US Mountain Standard Time			08/04/2021 07:16:13 AM US Mountain Standard Time	BANNER - UNIVERSITY CARE ADVANTAGE	Banner Medicare Advantage Dual	https://www.bannerhealth.com/medicare/	Banner Medicare Advantage Dual (HMO D-SNP)	01	01		1			H4931	001	0	2022	ACC: Cochise, Gila, Graham, Greenlee, La Paz		2	27378	2			1	3		1		1	https://www.bannerhealth.com/medicare/	https://www.bannerhealth.com/medicare/	https://www.bannerhealth.com/medicare/	(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	13	1	2	1	1		0	07/09/2021	2022.01	07/09/2021 02:10:32 PM US Mountain Standard Time	08/03/2021 03:37:32 PM US Mountain Standard Time	08/03/2021 02:57:54 PM US Mountain Standard Time			08/04/2021 07:16:13 AM US Mountain Standard Time	BANNER - UNIVERSITY CARE ADVANTAGE	Banner Medicare Advantage Dual	https://www.bannerhealth.com/medicare/	Banner Medicare Advantage Dual (HMO D-SNP)	01	01		1			H4931	006	0	2022	ACC: Pima County		2	48852	2			1	3		1		1	https://www.bannerhealth.com/medicare/	https://www.bannerhealth.com/medicare/	https://www.bannerhealth.com/medicare/	(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	12	1	2	1	1		0	07/09/2021	2022.01	07/09/2021 02:15:30 PM US Mountain Standard Time	08/03/2021 03:37:58 PM US Mountain Standard Time	08/03/2021 02:58:14 PM US Mountain Standard Time			08/04/2021 07:16:13 AM US Mountain Standard Time	BANNER - UNIVERSITY CARE ADVANTAGE	Banner Medicare Advantage Dual	https://www.bannerhealth.com/medicare/	Banner Medicare Advantage Dual (HMO D-SNP)	01	01		1			H4931	007	0	2022	ACC: Maricopa, Pinal Counties		2	30501	2			1	3		1		1	https://www.bannerhealth.com/medicare/	https://www.bannerhealth.com/medicare/	https://www.bannerhealth.com/medicare/	(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	12	1	2	1	1		0	07/09/2021	2022.01	07/09/2021 02:19:06 PM US Mountain Standard Time	08/03/2021 03:38:22 PM US Mountain Standard Time	08/03/2021 02:58:32 PM US Mountain Standard Time			08/04/2021 07:16:13 AM US Mountain Standard Time	BANNER - UNIVERSITY CARE ADVANTAGE	Banner Medicare Advantage Dual	https://www.bannerhealth.com/medicare/	Banner Medicare Advantage Dual (HMO D-SNP)	01	01		1			H4931	008	0	2022	ACC: Santa Cruz, Yuma Counties		2	53980	2			1	3		1		1	https://www.bannerhealth.com/medicare/	https://www.bannerhealth.com/medicare/	https://www.bannerhealth.com/medicare/	(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	12	1	2	1	1		0	07/09/2021	2022.01	07/09/2021 02:21:45 PM US Mountain Standard Time	08/03/2021 03:38:48 PM US Mountain Standard Time	08/03/2021 02:58:52 PM US Mountain Standard Time			08/04/2021 07:16:13 AM US Mountain Standard Time	BANNER - UNIVERSITY CARE ADVANTAGE	Banner Medicare Advantage Dual	https://www.bannerhealth.com/medicare/	Banner Medicare Advantage Dual (HMO D-SNP)	01	01		1			H4931	013	0	2022	ALTCS: Cochise, Gila, Graham, Greenlee, La Paz		2	5520	2			1	3		1		1	https://www.bannerhealth.com/medicare/	https://www.bannerhealth.com/medicare/	https://www.bannerhealth.com/medicare/	(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	12	1	2	1	1		0	07/09/2021	2022.01	07/09/2021 02:27:05 PM US Mountain Standard Time	08/03/2021 03:39:12 PM US Mountain Standard Time	08/03/2021 02:59:12 PM US Mountain Standard Time			08/04/2021 07:16:13 AM US Mountain Standard Time	BANNER - UNIVERSITY CARE ADVANTAGE	Banner Medicare Advantage Dual	https://www.bannerhealth.com/medicare/	Banner Medicare Advantage Dual (HMO D-SNP)	01	01		1			H4931	014	0	2022	ALTCS: Pima County		2	12776	2			1	3		1		1	https://www.bannerhealth.com/medicare/	https://www.bannerhealth.com/medicare/	https://www.bannerhealth.com/medicare/	(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	12	1	2	1	1		0	07/09/2021	2022.01	07/09/2021 02:51:41 PM US Mountain Standard Time	08/03/2021 03:39:36 PM US Mountain Standard Time	08/03/2021 02:59:30 PM US Mountain Standard Time			08/04/2021 07:16:13 AM US Mountain Standard Time	BANNER - UNIVERSITY CARE ADVANTAGE	Banner Medicare Advantage Dual	https://www.bannerhealth.com/medicare/	Banner Medicare Advantage Dual (HMO D-SNP)	01	01		1			H4931	015	0	2022	ALTCS: Maricopa, Pinal Counties		2	14845	2			1	3		1		1	https://www.bannerhealth.com/medicare/	https://www.bannerhealth.com/medicare/	https://www.bannerhealth.com/medicare/	(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	12	1	2	1	1		0	07/09/2021	2022.01	07/09/2021 02:55:12 PM US Mountain Standard Time	08/03/2021 03:40:00 PM US Mountain Standard Time	08/03/2021 02:59:50 PM US Mountain Standard Time			08/04/2021 07:16:13 AM US Mountain Standard Time	BANNER - UNIVERSITY CARE ADVANTAGE	Banner Medicare Advantage Dual	https://www.bannerhealth.com/medicare/	Banner Medicare Advantage Dual (HMO D-SNP)	01	01		1			H4931	016	0	2022	ALTCS: Santa Cruz, Yuma Counties		2	9033	2			1	3		1		1	https://www.bannerhealth.com/medicare/	https://www.bannerhealth.com/medicare/	https://www.bannerhealth.com/medicare/	(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			
H4937	001	0	1	04	01	H4937_001_0	7	1					0	07/23/2021	2022.01	07/23/2021 12:54:51 PM Pacific Daylight Time	08/04/2021 04:25:50 PM Pacific Daylight Time	07/29/2021 07:41:54 PM Pacific Daylight Time			08/05/2021 04:56:07 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	blueshieldca.com/medicare	Blue Shield Inspire (PPO)	01	04		1			H4937	001	0	2022	Alameda County		2		2			2						blueshieldca.com/medpharmacy2022	blueshieldca.com/medformulary2022	blueshieldca.com/find-a-doctor	(800)776-4466		(800)776-4466		(888)510-8074		(888)510-8074		(800)776-4466		(800)776-4466		(888)510-8074		(888)510-8074		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4937	801	0	1	04	01	H4937_801_0	5	1						05/18/2021	2022.01	05/18/2021 05:48:50 PM Pacific Daylight Time					06/07/2021 08:34:46 AM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	www.blueshieldca.com/findamedicareplan	Blue Shield Medicare (PPO)	01	04		1			H4937	801	0	2022	MA-PD Employer Group Plan		1	80033	2			2						blueshieldca.com/medpharmacy2022	blueshieldca.com/medformulary2022	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	1b;2;3-1;3-2;3-3;3-4;5;6;7e;7h;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;12;15;17a;17b;18a;	1	7k;17a;17b;18a;	1									
H4937	802	0	1	04	01	H4937_802_0	5	1						05/18/2021	2022.01	05/18/2021 05:36:07 PM Pacific Daylight Time					06/07/2021 08:34:46 AM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	www.blueshieldca.com/findamedicareplan	Blue Shield Medicare (PPO)	01	04		1			H4937	802	0	2022	MA-PD Employer Group Plan		1	0	2			2						blueshieldca.com/medpharmacy2022	blueshieldca.com/medformulary2022	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	1b;2;3-1;3-2;3-3;3-4;5;6;7e;7h;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;12;15;17a;17b;	1	7k;17a;17b;18a;	1									
H4937	803	0	1	04	01	H4937_803_0	5	1				0	0	05/18/2021	2022.01	05/18/2021 05:50:17 PM Pacific Daylight Time					06/07/2021 08:34:46 AM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	www.blueshieldca.com/findamedicareplan	Blue Shield Medicare without Rx (PPO)	01	04		1			H4937	803	0	2022	MA-only Employer Group Plan		1	0	2			2						blueshieldca.com/medpharmacy2022	blueshieldca.com/medformulary2021	blueshieldca.com/find-a-doctor	(800)776-4466		(800)776-4466		(800)776-4466		(800)776-4466										(711)-		(711)-		(711)-		(711)-										1	1	1b;2;3-1;3-2;3-3;3-4;5;6;7e;7h;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;12;15;17a;17b;	1	7k;17a;17b;18a;	1									
H4937	804	0	1	04	01	H4937_804_0	5	1				0	0	05/18/2021	2022.01	05/18/2021 05:50:46 PM Pacific Daylight Time					06/07/2021 08:34:46 AM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	www.blueshieldca.com/findamedicareplan	Blue Shield Medicare without Rx (PPO)	01	04		1			H4937	804	0	2022	MA-only Employer Group Plan		1	0	2			2						blueshieldca.com/medpharmacy2022	blueshieldca.com/medformulary2022	blueshieldca.com/find-a-doctor	(800)776-4466		(800)776-4466		(800)776-4466		(800)776-4466										(711)-		(711)-		(711)-		(711)-										1	1	1b;2;3-1;3-2;3-3;3-4;5;6;7e;7h;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;12;15;17a;17b;	1	7k;17a;17b;18a;	1									
H4961	001	0	1	04	01	H4961_001_0	7	1					0	08/04/2021	2022.01	08/04/2021 12:38:05 PM Pacific Daylight Time	08/02/2021 10:53:28 PM Pacific Daylight Time	07/30/2021 01:14:40 PM Pacific Daylight Time			08/04/2021 04:09:03 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	My Choice (PPO)	01	04		1			H4961	001	0	2022	Sacramento, Placer & Yolo , SJ, ST, Santa Cruz		2	18481	2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247	1	(323)728-7232	6	(844)227-7616		(844)227-7616		(888)979-2247	1	(323)728-7232	6	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4961	003	0	1	04	01	H4961_003_0	3	1					0	08/04/2021	2022.01	08/04/2021 12:38:25 PM Pacific Daylight Time	08/02/2021 10:55:58 PM Pacific Daylight Time	07/30/2021 01:15:28 PM Pacific Daylight Time			08/04/2021 04:09:03 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	My Choice (PPO)	01	04		1			H4961	003	0	2022	Sonoma, San Mateo Counties		2	3120	2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247	1	(323)728-7232	6	(844)227-7616		(844)227-7616		(888)979-2247	1	(323)728-7232	6	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4961	006	0	1	04	01	H4961_006_0	3	1					0	08/04/2021	2022.01	08/04/2021 12:38:49 PM Pacific Daylight Time	08/04/2021 03:41:50 PM Pacific Daylight Time	08/02/2021 09:32:46 AM Pacific Daylight Time			08/04/2021 04:09:03 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Balance (PPO)	01	04		1			H4961	006	0	2022	San Joaquin and Stanislaus		2	2718	2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247	1	(323)728-7232	6	(844)227-7616		(844)227-7616		(888)979-2247	1	(323)728-7232	6	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4961	007	0	1	04	01	H4961_007_0	9	1					0	07/12/2021	2022.01	07/12/2021 05:53:57 PM Pacific Daylight Time	08/04/2021 02:51:42 PM Pacific Daylight Time	07/30/2021 01:17:48 PM Pacific Daylight Time			08/04/2021 04:09:03 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	AVA (PPO)	01	04		1			H4961	007	0	2022	Los Angeles, Orange, San Diego		2	420	2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247	1	(323)728-7232	6	(844)227-7616		(844)227-7616		(888)979-2247	1	(323)728-7232	6	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4961	008	0	1	04	01	H4961_008_0	3	1					0	08/04/2021	2022.01	08/04/2021 12:39:13 PM Pacific Daylight Time	08/03/2021 05:03:56 PM Pacific Daylight Time	07/30/2021 01:19:38 PM Pacific Daylight Time			08/04/2021 04:09:03 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	AVA (PPO)	01	04		1			H4961	008	0	2022	Orange		2	114	2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247	1	(323)728-7232	6	(844)227-7616		(844)227-7616		(888)979-2247	1	(323)728-7232	6	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4961	801	0	1	04	01	H4961_801_0	2	1						07/12/2021	2022.01	07/12/2021 07:37:11 PM Pacific Daylight Time					07/13/2021 12:03:32 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan Retiree Options (PPO)	01	04		1			H4961	801	0	2022	National		1	6200	2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247	1	(323)728-7232	6	(844)227-7616		(844)227-7616		(888)979-2247	1	(323)728-7232	6	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4961	802	0	1	04	01	H4961_802_0	2	1						07/12/2021	2022.01	07/12/2021 07:40:49 PM Pacific Daylight Time					07/13/2021 12:03:32 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan Retiree Options (PPO)	01	04		1			H4961	802	0	2022	National		1	6200	2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247	1	(323)728-7232	6	(844)227-7616		(844)227-7616		(888)979-2247	1	(323)728-7232	6	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4961	803	0	1	04	01	H4961_803_0	2	1				0	0	07/12/2021	2022.01	07/12/2021 07:41:37 PM Pacific Daylight Time					07/13/2021 12:03:32 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan Retiree Options (PPO)	01	04		1			H4961	803	0	2022	National		1	6000	2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247	1	(323)728-7232	6									(711)-		(711)-		(711)-		(711)-										2					2						2			
H4961	804	0	1	04	01	H4961_804_0	2	1				0	0	07/13/2021	2022.01	07/13/2021 10:48:18 AM Pacific Daylight Time					07/13/2021 12:03:32 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan Retiree Options (PPO)	01	04		1			H4961	804	0	2022	National		1	6000	2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247	1	(323)728-7232	6									(711)-		(711)-		(711)-		(711)-										2					2						2			
H4961	805	0	1	04	01	H4961_805_0	2	1						07/12/2021	2022.01	07/12/2021 07:43:41 PM Pacific Daylight Time					07/13/2021 12:03:32 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan Retiree Options (PPO)	01	04		1			H4961	805	0	2022	National		1	8000	2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247	1	(323)728-7232	6	(844)227-7616		(844)227-7616		(888)979-2247	1	(323)728-7232	6	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4961	806	0	1	04	01	H4961_806_0	2	1						07/12/2021	2022.01	07/12/2021 07:44:24 PM Pacific Daylight Time					07/13/2021 12:03:32 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan Retiree Options (PPO)	01	04		1			H4961	806	0	2022	National		1	8000	2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247	1	(323)728-7232	6	(844)227-7616		(844)227-7616		(888)979-2247	1	(323)728-7232	6	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4982	001	0	1	01	01	H4982_001_0	2	1			2		0	08/02/2021	2022.01	08/02/2021 03:48:37 PM Eastern Daylight Time	08/02/2021 02:54:40 PM Eastern Daylight Time	08/02/2021 09:42:25 AM Eastern Daylight Time			08/04/2021 04:30:51 PM Eastern Daylight Time	AETNA BETTER HEALTH OF CALIFORNIA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plus Plan (HMO)	01	01		1			H4982	001	0	2022	Los Angeles and Orange Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4982	002	0	1	01	01	H4982_002_0	2	1			2		0	08/02/2021	2022.01	08/02/2021 10:21:14 AM Eastern Daylight Time	08/02/2021 02:55:31 PM Eastern Daylight Time	08/02/2021 09:42:29 AM Eastern Daylight Time			08/04/2021 04:30:51 PM Eastern Daylight Time	AETNA BETTER HEALTH OF CALIFORNIA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plus Plan (HMO)	01	01		1			H4982	002	0	2022	Riverside and San Bernardino Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4982	003	0	1	01	01	H4982_003_0	2	1			2		0	08/02/2021	2022.01	08/02/2021 10:19:04 AM Eastern Daylight Time	08/02/2021 02:56:20 PM Eastern Daylight Time	08/02/2021 09:42:33 AM Eastern Daylight Time			08/04/2021 04:30:51 PM Eastern Daylight Time	AETNA BETTER HEALTH OF CALIFORNIA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plus Plan (HMO)	01	01		1			H4982	003	0	2022	Kern County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4982	004	0	1	01	01	H4982_004_0	2	1			2		0	08/02/2021	2022.01	08/02/2021 04:04:49 PM Eastern Daylight Time	08/02/2021 02:57:11 PM Eastern Daylight Time	08/02/2021 09:42:38 AM Eastern Daylight Time			08/04/2021 04:30:51 PM Eastern Daylight Time	AETNA BETTER HEALTH OF CALIFORNIA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plus Plan (HMO)	01	01		1			H4982	004	0	2022	San Diego County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4982	005	0	1	01	01	H4982_005_0	2	1			2		0	08/02/2021	2022.01	08/02/2021 10:25:59 AM Eastern Daylight Time	08/02/2021 02:58:02 PM Eastern Daylight Time	08/02/2021 09:42:42 AM Eastern Daylight Time			08/04/2021 04:30:51 PM Eastern Daylight Time	AETNA BETTER HEALTH OF CALIFORNIA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plus Plan (HMO)	01	01		1			H4982	005	0	2022	Alameda County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4982	006	0	1	01	01	H4982_006_0	2	1			2		0	08/02/2021	2022.01	08/02/2021 10:27:53 AM Eastern Daylight Time	08/02/2021 02:58:51 PM Eastern Daylight Time	08/02/2021 09:42:46 AM Eastern Daylight Time			08/04/2021 04:30:51 PM Eastern Daylight Time	AETNA BETTER HEALTH OF CALIFORNIA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plus Plan (HMO)	01	01		1			H4982	006	0	2022	Santa Clara County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4982	007	0	1	01	01	H4982_007_0	2	1			2		0	08/02/2021	2022.01	08/02/2021 10:30:17 AM Eastern Daylight Time	08/02/2021 02:59:39 PM Eastern Daylight Time	08/02/2021 09:42:50 AM Eastern Daylight Time			08/04/2021 04:30:51 PM Eastern Daylight Time	AETNA BETTER HEALTH OF CALIFORNIA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plus Plan (HMO)	01	01		1			H4982	007	0	2022	San Francisco County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4982	008	0	1	01	01	H4982_008_0	3	1	2	1	1		0	08/02/2021	2022.01	08/02/2021 10:46:20 AM Eastern Daylight Time	08/02/2021 03:00:30 PM Eastern Daylight Time	08/02/2021 09:42:54 AM Eastern Daylight Time			08/04/2021 04:30:51 PM Eastern Daylight Time	AETNA BETTER HEALTH OF CALIFORNIA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Preferred Plan (HMO D-SNP)	01	01		1			H4982	008	0	2022	Alameda, Marin and San Francisco Counties		2		2			1	3		1		1	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4982	009	0	1	01	01	H4982_009_0	3	1	2	1	1		0	07/08/2021	2022.01	07/08/2021 10:01:01 AM Eastern Daylight Time	08/02/2021 03:01:20 PM Eastern Daylight Time	08/02/2021 09:42:58 AM Eastern Daylight Time			08/04/2021 04:30:51 PM Eastern Daylight Time	AETNA BETTER HEALTH OF CALIFORNIA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Preferred Plan (HMO D-SNP)	01	01		1			H4982	009	0	2022	Fresno, Kern and Ventura Counties		2		2			1	3		1		1	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4982	010	0	1	01	01	H4982_010_0	2	1			2		0	08/02/2021	2022.01	08/02/2021 10:35:17 AM Eastern Daylight Time	08/02/2021 03:02:09 PM Eastern Daylight Time	08/02/2021 09:43:03 AM Eastern Daylight Time			08/04/2021 04:30:51 PM Eastern Daylight Time	AETNA BETTER HEALTH OF CALIFORNIA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plus Plan (HMO)	01	01		1			H4982	010	0	2022	Fresno County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4982	011	0	1	01	01	H4982_011_0	2	1			2		0	08/02/2021	2022.01	08/02/2021 10:38:28 AM Eastern Daylight Time	08/02/2021 03:02:59 PM Eastern Daylight Time	08/02/2021 09:43:07 AM Eastern Daylight Time			08/04/2021 04:30:51 PM Eastern Daylight Time	AETNA BETTER HEALTH OF CALIFORNIA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plus Plan (HMO)	01	01		1			H4982	011	0	2022	Marin County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4982	012	0	1	01	01	H4982_012_0	2	1			2		0	08/02/2021	2022.01	08/02/2021 10:40:23 AM Eastern Daylight Time	08/02/2021 03:03:47 PM Eastern Daylight Time	08/02/2021 09:43:11 AM Eastern Daylight Time			08/04/2021 04:30:51 PM Eastern Daylight Time	AETNA BETTER HEALTH OF CALIFORNIA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plus Plan (HMO)	01	01		1			H4982	012	0	2022	Ventura County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4982	013	0	1	01	01	H4982_013_0	1	1			2	0	0	06/02/2021	2022.01	06/02/2021 02:21:49 PM Eastern Daylight Time	06/01/2021 08:38:18 PM Eastern Daylight Time				06/03/2021 02:01:04 PM Eastern Daylight Time	AETNA BETTER HEALTH OF CALIFORNIA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Eagle Plan (HMO)	01	01		1			H4982	013	0	2022	California		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H4982	015	0	1	01	01	H4982_015_0	3	1			2		0	06/02/2021	2022.01	06/02/2021 02:28:57 PM Eastern Daylight Time	08/02/2021 03:05:29 PM Eastern Daylight Time	08/02/2021 09:43:15 AM Eastern Daylight Time			08/04/2021 04:30:51 PM Eastern Daylight Time	AETNA BETTER HEALTH OF CALIFORNIA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plus Plan 2 (HMO)	01	01		1			H4982	015	0	2022	San Diego County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4982	801	0	1	01	01	H4982_801_0	1	1				0	0	05/27/2021	2022.01	05/27/2021 11:33:02 PM Eastern Daylight Time					06/03/2021 01:24:36 PM Eastern Daylight Time	AETNA BETTER HEALTH OF CALIFORNIA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (HMO)	01	01		1			H4982	801	0	2022	California		1	120	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H4982	802	0	1	01	01	H4982_802_0	1	1						05/27/2021	2022.01	05/27/2021 11:33:25 PM Eastern Daylight Time					06/03/2021 01:24:36 PM Eastern Daylight Time	AETNA BETTER HEALTH OF CALIFORNIA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan w/Rx (HMO)	01	01		1			H4982	802	0	2022	California		1	120	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H4999	001	0	1	20	08	H4999_001_0	1	1						06/05/2021	2022.01	06/05/2021 02:56:01 PM Eastern Daylight Time		06/05/2021 03:45:20 PM Eastern Daylight Time			06/05/2021 03:47:14 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	2022	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						06/05/2021	2022.01	06/05/2021 02:57:15 PM Eastern Daylight Time		06/05/2021 03:45:20 PM Eastern Daylight Time			06/05/2021 03:47:14 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	2022	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						06/02/2021	2022.01	06/02/2021 10:02:18 AM Pacific Daylight Time		06/01/2021 02:50:54 PM Pacific Daylight Time			06/02/2021 10:05:03 AM 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	2022	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						06/02/2021	2022.01	06/02/2021 10:03:04 AM Pacific Daylight Time		06/01/2021 02:53:00 PM Pacific Daylight Time			06/02/2021 10:05:03 AM 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	2022	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	02	01	H5008_001_0	3	1		1	2		0	08/04/2021	2022.01	08/04/2021 11:02:17 AM Central Daylight Time	08/03/2021 01:00:54 PM Central Daylight Time	07/29/2021 08:50:05 PM Central Daylight Time			08/04/2021 02:59:40 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (HMO-POS I-SNP)	01	02		1			H5008	001	0	2022	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	4	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 02:12:55 PM Central Daylight Time	08/03/2021 01:01:44 PM Central Daylight Time	07/29/2021 08:50:21 PM Central Daylight Time			08/04/2021 10:05:00 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO D-SNP)	01	01		1			H5008	002	0	2022	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	010	0	1	01	01	H5008_010_0	4	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 12:40:21 PM Central Daylight Time	08/03/2021 01:02:33 PM Central Daylight Time	07/29/2021 08:50:36 PM Central Daylight Time			08/04/2021 07:39:56 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO D-SNP)	01	01		1			H5008	010	0	2022	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	4	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 12:40:33 PM Central Daylight Time	08/03/2021 01:03:24 PM Central Daylight Time	07/29/2021 08:50:52 PM Central Daylight Time			08/04/2021 07:39:56 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO D-SNP)	01	01		1			H5008	011	0	2022	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	015	0	1	01	01	H5008_015_0	4	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 02:14:36 PM Central Daylight Time	08/03/2021 01:04:13 PM Central Daylight Time	07/29/2021 08:51:08 PM Central Daylight Time			08/04/2021 10:05:00 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Select (HMO D-SNP)	01	01		1			H5008	015	0	2022	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			
H5009	001	0	1	04	01	H5009_001_0	4	1				0	0	07/07/2021	2022.01	07/07/2021 11:07:20 AM Pacific Daylight Time	07/01/2021 02:20:01 PM Pacific Daylight Time				07/07/2021 03:24:11 PM Pacific Daylight Time	REGENCE BLUESHIELD	Regence BlueShield	www.regence.com/medicare	Regence Valiance (PPO)	01	04		1			H5009	001	0	2022	Select Counties in Washington		2	14147	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	7	1					1	07/07/2021	2022.01	07/07/2021 02:18:28 PM Pacific Daylight Time	08/04/2021 12:55:54 PM Pacific Daylight Time	08/06/2021 10:24:35 AM Pacific Daylight Time			08/09/2021 09:46:09 AM Pacific Daylight Time	REGENCE BLUESHIELD	Regence BlueShield	www.regence.com/medicare	Regence MedAdvantage + Rx Enhanced (PPO)	01	04		1			H5009	002	0	2022	Select Counties in Washington		2	138956	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	8	1					1	08/03/2021	2022.01	08/03/2021 01:55:32 PM Pacific Daylight Time	08/06/2021 11:35:32 AM Pacific Daylight Time	08/06/2021 10:26:26 AM Pacific Daylight Time			08/09/2021 09:46:09 AM Pacific Daylight Time	REGENCE BLUESHIELD	Regence BlueShield	www.regence.com/medicare	Regence MedAdvantage + Rx Classic (PPO)	01	04		1			H5009	008	0	2022	Select Counties in Washington		2	56221	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	009	0	1	04	01	H5009_009_0	8	1					1	07/07/2021	2022.01	07/07/2021 11:29:07 AM Pacific Daylight Time	08/05/2021 07:03:03 AM Pacific Daylight Time	08/06/2021 10:28:17 AM Pacific Daylight Time			08/09/2021 09:46:09 AM Pacific Daylight Time	REGENCE BLUESHIELD	Regence BlueShield	www.regence.com/medicare	Regence MedAdvantage + Rx Primary (PPO)	01	04		1			H5009	009	0	2022	Select Counties in Washington		2	75544	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	010	0	1	04	01	H5009_010_0	8	1					1	08/03/2021	2022.01	08/03/2021 01:55:12 PM Pacific Daylight Time	08/04/2021 12:58:20 PM Pacific Daylight Time	08/06/2021 10:31:43 AM Pacific Daylight Time			08/09/2021 09:46:09 AM Pacific Daylight Time	REGENCE BLUESHIELD	Regence BlueShield	www.regence.com/medicare	Regence MedAdvantage + Rx Core (PPO)	01	04		1			H5009	010	0	2022	King County and Snohomish County		2	4956	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	4	1				0	0	06/02/2021	2022.01	06/02/2021 10:58:58 AM Pacific Daylight Time					06/03/2021 11:12:52 AM Pacific Daylight Time	REGENCE BLUESHIELD	Regence BlueShield	www.regence.com/medicare	Regence MedAdvantage (PPO)	01	04		1			H5009	801	0	2022	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										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7c;7e;7h;7i;7k;8a;8b1;8b2;9a1;9a2;9b;9c;10a;11a;11b;11c;15;	2		1									
H5009	802	0	1	04	01	H5009_802_0	4	1						06/02/2021	2022.01	06/02/2021 10:59:26 AM Pacific Daylight Time					06/03/2021 11:12:52 AM Pacific Daylight Time	REGENCE BLUESHIELD	Regence BlueShield	www.regence.com/medicare	Regence MedAdvantage + Rx (PPO)	01	04		1			H5009	802	0	2022	Nationwide except territories		1	9458	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;7k;8a;8b1;8b2;9a1;9a2;9b;9c;10a;11a;11b;11c;15;	2		1									
H5009	803	0	1	04	01	H5009_803_0	4	1						06/02/2021	2022.01	06/02/2021 10:59:46 AM Pacific Daylight Time					06/03/2021 11:12:52 AM Pacific Daylight Time	REGENCE BLUESHIELD	Regence BlueShield	www.regence.com/medicare	Regence MedAdvantage + Rx 02 (PPO)	01	04		1			H5009	803	0	2022	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;7e;7h;7i;7k;8a;8b1;8b2;9a1;9a2;9b;9c;10a;11a;11b;11c;15;	2		1									
H5009	804	0	1	04	01	H5009_804_0	4	1						06/02/2021	2022.01	06/02/2021 11:00:07 AM Pacific Daylight Time					06/03/2021 11:12:52 AM Pacific Daylight Time	REGENCE BLUESHIELD	Regence BlueShield	www.regence.com/medicare	Regence MedAdvantage + Rx 03 (PPO)	01	04		1			H5009	804	0	2022	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;7e;7h;7i;7k;8a;8b1;8b2;9a1;9a2;9b;9c;10a;11a;11b;11c;15;	2		1									
H5010	001	0	1	04	01	H5010_001_0	4	1				0	0	07/07/2021	2022.01	07/07/2021 11:39:56 AM Pacific Daylight Time	07/01/2021 02:23:31 PM Pacific Daylight Time				07/07/2021 03:24:11 PM Pacific Daylight Time	ASURIS NORTHWEST HEALTH	Asuris Northwest Health	www.asuris.com/medicare	Asuris Esteem (PPO)	01	04		1			H5010	001	0	2022	Spokane and Chelan Counties		2	774	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	7	1					1	07/07/2021	2022.01	07/07/2021 11:45:53 AM Pacific Daylight Time	08/04/2021 12:59:14 PM Pacific Daylight Time	08/06/2021 10:33:43 AM Pacific Daylight Time			08/09/2021 09:46:09 AM Pacific Daylight Time	ASURIS NORTHWEST HEALTH	Asuris Northwest Health	www.asuris.com/medicare	Asuris TruAdvantage + Rx Classic (PPO)	01	04		1			H5010	002	0	2022	Spokane and Chelan Counties		2	5942	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	007	0	1	04	01	H5010_007_0	8	1					1	07/07/2021	2022.01	07/07/2021 11:53:47 AM Pacific Daylight Time	08/05/2021 07:03:54 AM Pacific Daylight Time	08/06/2021 10:35:17 AM Pacific Daylight Time			08/09/2021 09:46:09 AM Pacific Daylight Time	ASURIS NORTHWEST HEALTH	Asuris Northwest Health	www.asuris.com/medicare	Asuris TruAdvantage + Rx Primary (PPO)	01	04		1			H5010	007	0	2022	Spokane and Chelan Counties		2	2186	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			
H5015	001	0	1	01	01	H5015_001_0	13	1		1			0	08/05/2021	2022.01	08/05/2021 05:31:26 PM Eastern Daylight Time	08/05/2021 07:33:37 PM Eastern Daylight Time	08/05/2021 07:33:38 PM Eastern Daylight Time			08/05/2021 07:41:08 PM Eastern Daylight Time	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Texas Independence Health Plan	www.txindependencehealthplan.com	Texas Independence Health Plan, Inc. (HMO I-SNP)	01	01		1			H5015	001	0	2022	Texas (Partial)		2		2			1	1	1				www.txindependencehealthplan.com	www.txindependencehealthplan.com	www.txindependencehealthplan.com	(800)405-9681		(800)405-9681		(800)405-9681		(800)405-9681		(844)846-8007		(844)846-8007		(800)405-9681		(800)405-9681		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5037	001	0	1	20	08	H5037_001_0	1	1						06/02/2021	2022.01	06/02/2021 04:04:56 PM Eastern Daylight Time		06/02/2021 03:59:57 PM Eastern Daylight Time			06/02/2021 04:06:51 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	2022	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	1	1						06/02/2021	2022.01	06/02/2021 04:05:31 PM Eastern Daylight Time		06/02/2021 03:59:57 PM Eastern Daylight Time			06/02/2021 04:06:51 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	2022	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	009	0	1	04	01	H5042_009_0	8	1			1		1	09/21/2021	2022.01	09/21/2021 10:45:40 AM Eastern Daylight Time	08/05/2021 03:45:30 PM Eastern Daylight Time	08/05/2021 03:45:31 PM Eastern Daylight Time			09/21/2021 10:47:13 AM Eastern Daylight Time	CDPHP UNIVERSAL BENEFITS, INC.	CDPHP Medicare Advantage	https://www.cdphp.com/medicare	CDPHP Vital Rx (PPO)	01	04		1			H5042	009	0	2022	Greater Capital Region of New York State		2	17436	2			2						https://findadoc.cdphp.com/	https://www.cdphp.com/medicare/drug-coverage	https://findadoc.cdphp.com/	(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						1	10		18a1;
H5042	011	0	1	04	01	H5042_011_0	7	1			1		1	08/09/2021	2022.01	08/09/2021 02:05:50 PM Eastern Daylight Time	08/05/2021 03:45:32 PM Eastern Daylight Time	08/05/2021 03:45:32 PM Eastern Daylight Time			08/09/2021 02:40:16 PM Eastern Daylight Time	CDPHP UNIVERSAL BENEFITS, INC.	CDPHP Medicare Advantage	https://www.cdphp.com/medicare	CDPHP Flex Rx (PPO)	01	04		1			H5042	011	0	2022	Greater Capital Region of New York State		2	27504	2			2						https://findadoc.cdphp.com/	https://www.cdphp.com/medicare/drug-coverage	https://findadoc.cdphp.com/	(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						1	10		18a1;
H5042	012	0	1	04	01	H5042_012_0	6	1			1	0	0	08/09/2021	2022.01	08/09/2021 02:08:09 PM Eastern Daylight Time	06/07/2021 08:26:51 AM Eastern Daylight Time				08/09/2021 02:40:16 PM Eastern Daylight Time	CDPHP UNIVERSAL BENEFITS, INC.	CDPHP Medicare Advantage	https://www.cdphp.com/medicare	CDPHP Flex (PPO)	01	04		1			H5042	012	0	2022	Greater Capital Region of New York State		2	1956	2			2						https://findadoc.cdphp.com/	https://www.cdphp.com/medicare/drug-coverage	https://findadoc.cdphp.com/	(888)248-6522		(518)641-3950		(888)519-4455		(518)641-3400										(711)-		(711)-		(711)-		(711)-										2					2						1	10		18a1;
H5042	801	0	1	04	01	H5042_801_0	3	1						05/14/2021	2022.01	05/14/2021 11:27:36 AM Eastern Daylight Time					06/07/2021 08:28:58 AM Eastern Daylight Time	CDPHP UNIVERSAL BENEFITS, INC.	CDPHP Medicare Advantage		CDPHP Group Medicare Rx (PPO)	01	04		1			H5042	801	0	2022	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;	1	1a;	1									
H5042	802	0	1	04	01	H5042_802_0	3	1						05/14/2021	2022.01	05/14/2021 11:29:54 AM Eastern Daylight Time					06/07/2021 08:28:58 AM Eastern Daylight Time	CDPHP UNIVERSAL BENEFITS, INC.	CDPHP Medicare Advantage	https://www.cdphp.com/medicare	CDPHP Group Medicare Rx (PPO)	01	04		1			H5042	802	0	2022	Greater Capital Region of New York State		1	39058	2			2						https://findadoc.cdphp.com/	https://www.cdphp.com/medicare/drug-coverage	https://findadoc.cdphp.com/	(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;	1	1a;	1									
H5042	803	0	1	04	01	H5042_803_0	3	1				0	0	05/14/2021	2022.01	05/14/2021 11:31:51 AM Eastern Daylight Time					06/07/2021 08:28:58 AM Eastern Daylight Time	CDPHP UNIVERSAL BENEFITS, INC.	CDPHP Medicare Advantage	https://www.cdphp.com/medicare	CDPHP Group Medicare (PPO)	01	04		1			H5042	803	0	2022	Greater Capital Region of New York State		1	5398	2			2						https://findadoc.cdphp.com/	https://www.cdphp.com/medicare/drug-coverage	https://findadoc.cdphp.com/	(888)248-6522		(518)641-3950		(888)519-4455		(518)641-3400										(711)-		(711)-		(711)-		(711)-										1	1	1a;	1	1a;	1									
H5050	001	0	1	01	01	H5050_001_0	6	1				0	0	07/14/2021	2022.01	07/14/2021 07:30:55 AM Pacific Daylight Time	07/21/2021 05:31:21 PM Pacific Daylight Time				07/22/2021 12:11:21 PM Pacific Daylight Time	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Kaiser Permanente	kp.org/wa/medicare	Kaiser Permanente Medicare Advantage Basic (HMO)	01	01		1			H5050	001	0	2022	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	7	1					0	07/14/2021	2022.01	07/14/2021 09:56:01 AM Pacific Daylight Time	08/02/2021 09:13:18 AM Pacific Daylight Time	08/01/2021 09:23:44 PM Pacific Daylight Time			08/04/2021 11:54:37 AM Pacific Daylight Time	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Kaiser Permanente	kp.org/wa/medicare	Kaiser Permanente Medicare Advantage Optimal (HMO)	01	01		1			H5050	004	0	2022	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	7	1					0	08/02/2021	2022.01	08/02/2021 02:18:08 PM Pacific Daylight Time	08/02/2021 09:13:48 AM Pacific Daylight Time	08/01/2021 09:24:36 PM Pacific Daylight Time			08/04/2021 11:54:37 AM Pacific Daylight Time	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Kaiser Permanente	kp.org/wa/medicare	Kaiser Permanente Medicare Advantage Essential (HMO)	01	01		1			H5050	009	0	2022	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	7	1					0	07/14/2021	2022.01	07/14/2021 07:13:53 AM Pacific Daylight Time	08/02/2021 09:14:17 AM Pacific Daylight Time	08/01/2021 09:25:30 PM Pacific Daylight Time			08/04/2021 11:54:37 AM Pacific Daylight Time	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Kaiser Permanente	kp.org/wa/medicare	Kaiser Permanente Medicare Advantage Vital (HMO)	01	01		1			H5050	013	0	2022	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	7	1					0	07/14/2021	2022.01	07/14/2021 07:14:19 AM Pacific Daylight Time	08/02/2021 09:14:46 AM Pacific Daylight Time	08/01/2021 09:26:23 PM Pacific Daylight Time			08/04/2021 11:54:37 AM Pacific Daylight Time	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Kaiser Permanente	kp.org/wa/medicare	Kaiser Permanente Medicare Advantage Harbor (HMO)	01	01		1			H5050	017	0	2022	Counties: IS, SK, 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	8	1					0	07/14/2021	2022.01	07/14/2021 07:28:18 AM Pacific Daylight Time	08/02/2021 09:15:18 AM Pacific Daylight Time	08/01/2021 09:27:14 PM Pacific Daylight Time			08/04/2021 11:54:37 AM Pacific Daylight Time	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Kaiser Permanente	kp.org/wa/medicare	Kaiser Permanente Medicare Advantage Columbia (HMO)	01	01		1			H5050	019	0	2022	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	7	1					0	08/03/2021	2022.01	08/03/2021 09:45:44 AM Pacific Daylight Time	08/02/2021 09:15:47 AM Pacific Daylight Time	08/01/2021 09:32:14 PM Pacific Daylight Time			08/04/2021 11:54:37 AM Pacific Daylight Time	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Kaiser Permanente	kp.org/wa/medicare	Kaiser Permanente Medicare Advantage Centennial (HMO)	01	01		1			H5050	021	0	2022	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	7	1					0	08/02/2021	2022.01	08/02/2021 02:23:29 PM Pacific Daylight Time	08/02/2021 09:16:17 AM Pacific Daylight Time	08/01/2021 09:33:20 PM Pacific Daylight Time			08/04/2021 11:54:37 AM Pacific Daylight Time	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Kaiser Permanente	kp.org/wa/medicare	Kaiser Permanente Medicare Advantage Key (HMO)	01	01		1			H5050	022	0	2022	Island,King,Pierce,Snohomish 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	023	0	1	01	01	H5050_023_0	7	1					0	08/02/2021	2022.01	08/02/2021 03:17:06 PM Pacific Daylight Time	08/02/2021 09:16:46 AM Pacific Daylight Time	08/01/2021 09:34:35 PM Pacific Daylight Time			08/04/2021 11:54:37 AM Pacific Daylight Time	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Kaiser Permanente	kp.org/wa/medicare	Kaiser Permanente Medicare Advantage Anchor (HMO)	01	01		1			H5050	023	0	2022	Counties: Skagit, Whatcom		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	1	01	7a;7d;7g;	
H5050	801	0	1	01	01	H5050_801_0	6	1				0	0	06/17/2021	2022.01	06/17/2021 12:40:45 PM Pacific Daylight Time					06/17/2021 12:43:33 PM Pacific Daylight Time	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Kaiser Permanente	kp.org/wa/medicare	Kaiser Permanente Medicare Advantage Group [AB] (HMO)	01	01		1			H5050	801	0	2022	Puget Sound Area and Counties: GY, TH, LE, SP		1	334303	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)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7c;7d;7e;7f;7g;7h;7i;7k;8a;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;3-4;5;6;7c;7d;7f;7g;7i;7k;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	6	1						06/17/2021	2022.01	06/17/2021 12:40:58 PM Pacific Daylight Time					06/17/2021 12:43:33 PM Pacific Daylight Time	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Kaiser Permanente	kp.org/wa/medicare	Kaiser Permanente Medicare Advantage Group [ABD] (HMO)	01	01		1			H5050	802	0	2022	Puget Sound Area and Counties: GY, TH, LE, SP		1	41077	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)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7c;7d;7e;7f;7g;7h;7i;7k;8a;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;3-4;5;6;7c;7d;7f;7g;7i;7k;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						06/04/2021	2022.01	06/04/2021 10:45:53 AM Central Daylight Time		06/03/2021 08:40:33 PM Central Daylight Time			06/04/2021 10:54:46 AM Central Daylight Time	COMMUNITY PACE AT HOME, INC	Community PACE at Home, Inc,	www.communitypace.com	Community PACE at Home, Inc. - Dual Eligible (PACE)	08	20		1			H5085	003	0	2022	Lake, Newaygo, Oceana, Osceola, Mason, Mecosta,		2		2			2						N/A	N/A												(231)652-4618				(231)652-4618												(231)689-6675				(231)689-6675																
H5085	004	0	1	20	08	H5085_004_0	1	1						06/04/2021	2022.01	06/04/2021 10:52:21 AM Central Daylight Time		06/03/2021 08:40:34 PM Central Daylight Time			06/04/2021 10:54:46 AM Central Daylight Time	COMMUNITY PACE AT HOME, INC	Community PACE at Home, Inc,	www.communitypace.com	Community PACE at Home, Inc - Medicare Only (PACE)	08	20		1			H5085	004	0	2022	Lake, Newaygo, Oceana, Osceola, Mason, Mecosta,		2		2			2						N/A	N/A												(231)652-4618				(231)652-4618												(231)689-6675				(231)689-6675																
H5087	001	0	1	01	01	H5087_001_0	4	1	2	1			0	08/02/2021	2022.01	08/02/2021 09:26:36 PM Eastern Daylight Time	08/04/2021 12:24:39 AM Eastern Daylight Time	07/30/2021 11:29:28 AM Eastern Daylight Time			08/04/2021 11:49:10 PM Eastern Daylight Time	WELLCARE OF CALIFORNIA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Liberty Freedom (HMO D-SNP)	01	01		1			H5087	001	0	2022	Select counties in CA		2	38592	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)999-3945		(866)999-3945		(844)917-0175		(844)917-0175		(866)999-3945		(866)999-3945		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5087	002	0	1	01	01	H5087_002_0	4	1					0	08/02/2021	2022.01	08/02/2021 09:26:59 PM Eastern Daylight Time	08/04/2021 03:24:07 PM Eastern Daylight Time	07/30/2021 11:29:46 AM Eastern Daylight Time			08/04/2021 11:49:10 PM Eastern Daylight Time	WELLCARE OF CALIFORNIA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Plus (HMO)	01	01		1			H5087	002	0	2022	Select counties in CA		2	194182	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)999-3945		(866)999-3945		(844)917-0175		(844)917-0175		(866)999-3945		(866)999-3945		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5087	005	0	1	01	01	H5087_005_0	4	1					0	08/02/2021	2022.01	08/02/2021 09:21:51 PM Eastern Daylight Time	08/04/2021 12:25:37 AM Eastern Daylight Time	07/30/2021 11:30:04 AM Eastern Daylight Time			08/04/2021 11:49:10 PM Eastern Daylight Time	WELLCARE OF CALIFORNIA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium Best (HMO)	01	01		1			H5087	005	0	2022	Select counties in CA		2	196961	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)999-3945		(866)999-3945		(844)917-0175		(844)917-0175		(866)999-3945		(866)999-3945		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5087	016	0	1	01	01	H5087_016_0	4	1					0	08/02/2021	2022.01	08/02/2021 09:22:10 PM Eastern Daylight Time	08/04/2021 12:26:06 AM Eastern Daylight Time	07/30/2021 11:30:38 AM Eastern Daylight Time			08/04/2021 11:49:10 PM Eastern Daylight Time	WELLCARE OF CALIFORNIA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium Best (HMO)	01	01		1			H5087	016	0	2022	Select counties in CA		2	43400	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)999-3945		(866)999-3945		(844)917-0175		(844)917-0175		(866)999-3945		(866)999-3945		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5087	024	0	1	01	01	H5087_024_0	4	1					0	08/02/2021	2022.01	08/02/2021 09:22:35 PM Eastern Daylight Time	08/04/2021 12:26:34 AM Eastern Daylight Time	07/30/2021 11:31:44 AM Eastern Daylight Time			08/04/2021 11:49:10 PM Eastern Daylight Time	WELLCARE OF CALIFORNIA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO)	01	01		1			H5087	024	0	2022	Select counties in CA		2	23661	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)999-3945		(866)999-3945		(844)917-0175		(844)917-0175		(866)999-3945		(866)999-3945		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5087	025	0	1	01	01	H5087_025_0	4	1					0	08/02/2021	2022.01	08/02/2021 09:22:57 PM Eastern Daylight Time	08/04/2021 12:27:05 AM Eastern Daylight Time	07/30/2021 11:38:32 AM Eastern Daylight Time			08/04/2021 11:49:10 PM Eastern Daylight Time	WELLCARE OF CALIFORNIA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Giveback (HMO)	01	01		1			H5087	025	0	2022	Select counties in CA		2	352834	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)999-3945		(866)999-3945		(844)917-0175		(844)917-0175		(866)999-3945		(866)999-3945		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5087	026	0	1	01	01	H5087_026_0	4	1					0	08/02/2021	2022.01	08/02/2021 09:29:05 PM Eastern Daylight Time	08/04/2021 12:27:33 AM Eastern Daylight Time	07/30/2021 11:39:06 AM Eastern Daylight Time			08/04/2021 11:49:10 PM Eastern Daylight Time	WELLCARE OF CALIFORNIA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO)	01	01		1			H5087	026	0	2022	Select counties in CA		2	49197	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)999-3945		(866)999-3945		(844)917-0175		(844)917-0175		(866)999-3945		(866)999-3945		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5087	027	0	1	01	01	H5087_027_0	4	1	2	1			0	06/04/2021	2022.01	06/04/2021 02:31:51 PM Eastern Daylight Time	08/04/2021 12:28:01 AM Eastern Daylight Time	07/30/2021 11:41:56 AM Eastern Daylight Time			08/04/2021 11:49:10 PM Eastern Daylight Time	WELLCARE OF CALIFORNIA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Liberty (HMO D-SNP)	01	01		1			H5087	027	0	2022	Select counties in CA		2	967	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)999-3945		(866)999-3945		(844)917-0175		(844)917-0175		(866)999-3945		(866)999-3945		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5087	028	0	1	01	01	H5087_028_0	5	1					1	08/02/2021	2022.01	08/02/2021 09:23:32 PM Eastern Daylight Time	08/04/2021 12:28:31 AM Eastern Daylight Time	07/30/2021 11:42:30 AM Eastern Daylight Time			08/04/2021 11:49:10 PM Eastern Daylight Time	WELLCARE OF CALIFORNIA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Giveback Focus (HMO)	01	01		1			H5087	028	0	2022	Select counties in CA		2	9302	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)999-3945		(866)999-3945		(844)917-0175		(844)917-0175		(866)999-3945		(866)999-3945		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	7a;7c;7d;7f;7g;7i;7k;16b;17a;18a;	
H5106	013	0	1	04	01	H5106_013_0	6	1					1	08/04/2021	2022.01	08/04/2021 09:05:36 AM Eastern Daylight Time	08/03/2021 11:41:55 AM Eastern Daylight Time	07/30/2021 03:31:12 PM Eastern Daylight Time			08/05/2021 08:55:51 AM Eastern Daylight Time	HIGHMARK SENIOR SOLUTIONS COMPANY	Highmark Inc.	medicare.highmark.com	Freedom Blue PPO Standard (PPO)	01	04		1			H5106	013	0	2022	West Virginia Region 1 counties		2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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	029	1	1	04	01	H5106_029_1	6	1					1	08/04/2021	2022.01	08/04/2021 09:06:58 AM Eastern Daylight Time	08/03/2021 11:42:55 AM Eastern Daylight Time	07/30/2021 03:31:40 PM Eastern Daylight Time			08/05/2021 08:55:51 AM Eastern Daylight Time	HIGHMARK SENIOR SOLUTIONS COMPANY	Highmark Inc.	medicare.highmark.com	Freedom Blue PPO Distinct (PPO)	01	04		1			H5106	029	1	2022	Region 2 WV Counties	North WV	2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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	029	2	1	04	01	H5106_029_2	6	1					1	08/04/2021	2022.01	08/04/2021 09:07:41 AM Eastern Daylight Time	08/03/2021 11:43:56 AM Eastern Daylight Time	07/30/2021 03:32:08 PM Eastern Daylight Time			08/05/2021 08:55:51 AM Eastern Daylight Time	HIGHMARK SENIOR SOLUTIONS COMPANY	Highmark Inc.	medicare.highmark.com	Freedom Blue PPO Distinct (PPO)	01	04		1			H5106	029	2	2022	Region 2 WV Counties	South WV	2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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	030	1	1	04	01	H5106_030_1	6	1					0	07/16/2021	2022.01	07/16/2021 09:02:08 AM Eastern Daylight Time	08/03/2021 11:44:52 AM Eastern Daylight Time	07/30/2021 03:32:34 PM Eastern Daylight Time			08/05/2021 08:55:51 AM Eastern Daylight Time	HIGHMARK SENIOR SOLUTIONS COMPANY	Highmark Inc.	medicare.highmark.com	Freedom Blue PPO Signature (PPO)	01	04		1			H5106	030	1	2022	Region 2 WV Counties	North WV	2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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	030	2	1	04	01	H5106_030_2	6	1					0	07/16/2021	2022.01	07/16/2021 09:01:27 AM Eastern Daylight Time	08/03/2021 11:45:52 AM Eastern Daylight Time	07/30/2021 03:33:02 PM Eastern Daylight Time			08/05/2021 08:55:51 AM Eastern Daylight Time	HIGHMARK SENIOR SOLUTIONS COMPANY	Highmark Inc.	medicare.highmark.com	Freedom Blue PPO Signature (PPO)	01	04		1			H5106	030	2	2022	Region 2 WV Counties	South WV	2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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	2	1						05/04/2021	2022.01	05/04/2021 08:23:25 AM Eastern Daylight Time					06/04/2021 01:37:54 PM Eastern Daylight Time	HIGHMARK SENIOR SOLUTIONS COMPANY	Highmark Inc.	medicare.highmark.com	Freedom Blue PPO MAPD WV NON-CALENDAR (PPO)	01	04		1			H5106	806	0	2022	ALL WV COUNTIES		1	0	2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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;3-4;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;15;16b;	2		1									
H5106	807	0	1	04	01	H5106_807_0	2	1				0	0	05/04/2021	2022.01	05/04/2021 08:19:53 AM Eastern Daylight Time					06/04/2021 01:37:54 PM Eastern Daylight Time	HIGHMARK SENIOR SOLUTIONS COMPANY	Highmark Inc.	medicare.highmark.com	Freedom Blue PPO MA WV Calendar (PPO)	01	04		1			H5106	807	0	2022	ALL WV COUNTIES		1	0	2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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;3-4;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;15;16b;	2		1									
H5106	808	0	1	04	01	H5106_808_0	2	1						05/04/2021	2022.01	05/04/2021 08:26:41 AM Eastern Daylight Time					06/04/2021 01:37:54 PM Eastern Daylight Time	HIGHMARK SENIOR SOLUTIONS COMPANY	Highmark Inc.	medicare.highmark.com	Freedom Blue PPO MAPD WV CALENDAR (PPO)	01	04		1			H5106	808	0	2022	ALL WV COUNTIES		1	8814	2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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;3-4;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;15;16b;	2		1									
H5117	003	0	1	01	01	H5117_003_0	3	1					0	08/01/2021	2022.01	08/01/2021 12:38:21 PM Pacific Daylight Time	08/04/2021 08:28:18 AM Eastern Daylight Time	07/30/2021 11:42:50 AM Eastern Daylight Time			08/04/2021 10:52:49 PM Eastern Daylight Time	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Wellcare by Allwell	www.wellcare.com/allwellLA	Wellcare No Premium Medicare (HMO)	01	01		1			H5117	003	0	2022	Select counties in LA		2	8241	2			2						www.wellcare.com/allwellLA	www.wellcare.com/allwellLA	www.wellcare.com/allwellLA	(855)766-1572		(855)766-1572		(866)277-6583		(866)277-6583		(855)766-1572		(855)766-1572		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5117	004	0	1	01	01	H5117_004_0	3	1	2	1			0	06/04/2021	2022.01	06/04/2021 10:45:03 AM Pacific Daylight Time	08/04/2021 08:09:30 AM Eastern Daylight Time	07/30/2021 11:43:10 AM Eastern Daylight Time			08/04/2021 10:52:49 PM Eastern Daylight Time	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Wellcare by Allwell	www.wellcare.com/allwellLA	Wellcare Dual Access Medicare (HMO D-SNP)	01	01		1			H5117	004	0	2022	Select counties in LA		2	2648	2			1	3		1		1	www.wellcare.com/allwellLA	www.wellcare.com/allwellLA	www.wellcare.com/allwellLA	(833)541-0767		(833)541-0767		(866)277-6583		(866)277-6583		(833)541-0767		(833)541-0767		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5117	801	0	1	01	01	H5117_801_0	2	1						05/03/2021	2022.01	05/03/2021 02:03:08 PM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Wellcare by Allwell	allwell.louisianahealthconnect.com	Allwell Group (HMO)	01	01		1			H5117	801	0	2022	Louisiana		1	100	2			2						allwell.louisianahealthconnect.com/findadoctor	allwell.louisianahealthconnect.com/formulary	allwell.louisianahealthconnect.com/findadoctor	(855)766-1572		(855)766-1572		(844)942-0039		(844)942-0039		(855)766-1572		(855)766-1572		(844)942-0039		(844)942-0039		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H5117	802	0	1	01	01	H5117_802_0	2	1				0	0	05/03/2021	2022.01	05/03/2021 02:03:18 PM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Wellcare by Allwell	allwell.louisianahealthconnect.com	Allwell Group (HMO)	01	01		1			H5117	802	0	2022	Louisiana		1	100	2			2						allwell.louisianahealthconnect.com/findadoctor	allwell.louisianahealthconnect.com/formulary	allwell.louisianahealthconnect.com/findadoctor	(855)766-1572		(855)766-1572		(844)942-0039		(844)942-0039										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H5117	803	0	1	01	01	H5117_803_0	2	1						05/03/2021	2022.01	05/03/2021 02:03:30 PM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Wellcare by Allwell	allwell.louisianahealthconnect.com	Allwell Group (HMO)	01	01		1			H5117	803	0	2022	Louisiana		1	100	2			2						allwell.louisianahealthconnect.com/findadoctor	allwell.louisianahealthconnect.com/formulary	allwell.louisianahealthconnect.com/findadoctor	(855)766-1572		(855)766-1572		(844)942-0039		(844)942-0039		(855)766-1572		(855)766-1572		(844)942-0039		(844)942-0039		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H5124	001	0	1	20	08	H5124_001_0	1	1						06/02/2021	2022.01	06/02/2021 02:48:47 PM US Eastern Daylight Time		06/02/2021 02:24:50 PM US Eastern Daylight Time			06/02/2021 02:51:53 PM 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	2022	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						06/02/2021	2022.01	06/02/2021 02:49:27 PM US Eastern Daylight Time		06/02/2021 02:24:50 PM US Eastern Daylight Time			06/02/2021 02:51:53 PM 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	2022	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																
H5126	001	0	1	01	01	H5126_001_0	7	1					0	08/05/2021	2022.01	08/05/2021 08:24:44 AM Eastern Daylight Time	08/05/2021 07:02:45 AM Eastern Daylight Time	08/05/2021 07:02:55 AM Eastern Daylight Time			08/05/2021 08:36:05 AM Eastern Daylight Time	OSCAR INSURANCE COMPANY	Oscar	www.hioscar.com/medicare	Oscar Easy Care (HMO)	01	01		1			H5126	001	0	2022	Harris, Fort Bend, and Montgomery Counties		2	17900	2			2						www.hioscar.com/search	www.hioscar.com/search	www.hioscar.com/search	(855)672-2720		(855)672-2720		(855)672-2710		(855)672-2710		(855)672-2720		(855)672-2720		(855)672-2710		(855)672-2710		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5126	003	0	1	01	01	H5126_003_0	6	1					0	08/05/2021	2022.01	08/05/2021 08:26:31 AM Eastern Daylight Time	08/05/2021 07:03:06 AM Eastern Daylight Time	08/05/2021 07:03:18 AM Eastern Daylight Time			08/05/2021 08:36:05 AM Eastern Daylight Time	OSCAR INSURANCE COMPANY	Oscar	www.hioscar.com/medicare	Oscar Signature with $1000 O-Card (HMO)	01	01		1			H5126	003	0	2022	Harris, Fort Bend, and Montgomery Counties		2	4304	2			2						www.hioscar.com/search	www.hioscar.com/search	www.hioscar.com/search	(855)672-2720		(855)672-2720		(855)672-2710		(855)672-2710		(855)672-2720		(855)672-2720		(855)672-2710		(855)672-2710		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5140	001	0	1	04	01	H5140_001_0	11	1					0	07/26/2021	2022.01	07/26/2021 11:48:51 AM US Mountain Standard Time	08/03/2021 03:31:54 PM US Mountain Standard Time	08/03/2021 03:32:11 PM US Mountain Standard Time			08/04/2021 05:55:53 PM US Mountain Standard Time	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Blue Cross Blue Shield of Arizona	azbluemedicare.com	BlueJourney (PPO)	01	04		1			H5140	001	0	2022	Maricopa County		2		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			
H5140	002	0	1	04	01	H5140_002_0	11	1					0	06/25/2021	2022.01	06/25/2021 03:51:20 PM US Mountain Standard Time	08/03/2021 03:32:27 PM US Mountain Standard Time	08/03/2021 03:32:46 PM US Mountain Standard Time			08/04/2021 05:55:53 PM US Mountain Standard Time	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Blue Cross Blue Shield of Arizona	azbluemedicare.com	BlueJourney (PPO)	01	04		1			H5140	002	0	2022	Pima County		2		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			
H5141	001	0	1	04	01	H5141_001_0	17	1					1	08/05/2021	2022.01	08/05/2021 07:22:25 AM Eastern Daylight Time	08/05/2021 02:05:46 PM Eastern Daylight Time	08/12/2021 04:34:09 PM Eastern Daylight Time			08/12/2021 04:38:01 PM Eastern Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health Choice (PPO)	01	04		1			H5141	001	0	2022	Hudson County		2		2			2						www.cloverhealth.com/en/members/find-pharmacy	www.cloverhealth.com/en/members/formulary	www.cloverhealth.com/en/members/find-provider	(888)778-1478		(201)414-9690		(888)466-5044		(201)425-9257		(855)479-3657		(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					1	08/05/2021	2022.01	08/05/2021 07:33:03 AM Eastern Daylight Time	08/05/2021 02:05:46 PM Eastern Daylight Time	08/05/2021 02:06:04 PM Eastern Daylight Time			08/05/2021 02:23:31 PM Eastern Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health Choice (PPO)	01	04		1			H5141	004	0	2022	Select NJ Counties		2		2			2						www.cloverhealth.com/en/members/find-pharmacy	www.cloverhealth.com/en/members/formulary	www.cloverhealth.com/en/members/find-provider	(888)778-1478		(201)414-9690		(888)466-5044		(201)425-9257		(855)479-3657		(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	13	1					0	08/17/2021	2022.01	08/17/2021 07:30:59 PM Eastern Daylight Time	08/05/2021 02:05:46 PM Eastern Daylight Time	08/05/2021 02:06:04 PM Eastern Daylight Time			08/17/2021 07:31:58 PM Eastern Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health Choice Value (PPO)	01	04		1			H5141	007	0	2022	Select NJ Counties		2		2			2						www.cloverhealth.com/en/members/find-pharmacy	www.cloverhealth.com/en/members/formulary	www.cloverhealth.com/en/members/find-provider	(888)778-1478		(201)414-9690		(888)466-5044		(201)425-9257		(855)479-3657		(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	15	1					1	08/04/2021	2022.01	08/04/2021 10:59:13 PM Eastern Daylight Time	08/05/2021 02:05:46 PM Eastern Daylight Time	08/05/2021 02:06:04 PM Eastern Daylight Time			08/05/2021 02:23:31 PM Eastern Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health Choice (PPO)	01	04		1			H5141	025	0	2022	San Antonio Area		2		2			2						www.cloverhealth.com/en/members/find-pharmacy	www.cloverhealth.com/en/members/formulary	www.cloverhealth.com/en/members/find-provider	(888)778-1478		(201)414-9690		(888)466-5044		(201)425-9257		(855)479-3657		(201)414-9690		(888)466-5044		(201)425-9257		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5141	026	0	1	04	01	H5141_026_0	15	1					1	08/04/2021	2022.01	08/04/2021 11:05:51 PM Eastern Daylight Time	08/05/2021 02:05:46 PM Eastern Daylight Time	08/05/2021 02:06:04 PM Eastern Daylight Time			08/05/2021 02:23:31 PM Eastern Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health LiveHealthy (PPO)	01	04		1			H5141	026	0	2022	Savannah Area		2		2			2						www.cloverhealth.com/en/members/find-pharmacy	www.cloverhealth.com/en/members/formulary	www.cloverhealth.com/en/members/find-provider	(888)778-1478		(912)805-3271		(888)466-5044		(912)805-3269		(855)479-3657		(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	15	1					1	08/04/2021	2022.01	08/04/2021 11:11:36 PM Eastern Daylight Time	08/05/2021 02:05:46 PM Eastern Daylight Time	08/05/2021 02:06:04 PM Eastern Daylight Time			08/05/2021 02:23:31 PM Eastern Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health Choice (PPO)	01	04		1			H5141	032	0	2022	Select NJ Counties		2		2			2						www.cloverhealth.com/en/members/find-pharmacy	www.cloverhealth.com/en/members/formulary	www.cloverhealth.com/en/members/find-provider	(888)778-1478		(201)414-9690		(888)466-5044		(201)425-9257		(855)479-3657		(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	15	1					1	08/04/2021	2022.01	08/04/2021 11:14:29 PM Eastern Daylight Time	08/05/2021 02:05:46 PM Eastern Daylight Time	08/05/2021 02:06:04 PM Eastern Daylight Time			08/05/2021 02:23:31 PM Eastern Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health Choice (PPO)	01	04		1			H5141	033	0	2022	Davidson, Rutherford & Williamson Counties		2		2			2						www.cloverhealth.com/en/members/find-pharmacy	www.cloverhealth.com/en/members/formulary	www.cloverhealth.com/en/members/find-provider	(888)778-1478		(201)414-9690		(888)466-5044		(201)425-9257		(855)479-3657		(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					1	08/04/2021	2022.01	08/04/2021 11:30:53 PM Eastern Daylight Time	08/05/2021 02:05:46 PM Eastern Daylight Time	08/05/2021 02:06:04 PM Eastern Daylight Time			08/05/2021 02:23:31 PM Eastern Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health Choice Value (PPO)	01	04		1			H5141	034	0	2022	Davidson, Rutherford & Williamson Counties		2		2			2						www.cloverhealth.com/en/members/find-pharmacy	www.cloverhealth.com/en/members/formulary	www.cloverhealth.com/en/members/find-provider	(888)778-1478		(201)414-9690		(888)466-5044		(201)425-9257		(855)479-3657		(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	15	1					1	08/04/2021	2022.01	08/04/2021 11:36:08 PM Eastern Daylight Time	08/05/2021 02:05:46 PM Eastern Daylight Time	08/05/2021 02:06:04 PM Eastern Daylight Time			08/05/2021 02:23:31 PM Eastern Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health Choice (PPO)	01	04		1			H5141	035	0	2022	El Paso County		2		2			2						www.cloverhealth.com/en/members/find-pharmacy	www.cloverhealth.com/en/members/formulary	www.cloverhealth.com/en/members/find-provider	(888)778-1478		(201)414-9690		(888)466-5044		(201)425-9257		(855)479-3657		(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	15	1					1	08/04/2021	2022.01	08/04/2021 11:39:38 PM Eastern Daylight Time	08/05/2021 02:05:46 PM Eastern Daylight Time	08/05/2021 02:06:04 PM Eastern Daylight Time			08/05/2021 02:23:31 PM Eastern Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health LiveHealthy (PPO)	01	04		1			H5141	036	0	2022	Select SC Counties		2		2			2						www.cloverhealth.com/en/members/find-pharmacy	www.cloverhealth.com/en/members/formulary	www.cloverhealth.com/en/members/find-provider	(888)778-1478		(201)414-9690		(888)466-5044		(201)425-9257		(855)479-3657		(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	15	1					1	08/05/2021	2022.01	08/05/2021 12:02:44 AM Eastern Daylight Time	08/05/2021 02:05:46 PM Eastern Daylight Time	08/05/2021 02:06:04 PM Eastern Daylight Time			08/05/2021 02:23:31 PM Eastern Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health LiveHealthy Value (PPO)	01	04		1			H5141	037	0	2022	Select SC Counties		2		2			2						www.cloverhealth.com/en/members/find-pharmacy	www.cloverhealth.com/en/members/formulary	www.cloverhealth.com/en/members/find-provider	(888)778-1478		(201)414-9690		(888)466-5044		(201)425-9257		(855)479-3657		(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	15	1					1	08/05/2021	2022.01	08/05/2021 12:08:50 AM Eastern Daylight Time	08/05/2021 02:05:46 PM Eastern Daylight Time	08/05/2021 02:06:04 PM Eastern Daylight Time			08/05/2021 02:23:31 PM Eastern Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health Choice (PPO)	01	04		1			H5141	038	0	2022	Bucks, Philadelphia & Delaware Counties		2		2			2						www.cloverhealth.com/en/members/find-pharmacy	www.cloverhealth.com/en/members/formulary	www.cloverhealth.com/en/members/find-provider	(888)778-1478		(201)414-9690		(888)466-5044		(201)425-9257		(855)479-3657		(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	14	1					0	07/22/2021	2022.01	07/22/2021 12:56:37 PM Eastern Daylight Time	08/05/2021 02:05:46 PM Eastern Daylight Time	08/05/2021 02:06:04 PM Eastern Daylight Time			08/05/2021 02:23:31 PM Eastern Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health Choice Value (PPO)	01	04		1			H5141	039	0	2022	Bucks, Philadelphia & Delaware Counties		2		2			2						www.cloverhealth.com/en/members/find-pharmacy	www.cloverhealth.com/en/members/formulary	www.cloverhealth.com/en/members/find-provider	(888)778-1478		(201)414-9690		(888)466-5044		(201)425-9257		(855)479-3657		(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	15	1					1	08/05/2021	2022.01	08/05/2021 12:17:22 AM Eastern Daylight Time	08/05/2021 02:05:46 PM Eastern Daylight Time	08/05/2021 02:06:04 PM Eastern Daylight Time			08/05/2021 02:23:31 PM Eastern Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health Choice (PPO)	01	04		1			H5141	040	0	2022	Pima County		2		2			2						www.cloverhealth.com/en/members/find-pharmacy	www.cloverhealth.com/en/members/formulary	www.cloverhealth.com/en/members/find-provider	(888)778-1478		(201)414-9690		(888)466-5044		(201)425-9257		(855)479-3657		(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					0	08/05/2021	2022.01	08/05/2021 12:34:28 AM Eastern Daylight Time	08/05/2021 02:05:47 PM Eastern Daylight Time	08/05/2021 02:06:04 PM Eastern Daylight Time			08/05/2021 02:23:31 PM Eastern Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health Choice Value (PPO)	01	04		1			H5141	042	0	2022	Select NJ Counties		2		2			2						www.cloverhealth.com/en/members/find-pharmacy	www.cloverhealth.com/en/members/formulary	www.cloverhealth.com/en/members/find-provider	(888)778-1478		(201)414-9690		(888)466-5044		(201)425-9257		(855)479-3657		(201)414-9690		(888)466-5044		(201)425-9257		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5141	045	0	1	04	01	H5141_045_0	14	1					0	08/05/2021	2022.01	08/05/2021 12:41:17 AM Eastern Daylight Time	08/05/2021 02:05:47 PM Eastern Daylight Time	08/05/2021 02:06:04 PM Eastern Daylight Time			08/05/2021 02:23:31 PM Eastern Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health LiveHealthy Value (PPO)	01	04		1			H5141	045	0	2022	Savannah Area		2		2			2						www.cloverhealth.com/en/members/find-pharmacy	www.cloverhealth.com/en/members/formulary	www.cloverhealth.com/en/members/find-provider	(888)778-1478		(912)805-3271		(888)466-5044		(912)805-3269		(855)479-3657		(912)805-3271		(888)466-5044		(912)805-3269		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5141	046	0	1	04	01	H5141_046_0	15	1					1	08/05/2021	2022.01	08/05/2021 12:43:53 AM Eastern Daylight Time	08/05/2021 02:05:47 PM Eastern Daylight Time	08/05/2021 02:06:04 PM Eastern Daylight Time			08/05/2021 02:23:31 PM Eastern Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health LiveHealthy (PPO)	01	04		1			H5141	046	0	2022	Atlanta, Columbus, Macon, and rural areas		2		2			2						www.cloverhealth.com/en/members/find-pharmacy	www.cloverhealth.com/en/members/formulary	www.cloverhealth.com/en/members/find-provider	(888)778-1478		(912)805-3271		(888)466-5044		(912)805-3269		(855)479-3657		(912)805-3271		(888)466-5044		(912)805-3269		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5141	047	0	1	04	01	H5141_047_0	14	1					0	08/05/2021	2022.01	08/05/2021 12:50:20 AM Eastern Daylight Time	08/05/2021 02:05:47 PM Eastern Daylight Time	08/05/2021 02:06:04 PM Eastern Daylight Time			08/05/2021 02:23:31 PM Eastern Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health LiveHealthy Value (PPO)	01	04		1			H5141	047	0	2022	Atlanta, Columbus, Macon, and rural areas		2		2			2						www.cloverhealth.com/en/members/find-pharmacy	www.cloverhealth.com/en/members/formulary	www.cloverhealth.com/en/members/find-provider	(888)778-1478		(912)805-3271		(888)466-5044		(912)805-3269		(855)479-3657		(912)805-3271		(888)466-5044		(912)805-3269		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5141	048	0	1	04	01	H5141_048_0	15	1					1	08/05/2021	2022.01	08/05/2021 12:53:50 AM Eastern Daylight Time	08/05/2021 02:05:47 PM Eastern Daylight Time	08/05/2021 02:06:04 PM Eastern Daylight Time			08/05/2021 02:23:31 PM Eastern Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health LiveHealthy (PPO)	01	04		1			H5141	048	0	2022	Select Counties in GA		2		2			2						www.cloverhealth.com/en/members/find-pharmacy	www.cloverhealth.com/en/members/formulary	www.cloverhealth.com/en/members/find-provider	(888)778-1478		(912)805-3271		(888)466-5044		(912)805-3269		(855)479-3657		(912)805-3271		(888)466-5044		(912)805-3269		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5141	049	0	1	04	01	H5141_049_0	14	1					0	08/05/2021	2022.01	08/05/2021 01:00:40 AM Eastern Daylight Time	08/05/2021 02:05:47 PM Eastern Daylight Time	08/05/2021 02:06:04 PM Eastern Daylight Time			08/05/2021 02:23:31 PM Eastern Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health LiveHealthy Value (PPO)	01	04		1			H5141	049	0	2022	Select Counties in GA		2		2			2						www.cloverhealth.com/en/members/find-pharmacy	www.cloverhealth.com/en/members/formulary	www.cloverhealth.com/en/members/find-provider	(888)778-1478		(912)805-3271		(888)466-5044		(912)805-3269		(855)479-3657		(912)805-3271		(888)466-5044		(912)805-3269		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5141	050	0	1	04	01	H5141_050_0	15	1					1	08/05/2021	2022.01	08/05/2021 01:03:18 AM Eastern Daylight Time	08/05/2021 02:05:47 PM Eastern Daylight Time	08/05/2021 02:06:04 PM Eastern Daylight Time			08/05/2021 02:23:31 PM Eastern Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health LiveHealthy (PPO)	01	04		1			H5141	050	0	2022	Jackson and rural areas		2		2			2						www.cloverhealth.com/en/members/find-pharmacy	www.cloverhealth.com/en/members/formulary	www.cloverhealth.com/en/members/find-provider	(888)778-1478		(201)414-9690		(888)466-5044		(201)425-9257		(855)479-3657		(201)414-9690		(888)466-5044		(201)425-9257		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5141	051	0	1	04	01	H5141_051_0	14	1					0	08/05/2021	2022.01	08/05/2021 01:05:52 AM Eastern Daylight Time	08/05/2021 02:05:47 PM Eastern Daylight Time	08/05/2021 02:06:04 PM Eastern Daylight Time			08/05/2021 02:23:31 PM Eastern Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health LiveHealthy Value (PPO)	01	04		1			H5141	051	0	2022	Jackson and rural areas		2		2			2						www.cloverhealth.com/en/members/find-pharmacy	www.cloverhealth.com/en/members/formulary	www.cloverhealth.com/en/members/find-provider	(888)778-1478		(201)414-9690		(888)466-5044		(201)425-9257		(855)479-3657		(201)414-9690		(888)466-5044		(201)425-9257		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5141	052	0	1	04	01	H5141_052_0	15	1					1	08/05/2021	2022.01	08/05/2021 01:08:07 AM Eastern Daylight Time	08/05/2021 02:05:47 PM Eastern Daylight Time	08/05/2021 02:06:04 PM Eastern Daylight Time			08/05/2021 02:23:31 PM Eastern Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health LiveHealthy (PPO)	01	04		1			H5141	052	0	2022	Select AL Counties		2	500	2			2						www.cloverhealth.com/en/members/find-pharmacy	www.cloverhealth.com/en/members/formulary	www.cloverhealth.com/en/members/find-provider	(888)778-1478		(912)805-3271		(888)466-5044		(912)805-3269		(855)479-3657		(912)805-3271		(888)466-5044		(912)805-3269		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5141	053	0	1	04	01	H5141_053_0	14	1					0	08/05/2021	2022.01	08/05/2021 01:20:39 AM Eastern Daylight Time	08/05/2021 02:05:47 PM Eastern Daylight Time	08/05/2021 02:06:04 PM Eastern Daylight Time			08/05/2021 02:23:31 PM Eastern Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health LiveHealthy Value (PPO)	01	04		1			H5141	053	0	2022	Select AL Counties		2		2			2						www.cloverhealth.com/en/members/find-pharmacy	www.cloverhealth.com/en/members/formulary	www.cloverhealth.com/en/members/find-provider	(888)778-1478		(912)805-3271		(888)466-5044		(912)805-3269		(855)479-3657		(912)805-3271		(888)466-5044		(912)805-3269		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5141	054	0	1	04	01	H5141_054_0	14	1					1	08/05/2021	2022.01	08/05/2021 01:25:14 AM Eastern Daylight Time	08/05/2021 02:05:47 PM Eastern Daylight Time	08/05/2021 02:06:04 PM Eastern Daylight Time			08/05/2021 02:23:31 PM Eastern Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health Premier (PPO)	01	04		1			H5141	054	0	2022	Select NJ Counties		2		2			2						www.cloverhealth.com/en/members/find-pharmacy	www.cloverhealth.com/en/members/formulary	www.cloverhealth.com/en/members/find-provider	(888)778-1478		(201)414-9690		(888)466-5044		(201)425-9257		(855)479-3657		(201)414-9690		(888)466-5044		(201)425-9257		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5141	055	0	1	04	01	H5141_055_0	13	1					0	09/15/2021	2022.01	09/15/2021 02:53:14 PM Eastern Daylight Time	08/05/2021 02:05:47 PM Eastern Daylight Time	08/05/2021 02:06:04 PM Eastern Daylight Time			09/15/2021 02:54:13 PM Eastern Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health Premier Value (PPO)	01	04		1			H5141	055	0	2022	Select NJ Counties		2	500	2			2						www.cloverhealth.com/en/members/find-pharmacy	www.cloverhealth.com/en/members/formulary	www.cloverhealth.com/en/members/find-provider	(888)778-1478		(201)414-9690		(888)466-5044		(201)425-9257		(855)479-3657		(201)414-9690		(888)466-5044		(201)425-9257		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5141	801	0	1	04	01	H5141_801_0	10	1						05/28/2021	2022.01	05/28/2021 07:09:01 PM Eastern Daylight Time					06/07/2021 08:13:56 PM Eastern Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health Employer Group Plan (PPO)	01	04		1			H5141	801	0	2022	Select NJ & PA Counties		1	2400	2			2						www.cloverhealth.com/en/members/find-pharmacy	www.cloverhealth.com/en/members/formulary	www.cloverhealth.com/en/members/find-provider	(888)778-1478		(201)414-9690		(888)466-5044		(201)425-9257		(855)479-3657		(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						06/03/2021	2022.01	06/03/2021 01:25:05 PM Mountain Daylight Time		05/25/2021 11:23:42 AM Mountain Daylight Time			06/03/2021 01:27:54 PM Mountain Daylight Time	ROCKY MOUNTAIN HEALTH CARE SERVICES	Rocky Mountain PACE	rmhcare.org	Rocky Mountain PACE (PACE)	08	20		1			H5167	001	0	2022	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	1	1						06/03/2021	2022.01	06/03/2021 01:25:44 PM Mountain Daylight Time		05/25/2021 11:24:16 AM Mountain Daylight Time			06/03/2021 01:27:54 PM Mountain Daylight Time	ROCKY MOUNTAIN HEALTH CARE SERVICES	Rocky Mountain PACE	rmhcare.org	Rocky Mountain PACE (PACE)	08	20		1			H5167	002	0	2022	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	6	1						07/27/2021	2022.01	07/27/2021 01:11:53 PM Pacific Daylight Time					07/27/2021 01:12:31 PM 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	2022	San Diego, California		2	88614	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																
H5178	001	0	1	01	01	H5178_001_0	3	1					0	07/22/2021	2022.01	07/22/2021 04:40:02 PM Eastern Daylight Time	08/03/2021 05:47:49 PM Eastern Daylight Time	07/30/2021 10:45:14 AM Eastern Daylight Time			08/04/2021 02:19:11 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5178-001 (HMO)	01	01		1			H5178	001	0	2022	Greenville County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5190	001	0	1	01	01	H5190_001_0	5	1	2	1			0	07/30/2021	2022.01	07/30/2021 04:07:57 PM Eastern Daylight Time	08/04/2021 12:29:28 AM Eastern Daylight Time	07/30/2021 11:43:30 AM Eastern Daylight Time			08/04/2021 10:03:14 PM Eastern Daylight Time	SUNSHINE STATE HEALTH PLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellFL	Wellcare Dual Medicare (HMO D-SNP)	01	01		1			H5190	001	0	2022	Select counties in FL		2	3358	2			1	3		2		2	www.wellcare.com/allwellFL	www.wellcare.com/allwellFL	www.wellcare.com/allwellFL	(877)935-8022		(877)935-8022		(866)277-6583		(866)277-6583		(877)935-8022		(877)935-8022		(866)277-6583		(866)277-6583		(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			0	05/31/2021	2022.01	05/31/2021 09:12:20 AM Eastern Daylight Time	08/04/2021 12:29:56 AM Eastern Daylight Time	07/30/2021 11:43:56 AM Eastern Daylight Time			08/04/2021 10:03:14 PM Eastern Daylight Time	SUNSHINE STATE HEALTH PLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellFL	Wellcare Dual Medicare (HMO D-SNP)	01	01		1			H5190	002	0	2022	Select counties in FL		2	7920	2			1	3		2		2	www.wellcare.com/allwellFL	www.wellcare.com/allwellFL	www.wellcare.com/allwellFL	(877)935-8022		(877)935-8022		(866)277-6583		(866)277-6583		(877)935-8022		(877)935-8022		(866)277-6583		(866)277-6583		(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			0	07/30/2021	2022.01	07/30/2021 04:10:59 PM Eastern Daylight Time	08/04/2021 12:30:24 AM Eastern Daylight Time	07/30/2021 11:44:30 AM Eastern Daylight Time			08/04/2021 10:03:14 PM Eastern Daylight Time	SUNSHINE STATE HEALTH PLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellFL	Wellcare Dual Medicare (HMO D-SNP)	01	01		1			H5190	003	0	2022	Select counties in FL		2	1701	2			1	3		2		2	www.wellcare.com/allwellFL	www.wellcare.com/allwellFL	www.wellcare.com/allwellFL	(877)935-8022		(877)935-8022		(866)277-6583		(866)277-6583		(877)935-8022		(877)935-8022		(866)277-6583		(866)277-6583		(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			0	05/31/2021	2022.01	05/31/2021 09:09:33 AM Eastern Daylight Time	08/04/2021 12:30:52 AM Eastern Daylight Time	07/30/2021 11:44:50 AM Eastern Daylight Time			08/04/2021 10:03:14 PM Eastern Daylight Time	SUNSHINE STATE HEALTH PLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellFL	Wellcare Dual Medicare (HMO D-SNP)	01	01		1			H5190	004	0	2022	Select counties in FL		2	1492	2			1	3		2		2	www.wellcare.com/allwellFL	www.wellcare.com/allwellFL	www.wellcare.com/allwellFL	(877)935-8022		(877)935-8022		(866)277-6583		(866)277-6583		(877)935-8022		(877)935-8022		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5190	005	0	1	01	01	H5190_005_0	5	1	2	1			0	07/30/2021	2022.01	07/30/2021 04:13:34 PM Eastern Daylight Time	08/04/2021 12:31:20 AM Eastern Daylight Time	07/30/2021 11:45:10 AM Eastern Daylight Time			08/04/2021 10:03:14 PM Eastern Daylight Time	SUNSHINE STATE HEALTH PLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellFL	Wellcare Dual Nurture (HMO D-SNP)	01	01		1			H5190	005	0	2022	Select counties in FL		2	77	2			1	3		1		1	www.wellcare.com/allwellFL	www.wellcare.com/allwellFL	www.wellcare.com/allwellFL	(877)935-8022		(877)935-8022		(866)277-6583		(866)277-6583		(877)935-8022		(877)935-8022		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5190	006	0	1	01	01	H5190_006_0	5	1	2	1			0	07/30/2021	2022.01	07/30/2021 04:16:56 PM Eastern Daylight Time	08/04/2021 12:31:48 AM Eastern Daylight Time	07/30/2021 11:45:28 AM Eastern Daylight Time			08/04/2021 10:03:14 PM Eastern Daylight Time	SUNSHINE STATE HEALTH PLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellFL	Wellcare Dual Nurture (HMO D-SNP)	01	01		1			H5190	006	0	2022	Select counties in FL		2	21	2			1	3		1		1	www.wellcare.com/allwellFL	www.wellcare.com/allwellFL	www.wellcare.com/allwellFL	(877)935-8022		(877)935-8022		(866)277-6583		(866)277-6583		(877)935-8022		(877)935-8022		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5199	008	0	1	04	01	H5199_008_0	5	1					0	07/30/2021	2022.01	07/30/2021 04:27:37 PM Eastern Daylight Time	08/04/2021 08:17:45 AM Eastern Daylight Time	07/30/2021 11:45:50 AM Eastern Daylight Time			08/04/2021 10:03:14 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium Open (PPO)	01	04		1			H5199	008	0	2022	Select counties in FL		2	46900	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5199	010	0	1	04	01	H5199_010_0	5	1					0	07/30/2021	2022.01	07/30/2021 04:31:06 PM Eastern Daylight Time	08/04/2021 08:18:35 AM Eastern Daylight Time	07/30/2021 11:46:30 AM Eastern Daylight Time			08/04/2021 10:03:14 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Premium Enhanced Open (PPO)	01	04		1			H5199	010	0	2022	Select counties in FL		2	6526	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5199	012	0	1	04	01	H5199_012_0	5	1					0	07/30/2021	2022.01	07/30/2021 04:35:05 PM Eastern Daylight Time	08/04/2021 08:19:46 AM Eastern Daylight Time	07/30/2021 11:46:52 AM Eastern Daylight Time			08/04/2021 10:03:14 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium Open (PPO)	01	04		1			H5199	012	0	2022	Select counties in FL		2	44463	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5199	013	0	1	04	01	H5199_013_0	5	1					0	07/30/2021	2022.01	07/30/2021 04:39:35 PM Eastern Daylight Time	08/04/2021 08:21:30 AM Eastern Daylight Time	07/30/2021 11:47:12 AM Eastern Daylight Time			08/04/2021 10:03:14 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Premium Enhanced Open (PPO)	01	04		1			H5199	013	0	2022	Select counties in FL		2	3061	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5199	014	0	1	04	01	H5199_014_0	5	1					0	07/30/2021	2022.01	07/30/2021 04:43:36 PM Eastern Daylight Time	08/04/2021 08:22:20 AM Eastern Daylight Time	07/30/2021 11:47:34 AM Eastern Daylight Time			08/04/2021 10:03:14 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium Open (PPO)	01	04		1			H5199	014	0	2022	Select counties in FL		2	12722	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5199	015	0	1	04	01	H5199_015_0	5	1					0	07/30/2021	2022.01	07/30/2021 04:48:01 PM Eastern Daylight Time	08/04/2021 08:23:10 AM Eastern Daylight Time	07/30/2021 11:47:52 AM Eastern Daylight Time			08/04/2021 10:03:14 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium Open (PPO)	01	04		1			H5199	015	0	2022	Select counties in FL		2	1966	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5199	016	0	1	04	01	H5199_016_0	6	1	2	1			0	07/30/2021	2022.01	07/30/2021 04:52:21 PM Eastern Daylight Time	08/04/2021 08:11:17 AM Eastern Daylight Time	07/30/2021 11:48:12 AM Eastern Daylight Time			08/04/2021 10:03:14 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Access Open (PPO D-SNP)	01	04		1			H5199	016	0	2022	Select counties in FL		2	1620	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5209	002	0	1	01	01	H5209_002_0	5	1	2	1			0	06/04/2021	2022.01	06/04/2021 12:40:22 PM Central Daylight Time	08/03/2021 01:04:23 PM Central Daylight Time	08/03/2021 01:04:23 PM Central Daylight Time			08/03/2021 01:37:50 PM Central Daylight Time	My Choice Wisconsin Health Plan, Inc.	My Choice Wisconsin Health Plan	www.mychoicewi.org	My Choice Wisconsin Partnership Plan (HMO D-SNP)	01	01		1			H5209	002	0	2022	Southcentral and Eastern Wisconsin		2		2			1	3		1		1	www.mychoicewi.org	www.mychoicewi.org	www.mychoicewi.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	1b;2;3-1;3-2;3-3;5;6;7b;7c;7e;7i;8b1;9a1;9a2;9b;9c;11a;11b;15;	2		1					1				
H5209	004	0	1	01	01	H5209_004_0	7	1	2	1			0	07/13/2021	2022.01	07/13/2021 08:52:55 AM Central Daylight Time	08/11/2021 10:20:44 AM Central Daylight Time	08/11/2021 10:20:44 AM Central Daylight Time			08/11/2021 10:21:51 AM Central Daylight Time	My Choice Wisconsin Health Plan, Inc.	My Choice Wisconsin Health Plan	www.mychoicewi.org	My Choice Wisconsin Medicare Dual Advantage Plan (HMO D-SNP)	01	01		1			H5209	004	0	2022	Southern, Central and Northeastern Wisconsin		2		2			1	3		1		1	www.mychoicewi.org	www.mychoicewi.org	www.mychoicewi.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	8	1				0	0	07/14/2021	2022.01	07/14/2021 03:52:24 PM Central Daylight Time	07/12/2021 07:41:57 PM Central Daylight Time				07/23/2021 11:20:48 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	2022	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	9	1					1	07/14/2021	2022.01	07/14/2021 03:51:25 PM Central Daylight Time	08/04/2021 08:24:05 AM Central Daylight Time	08/04/2021 06:50:05 AM Central Daylight Time			08/05/2021 11:13:31 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	2022	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	003	0	1	02	01	H5211_003_0	8	1				0	0	07/14/2021	2022.01	07/14/2021 03:50:47 PM Central Daylight Time	07/12/2021 08:14:34 PM Central Daylight Time				07/23/2021 11:20:48 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	2022	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	004	0	1	02	01	H5211_004_0	8	1					1	07/14/2021	2022.01	07/14/2021 03:53:56 PM Central Daylight Time	08/04/2021 08:08:34 AM Central Daylight Time	08/04/2021 06:58:45 AM Central Daylight Time			08/05/2021 11:13:31 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	2022	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	010	0	1	01	01	H5211_010_0	8	1	2	1			0	07/14/2021	2022.01	07/14/2021 03:35:57 PM Central Daylight Time	08/04/2021 11:46:25 AM Central Daylight Time	07/30/2021 05:38:04 PM Central Daylight Time			08/05/2021 11:13:31 AM Central Daylight Time	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Security Health Plan of Wisconsin, Inc.	www.securityhealth.org/medicareadvantage	Ally Rx (HMO D-SNP)	01	01		1			H5211	010	0	2022	Central Wisconsin		2		2			1	3		2		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	9	1					1	08/05/2021	2022.01	08/05/2021 10:41:34 AM Central Daylight Time	08/04/2021 07:52:18 AM Central Daylight Time	08/04/2021 07:06:45 AM Central Daylight Time			08/05/2021 11:13:31 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	2022	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	013	0	1	02	01	H5211_013_0	8	1					1	08/05/2021	2022.01	08/05/2021 10:41:51 AM Central Daylight Time	08/04/2021 07:31:20 AM Central Daylight Time	08/04/2021 07:14:45 AM Central Daylight Time			08/05/2021 11:13:31 AM Central Daylight Time	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Security Health Plan of Wisconsin, Inc.	www.securityhealth.org/medicareadvantage	Ascend Rx (HMO-POS)	01	02		1			H5211	013	0	2022	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			
H5212	001	0	1	20	08	H5212_001_0	1	1						04/26/2021	2022.01	04/26/2021 12:28:57 PM Central Daylight Time		05/28/2021 10:32:11 AM Central Daylight Time			05/28/2021 10:35:13 AM Central Daylight Time	COMMUNITY CARE, INC.	Community Care	www.communitycareinc.org	Community Care's PACE Program (PACE)	08	20		1			H5212	001	0	2022	Milwaukee, Waukesha, Racine, Kenosha Counties		2	6435	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						04/26/2021	2022.01	04/26/2021 12:30:48 PM Central Daylight Time		05/28/2021 10:32:11 AM Central Daylight Time			05/28/2021 10:35:13 AM Central Daylight Time	COMMUNITY CARE, INC.	Community Care	www.communitycareinc.org	Community Care's PACE Program (PACE)	08	20		1			H5212	002	0	2022	Milwaukee, Waukesha, Racine, Kenosha Counties		2	12	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	1	1						05/27/2021	2022.01	05/27/2021 09:17:35 AM Mountain Daylight Time		05/27/2021 08:41:43 AM Mountain Daylight Time			05/27/2021 09:22:18 AM 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	2022	Albuquerque Metro Area		2		2			2						www.granerx.com	N/A										(844)704-9613	711	(844)704-9613		(844)704-9613		(844)704-9613										(844)704-9613	711	(844)704-9613	711	(844)704-9613		(844)704-9613																
H5213	002	0	1	20	08	H5213_002_0	1	1						05/27/2021	2022.01	05/27/2021 09:17:47 AM Mountain Daylight Time		05/27/2021 08:41:43 AM Mountain Daylight Time			05/27/2021 09:22:18 AM 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	2022	Albuquerque Metro Area		2		2			2						www.granerx.com	N/A										(844)704-9613	711	(844)704-9613		(844)704-9613		(844)704-9613										(844)704-9613	711	(844)704-9613	711	(844)704-9613		(844)704-9613																
H5215	001	0	1	04	01	H5215_001_0	7	1				0	0	06/03/2021	2022.01	06/03/2021 10:29:58 AM Central Daylight Time	06/02/2021 07:35:48 PM Central Daylight Time				06/04/2021 12:20:24 PM Central Daylight Time	NETWORK HEALTH INSURANCE CORPORATION	Network Health Medicare Advantage Plans	https://networkhealth.com/	Network PlatinumPlus (PPO)	01	04		1			H5215	001	0	2022	East Central Wisconsin		2		2			2						https://networkhealth.com/find-a-pharmacy.html	https://networkhealth.com/look-up-medications.html	https://networkhealth.com/find-a-doctor/	(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	9	1					0	08/04/2021	2022.01	08/04/2021 03:26:22 PM Eastern Daylight Time	08/02/2021 02:39:15 PM Eastern Daylight Time	08/04/2021 12:41:19 PM Eastern Daylight Time			08/04/2021 04:38:21 PM Eastern Daylight Time	NETWORK HEALTH INSURANCE CORPORATION	Network Health Medicare Advantage Plans	https://networkhealth.com/	Network PlatinumPlus Pharmacy (PPO)	01	04		1			H5215	002	0	2022	East Central Wisconsin		2		2			2						https://networkhealth.com/find-a-pharmacy.html	https://networkhealth.com/look-up-medications.html	https://networkhealth.com/find-a-doctor/	(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	7	1					0	08/04/2021	2022.01	08/04/2021 03:26:10 PM Eastern Daylight Time	07/31/2021 02:23:41 PM Eastern Daylight Time	08/04/2021 12:41:27 PM Eastern Daylight Time			08/04/2021 04:38:21 PM Eastern Daylight Time	NETWORK HEALTH INSURANCE CORPORATION	Network Health Medicare Advantage Plans	https://networkhealth.com/	Network PlatinumPremier Pharmacy (PPO)	01	04		1			H5215	005	0	2022	East Central Wisconsin		2		2			2						https://networkhealth.com/find-a-pharmacy.html	https://networkhealth.com/look-up-medications.html	https://networkhealth.com/find-a-doctor/	(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				0	0	07/14/2021	2022.01	07/14/2021 04:36:57 PM Central Daylight Time	07/01/2021 08:16:54 AM Central Daylight Time				07/19/2021 03:04:58 PM Central Daylight Time	NETWORK HEALTH INSURANCE CORPORATION	Network Health Medicare Advantage Plans	https://networkhealth.com/	Network PlatinumPremier (PPO)	01	04		1			H5215	006	0	2022	East Central Wisconsin		2		2			2						https://networkhealth.com/find-a-pharmacy.html	https://networkhealth.com/look-up-medications.html	https://networkhealth.com/find-a-doctor/	(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	8	1	2	1			0	08/04/2021	2022.01	08/04/2021 03:25:50 PM Eastern Daylight Time	07/31/2021 02:24:10 PM Eastern Daylight Time	08/04/2021 12:41:36 PM Eastern Daylight Time			08/04/2021 04:38:21 PM Eastern Daylight Time	NETWORK HEALTH INSURANCE CORPORATION	Network Health Medicare Advantage Plans	https://networkhealth.com/	NetworkCares (PPO D-SNP)	01	04		1			H5215	007	0	2022	East Central Wisconsin		2		2			1	3		2		2	https://networkhealth.com/find-a-pharmacy.html	https://networkhealth.com/look-up-medications.html	https://networkhealth.com/find-a-doctor/	(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					0	09/28/2021	2022.01	09/28/2021 11:07:31 AM Central Daylight Time	07/31/2021 06:43:43 PM Central Daylight Time	08/04/2021 11:41:44 AM Central Daylight Time			09/28/2021 11:44:34 AM Central Daylight Time	NETWORK HEALTH INSURANCE CORPORATION	Network Health Medicare Advantage Plans	https://networkhealth.com/	Network PlatinumSelect (PPO)	01	04		1			H5215	008	0	2022	East Central Wisconsin		2		2			2						https://networkhealth.com/find-a-pharmacy.html	https://networkhealth.com/look-up-medications.html	https://networkhealth.com/find-a-doctor/	(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	10	1					0	09/28/2021	2022.01	09/28/2021 11:07:18 AM Central Daylight Time	07/31/2021 01:25:07 PM Central Daylight Time	08/04/2021 11:41:52 AM Central Daylight Time			09/28/2021 11:44:34 AM Central Daylight Time	NETWORK HEALTH INSURANCE CORPORATION	Network Health Medicare Advantage Plans	https://networkhealth.com/	Network Health Medicare Go (PPO)	01	04		1			H5215	009	0	2022	Southeast Wisconsin		2		2			2						https://networkhealth.com/find-a-pharmacy.html	https://networkhealth.com/look-up-medications.html	https://networkhealth.com/find-a-doctor/	(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	7	1					0	08/04/2021	2022.01	08/04/2021 03:28:56 PM Eastern Daylight Time	07/31/2021 02:25:35 PM Eastern Daylight Time	08/04/2021 12:42:01 PM Eastern Daylight Time			08/04/2021 04:38:21 PM Eastern Daylight Time	NETWORK HEALTH INSURANCE CORPORATION	Network Health Medicare Advantage Plans	https://networkhealth.com/	Network Health Medicare Anywhere (PPO)	01	04		1			H5215	010	0	2022	Southeast Wisconsin		2		2			2						https://networkhealth.com/find-a-pharmacy.html	https://networkhealth.com/look-up-medications.html	https://networkhealth.com/find-a-doctor/	(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	7	1					0	08/04/2021	2022.01	08/04/2021 03:29:35 PM Eastern Daylight Time	07/31/2021 02:26:05 PM Eastern Daylight Time	08/04/2021 12:42:10 PM Eastern Daylight Time			08/04/2021 04:38:21 PM Eastern Daylight Time	NETWORK HEALTH INSURANCE CORPORATION	Network Health Medicare Advantage Plans	https://networkhealth.com/	Network PlatinumChoice (PPO)	01	04		1			H5215	011	0	2022	East Central Wisconsin		2		2			2						https://networkhealth.com/find-a-pharmacy.html	https://networkhealth.com/look-up-medications.html	https://networkhealth.com/find-a-doctor/	(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	012	0	1	04	01	H5215_012_0	9	1					0	09/28/2021	2022.01	09/28/2021 11:07:06 AM Central Daylight Time	07/31/2021 06:44:11 PM Central Daylight Time	08/04/2021 11:42:19 AM Central Daylight Time			09/28/2021 11:44:34 AM Central Daylight Time	NETWORK HEALTH INSURANCE CORPORATION	Network Health Medicare Advantage Plans	https://networkhealth.com/	Network Health Medicare Advantage PlatinumZero (PPO)	01	04		1			H5215	012	0	2022	Northeast Wisconsin		2		2			2						https://networkhealth.com/find-a-pharmacy.html	https://networkhealth.com/look-up-medications.html	https://networkhealth.com/find-a-doctor/	(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	2	1						05/21/2021	2022.01	05/21/2021 09:55:00 PM Central Daylight Time					05/27/2021 05:22:21 PM Central Daylight Time	NETWORK HEALTH INSURANCE CORPORATION	Network Health Medicare Advantage Plans	https://networkhealth.com/	Network PlatinumPlus Pharmacy EGP (PPO)	01	04		1			H5215	806	0	2022	Wisconsin		1	1200	2			2						https://networkhealth.com/find-a-pharmacy.html	https://networkhealth.com/look-up-medications.html	https://networkhealth.com/find-a-doctor/	(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;3-4;5;6;7b;7c;7d;7e;7f;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;15;	2		1									
H5215	807	0	1	04	01	H5215_807_0	2	1				0	0	05/21/2021	2022.01	05/21/2021 05:13:29 PM Eastern Daylight Time					05/27/2021 05:22:21 PM Central Daylight Time	NETWORK HEALTH INSURANCE CORPORATION	Network Health Medicare Advantage Plans	https://networkhealth.com/	Network PlatinumPremier EGP (PPO)	01	04		1			H5215	807	0	2022	Wisconsin		1	1200	2			2						https://networkhealth.com/find-a-pharmacy.html	https://networkhealth.com/look-up-medications.html	https://networkhealth.com/find-a-doctor/	(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;3-4;5;6;7b;7c;7d;7e;7f;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;15;	2		1									
H5215	808	0	1	04	01	H5215_808_0	2	1						05/21/2021	2022.01	05/21/2021 05:13:18 PM Eastern Daylight Time					05/27/2021 05:22:21 PM Central Daylight Time	NETWORK HEALTH INSURANCE CORPORATION	Network Health Medicare Advantage Plans	https://networkhealth.com/	Network PlatinumPremier Pharmacy EGP (PPO)	01	04		1			H5215	808	0	2022	Wisconsin		1	1200	2			2						https://networkhealth.com/find-a-pharmacy.html	https://networkhealth.com/look-up-medications.html	https://networkhealth.com/find-a-doctor/	(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;3-4;5;6;7b;7c;7d;7e;7f;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;15;	2		1									
H5216	001	0	1	04	01	H5216_001_0	5	1			1		1	08/11/2021	2022.01	08/11/2021 02:28:02 PM Eastern Daylight Time	08/03/2021 07:48:45 PM Eastern Daylight Time	07/30/2021 10:45:26 AM Eastern Daylight Time			08/11/2021 03:15:39 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-001 (PPO)	01	04		1			H5216	001	0	2022	Select Counties in Eastern Wisconsin		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		1	08/02/2021	2022.01	08/02/2021 03:39:21 PM Eastern Daylight Time	08/03/2021 07:43:51 PM Eastern Daylight Time	07/30/2021 10:45:38 AM Eastern Daylight Time			08/04/2021 06:29:06 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-006 (PPO)	01	04		1			H5216	006	0	2022	Madison area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	7	1			1		1	07/15/2021	2022.01	07/15/2021 05:05:57 PM Eastern Daylight Time	08/03/2021 05:46:28 PM Eastern Daylight Time	07/30/2021 10:45:50 AM Eastern Daylight Time			08/04/2021 04:39:24 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-009 (PPO)	01	04		1			H5216	009	0	2022	Select Counties in Western Michigan		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		0	07/15/2021	2022.01	07/15/2021 05:06:38 PM Eastern Daylight Time	08/03/2021 05:46:41 PM Eastern Daylight Time	07/30/2021 10:46:02 AM Eastern Daylight Time			08/04/2021 02:05:54 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-011 (PPO)	01	04		1			H5216	011	0	2022	Oakland, Macomb, and Wayne counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		1	08/04/2021	2022.01	08/04/2021 11:24:52 AM Eastern Daylight Time	08/03/2021 08:18:27 PM Eastern Daylight Time	07/30/2021 10:46:14 AM Eastern Daylight Time			08/04/2021 05:50:55 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-013 (PPO)	01	04		1			H5216	013	0	2022	Select Counties in Illinois		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		0	07/08/2021	2022.01	07/08/2021 04:37:51 PM Eastern Daylight Time	08/03/2021 05:39:30 PM Eastern Daylight Time	07/30/2021 10:46:24 AM Eastern Daylight Time			08/04/2021 01:53:51 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-014 (PPO)	01	04		1			H5216	014	0	2022	Select Counties in Iowa and Nebraska		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		0	08/01/2021	2022.01	08/01/2021 12:32:43 PM Eastern Daylight Time	08/03/2021 09:46:53 PM Eastern Daylight Time	07/30/2021 10:46:38 AM Eastern Daylight Time			08/04/2021 02:09:43 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-017 (PPO)	01	04		1			H5216	017	0	2022	Greensboro		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		1	08/04/2021	2022.01	08/04/2021 01:42:56 PM Eastern Daylight Time	08/03/2021 05:30:59 PM Eastern Daylight Time	07/30/2021 10:46:50 AM Eastern Daylight Time			08/04/2021 01:49:58 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-019 (PPO)	01	04		1			H5216	019	0	2022	Central Kentucky		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		1	07/23/2021	2022.01	07/23/2021 01:39:38 PM Eastern Daylight Time	08/03/2021 05:21:40 PM Eastern Daylight Time	07/30/2021 10:47:02 AM Eastern Daylight Time			08/04/2021 01:53:48 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-021 (PPO)	01	04		1			H5216	021	0	2022	Charleston-Huntington Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		0	07/15/2021	2022.01	07/15/2021 01:00:26 PM Eastern Daylight Time	08/03/2021 05:24:11 PM Eastern Daylight Time	07/30/2021 10:47:14 AM Eastern Daylight Time			08/04/2021 01:53:48 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-022 (PPO)	01	04		1			H5216	022	0	2022	Martinsburg Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		0	07/15/2021	2022.01	07/15/2021 05:46:40 PM Eastern Daylight Time	08/03/2021 05:47:48 PM Eastern Daylight Time	07/30/2021 10:47:26 AM Eastern Daylight Time			08/04/2021 02:32:00 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-023 (PPO)	01	04		1			H5216	023	0	2022	Cincinnati, Dayton and Columbus Metro Areas		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		1	07/08/2021	2022.01	07/08/2021 04:15:19 PM Eastern Daylight Time	08/03/2021 05:41:42 PM Eastern Daylight Time	07/30/2021 10:47:38 AM Eastern Daylight Time			08/04/2021 02:32:00 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-024 (PPO)	01	04		1			H5216	024	0	2022	Cleveland-Akron Metro Areas		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		1	07/08/2021	2022.01	07/08/2021 03:54:25 PM Eastern Daylight Time	08/03/2021 09:47:36 PM Eastern Daylight Time	07/30/2021 10:47:52 AM Eastern Daylight Time			08/04/2021 02:09:43 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-027 (PPO)	01	04		1			H5216	027	0	2022	Northeast Virginia		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		1	07/22/2021	2022.01	07/22/2021 01:35:28 PM Eastern Daylight Time	08/03/2021 09:44:04 PM Eastern Daylight Time	07/30/2021 10:48:04 AM Eastern Daylight Time			08/04/2021 02:09:43 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-029 (PPO)	01	04		1			H5216	029	0	2022	Delaware and Maryland		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	08/02/2021	2022.01	08/02/2021 12:30:56 PM Eastern Daylight Time	08/03/2021 05:50:01 PM Eastern Daylight Time	07/30/2021 10:48:16 AM Eastern Daylight Time			08/04/2021 02:38:36 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-032 (PPO)	01	04		1			H5216	032	0	2022	Select Counties in Illinois, Kansas and Missouri		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	07/09/2021	2022.01	07/09/2021 10:48:45 AM Eastern Daylight Time	08/03/2021 05:50:54 PM Eastern Daylight Time	07/30/2021 10:48:28 AM Eastern Daylight Time			08/04/2021 02:38:36 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-033 (PPO)	01	04		1			H5216	033	1	2022	Select Counties in Illinois, Kansas, and Missouri	Select Counties in Kansas and Missouri	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		1	08/01/2021	2022.01	08/01/2021 01:46:32 PM Eastern Daylight Time	08/03/2021 05:56:33 PM Eastern Daylight Time	07/30/2021 10:48:40 AM Eastern Daylight Time			08/04/2021 02:38:36 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-033 (PPO)	01	04		1			H5216	033	2	2022	Select Counties in Illinois, Kansas, and Missouri	Select Counties in Illinois and Missouri	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	07/09/2021	2022.01	07/09/2021 10:20:45 AM Eastern Daylight Time	08/03/2021 07:06:45 PM Eastern Daylight Time	07/30/2021 10:48:52 AM Eastern Daylight Time			08/04/2021 01:27:12 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-034 (PPO)	01	04		1			H5216	034	0	2022	Select Counties in Arizona		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		0	07/15/2021	2022.01	07/15/2021 03:33:21 PM Eastern Daylight Time	08/03/2021 07:09:56 PM Eastern Daylight Time	07/30/2021 10:49:04 AM Eastern Daylight Time			08/04/2021 02:51:23 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-036 (PPO)	01	04		1			H5216	036	0	2022	Clark and Nye (partial) counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		0	07/08/2021	2022.01	07/08/2021 03:36:02 PM Eastern Daylight Time	08/03/2021 07:11:31 PM Eastern Daylight Time	07/30/2021 10:49:16 AM Eastern Daylight Time			08/04/2021 02:51:23 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-037 (PPO)	01	04		1			H5216	037	0	2022	Clark and Nye (partial) counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		0	07/31/2021	2022.01	07/31/2021 02:48:17 PM Eastern Daylight Time	08/03/2021 07:51:40 PM Eastern Daylight Time	07/30/2021 10:49:28 AM Eastern Daylight Time			08/04/2021 02:46:24 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-039 (PPO)	01	04		1			H5216	039	0	2022	Select Counties in Nevada		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		0	07/08/2021	2022.01	07/08/2021 05:30:56 PM Eastern Daylight Time	08/03/2021 05:55:51 PM Eastern Daylight Time	07/30/2021 10:49:40 AM Eastern Daylight Time			08/04/2021 02:34:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-042 (PPO)	01	04		1			H5216	042	0	2022	Select Counties in Texas		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		1	08/01/2021	2022.01	08/01/2021 02:23:06 PM Eastern Daylight Time	08/03/2021 05:56:10 PM Eastern Daylight Time	07/30/2021 10:49:54 AM Eastern Daylight Time			08/04/2021 02:34:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-043 (PPO)	01	04		1			H5216	043	1	2022	Select Counties in Texas	Select Counties in Texas	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	07/08/2021	2022.01	07/08/2021 05:32:16 PM Eastern Daylight Time	08/03/2021 05:56:27 PM Eastern Daylight Time	07/30/2021 10:50:06 AM Eastern Daylight Time			08/04/2021 02:34:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-043 (PPO)	01	04		1			H5216	043	2	2022	Select Counties in Texas	Select Counties in Texas	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		1	08/04/2021	2022.01	08/04/2021 02:40:09 PM Eastern Daylight Time	08/03/2021 05:53:48 PM Eastern Daylight Time	07/30/2021 10:50:18 AM Eastern Daylight Time			08/04/2021 02:48:19 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-044 (PPO)	01	04		1			H5216	044	0	2022	Select counties in Idaho and Oregon		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	047	0	1	04	01	H5216_047_0	4	1			1		1	08/04/2021	2022.01	08/04/2021 02:40:17 PM Eastern Daylight Time	08/03/2021 06:13:58 PM Eastern Daylight Time	07/30/2021 10:50:30 AM Eastern Daylight Time			08/04/2021 02:48:19 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-047 (PPO)	01	04		1			H5216	047	0	2022	Select Counties in Washington and Oregon		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		0	08/04/2021	2022.01	08/04/2021 02:40:25 PM Eastern Daylight Time	08/03/2021 06:21:36 PM Eastern Daylight Time	07/30/2021 10:50:42 AM Eastern Daylight Time			08/04/2021 02:48:19 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-048 (PPO)	01	04		1			H5216	048	0	2022	Select counties in OR and WA		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		0	07/15/2021	2022.01	07/15/2021 05:47:17 PM Eastern Daylight Time	08/03/2021 05:55:21 PM Eastern Daylight Time	07/30/2021 10:50:54 AM Eastern Daylight Time			08/04/2021 02:32:00 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-050 (PPO)	01	04		1			H5216	050	0	2022	Northwest Ohio Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		1	07/15/2021	2022.01	07/15/2021 05:47:56 PM Eastern Daylight Time	08/03/2021 05:54:09 PM Eastern Daylight Time	07/30/2021 10:51:06 AM Eastern Daylight Time			08/04/2021 02:32:00 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-051 (PPO)	01	04		1			H5216	051	0	2022	Canton-Youngstown Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		1	07/15/2021	2022.01	07/15/2021 05:48:34 PM Eastern Daylight Time	08/03/2021 05:50:42 PM Eastern Daylight Time	07/30/2021 10:51:18 AM Eastern Daylight Time			08/04/2021 02:32:00 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-052 (PPO)	01	04		1			H5216	052	1	2022	Select counties in Ohio	Ohio Valley - OH	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		1	07/15/2021	2022.01	07/15/2021 05:50:09 PM Eastern Daylight Time	08/03/2021 05:48:10 PM Eastern Daylight Time	07/30/2021 10:51:30 AM Eastern Daylight Time			08/04/2021 02:32:00 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-052 (PPO)	01	04		1			H5216	052	2	2022	Select counties in Ohio	Ohio Valley - WV	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		1	07/15/2021	2022.01	07/15/2021 05:07:16 PM Eastern Daylight Time	08/03/2021 05:40:36 PM Eastern Daylight Time	07/30/2021 10:51:42 AM Eastern Daylight Time			08/04/2021 02:05:54 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-053 (PPO)	01	04		1			H5216	053	0	2022	Central Indiana Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		0	07/15/2021	2022.01	07/15/2021 05:07:47 PM Eastern Daylight Time	08/03/2021 05:50:00 PM Eastern Daylight Time	07/30/2021 10:51:56 AM Eastern Daylight Time			08/04/2021 02:05:54 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-054 (PPO)	01	04		1			H5216	054	0	2022	Southern Indiana Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		1	07/15/2021	2022.01	07/15/2021 05:09:04 PM Eastern Daylight Time	08/03/2021 05:51:22 PM Eastern Daylight Time	07/30/2021 10:52:08 AM Eastern Daylight Time			08/04/2021 02:05:54 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-055 (PPO)	01	04		1			H5216	055	0	2022	Northern Indiana Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	07/22/2021	2022.01	07/22/2021 02:18:25 PM Eastern Daylight Time	08/03/2021 05:44:55 PM Eastern Daylight Time	07/30/2021 10:52:20 AM Eastern Daylight Time			08/04/2021 02:16:27 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-057 (PPO)	01	04		1			H5216	057	0	2022	New Hampshire and Select Counties in Vermont		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		0	08/01/2021	2022.01	08/01/2021 12:54:36 PM Eastern Daylight Time	08/03/2021 05:45:53 PM Eastern Daylight Time	07/30/2021 10:52:32 AM Eastern Daylight Time			08/04/2021 02:16:27 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-058 (PPO)	01	04		1			H5216	058	0	2022	New Hampshire and Select Counties in Vermont		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			2	0	0	07/22/2021	2022.01	07/22/2021 02:18:42 PM Eastern Daylight Time	07/21/2021 02:52:05 PM Eastern Daylight Time				07/22/2021 02:32:25 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Honor (PPO)	01	04		1			H5216	059	0	2022	ME and NH. Select Counties in CT, MA, and VT		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_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	062	0	1	04	01	H5216_062_0	4	1			1		1	07/31/2021	2022.01	07/31/2021 12:13:53 PM Eastern Daylight Time	08/03/2021 05:40:38 PM Eastern Daylight Time	07/30/2021 10:52:44 AM Eastern Daylight Time			08/04/2021 01:39:21 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice Florida H5216-062 (PPO)	01	04		1			H5216	062	0	2022	Select Counties in Florida		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	08/01/2021	2022.01	08/01/2021 12:12:58 PM Eastern Daylight Time	08/03/2021 07:52:06 PM Eastern Daylight Time	07/30/2021 10:52:56 AM Eastern Daylight Time			08/04/2021 05:50:55 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-063 (PPO)	01	04		1			H5216	063	0	2022	Select Counties in Minnesota		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	08/03/2021	2022.01	08/03/2021 02:13:29 PM Eastern Daylight Time	08/03/2021 06:32:53 PM Eastern Daylight Time	07/30/2021 10:53:08 AM Eastern Daylight Time			08/04/2021 02:44:49 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-064 (PPO)	01	04		1			H5216	064	0	2022	Select Louisiana Parishes		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		0	07/08/2021	2022.01	07/08/2021 04:42:29 PM Eastern Daylight Time	08/03/2021 05:32:32 PM Eastern Daylight Time	07/30/2021 10:53:20 AM Eastern Daylight Time			08/04/2021 01:39:21 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-065 (PPO)	01	04		1			H5216	065	0	2022	Broward, Miami-Dade and Palm Beach Counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		0	07/31/2021	2022.01	07/31/2021 12:16:09 PM Eastern Daylight Time	08/03/2021 05:39:44 PM Eastern Daylight Time	07/30/2021 10:53:32 AM Eastern Daylight Time			08/04/2021 01:39:21 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice Florida H5216-068 (PPO)	01	04		1			H5216	068	0	2022	Broward, Miami-Dade and Palm Beach Counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	08/01/2021	2022.01	08/01/2021 12:12:55 PM Eastern Daylight Time	08/03/2021 05:36:47 PM Eastern Daylight Time	07/30/2021 10:53:44 AM Eastern Daylight Time			08/04/2021 01:25:06 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice Florida H5216-070 (PPO)	01	04		1			H5216	070	0	2022	Select Counties in Florida		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		0	07/22/2021	2022.01	07/22/2021 04:25:53 PM Eastern Daylight Time	08/03/2021 05:31:43 PM Eastern Daylight Time	07/30/2021 10:53:56 AM Eastern Daylight Time			08/04/2021 02:06:50 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-071 (PPO)	01	04		1			H5216	071	0	2022	Cobb, Paulding, Douglas Counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	6	1			1		1	08/01/2021	2022.01	08/01/2021 10:46:29 AM Eastern Daylight Time	08/03/2021 05:34:20 PM Eastern Daylight Time	07/30/2021 10:54:08 AM Eastern Daylight Time			08/04/2021 02:07:37 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice Florida H5216-072 (PPO)	01	04		1			H5216	072	0	2022	Select Counties in Florida		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		0	07/22/2021	2022.01	07/22/2021 04:25:57 PM Eastern Daylight Time	08/03/2021 05:30:44 PM Eastern Daylight Time	07/30/2021 10:54:20 AM Eastern Daylight Time			08/04/2021 02:06:50 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-073 (PPO)	01	04		1			H5216	073	0	2022	Atlanta Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	08/01/2021	2022.01	08/01/2021 12:16:57 PM Eastern Daylight Time	08/03/2021 05:35:04 PM Eastern Daylight Time	07/30/2021 10:54:32 AM Eastern Daylight Time			08/04/2021 01:39:20 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice Florida H5216-074 (PPO)	01	04		1			H5216	074	0	2022	Lake, Marion and Sumter counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		0	07/22/2021	2022.01	07/22/2021 04:55:59 PM Eastern Daylight Time	08/03/2021 05:46:49 PM Eastern Daylight Time	07/30/2021 10:54:44 AM Eastern Daylight Time			08/04/2021 01:38:25 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-075 (PPO)	01	04		1			H5216	075	0	2022	Charleston Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(833)502-2012		(833)502-2012		(800)833-2364		(800)833-2364		(833)502-2012		(833)502-2012		(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	4	1			2	0	0	07/19/2021	2022.01	07/19/2021 01:51:20 PM Eastern Daylight Time	07/22/2021 08:43:32 AM Eastern Daylight Time				07/22/2021 03:02:46 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-077 (PPO)	01	04		1			H5216	077	0	2022	Select Counties in Colorado and New Mexico		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_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;8b3;	
H5216	078	1	1	04	01	H5216_078_1	4	1			1		1	07/09/2021	2022.01	07/09/2021 10:23:03 AM Eastern Daylight Time	08/03/2021 06:53:41 PM Eastern Daylight Time	07/30/2021 10:54:56 AM Eastern Daylight Time			08/04/2021 01:27:12 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-078 (PPO)	01	04		1			H5216	078	1	2022	Select Counties in Colorado	Select Counties in Colorado	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)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			1		1	08/01/2021	2022.01	08/01/2021 02:18:54 PM Eastern Daylight Time	08/03/2021 06:54:23 PM Eastern Daylight Time	07/30/2021 10:55:08 AM Eastern Daylight Time			08/04/2021 01:27:12 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-078 (PPO)	01	04		1			H5216	078	2	2022	Select Counties in Colorado	Colorado New Mexico	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)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;8b3;	
H5216	080	1	1	04	01	H5216_080_1	6	1			1		1	08/04/2021	2022.01	08/04/2021 04:55:32 PM Eastern Daylight Time	08/03/2021 07:49:15 PM Eastern Daylight Time	07/30/2021 10:55:20 AM Eastern Daylight Time			08/04/2021 05:50:55 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-080 (PPO)	01	04		1			H5216	080	1	2022	Twin Cities, Rochester, Duluth Areas	Twin Cities, Rochester, Duluth Areas	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		1	07/22/2021	2022.01	07/22/2021 01:18:27 PM Eastern Daylight Time	08/03/2021 07:49:47 PM Eastern Daylight Time	07/30/2021 10:55:34 AM Eastern Daylight Time			08/04/2021 05:50:55 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-080 (PPO)	01	04		1			H5216	080	2	2022	Twin Cities, Rochester, Duluth Areas	Twin Cities, Rochester, Duluth Areas	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	6	1			1		1	08/04/2021	2022.01	08/04/2021 04:56:14 PM Eastern Daylight Time	08/03/2021 07:51:32 PM Eastern Daylight Time	07/30/2021 10:55:46 AM Eastern Daylight Time			08/04/2021 05:50:55 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-080 (PPO)	01	04		1			H5216	080	3	2022	Twin Cities, Rochester, Duluth Areas	Twin Cities, Rochester, Duluth Areas	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		1	07/09/2021	2022.01	07/09/2021 10:50:27 AM Eastern Daylight Time	08/03/2021 05:53:43 PM Eastern Daylight Time	07/30/2021 10:55:58 AM Eastern Daylight Time			08/04/2021 02:38:36 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-081 (PPO)	01	04		1			H5216	081	0	2022	Select Counties in Oklahoma		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	6	1			1		1	07/08/2021	2022.01	07/08/2021 06:49:23 PM Eastern Daylight Time	08/03/2021 05:54:39 PM Eastern Daylight Time	07/30/2021 10:56:10 AM Eastern Daylight Time			08/04/2021 02:05:43 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-083 (PPO)	01	04		1			H5216	083	0	2022	Select Counties in AR, KS, MO, and OK		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	088	0	1	04	01	H5216_088_0	4	1			1		1	08/02/2021	2022.01	08/02/2021 05:56:08 PM Eastern Daylight Time	08/03/2021 07:45:58 PM Eastern Daylight Time	07/30/2021 10:56:22 AM Eastern Daylight Time			08/04/2021 06:08:57 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-088 (PPO)	01	04		1			H5216	088	0	2022	Select Counties in North and South Dakota		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	08/04/2021	2022.01	08/04/2021 02:18:09 PM Eastern Daylight Time	08/03/2021 06:30:41 PM Eastern Daylight Time	07/30/2021 10:56:34 AM Eastern Daylight Time			08/04/2021 02:25:33 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-089 (PPO)	01	04		1			H5216	089	0	2022	Select Counties in Montana		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	6	1			1		1	08/01/2021	2022.01	08/01/2021 12:13:11 PM Eastern Daylight Time	08/03/2021 07:50:20 PM Eastern Daylight Time	07/30/2021 10:56:46 AM Eastern Daylight Time			08/04/2021 05:50:55 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-092 (PPO)	01	04		1			H5216	092	0	2022	Select Counties in MN, ND and SD		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		0	08/02/2021	2022.01	08/02/2021 10:47:00 AM Eastern Daylight Time	08/03/2021 06:48:04 PM Eastern Daylight Time	07/30/2021 10:56:56 AM Eastern Daylight Time			08/04/2021 01:29:26 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-093 (PPO)	01	04		1			H5216	093	0	2022	Memphis Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		0	07/08/2021	2022.01	07/08/2021 03:37:23 PM Eastern Daylight Time	08/03/2021 07:00:35 PM Eastern Daylight Time	07/30/2021 10:57:10 AM Eastern Daylight Time			08/04/2021 01:29:26 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-096 (PPO)	01	04		1			H5216	096	0	2022	Dothan Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		0	07/08/2021	2022.01	07/08/2021 03:38:18 PM Eastern Daylight Time	08/03/2021 06:48:33 PM Eastern Daylight Time	07/30/2021 10:57:22 AM Eastern Daylight Time			08/04/2021 01:29:26 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-097 (PPO)	01	04		1			H5216	097	0	2022	Nashville Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		0	08/02/2021	2022.01	08/02/2021 10:45:47 AM Eastern Daylight Time	08/03/2021 06:49:00 PM Eastern Daylight Time	07/30/2021 10:57:32 AM Eastern Daylight Time			08/04/2021 01:29:26 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-098 (PPO)	01	04		1			H5216	098	0	2022	Chattanooga Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		1	08/01/2021	2022.01	08/01/2021 12:38:08 PM Eastern Daylight Time	08/03/2021 06:49:30 PM Eastern Daylight Time	07/30/2021 10:57:44 AM Eastern Daylight Time			08/04/2021 01:29:26 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-099 (PPO)	01	04		1			H5216	099	0	2022	Knoxville Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		0	08/01/2021	2022.01	08/01/2021 12:34:36 PM Eastern Daylight Time	08/03/2021 06:49:59 PM Eastern Daylight Time	07/30/2021 10:57:56 AM Eastern Daylight Time			08/04/2021 01:29:26 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-100 (PPO)	01	04		1			H5216	100	0	2022	Select Counties in the Tri-Cities Area of Virginia		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		1	07/22/2021	2022.01	07/22/2021 01:22:42 PM Eastern Daylight Time	08/03/2021 08:19:58 PM Eastern Daylight Time	07/30/2021 10:58:08 AM Eastern Daylight Time			08/04/2021 06:08:57 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-103 (PPO)	01	04		1			H5216	103	0	2022	Select Counties in North Dakota and South Dakota		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			2	0	0	07/22/2021	2022.01	07/22/2021 01:24:01 PM Eastern Daylight Time	07/22/2021 10:02:57 AM Eastern Daylight Time				07/22/2021 01:33:34 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-105 (PPO)	01	04		1			H5216	105	0	2022	Kentucky and West Virginia		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_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	5	1			1		1	07/31/2021	2022.01	07/31/2021 02:55:53 PM Eastern Daylight Time	08/03/2021 05:52:02 PM Eastern Daylight Time	07/30/2021 10:58:20 AM Eastern Daylight Time			08/04/2021 02:32:00 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-106 (PPO)	01	04		1			H5216	106	0	2022	Select counties in Northeast Ohio		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		0	08/04/2021	2022.01	08/04/2021 01:43:14 PM Eastern Daylight Time	08/03/2021 05:39:51 PM Eastern Daylight Time	07/30/2021 10:58:30 AM Eastern Daylight Time			08/04/2021 01:49:58 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-107 (PPO)	01	04		1			H5216	107	0	2022	Select counties in Kentucky		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		0	07/31/2021	2022.01	07/31/2021 02:56:05 PM Eastern Daylight Time	08/03/2021 05:53:11 PM Eastern Daylight Time	07/30/2021 10:58:42 AM Eastern Daylight Time			08/04/2021 02:32:00 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-109 (PPO)	01	04		1			H5216	109	0	2022	Ohio & N KY		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		1	07/31/2021	2022.01	07/31/2021 02:53:07 PM Eastern Daylight Time	08/03/2021 05:54:51 PM Eastern Daylight Time	07/30/2021 10:58:54 AM Eastern Daylight Time			08/04/2021 02:05:54 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-111 (PPO)	01	04		1			H5216	111	0	2022	Select Counties in Indiana and Kentucky		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	08/02/2021	2022.01	08/02/2021 03:11:03 PM Eastern Daylight Time	08/03/2021 05:59:41 PM Eastern Daylight Time	07/30/2021 10:59:06 AM Eastern Daylight Time			08/04/2021 02:05:54 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-112 (PPO)	01	04		1			H5216	112	0	2022	Select counties in Northeast and Fort Wayne IN		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		1	07/31/2021	2022.01	07/31/2021 02:53:33 PM Eastern Daylight Time	08/03/2021 05:56:34 PM Eastern Daylight Time	07/30/2021 10:59:18 AM Eastern Daylight Time			08/04/2021 02:05:54 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-114 (PPO)	01	04		1			H5216	114	0	2022	Select counties in Indianapolis		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		0	08/01/2021	2022.01	08/01/2021 11:08:57 AM Eastern Daylight Time	08/03/2021 05:41:35 PM Eastern Daylight Time	07/30/2021 10:59:30 AM Eastern Daylight Time			08/04/2021 01:49:58 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Value Plus H5216-115 (PPO)	01	04		1			H5216	115	0	2022	Select counties in Kentucky		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			2	0	0	07/23/2021	2022.01	07/23/2021 03:35:05 PM Eastern Daylight Time	07/24/2021 02:24:21 PM Eastern Daylight Time				07/26/2021 03:29:03 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-116 (PPO)	01	04		1			H5216	116	0	2022	Select Counties in Pennsylvania and New Jersey		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_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	4	1			1		0	07/08/2021	2022.01	07/08/2021 05:10:02 PM Eastern Daylight Time	08/03/2021 05:42:47 PM Eastern Daylight Time	07/30/2021 10:59:44 AM Eastern Daylight Time			08/04/2021 01:53:48 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Value Plus H5216-117 (PPO)	01	04		1			H5216	117	0	2022	Greater Pittsburgh Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	6	1			1		0	08/05/2021	2022.01	08/05/2021 01:40:14 PM Eastern Daylight Time	08/03/2021 05:43:31 PM Eastern Daylight Time	07/30/2021 10:59:56 AM Eastern Daylight Time			08/05/2021 03:49:12 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-120 (PPO)	01	04		1			H5216	120	0	2022	South Central Pennsylvania Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	124	0	1	04	01	H5216_124_0	6	1			1		0	08/05/2021	2022.01	08/05/2021 01:39:54 PM Eastern Daylight Time	08/03/2021 05:40:12 PM Eastern Daylight Time	08/05/2021 08:58:32 AM Eastern Daylight Time			08/05/2021 03:49:12 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-124 (PPO)	01	04		1			H5216	124	0	2022	Select counties in West Virginia		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		0	07/08/2021	2022.01	07/08/2021 05:27:33 PM Eastern Daylight Time	08/03/2021 05:43:09 PM Eastern Daylight Time	07/30/2021 11:00:20 AM Eastern Daylight Time			08/04/2021 01:53:48 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Value Plus H5216-125 (PPO)	01	04		1			H5216	125	0	2022	Select counties in West Virginia		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	128	0	1	04	01	H5216_128_0	2	1			2	0	0	06/03/2021	2022.01	06/03/2021 03:05:00 PM Eastern Daylight Time	07/22/2021 10:06:24 AM Eastern Daylight Time				07/22/2021 02:32:02 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Honor (PPO)	01	04		1			H5216	128	0	2022	Select Counties in Texas		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_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			2	0	0	07/22/2021	2022.01	07/22/2021 01:35:49 PM Eastern Daylight Time	07/22/2021 08:47:55 AM Eastern Daylight Time				07/22/2021 02:02:24 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Honor (PPO)	01	04		1			H5216	129	0	2022	Delaware and Maryland		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_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			1		1	08/02/2021	2022.01	08/02/2021 01:31:15 PM Eastern Daylight Time	08/03/2021 06:55:47 PM Eastern Daylight Time	07/30/2021 11:00:30 AM Eastern Daylight Time			08/04/2021 02:48:19 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-131 (PPO)	01	04		1			H5216	131	0	2022	Davis, Salt Lake, Utah and Weber Counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		1	08/02/2021	2022.01	08/02/2021 01:41:14 PM Eastern Daylight Time	08/03/2021 06:57:24 PM Eastern Daylight Time	07/30/2021 11:00:42 AM Eastern Daylight Time			08/04/2021 02:48:19 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-132 (PPO)	01	04		1			H5216	132	0	2022	Select Counties in Idaho and Malheur County Oregon		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	6	1			1		0	07/20/2021	2022.01	07/20/2021 09:53:43 AM Eastern Daylight Time	08/03/2021 06:02:59 PM Eastern Daylight Time	07/30/2021 11:00:54 AM Eastern Daylight Time			08/04/2021 02:05:54 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-133 (PPO)	01	04		1			H5216	133	0	2022	Macomb, Oakland and Wayne counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		1	08/03/2021	2022.01	08/03/2021 01:41:10 PM Eastern Daylight Time	08/03/2021 06:37:49 PM Eastern Daylight Time	07/30/2021 11:01:06 AM Eastern Daylight Time			08/04/2021 02:59:21 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-136 (PPO)	01	04		1			H5216	136	0	2022	Select Counties in Mississippi		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		1	07/31/2021	2022.01	07/31/2021 02:18:42 PM Eastern Daylight Time	08/03/2021 06:55:12 PM Eastern Daylight Time	07/30/2021 11:01:18 AM Eastern Daylight Time			08/04/2021 01:27:12 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-137 (PPO)	01	04		1			H5216	137	0	2022	Select Counties in New Mexico, Colorado, & Arizona		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	6	1			1		0	07/22/2021	2022.01	07/22/2021 02:18:50 PM Eastern Daylight Time	08/03/2021 05:59:21 PM Eastern Daylight Time	07/30/2021 11:01:28 AM Eastern Daylight Time			08/04/2021 02:16:27 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-138 (PPO)	01	04		1			H5216	138	0	2022	ME and NH. Select Counties in MA and VT		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			2	0	0	06/03/2021	2022.01	06/03/2021 03:17:39 PM Eastern Daylight Time	07/22/2021 09:53:42 AM Eastern Daylight Time				07/22/2021 02:09:09 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Honor (PPO)	01	04		1			H5216	140	0	2022	Select Counties in AR, IL, KS, MO, and OK		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_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			1		0	07/08/2021	2022.01	07/08/2021 03:37:30 PM Eastern Daylight Time	08/03/2021 07:37:51 PM Eastern Daylight Time	07/30/2021 11:01:40 AM Eastern Daylight Time			08/04/2021 02:51:23 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-141 (PPO)	01	04		1			H5216	141	0	2022	Clark and Nye (partial) counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		0	08/11/2021	2022.01	08/11/2021 01:27:54 PM Eastern Daylight Time	08/03/2021 05:33:21 PM Eastern Daylight Time	07/30/2021 11:01:52 AM Eastern Daylight Time			08/11/2021 04:47:20 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-142 (PPO)	01	04		1			H5216	142	1	2022	Select Counties in Georgia and South Carolina	Select counties in Georgia and South Carolina	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		0	07/22/2021	2022.01	07/22/2021 04:56:12 PM Eastern Daylight Time	08/03/2021 05:33:43 PM Eastern Daylight Time	07/30/2021 11:02:04 AM Eastern Daylight Time			08/04/2021 01:38:25 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-142 (PPO)	01	04		1			H5216	142	2	2022	Select Counties in Georgia and South Carolina	Select Counties in Georgia and South Carolina	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		1	08/02/2021	2022.01	08/02/2021 11:44:17 AM Eastern Daylight Time	08/03/2021 05:34:02 PM Eastern Daylight Time	07/30/2021 11:02:14 AM Eastern Daylight Time			08/04/2021 02:06:50 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-143 (PPO)	01	04		1			H5216	143	0	2022	Select counties in Georgia		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		1	07/08/2021	2022.01	07/08/2021 04:01:11 PM Eastern Daylight Time	08/03/2021 10:07:30 PM Eastern Daylight Time	07/30/2021 11:02:26 AM Eastern Daylight Time			08/04/2021 02:09:43 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-144 (PPO)	01	04		1			H5216	144	0	2022	Richmond-Tidewater Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	7	1			1		0	07/29/2021	2022.01	07/29/2021 12:05:59 PM Eastern Daylight Time	08/03/2021 10:06:48 PM Eastern Daylight Time	07/30/2021 11:02:38 AM Eastern Daylight Time			08/04/2021 02:09:43 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-149 (PPO)	01	04		1			H5216	149	0	2022	Lynchburg - Winchester Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1				0	0	08/05/2021	2022.01	08/05/2021 11:59:21 AM Eastern Daylight Time	07/23/2021 04:31:34 PM Eastern Daylight Time				08/05/2021 01:49:17 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-152 (PPO)	01	04		1			H5216	152	0	2022	Virginia		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_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	154	0	1	04	01	H5216_154_0	4	1			1		1	07/31/2021	2022.01	07/31/2021 03:05:37 PM Eastern Daylight Time	08/03/2021 05:34:23 PM Eastern Daylight Time	07/30/2021 11:02:50 AM Eastern Daylight Time			08/04/2021 02:06:50 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-154 (PPO)	01	04		1			H5216	154	0	2022	Select Counties in Georgia and South Carolina		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	2	1			2	0	0	07/22/2021	2022.01	07/22/2021 04:26:18 PM Eastern Daylight Time	07/22/2021 09:02:48 AM Eastern Daylight Time				07/22/2021 04:34:19 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-157 (PPO)	01	04		1			H5216	157	0	2022	Select Counties in Georgia and South Carolina		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_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	5	1			1		0	07/15/2021	2022.01	07/15/2021 03:34:24 PM Eastern Daylight Time	08/03/2021 06:41:07 PM Eastern Daylight Time	07/30/2021 11:03:02 AM Eastern Daylight Time			08/04/2021 02:59:21 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-158 (PPO)	01	04		1			H5216	158	0	2022	Select Counties in Mississippi		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		0	07/08/2021	2022.01	07/08/2021 04:56:37 PM Eastern Daylight Time	08/03/2021 06:42:02 PM Eastern Daylight Time	07/30/2021 11:03:12 AM Eastern Daylight Time			08/04/2021 02:59:21 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Value Plus H5216-160 (PPO)	01	04		1			H5216	160	0	2022	Select Counties in Mississippi		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		0	07/23/2021	2022.01	07/23/2021 09:48:32 AM Eastern Daylight Time	08/03/2021 06:43:04 PM Eastern Daylight Time	07/30/2021 11:03:24 AM Eastern Daylight Time			08/04/2021 02:44:49 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Value Plus H5216-161 (PPO)	01	04		1			H5216	161	0	2022	Select Louisiana Parishes		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	07/08/2021	2022.01	07/08/2021 06:51:05 PM Eastern Daylight Time	08/03/2021 05:31:38 PM Eastern Daylight Time	07/30/2021 11:03:36 AM Eastern Daylight Time			08/04/2021 02:05:43 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-163 (PPO)	01	04		1			H5216	163	0	2022	Select Counties in Arkansas, Kansas and Missouri		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	7	1	2	1	1		0	07/23/2021	2022.01	07/23/2021 01:44:23 PM Eastern Daylight Time	08/03/2021 05:55:44 PM Eastern Daylight Time	07/30/2021 11:03:48 AM Eastern Daylight Time			08/04/2021 02:38:36 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice SNP-DE H5216-164 (PPO D-SNP)	01	04		1			H5216	164	0	2022	Select Counties in Missouri		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	7	1			1		0	07/21/2021	2022.01	07/21/2021 05:03:06 PM Eastern Daylight Time	08/03/2021 06:29:25 PM Eastern Daylight Time	07/30/2021 11:03:58 AM Eastern Daylight Time			08/04/2021 02:05:43 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Value Plus H5216-165 (PPO)	01	04		1			H5216	165	0	2022	Select Counties in Arkansas		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	7	1			1		0	07/19/2021	2022.01	07/19/2021 04:43:15 PM Eastern Daylight Time	08/03/2021 05:48:38 PM Eastern Daylight Time	07/30/2021 11:04:10 AM Eastern Daylight Time			08/04/2021 02:38:36 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Value Plus H5216-166 (PPO)	01	04		1			H5216	166	0	2022	Select Counties in Kansas		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	08/01/2021	2022.01	08/01/2021 01:01:11 PM Eastern Daylight Time	08/03/2021 08:21:40 PM Eastern Daylight Time	07/30/2021 11:04:22 AM Eastern Daylight Time			08/04/2021 06:29:06 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-167 (PPO)	01	04		1			H5216	167	0	2022	Select Counties in Minnesota		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		1	08/11/2021	2022.01	08/11/2021 02:32:17 PM Eastern Daylight Time	08/03/2021 08:23:21 PM Eastern Daylight Time	07/30/2021 11:04:34 AM Eastern Daylight Time			08/11/2021 03:23:17 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-168 (PPO)	01	04		1			H5216	168	0	2022	Select Counties in Wisconsin		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		0	08/03/2021	2022.01	08/03/2021 11:22:00 AM Eastern Daylight Time	08/03/2021 05:47:37 PM Eastern Daylight Time	07/30/2021 11:04:46 AM Eastern Daylight Time			08/04/2021 01:51:34 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-169 (PPO)	01	04		1			H5216	169	0	2022	Select Counties in New Jersey		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		1	08/03/2021	2022.01	08/03/2021 04:36:09 PM Eastern Daylight Time	08/03/2021 05:47:17 PM Eastern Daylight Time	07/30/2021 11:04:56 AM Eastern Daylight Time			08/04/2021 01:51:34 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-170 (PPO)	01	04		1			H5216	170	0	2022	Select Counties in New Jersey		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		0	07/08/2021	2022.01	07/08/2021 06:57:58 PM Eastern Daylight Time	08/03/2021 05:58:29 PM Eastern Daylight Time	07/30/2021 11:05:08 AM Eastern Daylight Time			08/04/2021 02:05:43 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Value Plus H5216-171 (PPO)	01	04		1			H5216	171	0	2022	Select Counties in IA, NE, ND, and SD		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		0	08/03/2021	2022.01	08/03/2021 11:23:29 AM Eastern Daylight Time	08/03/2021 05:47:57 PM Eastern Daylight Time	07/30/2021 11:05:20 AM Eastern Daylight Time			08/04/2021 01:51:34 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-172 (PPO)	01	04		1			H5216	172	0	2022	Select Counties in New Jersey		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		0	07/21/2021	2022.01	07/21/2021 04:31:54 PM Eastern Daylight Time	08/03/2021 08:25:02 PM Eastern Daylight Time	07/30/2021 11:05:32 AM Eastern Daylight Time			08/04/2021 06:08:57 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Value Plus H5216-173 (PPO)	01	04		1			H5216	173	0	2022	Select Counties in Wisconsin		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			2	0	0	07/22/2021	2022.01	07/22/2021 01:27:55 PM Eastern Daylight Time	07/21/2021 02:54:43 PM Eastern Daylight Time				07/22/2021 01:34:49 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Honor (PPO)	01	04		1			H5216	174	0	2022	Select Counties in New Jersey		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_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	4	1			1		0	08/01/2021	2022.01	08/01/2021 12:55:18 PM Eastern Daylight Time	08/03/2021 05:48:16 PM Eastern Daylight Time	07/30/2021 11:05:44 AM Eastern Daylight Time			08/04/2021 02:16:27 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-175 (PPO)	01	04		1			H5216	175	0	2022	Maine		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		0	07/23/2021	2022.01	07/23/2021 01:25:36 PM Eastern Daylight Time	08/03/2021 08:26:33 PM Eastern Daylight Time	07/30/2021 11:05:56 AM Eastern Daylight Time			08/04/2021 06:08:57 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Value Plus H5216-176 (PPO)	01	04		1			H5216	176	0	2022	Select Counties in Minnesota		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	08/01/2021	2022.01	08/01/2021 12:55:37 PM Eastern Daylight Time	08/03/2021 05:48:36 PM Eastern Daylight Time	07/30/2021 11:06:06 AM Eastern Daylight Time			08/04/2021 02:16:27 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-177 (PPO)	01	04		1			H5216	177	0	2022	Maine		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	179	0	1	04	01	H5216_179_0	5	1			1		0	08/01/2021	2022.01	08/01/2021 12:38:38 PM Eastern Daylight Time	08/03/2021 06:59:46 PM Eastern Daylight Time	07/30/2021 11:06:18 AM Eastern Daylight Time			08/04/2021 01:29:26 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-179 (PPO)	01	04		1			H5216	179	0	2022	Select Counties in Alabama		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		0	08/01/2021	2022.01	08/01/2021 12:39:01 PM Eastern Daylight Time	08/03/2021 06:51:55 PM Eastern Daylight Time	07/30/2021 11:06:30 AM Eastern Daylight Time			08/04/2021 01:29:26 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-180 (PPO)	01	04		1			H5216	180	0	2022	Select Counties in TN		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	6	1			1		0	08/01/2021	2022.01	08/01/2021 12:39:33 PM Eastern Daylight Time	08/03/2021 06:53:03 PM Eastern Daylight Time	07/30/2021 11:06:42 AM Eastern Daylight Time			08/04/2021 01:29:26 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-181 (PPO)	01	04		1			H5216	181	0	2022	Select VA Counties in the Tri-Cities Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		0	08/02/2021	2022.01	08/02/2021 12:37:58 PM Eastern Daylight Time	08/03/2021 05:47:39 PM Eastern Daylight Time	07/30/2021 11:06:52 AM Eastern Daylight Time			08/04/2021 03:19:53 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-182 (PPO)	01	04		1			H5216	182	0	2022	West Virginia		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	6	1			1		1	08/05/2021	2022.01	08/05/2021 01:43:41 PM Eastern Daylight Time	08/03/2021 05:48:00 PM Eastern Daylight Time	07/30/2021 11:07:04 AM Eastern Daylight Time			08/05/2021 03:43:52 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-185 (PPO)	01	04		1			H5216	185	0	2022	Select Counties in New Jersey		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	6	1			1		0	08/05/2021	2022.01	08/05/2021 01:44:06 PM Eastern Daylight Time	08/03/2021 05:48:19 PM Eastern Daylight Time	07/30/2021 11:07:16 AM Eastern Daylight Time			08/05/2021 03:43:52 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-186 (PPO)	01	04		1			H5216	186	0	2022	Select Counties in New Jersey		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	08/04/2021	2022.01	08/04/2021 01:43:22 PM Eastern Daylight Time	08/03/2021 05:46:31 PM Eastern Daylight Time	07/30/2021 11:07:28 AM Eastern Daylight Time			08/04/2021 01:49:58 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-188 (PPO)	01	04		1			H5216	188	0	2022	Select Counties in Indiana and Kentucky		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		1	08/04/2021	2022.01	08/04/2021 02:40:44 PM Eastern Daylight Time	08/03/2021 07:01:50 PM Eastern Daylight Time	07/30/2021 11:07:40 AM Eastern Daylight Time			08/04/2021 02:48:19 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-189 (PPO)	01	04		1			H5216	189	0	2022	Iron and Washington counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			2	0	0	07/15/2021	2022.01	07/15/2021 04:30:09 PM Eastern Daylight Time	07/22/2021 09:53:09 AM Eastern Daylight Time				07/22/2021 01:39:37 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Honor (PPO)	01	04		1			H5216	190	0	2022	Select counties in Michigan		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_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			1		1	08/02/2021	2022.01	08/02/2021 03:40:42 PM Eastern Daylight Time	08/03/2021 06:09:28 PM Eastern Daylight Time	07/30/2021 11:07:50 AM Eastern Daylight Time			08/04/2021 01:32:44 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-192 (PPO)	01	04		1			H5216	192	0	2022	Select counties in Indiana		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		0	07/08/2021	2022.01	07/08/2021 04:06:29 PM Eastern Daylight Time	08/03/2021 06:13:10 PM Eastern Daylight Time	07/30/2021 11:08:02 AM Eastern Daylight Time			08/04/2021 01:32:44 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Value Plus H5216-193 (PPO)	01	04		1			H5216	193	0	2022	Select counties in Indiana		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		0	07/08/2021	2022.01	07/08/2021 03:38:31 PM Eastern Daylight Time	08/03/2021 07:39:52 PM Eastern Daylight Time	07/30/2021 11:08:14 AM Eastern Daylight Time			08/04/2021 02:51:23 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-194 (PPO)	01	04		1			H5216	194	0	2022	Select Counties in Nevada		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		0	07/23/2021	2022.01	07/23/2021 09:54:43 AM Eastern Daylight Time	08/03/2021 07:10:34 PM Eastern Daylight Time	07/30/2021 11:08:26 AM Eastern Daylight Time			08/04/2021 01:27:12 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Value Plus H5216-195 (PPO)	01	04		1			H5216	195	0	2022	Colorado		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		1	07/31/2021	2022.01	07/31/2021 02:34:29 PM Eastern Daylight Time	08/03/2021 07:22:19 PM Eastern Daylight Time	07/30/2021 11:08:36 AM Eastern Daylight Time			08/04/2021 01:27:12 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-196 (PPO)	01	04		1			H5216	196	1	2022	New Mexico	Southern New Mexico	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)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;8b3;	
H5216	196	2	1	04	01	H5216_196_2	4	1			1		1	07/31/2021	2022.01	07/31/2021 02:28:26 PM Eastern Daylight Time	08/03/2021 07:07:45 PM Eastern Daylight Time	07/30/2021 11:08:48 AM Eastern Daylight Time			08/04/2021 01:27:12 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-196 (PPO)	01	04		1			H5216	196	2	2022	New Mexico	Greater New Mexico	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)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;8b3;	
H5216	197	0	1	04	01	H5216_197_0	5	1			1		0	07/23/2021	2022.01	07/23/2021 03:15:27 PM Eastern Daylight Time	08/03/2021 06:55:51 PM Eastern Daylight Time	07/30/2021 11:09:00 AM Eastern Daylight Time			08/04/2021 01:36:12 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Value Plus H5216-197 (PPO)	01	04		1			H5216	197	0	2022	Select counties in Arizona		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		1	07/31/2021	2022.01	07/31/2021 02:29:46 PM Eastern Daylight Time	08/03/2021 06:56:26 PM Eastern Daylight Time	07/30/2021 11:09:12 AM Eastern Daylight Time			08/04/2021 01:36:12 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-198 (PPO)	01	04		1			H5216	198	0	2022	Select Counties in Arizona		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		0	07/15/2021	2022.01	07/15/2021 02:19:52 PM Eastern Daylight Time	08/03/2021 07:00:31 PM Eastern Daylight Time	07/30/2021 11:09:22 AM Eastern Daylight Time			08/04/2021 01:36:12 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Value Plus H5216-199 (PPO)	01	04		1			H5216	199	0	2022	Select counties in New Mexico		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	200	0	1	04	01	H5216_200_0	2	1			2	0	0	06/04/2021	2022.01	06/04/2021 02:01:10 PM Eastern Daylight Time	07/22/2021 10:23:50 AM Eastern Daylight Time				07/22/2021 04:38:03 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Honor (PPO)	01	04		1			H5216	200	0	2022	Select Counties in Mississippi		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_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	201	0	1	04	01	H5216_201_0	2	1			2	0	0	06/03/2021	2022.01	06/03/2021 03:59:26 PM Eastern Daylight Time	07/22/2021 10:26:02 AM Eastern Daylight Time				07/22/2021 04:54:00 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Honor (PPO)	01	04		1			H5216	201	0	2022	Louisiana Statewide		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_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	202	0	1	04	01	H5216_202_0	5	1			1		1	08/01/2021	2022.01	08/01/2021 02:03:00 PM Eastern Daylight Time	08/03/2021 06:45:32 PM Eastern Daylight Time	07/30/2021 11:09:34 AM Eastern Daylight Time			08/04/2021 02:44:49 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-202 (PPO)	01	04		1			H5216	202	0	2022	Select Parishes in Louisiana		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	203	1	1	04	01	H5216_203_1	4	1			1		1	07/31/2021	2022.01	07/31/2021 02:59:46 PM Eastern Daylight Time	08/03/2021 05:47:26 PM Eastern Daylight Time	07/30/2021 11:09:46 AM Eastern Daylight Time			08/04/2021 01:38:25 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-203 (PPO)	01	04		1			H5216	203	1	2022	Select counties in Georgia	Select counties in Georgia	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	203	2	1	04	01	H5216_203_2	4	1			1		1	07/31/2021	2022.01	07/31/2021 03:00:32 PM Eastern Daylight Time	08/03/2021 05:53:53 PM Eastern Daylight Time	07/30/2021 11:09:58 AM Eastern Daylight Time			08/04/2021 01:38:25 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-203 (PPO)	01	04		1			H5216	203	2	2022	Select counties in Georgia	Macon and Albany Area	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	205	0	1	04	01	H5216_205_0	7	1	2	1	1		0	07/22/2021	2022.01	07/22/2021 04:56:31 PM Eastern Daylight Time	08/03/2021 05:34:45 PM Eastern Daylight Time	07/30/2021 11:10:08 AM Eastern Daylight Time			08/04/2021 01:38:25 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice SNP-DE H5216-205 (PPO D-SNP)	01	04		1			H5216	205	0	2022	Select Counties in Georgia		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	206	0	1	04	01	H5216_206_0	4	1	2	1	1		0	07/22/2021	2022.01	07/22/2021 04:26:25 PM Eastern Daylight Time	08/03/2021 05:35:02 PM Eastern Daylight Time	07/30/2021 11:10:20 AM Eastern Daylight Time			08/04/2021 02:06:50 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice SNP-DE H5216-206 (PPO D-SNP)	01	04		1			H5216	206	0	2022	Select Counties in Georgia		2		2			1	3		2		2	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	207	0	1	04	01	H5216_207_0	4	1			1		1	08/02/2021	2022.01	08/02/2021 11:55:14 AM Eastern Daylight Time	08/03/2021 05:47:07 PM Eastern Daylight Time	07/30/2021 11:10:32 AM Eastern Daylight Time			08/04/2021 02:06:50 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-207 (PPO)	01	04		1			H5216	207	0	2022	Select Counties in Georgia		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	211	0	1	04	01	H5216_211_0	5	1			1		1	07/22/2021	2022.01	07/22/2021 01:36:32 PM Eastern Daylight Time	08/03/2021 10:12:08 PM Eastern Daylight Time	07/30/2021 11:10:42 AM Eastern Daylight Time			08/04/2021 02:09:43 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-211 (PPO)	01	04		1			H5216	211	0	2022	North Carolina		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	212	0	1	04	01	H5216_212_0	4	1			1		0	08/02/2021	2022.01	08/02/2021 10:48:33 AM Eastern Daylight Time	08/03/2021 06:53:33 PM Eastern Daylight Time	07/30/2021 11:10:54 AM Eastern Daylight Time			08/04/2021 01:41:24 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-212 (PPO)	01	04		1			H5216	212	0	2022	East Alabama		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	213	0	1	04	01	H5216_213_0	2	1			2	0	0	06/03/2021	2022.01	06/03/2021 02:06:19 PM Eastern Daylight Time	07/22/2021 09:06:11 AM Eastern Daylight Time				07/22/2021 03:38:57 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Honor (PPO)	01	04		1			H5216	213	0	2022	Select Counties in Arizona, Colorado, New Mexico		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_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	214	1	1	04	01	H5216_214_1	4	1			1		0	08/02/2021	2022.01	08/02/2021 10:49:33 AM Eastern Daylight Time	08/03/2021 06:54:58 PM Eastern Daylight Time	07/30/2021 11:11:06 AM Eastern Daylight Time			08/04/2021 01:41:24 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-214 (PPO)	01	04		1			H5216	214	1	2022	Select Counties in Alabama	Select Counties in Alabama	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	214	2	1	04	01	H5216_214_2	4	1			1		0	08/02/2021	2022.01	08/02/2021 10:50:13 AM Eastern Daylight Time	08/03/2021 06:54:30 PM Eastern Daylight Time	07/30/2021 11:11:18 AM Eastern Daylight Time			08/04/2021 01:41:24 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-214 (PPO)	01	04		1			H5216	214	2	2022	Select Counties in Alabama	Select Counties in Alabama	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	214	3	1	04	01	H5216_214_3	4	1			1		0	08/02/2021	2022.01	08/02/2021 10:51:09 AM Eastern Daylight Time	08/03/2021 06:54:01 PM Eastern Daylight Time	07/30/2021 11:11:28 AM Eastern Daylight Time			08/04/2021 01:41:24 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-214 (PPO)	01	04		1			H5216	214	3	2022	Select Counties in Alabama	Select Counties in Alabama	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	215	0	1	04	01	H5216_215_0	4	1			1		1	08/03/2021	2022.01	08/03/2021 02:18:47 PM Eastern Daylight Time	08/03/2021 08:30:23 PM Eastern Daylight Time	07/30/2021 11:11:40 AM Eastern Daylight Time			08/04/2021 05:50:55 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-215 (PPO)	01	04		1			H5216	215	0	2022	Select Counties in Illinois		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	216	0	1	04	01	H5216_216_0	2	1			2	0	0	06/03/2021	2022.01	06/03/2021 02:16:45 PM Eastern Daylight Time	07/22/2021 09:08:22 AM Eastern Daylight Time				07/22/2021 04:15:55 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Honor (PPO)	01	04		1			H5216	216	0	2022	Select Counties in Nevada		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_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	217	0	1	04	01	H5216_217_0	3	1			2	0	0	07/22/2021	2022.01	07/22/2021 04:56:38 PM Eastern Daylight Time	07/22/2021 09:05:36 AM Eastern Daylight Time				07/22/2021 05:05:16 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Honor (PPO)	01	04		1			H5216	217	0	2022	Select Counties in Georgia and South Carolina		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_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	218	0	1	04	01	H5216_218_0	3	1			2	0	0	07/15/2021	2022.01	07/15/2021 05:11:36 PM Eastern Daylight Time	07/22/2021 10:16:10 AM Eastern Daylight Time				07/22/2021 01:18:21 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Honor (PPO)	01	04		1			H5216	218	0	2022	States of Indiana and Ohio		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_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	219	0	1	04	01	H5216_219_0	7	1	2	1	1		0	07/23/2021	2022.01	07/23/2021 01:41:55 PM Eastern Daylight Time	08/03/2021 06:04:23 PM Eastern Daylight Time	07/30/2021 11:11:52 AM Eastern Daylight Time			08/04/2021 02:05:43 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice SNP-DE H5216-219 (PPO D-SNP)	01	04		1			H5216	219	0	2022	Select Counties in Arkansas		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	220	0	1	04	01	H5216_220_0	7	1	2	1	1		0	07/20/2021	2022.01	07/20/2021 01:31:47 PM Eastern Daylight Time	08/03/2021 05:49:29 PM Eastern Daylight Time	07/30/2021 11:12:04 AM Eastern Daylight Time			08/04/2021 02:16:11 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice SNP-DE H5216-220 (PPO D-SNP)	01	04		1			H5216	220	0	2022	Select Counties in West Virginia		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	221	0	1	04	01	H5216_221_0	2	1			2	0	0	06/03/2021	2022.01	06/03/2021 02:11:33 PM Eastern Daylight Time	07/22/2021 10:15:30 AM Eastern Daylight Time				07/22/2021 03:04:08 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Honor (PPO)	01	04		1			H5216	221	0	2022	Select Counties in Pennsylvania and New Jersey		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_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	222	0	1	04	01	H5216_222_0	4	1			1		1	08/04/2021	2022.01	08/04/2021 02:40:55 PM Eastern Daylight Time	08/03/2021 07:03:17 PM Eastern Daylight Time	07/30/2021 11:12:16 AM Eastern Daylight Time			08/04/2021 02:56:32 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-222 (PPO)	01	04		1			H5216	222	0	2022	Bannock, Bingham and Bonneville counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	223	0	1	04	01	H5216_223_0	4	1			1		1	07/31/2021	2022.01	07/31/2021 02:04:53 PM Eastern Daylight Time	08/03/2021 07:23:29 PM Eastern Daylight Time	07/30/2021 11:12:26 AM Eastern Daylight Time			08/04/2021 01:05:01 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-223 (PPO)	01	04		1			H5216	223	0	2022	Greater Colorado		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)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;8b3;	
H5216	224	0	1	04	01	H5216_224_0	5	1			1		1	07/15/2021	2022.01	07/15/2021 02:41:20 PM Eastern Daylight Time	08/03/2021 07:12:32 PM Eastern Daylight Time	07/30/2021 11:12:38 AM Eastern Daylight Time			08/04/2021 01:05:01 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-224 (PPO)	01	04		1			H5216	224	0	2022	Southern Arizona		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	225	0	1	04	01	H5216_225_0	2	1			2	0	0	07/22/2021	2022.01	07/22/2021 01:24:27 PM Eastern Daylight Time	07/22/2021 10:18:12 AM Eastern Daylight Time				07/22/2021 01:33:34 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Honor (PPO)	01	04		1			H5216	225	0	2022	Kentucky and West Virginia		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_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	226	0	1	04	01	H5216_226_0	4	1			1		0	08/02/2021	2022.01	08/02/2021 11:50:01 AM Eastern Daylight Time	08/03/2021 05:50:41 PM Eastern Daylight Time	07/30/2021 11:12:50 AM Eastern Daylight Time			08/04/2021 01:49:58 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-226 (PPO)	01	04		1			H5216	226	0	2022	Rural Kentucky		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	227	0	1	04	01	H5216_227_0	6	1	2	1	1		0	07/20/2021	2022.01	07/20/2021 01:33:12 PM Eastern Daylight Time	08/03/2021 06:01:58 PM Eastern Daylight Time	07/30/2021 11:13:02 AM Eastern Daylight Time			08/04/2021 01:53:48 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice SNP-DE H5216-227 (PPO D-SNP)	01	04		1			H5216	227	0	2022	Select Counties in Pennsylvania		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	228	0	1	04	01	H5216_228_0	8	1	2	1	1		0	08/02/2021	2022.01	08/02/2021 12:32:35 PM Eastern Daylight Time	08/03/2021 06:09:35 PM Eastern Daylight Time	07/30/2021 11:13:14 AM Eastern Daylight Time			08/04/2021 02:38:36 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice SNP-DE H5216-228 (PPO D-SNP)	01	04		1			H5216	228	0	2022	Select Counties in Oklahoma		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	229	0	1	04	01	H5216_229_0	5	1			1		1	07/31/2021	2022.01	07/31/2021 02:53:44 PM Eastern Daylight Time	08/03/2021 06:22:46 PM Eastern Daylight Time	07/30/2021 11:13:26 AM Eastern Daylight Time			08/04/2021 02:05:54 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-229 (PPO)	01	04		1			H5216	229	0	2022	Northwest/Southern Indiana		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	230	0	1	04	01	H5216_230_0	5	1			1		0	08/01/2021	2022.01	08/01/2021 12:46:11 PM Eastern Daylight Time	08/03/2021 06:11:21 PM Eastern Daylight Time	07/30/2021 11:13:36 AM Eastern Daylight Time			08/04/2021 02:54:56 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-230 (PPO)	01	04		1			H5216	230	0	2022	Select Counties in Oklahoma		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	231	0	1	04	01	H5216_231_0	6	1			1		0	08/01/2021	2022.01	08/01/2021 01:15:29 PM Eastern Daylight Time	08/03/2021 06:26:01 PM Eastern Daylight Time	07/30/2021 11:13:48 AM Eastern Daylight Time			08/04/2021 02:23:59 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-231 (PPO)	01	04		1			H5216	231	0	2022	Northwest Arkansas		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	232	1	1	04	01	H5216_232_1	4	1			1		1	08/04/2021	2022.01	08/04/2021 11:50:40 AM Eastern Daylight Time	08/03/2021 07:42:06 PM Eastern Daylight Time	07/30/2021 11:14:00 AM Eastern Daylight Time			08/04/2021 02:33:03 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-232 (PPO)	01	04		1			H5216	232	1	2022	Honolulu, Kauai and Maui counties	Honolulu County	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	232	2	1	04	01	H5216_232_2	4	1			1		1	08/04/2021	2022.01	08/04/2021 11:51:19 AM Eastern Daylight Time	08/03/2021 07:42:32 PM Eastern Daylight Time	07/30/2021 11:14:12 AM Eastern Daylight Time			08/04/2021 02:33:03 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-232 (PPO)	01	04		1			H5216	232	2	2022	Honolulu, Kauai and Maui counties	Kauai and Maui counties	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	233	1	1	04	01	H5216_233_1	4	1			1		1	07/31/2021	2022.01	07/31/2021 02:43:51 PM Eastern Daylight Time	08/03/2021 07:43:06 PM Eastern Daylight Time	07/30/2021 11:14:24 AM Eastern Daylight Time			08/04/2021 02:33:03 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-233 (PPO)	01	04		1			H5216	233	1	2022	Honolulu, Kauai and Maui counties	Honolulu County	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	233	2	1	04	01	H5216_233_2	4	1			1		1	07/31/2021	2022.01	07/31/2021 02:44:00 PM Eastern Daylight Time	08/03/2021 07:52:32 PM Eastern Daylight Time	07/30/2021 11:14:34 AM Eastern Daylight Time			08/04/2021 02:33:03 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-233 (PPO)	01	04		1			H5216	233	2	2022	Honolulu, Kauai and Maui counties	Kauai and Maui counties	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	234	0	1	04	01	H5216_234_0	2	1			2	0	0	06/03/2021	2022.01	06/03/2021 02:08:44 PM Eastern Daylight Time	07/22/2021 09:20:05 AM Eastern Daylight Time				07/22/2021 04:23:24 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Honor (PPO)	01	04		1			H5216	234	0	2022	Honolulu County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_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	235	0	1	04	01	H5216_235_0	3	1			2	0	0	07/19/2021	2022.01	07/19/2021 11:55:32 AM Eastern Daylight Time	07/22/2021 09:09:04 AM Eastern Daylight Time				07/22/2021 02:30:24 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Honor (PPO)	01	04		1			H5216	235	0	2022	Greater Tennessee		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_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	236	0	1	04	01	H5216_236_0	3	1			2	0	0	07/19/2021	2022.01	07/19/2021 11:57:00 AM Eastern Daylight Time	07/22/2021 09:09:34 AM Eastern Daylight Time				07/22/2021 02:30:24 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Honor (PPO)	01	04		1			H5216	236	0	2022	Greater Alabama		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_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	237	1	1	04	01	H5216_237_1	4	1			1		0	07/22/2021	2022.01	07/22/2021 04:56:43 PM Eastern Daylight Time	08/03/2021 05:54:12 PM Eastern Daylight Time	07/30/2021 11:14:46 AM Eastern Daylight Time			08/04/2021 01:54:37 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-237 (PPO)	01	04		1			H5216	237	1	2022	Upstate South Carolina	Upstate South Carolina	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	237	2	1	04	01	H5216_237_2	4	1			1		0	07/22/2021	2022.01	07/22/2021 04:56:52 PM Eastern Daylight Time	08/03/2021 05:48:49 PM Eastern Daylight Time	07/30/2021 11:14:58 AM Eastern Daylight Time			08/04/2021 01:54:37 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-237 (PPO)	01	04		1			H5216	237	2	2022	Upstate South Carolina	Upstate South Carolina	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	239	0	1	04	01	H5216_239_0	4	1			1		0	08/02/2021	2022.01	08/02/2021 12:13:31 PM Eastern Daylight Time	08/03/2021 05:49:10 PM Eastern Daylight Time	07/30/2021 11:15:10 AM Eastern Daylight Time			08/04/2021 01:54:37 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Care Extra (PPO)	01	04		1			H5216	239	0	2022	Atlanta Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	240	0	1	04	01	H5216_240_0	5	1	2	1	1		0	07/23/2021	2022.01	07/23/2021 01:22:11 PM Eastern Daylight Time	08/03/2021 05:54:29 PM Eastern Daylight Time	07/30/2021 11:15:20 AM Eastern Daylight Time			08/04/2021 01:54:37 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Care Extra (PPO D-SNP)	01	04		1			H5216	240	0	2022	Atlanta Metro Area		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	242	0	1	04	01	H5216_242_0	6	1		1	1		0	07/22/2021	2022.01	07/22/2021 06:59:39 PM Eastern Daylight Time	08/03/2021 05:49:49 PM Eastern Daylight Time	07/30/2021 11:15:32 AM Eastern Daylight Time			08/04/2021 02:06:50 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Together in Health (PPO I-SNP)	01	04		1			H5216	242	0	2022	Select Counties in Georgia		2		2			1	1	1				https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	243	0	1	04	01	H5216_243_0	6	1		1	1		0	07/22/2021	2022.01	07/22/2021 06:55:12 PM Eastern Daylight Time	08/03/2021 05:54:52 PM Eastern Daylight Time	07/30/2021 11:15:44 AM Eastern Daylight Time			08/04/2021 01:54:37 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Together in Health (PPO I-SNP)	01	04		1			H5216	243	0	2022	Upstate South Carolina		2		2			1	1	1				https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	244	0	1	04	01	H5216_244_0	5	1		1	1		1	08/02/2021	2022.01	08/02/2021 12:16:29 PM Eastern Daylight Time	08/03/2021 05:49:29 PM Eastern Daylight Time	07/30/2021 11:15:56 AM Eastern Daylight Time			08/04/2021 01:54:37 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice - Diabetes and Heart (PPO C-SNP)	01	04		1			H5216	244	0	2022	South Carolina		2		2			1	4			00000000000000001000		https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	246	0	1	04	01	H5216_246_0	5	1		1	1		1	08/02/2021	2022.01	08/02/2021 11:57:22 AM Eastern Daylight Time	08/03/2021 05:56:41 PM Eastern Daylight Time	07/30/2021 11:16:06 AM Eastern Daylight Time			08/04/2021 02:06:50 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice - Diabetes and Heart (PPO C-SNP)	01	04		1			H5216	246	0	2022	Select Counties in Georgia		2		2			1	4			00000000000000001000		https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	247	0	1	04	01	H5216_247_0	4	1			1		1	08/02/2021	2022.01	08/02/2021 01:43:25 PM Eastern Daylight Time	08/03/2021 07:04:46 PM Eastern Daylight Time	07/30/2021 11:16:18 AM Eastern Daylight Time			08/04/2021 02:56:32 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-247 (PPO)	01	04		1			H5216	247	0	2022	Select counties in OR, UT and WA		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	248	1	1	04	01	H5216_248_1	4	1			1		1	08/01/2021	2022.01	08/01/2021 12:42:50 PM Eastern Daylight Time	08/03/2021 10:13:50 PM Eastern Daylight Time	07/30/2021 11:16:30 AM Eastern Daylight Time			08/04/2021 02:09:43 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-248 (PPO)	01	04		1			H5216	248	1	2022	Virginia	Winchester/Fredericksburg	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	248	2	1	04	01	H5216_248_2	4	1			1		1	08/02/2021	2022.01	08/02/2021 12:24:23 PM Eastern Daylight Time	08/03/2021 10:14:11 PM Eastern Daylight Time	07/30/2021 11:16:40 AM Eastern Daylight Time			08/04/2021 02:09:43 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-248 (PPO)	01	04		1			H5216	248	2	2022	Virginia	Central Virginia	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	249	0	1	04	01	H5216_249_0	4	1			1		0	08/01/2021	2022.01	08/01/2021 12:55:56 PM Eastern Daylight Time	08/03/2021 05:49:54 PM Eastern Daylight Time	07/30/2021 11:16:52 AM Eastern Daylight Time			08/04/2021 02:16:27 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-249 (PPO)	01	04		1			H5216	249	0	2022	Select Counties in Massachusetts		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	250	0	1	04	01	H5216_250_0	4	1			1		0	08/01/2021	2022.01	08/01/2021 12:56:53 PM Eastern Daylight Time	08/03/2021 05:49:34 PM Eastern Daylight Time	07/30/2021 11:17:04 AM Eastern Daylight Time			08/04/2021 02:16:27 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-250 (PPO)	01	04		1			H5216	250	0	2022	Select Counties in Massachusetts		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	251	0	1	04	01	H5216_251_0	4	1			1		1	08/01/2021	2022.01	08/01/2021 12:13:26 PM Eastern Daylight Time	08/03/2021 08:33:32 PM Eastern Daylight Time	07/30/2021 11:17:14 AM Eastern Daylight Time			08/04/2021 05:50:55 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-251 (PPO)	01	04		1			H5216	251	0	2022	Select Counties in Illinois		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	252	0	1	04	01	H5216_252_0	4	1			1		1	08/01/2021	2022.01	08/01/2021 12:54:34 PM Eastern Daylight Time	08/03/2021 08:35:17 PM Eastern Daylight Time	07/30/2021 11:17:26 AM Eastern Daylight Time			08/04/2021 06:08:57 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-252 (PPO)	01	04		1			H5216	252	0	2022	Select Counties in Eastern Wisconsin		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	253	0	1	04	01	H5216_253_0	4	1			1		1	08/02/2021	2022.01	08/02/2021 03:24:15 PM Eastern Daylight Time	08/03/2021 08:37:08 PM Eastern Daylight Time	07/30/2021 11:17:38 AM Eastern Daylight Time			08/04/2021 06:08:57 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-253 (PPO)	01	04		1			H5216	253	0	2022	Select Counties in Eastern Wisconsin		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	254	0	1	04	01	H5216_254_0	5	1			1		1	08/01/2021	2022.01	08/01/2021 03:58:34 PM Eastern Daylight Time	08/03/2021 06:05:42 PM Eastern Daylight Time	07/30/2021 11:17:48 AM Eastern Daylight Time			08/04/2021 02:23:59 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-254 (PPO)	01	04		1			H5216	254	0	2022	Select Counties in Iowa and Nebraska		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	255	0	1	04	01	H5216_255_0	4	1			1		1	08/01/2021	2022.01	08/01/2021 09:32:59 AM Eastern Daylight Time	08/03/2021 07:11:55 PM Eastern Daylight Time	07/30/2021 11:18:00 AM Eastern Daylight Time			08/04/2021 02:25:33 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-255 (PPO)	01	04		1			H5216	255	0	2022	Select Counties in Montana		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	256	0	1	04	01	H5216_256_0	2	1			2	0	0	05/29/2021	2022.01	05/29/2021 11:41:49 AM Eastern Daylight Time	07/22/2021 09:44:44 AM Eastern Daylight Time				07/22/2021 02:30:01 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Honor (PPO)	01	04		1			H5216	256	0	2022	Select Counties in Florida		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_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	257	0	1	04	01	H5216_257_0	5	1			2	0	0	07/19/2021	2022.01	07/19/2021 08:28:33 PM Eastern Daylight Time	07/22/2021 09:39:19 AM Eastern Daylight Time				07/22/2021 01:20:25 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Honor (PPO)	01	04		1			H5216	257	0	2022	Rural Jacksonville		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_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	258	0	1	04	01	H5216_258_0	4	1			2	0	0	07/22/2021	2022.01	07/22/2021 01:19:08 PM Eastern Daylight Time	07/22/2021 09:55:30 AM Eastern Daylight Time				07/22/2021 01:43:54 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Honor (PPO)	01	04		1			H5216	258	0	2022	Select Counties in IL, WI		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_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	260	0	1	04	01	H5216_260_0	3	1			2		1	08/02/2021	2022.01	08/02/2021 11:34:37 AM Eastern Daylight Time	08/03/2021 07:17:04 PM Eastern Daylight Time	07/30/2021 11:18:12 AM Eastern Daylight Time			08/04/2021 01:05:01 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-260 (PPO)	01	04		1			H5216	260	0	2022	Select Counties in Arizona and New Mexico		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	261	0	1	04	01	H5216_261_0	4	1			2		1	08/02/2021	2022.01	08/02/2021 11:53:26 AM Eastern Daylight Time	08/03/2021 07:13:45 PM Eastern Daylight Time	07/30/2021 11:18:22 AM Eastern Daylight Time			08/04/2021 01:05:01 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-261 (PPO)	01	04		1			H5216	261	0	2022	Denver and North Colorado		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)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;8b3;	
H5216	262	0	1	04	01	H5216_262_0	5	1			2		0	08/02/2021	2022.01	08/02/2021 12:34:34 PM Eastern Daylight Time	08/03/2021 06:23:55 PM Eastern Daylight Time	07/30/2021 11:18:34 AM Eastern Daylight Time			08/04/2021 02:54:56 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-262 (PPO)	01	04		1			H5216	262	0	2022	Kansas City		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	263	0	1	04	01	H5216_263_0	5	1			2		1	08/02/2021	2022.01	08/02/2021 11:55:46 AM Eastern Daylight Time	08/03/2021 07:14:45 PM Eastern Daylight Time	07/30/2021 11:18:46 AM Eastern Daylight Time			08/04/2021 01:05:01 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-263 (PPO)	01	04		1			H5216	263	0	2022	Greater Arizona		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	264	0	1	04	01	H5216_264_0	3	1			2		0	08/02/2021	2022.01	08/02/2021 12:36:28 PM Eastern Daylight Time	08/03/2021 06:33:40 PM Eastern Daylight Time	07/30/2021 11:18:58 AM Eastern Daylight Time			08/04/2021 02:54:56 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-264 (PPO)	01	04		1			H5216	264	0	2022	Select Counties in Oklahoma		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	265	0	1	04	01	H5216_265_0	3	1			2		1	08/02/2021	2022.01	08/02/2021 11:58:02 AM Eastern Daylight Time	08/03/2021 07:15:45 PM Eastern Daylight Time	07/30/2021 11:19:08 AM Eastern Daylight Time			08/04/2021 01:05:01 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-265 (PPO)	01	04		1			H5216	265	0	2022	Maricopa Pinal		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	266	0	1	04	01	H5216_266_0	5	1			1		0	08/02/2021	2022.01	08/02/2021 12:26:27 PM Eastern Daylight Time	08/03/2021 10:14:56 PM Eastern Daylight Time	07/30/2021 11:19:20 AM Eastern Daylight Time			08/04/2021 02:09:43 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-266 (PPO)	01	04		1			H5216	266	0	2022	Virginia		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	267	0	1	04	01	H5216_267_0	4	1	2	1	1		0	08/02/2021	2022.01	08/02/2021 11:11:34 AM Eastern Daylight Time	08/03/2021 07:18:20 PM Eastern Daylight Time	07/30/2021 11:19:32 AM Eastern Daylight Time			08/04/2021 01:05:01 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice SNP-DE H5216-267 (PPO D-SNP)	01	04		1			H5216	267	0	2022	Colorado		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	268	0	1	04	01	H5216_268_0	7	1	2	1	1		0	08/02/2021	2022.01	08/02/2021 12:18:28 PM Eastern Daylight Time	08/03/2021 06:13:26 PM Eastern Daylight Time	07/30/2021 11:19:44 AM Eastern Daylight Time			08/04/2021 02:23:59 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice SNP-DE H5216-268 (PPO D-SNP)	01	04		1			H5216	268	0	2022	Select Counties in Iowa		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	269	0	1	04	01	H5216_269_0	3	1			2		1	08/02/2021	2022.01	08/02/2021 10:55:09 AM Eastern Daylight Time	08/03/2021 06:55:59 PM Eastern Daylight Time	07/30/2021 11:19:54 AM Eastern Daylight Time			08/04/2021 02:00:40 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-269 (PPO)	01	04		1			H5216	269	0	2022	Birmingham		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	270	1	1	04	01	H5216_270_1	4	1			1		0	08/02/2021	2022.01	08/02/2021 06:07:35 PM Eastern Daylight Time	08/03/2021 06:34:31 PM Eastern Daylight Time	07/30/2021 11:20:06 AM Eastern Daylight Time			08/04/2021 02:23:59 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-270 (PPO)	01	04		1			H5216	270	1	2022	Select Counties in Arkansas and Oklahoma	Select Counties in Arkansas and Oklahoma	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	270	2	1	04	01	H5216_270_2	5	1			1		0	08/02/2021	2022.01	08/02/2021 04:31:28 PM Eastern Daylight Time	08/03/2021 06:25:04 PM Eastern Daylight Time	07/30/2021 11:20:18 AM Eastern Daylight Time			08/04/2021 02:23:59 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-270 (PPO)	01	04		1			H5216	270	2	2022	Select Counties in Arkansas and Oklahoma	Select Counties in Arkansas and Oklahoma	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	271	0	1	04	01	H5216_271_0	3	1			2		1	08/01/2021	2022.01	08/01/2021 12:23:41 PM Eastern Daylight Time	08/03/2021 06:57:02 PM Eastern Daylight Time	07/30/2021 11:20:30 AM Eastern Daylight Time			08/04/2021 02:00:40 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-271 (PPO)	01	04		1			H5216	271	0	2022	Select VA Counties in Tri-Cities Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	272	0	1	04	01	H5216_272_0	3	1			2		1	08/02/2021	2022.01	08/02/2021 10:54:13 AM Eastern Daylight Time	08/03/2021 06:56:31 PM Eastern Daylight Time	07/30/2021 11:20:40 AM Eastern Daylight Time			08/04/2021 02:00:40 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-272 (PPO)	01	04		1			H5216	272	0	2022	Select Counties in Alabama		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	273	0	1	04	01	H5216_273_0	3	1			2		1	08/02/2021	2022.01	08/02/2021 03:24:34 PM Eastern Daylight Time	08/03/2021 08:42:36 PM Eastern Daylight Time	07/30/2021 11:20:52 AM Eastern Daylight Time			08/04/2021 06:08:57 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-273 (PPO)	01	04		1			H5216	273	0	2022	Select Counties in ND/SD		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	274	0	1	04	01	H5216_274_0	3	1			2		1	08/01/2021	2022.01	08/01/2021 12:54:59 PM Eastern Daylight Time	08/03/2021 06:58:02 PM Eastern Daylight Time	07/30/2021 11:21:04 AM Eastern Daylight Time			08/04/2021 02:00:40 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-274 (PPO)	01	04		1			H5216	274	0	2022	Nashville Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	275	0	1	04	01	H5216_275_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 10:18:40 AM Eastern Daylight Time	08/03/2021 08:38:45 PM Eastern Daylight Time	07/30/2021 11:21:16 AM Eastern Daylight Time			08/04/2021 06:08:57 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-275 (PPO)	01	04		1			H5216	275	0	2022	Twin Cities Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	277	0	1	04	01	H5216_277_0	6	1	2	1	1		0	07/22/2021	2022.01	07/22/2021 04:40:12 PM Eastern Daylight Time	08/03/2021 05:57:22 PM Eastern Daylight Time	07/30/2021 11:21:26 AM Eastern Daylight Time			08/04/2021 02:19:11 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice SNP-DE H5216-277 (PPO D-SNP)	01	04		1			H5216	277	0	2022	South Carolina		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	278	1	1	04	01	H5216_278_1	3	1			2	0	0	07/23/2021	2022.01	07/23/2021 12:53:26 PM Eastern Daylight Time	07/24/2021 02:22:55 PM Eastern Daylight Time				07/26/2021 03:29:34 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Honor (PPO)	01	04		1			H5216	278	1	2022	Select Counties in IA, MN, MT, NE, ND, SD	Select Counties in MN, ND, SD	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_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	278	2	1	04	01	H5216_278_2	4	1			2	0	0	07/28/2021	2022.01	07/28/2021 09:56:54 AM Eastern Daylight Time	07/24/2021 02:23:58 PM Eastern Daylight Time				07/28/2021 01:39:09 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Honor (PPO)	01	04		1			H5216	278	2	2022	Select Counties in IA, MN, MT, NE, ND, SD	Select Counties in IA/NE	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_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	278	3	1	04	01	H5216_278_3	6	1			2	0	0	08/03/2021	2022.01	08/03/2021 11:14:09 AM Eastern Daylight Time	07/24/2021 02:25:08 PM Eastern Daylight Time				08/05/2021 03:53:59 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Honor (PPO)	01	04		1			H5216	278	3	2022	Select Counties in IA, MN, MT, NE, ND, SD	Select Counties in MT	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_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	279	0	1	04	01	H5216_279_0	4	1			2		0	08/11/2021	2022.01	08/11/2021 01:29:20 PM Eastern Daylight Time	08/03/2021 05:57:57 PM Eastern Daylight Time	07/30/2021 11:21:38 AM Eastern Daylight Time			08/11/2021 04:53:11 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-279 (PPO)	01	04		1			H5216	279	0	2022	South Carolina		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	280	1	1	04	01	H5216_280_1	4	1			1		0	08/02/2021	2022.01	08/02/2021 12:37:08 PM Eastern Daylight Time	08/03/2021 05:59:32 PM Eastern Daylight Time	07/30/2021 11:21:50 AM Eastern Daylight Time			08/04/2021 02:19:11 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-280 (PPO)	01	04		1			H5216	280	1	2022	Select counties in Georgia and South Carolina	Select counties in Georgia	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	280	2	1	04	01	H5216_280_2	5	1			1		0	08/02/2021	2022.01	08/02/2021 12:53:44 PM Eastern Daylight Time	08/03/2021 05:59:49 PM Eastern Daylight Time	07/30/2021 11:22:02 AM Eastern Daylight Time			08/04/2021 02:19:11 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-280 (PPO)	01	04		1			H5216	280	2	2022	Select counties in Georgia and South Carolina	South Carolina	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	281	0	1	04	01	H5216_281_0	4	1			2		1	08/04/2021	2022.01	08/04/2021 11:52:41 AM Eastern Daylight Time	08/03/2021 07:45:43 PM Eastern Daylight Time	07/30/2021 11:22:12 AM Eastern Daylight Time			08/04/2021 02:46:24 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-281 (PPO)	01	04		1			H5216	281	0	2022	Clark and Nye (partial) counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	282	1	1	04	01	H5216_282_1	4	1			1		1	07/31/2021	2022.01	07/31/2021 03:09:28 PM Eastern Daylight Time	08/03/2021 06:00:40 PM Eastern Daylight Time	07/30/2021 11:22:24 AM Eastern Daylight Time			08/04/2021 02:19:11 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-282 (PPO)	01	04		1			H5216	282	1	2022	Select counties in Georgia and South Carolina	Select counties in Georgia and South Carolina	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	282	2	1	04	01	H5216_282_2	6	1			1		1	07/31/2021	2022.01	07/31/2021 03:09:44 PM Eastern Daylight Time	08/03/2021 06:01:52 PM Eastern Daylight Time	07/30/2021 11:22:36 AM Eastern Daylight Time			08/04/2021 02:19:11 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-282 (PPO)	01	04		1			H5216	282	2	2022	Select counties in Georgia and South Carolina	Charleston Metro Area	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	283	0	1	04	01	H5216_283_0	4	1			2		1	08/03/2021	2022.01	08/03/2021 10:56:28 AM Eastern Daylight Time	08/03/2021 08:47:45 PM Eastern Daylight Time	07/30/2021 11:22:48 AM Eastern Daylight Time			08/04/2021 05:50:55 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-283 (PPO)	01	04		1			H5216	283	0	2022	Select Counties in IL		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	284	0	1	04	01	H5216_284_0	3	1			2		0	08/02/2021	2022.01	08/02/2021 11:34:00 AM Eastern Daylight Time	08/03/2021 05:58:30 PM Eastern Daylight Time	07/30/2021 11:23:00 AM Eastern Daylight Time			08/04/2021 01:54:37 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-284 (PPO)	01	04		1			H5216	284	0	2022	Select counties in Georgia		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	285	0	1	04	01	H5216_285_0	3	1			2		0	08/02/2021	2022.01	08/02/2021 03:22:16 PM Eastern Daylight Time	08/03/2021 06:27:16 PM Eastern Daylight Time	07/30/2021 11:23:10 AM Eastern Daylight Time			08/04/2021 02:32:00 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-285 (PPO)	01	04		1			H5216	285	0	2022	Ohio & N KY		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	286	0	1	04	01	H5216_286_0	3	1			2	0	0	07/28/2021	2022.01	07/28/2021 10:51:54 AM Eastern Daylight Time	07/23/2021 03:59:40 PM Eastern Daylight Time				07/28/2021 12:26:42 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Honor (PPO)	01	04		1			H5216	286	0	2022	Select counties in Georgia and South Carolina		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_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	287	0	1	04	01	H5216_287_0	4	1			1		0	08/02/2021	2022.01	08/02/2021 03:14:02 PM Eastern Daylight Time	08/03/2021 06:24:11 PM Eastern Daylight Time	07/30/2021 11:23:22 AM Eastern Daylight Time			08/04/2021 02:05:54 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-287 (PPO)	01	04		1			H5216	287	0	2022	Detroit		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	288	0	1	04	01	H5216_288_0	5	1			2		0	08/01/2021	2022.01	08/01/2021 12:57:10 PM Eastern Daylight Time	08/03/2021 05:54:13 PM Eastern Daylight Time	07/30/2021 11:23:34 AM Eastern Daylight Time			08/04/2021 02:26:09 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-288 (PPO)	01	04		1			H5216	288	0	2022	Select Counties in Connecticut		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	289	0	1	04	01	H5216_289_0	5	1			2		0	08/01/2021	2022.01	08/01/2021 12:57:27 PM Eastern Daylight Time	08/03/2021 05:53:34 PM Eastern Daylight Time	07/30/2021 11:23:44 AM Eastern Daylight Time			08/04/2021 02:26:09 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-289 (PPO)	01	04		1			H5216	289	0	2022	Select Counties in Connecticut		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	290	0	1	04	01	H5216_290_0	5	1	2	1	1		0	07/22/2021	2022.01	07/22/2021 02:19:56 PM Eastern Daylight Time	08/03/2021 05:53:54 PM Eastern Daylight Time	07/30/2021 11:23:56 AM Eastern Daylight Time			08/04/2021 02:26:09 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice SNP-DE H5216-290 (PPO D-SNP)	01	04		1			H5216	290	0	2022	Select Counties in Connecticut		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	291	0	1	04	01	H5216_291_0	5	1	2	1	1		0	07/22/2021	2022.01	07/22/2021 02:20:06 PM Eastern Daylight Time	08/03/2021 05:52:10 PM Eastern Daylight Time	07/30/2021 11:24:06 AM Eastern Daylight Time			08/04/2021 02:26:09 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice SNP-DE H5216-291 (PPO D-SNP)	01	04		1			H5216	291	0	2022	Maine		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	292	0	1	04	01	H5216_292_0	4	1	2	1	1		0	07/08/2021	2022.01	07/08/2021 04:32:34 PM Eastern Daylight Time	08/03/2021 06:55:11 PM Eastern Daylight Time	07/30/2021 11:24:18 AM Eastern Daylight Time			08/04/2021 02:44:49 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice SNP-DE H5216-292 (PPO D-SNP)	01	04		1			H5216	292	0	2022	Select Counties in Mississippi		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	293	0	1	04	01	H5216_293_0	6	1			2		0	08/04/2021	2022.01	08/04/2021 02:41:18 PM Eastern Daylight Time	08/03/2021 07:21:50 PM Eastern Daylight Time	07/30/2021 11:24:30 AM Eastern Daylight Time			08/04/2021 02:56:32 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Value Plus H5216-293 (PPO)	01	04		1			H5216	293	0	2022	Select Counties in ID		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	294	0	1	04	01	H5216_294_0	6	1			2		0	08/04/2021	2022.01	08/04/2021 02:41:26 PM Eastern Daylight Time	08/03/2021 07:23:30 PM Eastern Daylight Time	07/30/2021 11:24:42 AM Eastern Daylight Time			08/04/2021 02:56:32 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Value Plus H5216-294 (PPO)	01	04		1			H5216	294	0	2022	Select counties in OR		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	295	0	1	04	01	H5216_295_0	6	1			2		0	08/04/2021	2022.01	08/04/2021 02:41:35 PM Eastern Daylight Time	08/03/2021 07:24:53 PM Eastern Daylight Time	07/30/2021 11:24:54 AM Eastern Daylight Time			08/04/2021 02:56:32 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Value Plus H5216-295 (PPO)	01	04		1			H5216	295	0	2022	Select Counties in Utah		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	296	0	1	04	01	H5216_296_0	9	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 02:41:42 PM Eastern Daylight Time	08/03/2021 07:27:45 PM Eastern Daylight Time	07/30/2021 11:25:04 AM Eastern Daylight Time			08/04/2021 02:56:32 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice SNP-DE H5216-296 (PPO D-SNP)	01	04		1			H5216	296	0	2022	Select counties in Utah		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	298	0	1	04	01	H5216_298_0	4	1	2	1	1		0	07/08/2021	2022.01	07/08/2021 04:36:49 PM Eastern Daylight Time	08/03/2021 06:56:13 PM Eastern Daylight Time	07/30/2021 11:25:16 AM Eastern Daylight Time			08/04/2021 02:59:21 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice SNP-DE H5216-298 (PPO D-SNP)	01	04		1			H5216	298	0	2022	Select Counties in Mississippi		2		2			1	3		2		2	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	300	0	1	04	01	H5216_300_0	3	1			2		1	08/02/2021	2022.01	08/02/2021 06:28:08 PM Eastern Daylight Time	08/03/2021 06:57:18 PM Eastern Daylight Time	07/30/2021 11:25:28 AM Eastern Daylight Time			08/04/2021 02:59:21 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-300 (PPO)	01	04		1			H5216	300	0	2022	Select Counties in Mississippi		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	301	1	1	04	01	H5216_301_1	3	1			2	0	0	07/19/2021	2022.01	07/19/2021 05:03:11 PM Eastern Daylight Time	07/22/2021 10:18:16 AM Eastern Daylight Time				07/22/2021 02:30:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Honor (PPO)	01	04		1			H5216	301	1	2022	Select counties in ID,OR, WA and UT	Select counties in Oregon	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_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	301	2	1	04	01	H5216_301_2	3	1			2	0	0	07/19/2021	2022.01	07/19/2021 02:03:44 PM Eastern Daylight Time	07/22/2021 10:16:34 AM Eastern Daylight Time				07/22/2021 02:30:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Honor (PPO)	01	04		1			H5216	301	2	2022	Select counties in ID,OR, WA and UT	Select counties in Utah	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_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	301	3	1	04	01	H5216_301_3	3	1			2	0	0	07/19/2021	2022.01	07/19/2021 02:04:49 PM Eastern Daylight Time	07/22/2021 10:14:33 AM Eastern Daylight Time				07/22/2021 02:30:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Honor (PPO)	01	04		1			H5216	301	3	2022	Select counties in ID,OR, WA and UT	Select counties in Idaho	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_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	301	4	1	04	01	H5216_301_4	3	1			2	0	0	07/19/2021	2022.01	07/19/2021 02:05:07 PM Eastern Daylight Time	07/22/2021 10:12:16 AM Eastern Daylight Time				07/22/2021 02:30:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Honor (PPO)	01	04		1			H5216	301	4	2022	Select counties in ID,OR, WA and UT	Select counties in Washington	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_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	302	0	1	04	01	H5216_302_0	4	1	2	1	1		0	08/02/2021	2022.01	08/02/2021 10:45:52 AM Eastern Daylight Time	08/03/2021 07:52:58 PM Eastern Daylight Time	07/30/2021 11:25:40 AM Eastern Daylight Time			08/04/2021 02:33:03 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice SNP-DE H5216-302 (PPO D-SNP)	01	04		1			H5216	302	0	2022	Select Counties in Nevada		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	303	0	1	04	01	H5216_303_0	3	1			2		1	08/02/2021	2022.01	08/02/2021 03:25:36 PM Eastern Daylight Time	08/03/2021 08:40:49 PM Eastern Daylight Time	07/30/2021 11:25:52 AM Eastern Daylight Time			08/04/2021 06:08:57 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-303 (PPO)	01	04		1			H5216	303	0	2022	Duluth Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1						05/25/2021	2022.01	05/25/2021 02:01:40 PM Eastern Daylight Time					07/21/2021 12:21:25 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H5216	805	0	2022	Select Counties in Multi-States		1	5675157	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242		(866)396-8810		(866)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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H5216	806	0	1	04	01	H5216_806_0	2	1				0	0	05/25/2021	2022.01	05/25/2021 02:07:17 PM Eastern Daylight Time					07/21/2021 12:21:25 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H5216	806	0	2022	Select Counties in Multi-States		1	349847	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H5216	808	0	2	04	01	H5216_808_0	2	1						05/25/2021	2022.01	05/25/2021 02:19:09 PM Eastern Daylight Time					07/21/2021 12:21:25 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		2	1		H5216	808	0	2022	Select Counties in Multi-States		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242		(866)396-8810		(866)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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H5216	809	0	2	04	01	H5216_809_0	2	1				0	0	05/25/2021	2022.01	05/25/2021 02:24:29 PM Eastern Daylight Time					07/21/2021 12:21:25 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		2	1		H5216	809	0	2022	Select Counties in Multi-States		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H5216	811	0	1	04	01	H5216_811_0	2	1						05/25/2021	2022.01	05/25/2021 02:29:28 PM Eastern Daylight Time					07/21/2021 12:21:25 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H5216	811	0	2022	Select Counties in Multi-States		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242		(866)396-8810		(866)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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H5216	812	0	1	04	01	H5216_812_0	2	1				0	0	05/25/2021	2022.01	05/25/2021 02:34:44 PM Eastern Daylight Time					07/21/2021 12:21:25 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H5216	812	0	2022	Select Counties in Multi-States		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H5216	813	0	1	04	01	H5216_813_0	2	1						05/25/2021	2022.01	05/25/2021 02:39:34 PM Eastern Daylight Time					07/21/2021 12:21:25 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H5216	813	0	2022	Select Counties in Multi-States		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242		(866)396-8810		(866)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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H5216	814	0	1	04	01	H5216_814_0	2	1				0	0	05/25/2021	2022.01	05/25/2021 02:45:52 PM Eastern Daylight Time					07/21/2021 12:21:25 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H5216	814	0	2022	Select Counties in Multi-States		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H5216	815	0	1	04	01	H5216_815_0	2	1						05/25/2021	2022.01	05/25/2021 02:50:25 PM Eastern Daylight Time					07/21/2021 12:21:25 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H5216	815	0	2022	Select Counties in Multi-States		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242		(866)396-8810		(866)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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H5216	816	0	1	04	01	H5216_816_0	2	1				0	0	05/25/2021	2022.01	05/25/2021 02:54:59 PM Eastern Daylight Time					07/21/2021 12:21:25 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H5216	816	0	2022	Select Counties in Multi-States		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H5216	817	0	1	04	01	H5216_817_0	2	1						05/25/2021	2022.01	05/25/2021 02:58:24 PM Eastern Daylight Time					07/21/2021 12:21:25 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H5216	817	0	2022	Select Counties in Multi-States		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242		(866)396-8810		(866)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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H5216	818	0	1	04	01	H5216_818_0	2	1				0	0	05/25/2021	2022.01	05/25/2021 03:01:43 PM Eastern Daylight Time					07/21/2021 12:21:25 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H5216	818	0	2022	Select Counties in Multi-States		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H5232	001	0	1	04	01	H5232_001_0	6	1					0	07/09/2021	2022.01	07/09/2021 01:06:25 PM Eastern Daylight Time	08/02/2021 11:47:42 AM Eastern Daylight Time	08/02/2021 11:31:20 AM Eastern Daylight Time			08/04/2021 04:23:28 PM Eastern Daylight Time	PARAMOUNT CARE, INC.	Paramount Elite Medicare Plans	paramounthealthcare.com/medicareplans	Paramount Elite Preferred PPO (PPO)	01	04		1			H5232	001	0	2022	Paramount Elite Preferred PPO (Northwestern Ohio)		2		2			2						http://www.paramounthealthcare.com/medicareplans	http://www.paramounthealthcare.com/medicareplans	http://www.paramounthealthcare.com/medicareplans	(833)554-2335		(567)585-9888		(833)554-2335		(567)585-9888		(833)554-2335		(567)585-9888		(833)554-2335		(567)585-9888		(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			
H5253	004	0	1	02	01	H5253_004_0	5	1			2		1	08/04/2021	2022.01	08/04/2021 10:10:37 AM Central Daylight Time	08/03/2021 11:53:34 AM Central Daylight Time	07/29/2021 08:51:24 PM Central Daylight Time			08/04/2021 04:48:24 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	01	02		1			H5253	004	0	2022	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	2		0	08/04/2021	2022.01	08/04/2021 11:07:13 AM Central Daylight Time	08/03/2021 11:54:07 AM Central Daylight Time	07/29/2021 08:51:40 PM Central Daylight Time			08/04/2021 03:05:24 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (HMO-POS I-SNP)	01	02		1			H5253	007	0	2022	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	02	01	H5253_011_0	4	1			2		1	08/04/2021	2022.01	08/04/2021 10:12:08 AM Central Daylight Time	08/03/2021 11:54:40 AM Central Daylight Time	07/29/2021 08:51:55 PM Central Daylight Time			08/04/2021 04:48:24 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	01	02		1			H5253	011	0	2022	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	02	01	H5253_021_0	2	1			2	0	0	07/14/2021	2022.01	07/14/2021 06:04:42 PM Central Daylight Time	06/03/2021 02:51:03 PM Central Daylight Time				07/15/2021 01:34:55 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot Plan 2 (HMO-POS)	01	02		1			H5253	021	0	2022	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	5	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 10:15:59 AM Central Daylight Time	08/03/2021 11:55:13 AM Central Daylight Time	07/29/2021 08:52:11 PM Central Daylight Time			08/04/2021 04:48:24 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete LP (HMO D-SNP)	01	01		1			H5253	024	0	2022	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	02	01	H5253_030_0	4	1			2		1	08/04/2021	2022.01	08/04/2021 10:17:41 AM Central Daylight Time	08/03/2021 11:55:46 AM Central Daylight Time	07/29/2021 08:52:27 PM Central Daylight Time			08/04/2021 04:48:24 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	01	02		1			H5253	030	0	2022	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	02	01	H5253_033_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 10:19:21 AM Central Daylight Time	08/03/2021 11:56:20 AM Central Daylight Time	07/29/2021 08:52:43 PM Central Daylight Time			08/04/2021 04:48:24 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Value (HMO-POS)	01	02		1			H5253	033	0	2022	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	02	01	H5253_034_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 10:20:55 AM Central Daylight Time	08/03/2021 11:56:54 AM Central Daylight Time	07/29/2021 08:52:58 PM Central Daylight Time			08/04/2021 04:48:24 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Value (HMO-POS)	01	02		1			H5253	034	0	2022	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			2		1	08/04/2021	2022.01	08/04/2021 11:47:37 AM Central Daylight Time	08/03/2021 11:57:29 AM Central Daylight Time	07/29/2021 08:53:14 PM Central Daylight Time			08/04/2021 08:05:11 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plus (HMO-POS)	01	02		1			H5253	035	0	2022	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			2		1	08/04/2021	2022.01	08/04/2021 11:48:40 AM Central Daylight Time	08/03/2021 11:58:03 AM Central Daylight Time	07/29/2021 08:53:30 PM Central Daylight Time			08/04/2021 08:05:11 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO)	01	01		1			H5253	036	0	2022	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	02	01	H5253_037_0	5	1			2		1	08/04/2021	2022.01	08/04/2021 09:50:06 AM Central Daylight Time	08/03/2021 11:58:38 AM Central Daylight Time	07/29/2021 08:53:46 PM Central Daylight Time			08/04/2021 04:41:32 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO-POS)	01	02		1			H5253	037	0	2022	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	038	0	1	02	01	H5253_038_0	4	1			2		1	08/04/2021	2022.01	08/04/2021 09:51:51 AM Central Daylight Time	08/03/2021 11:59:14 AM Central Daylight Time	07/29/2021 08:54:02 PM Central Daylight Time			08/04/2021 04:41:32 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO-POS)	01	02		1			H5253	038	0	2022	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	039	0	1	02	01	H5253_039_0	4	1			2		1	08/04/2021	2022.01	08/04/2021 09:53:41 AM Central Daylight Time	08/03/2021 11:59:51 AM Central Daylight Time	07/29/2021 08:54:17 PM Central Daylight Time			08/04/2021 04:41:32 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO-POS)	01	02		1			H5253	039	0	2022	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	02	01	H5253_040_0	3	1			2	0	0	07/15/2021	2022.01	07/15/2021 03:57:51 PM Central Daylight Time	06/03/2021 02:53:37 PM Central Daylight Time				07/16/2021 01:56:35 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (HMO-POS)	01	02		1			H5253	040	0	2022	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	2			
H5253	041	0	1	02	01	H5253_041_0	5	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 09:57:03 AM Central Daylight Time	08/03/2021 12:00:29 PM Central Daylight Time	07/29/2021 08:54:33 PM Central Daylight Time			08/04/2021 04:41:32 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO-POS D-SNP)	01	02		1			H5253	041	0	2022	Select Counties in North Carolina		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			
H5253	042	0	1	02	01	H5253_042_0	3	1		1	2		0	08/04/2021	2022.01	08/04/2021 11:09:54 AM Central Daylight Time	08/03/2021 12:01:07 PM Central Daylight Time	07/29/2021 08:54:50 PM Central Daylight Time			08/04/2021 03:05:24 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (HMO-POS I-SNP)	01	02		1			H5253	042	0	2022	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	3	1		1	2		1	08/04/2021	2022.01	08/04/2021 11:11:31 AM Central Daylight Time	08/03/2021 12:01:45 PM Central Daylight Time	07/29/2021 08:55:05 PM Central Daylight Time			08/04/2021 03:05:24 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Assisted Living Plan (HMO-POS I-SNP)	01	02		1			H5253	043	0	2022	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	047	0	1	01	01	H5253_047_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 10:21:58 AM Central Daylight Time	08/03/2021 12:02:23 PM Central Daylight Time	07/29/2021 08:55:20 PM Central Daylight Time			08/04/2021 01:59:15 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO)	01	01		1			H5253	047	0	2022	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	01	01	H5253_048_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 10:20:35 AM Central Daylight Time	08/03/2021 12:03:01 PM Central Daylight Time	07/29/2021 08:55:35 PM Central Daylight Time			08/04/2021 01:59:15 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO)	01	01		1			H5253	048	0	2022	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			2		1	08/04/2021	2022.01	08/04/2021 10:22:43 AM Central Daylight Time	08/03/2021 12:03:38 PM Central Daylight Time	07/29/2021 08:55:51 PM Central Daylight Time			08/04/2021 04:48:24 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 7 (HMO)	01	01		1			H5253	049	0	2022	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			2		1	08/04/2021	2022.01	08/04/2021 10:24:59 AM Central Daylight Time	08/03/2021 12:04:13 PM Central Daylight Time	07/29/2021 08:56:06 PM Central Daylight Time			08/04/2021 04:48:24 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO)	01	01		1			H5253	050	0	2022	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	3	1			2		1	08/04/2021	2022.01	08/04/2021 10:26:39 AM Central Daylight Time	08/03/2021 12:04:49 PM Central Daylight Time	07/29/2021 08:56:22 PM Central Daylight Time			08/04/2021 04:48:24 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 3 (HMO)	01	01		1			H5253	051	0	2022	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			2		1	08/04/2021	2022.01	08/04/2021 10:28:24 AM Central Daylight Time	08/03/2021 12:05:23 PM Central Daylight Time	07/29/2021 08:56:38 PM Central Daylight Time			08/04/2021 04:48:24 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 6 (HMO)	01	01		1			H5253	052	0	2022	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	059	0	1	01	01	H5253_059_0	4	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 10:30:05 AM Central Daylight Time	08/03/2021 12:05:59 PM Central Daylight Time	07/29/2021 08:56:54 PM Central Daylight Time			08/04/2021 04:48:24 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete LP (HMO D-SNP)	01	01		1			H5253	059	0	2022	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	3	1		1	2		0	08/04/2021	2022.01	08/04/2021 11:14:12 AM Central Daylight Time	08/03/2021 12:06:33 PM Central Daylight Time	07/29/2021 08:57:10 PM Central Daylight Time			08/04/2021 03:05:24 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (HMO-POS I-SNP)	01	02		1			H5253	060	0	2022	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	2		1	08/04/2021	2022.01	08/04/2021 11:15:48 AM Central Daylight Time	08/03/2021 12:07:07 PM Central Daylight Time	07/29/2021 08:57:26 PM Central Daylight Time			08/04/2021 03:05:24 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Assisted Living Plan (HMO-POS I-SNP)	01	02		1			H5253	061	0	2022	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	4	1			2		1	08/04/2021	2022.01	08/04/2021 10:32:32 AM Central Daylight Time	08/03/2021 12:07:42 PM Central Daylight Time	07/29/2021 08:57:42 PM Central Daylight Time			08/04/2021 04:48:24 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 5 (HMO)	01	01		1			H5253	062	0	2022	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	3	1		1	2		1	08/04/2021	2022.01	08/04/2021 11:17:28 AM Central Daylight Time	08/03/2021 12:08:16 PM Central Daylight Time	07/29/2021 08:57:56 PM Central Daylight Time			08/04/2021 03:05:24 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Assisted Living Plan (HMO-POS I-SNP)	01	02		1			H5253	064	0	2022	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	072	0	1	02	01	H5253_072_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 10:34:30 AM Central Daylight Time	08/03/2021 12:08:52 PM Central Daylight Time	07/29/2021 08:58:12 PM Central Daylight Time			08/04/2021 04:48:24 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Value (HMO-POS)	01	02		1			H5253	072	0	2022	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	02	01	H5253_073_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 10:36:01 AM Central Daylight Time	08/03/2021 12:09:26 PM Central Daylight Time	07/29/2021 08:58:28 PM Central Daylight Time			08/04/2021 04:48:24 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	01	02		1			H5253	073	0	2022	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	079	0	1	02	01	H5253_079_0	4	1			2		1	08/04/2021	2022.01	08/04/2021 09:59:06 AM Central Daylight Time	08/03/2021 12:10:01 PM Central Daylight Time	07/29/2021 08:58:43 PM Central Daylight Time			08/04/2021 04:41:32 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO-POS)	01	02		1			H5253	079	0	2022	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	2			
H5253	080	0	1	02	01	H5253_080_0	4	1			2		1	08/04/2021	2022.01	08/04/2021 10:22:59 AM Central Daylight Time	08/03/2021 12:10:35 PM Central Daylight Time	07/29/2021 08:58:59 PM Central Daylight Time			08/04/2021 04:41:32 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO-POS)	01	02		1			H5253	080	0	2022	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	2			
H5253	081	0	1	01	01	H5253_081_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 10:18:47 AM Central Daylight Time	08/03/2021 12:11:10 PM Central Daylight Time	07/29/2021 08:59:15 PM Central Daylight Time			08/04/2021 01:59:15 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO)	01	01		1			H5253	081	0	2022	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			2		1	08/04/2021	2022.01	08/04/2021 10:14:20 AM Central Daylight Time	08/03/2021 12:11:44 PM Central Daylight Time	07/29/2021 08:59:31 PM Central Daylight Time			08/04/2021 01:59:15 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO)	01	01		1			H5253	082	0	2022	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			2		1	08/04/2021	2022.01	08/04/2021 10:12:51 AM Central Daylight Time	08/03/2021 12:12:19 PM Central Daylight Time	07/29/2021 08:59:46 PM Central Daylight Time			08/04/2021 01:59:15 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO)	01	01		1			H5253	083	0	2022	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			2		1	08/04/2021	2022.01	08/04/2021 10:11:24 AM Central Daylight Time	08/03/2021 12:12:54 PM Central Daylight Time	07/29/2021 09:00:03 PM Central Daylight Time			08/04/2021 01:59:15 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO)	01	01		1			H5253	084	0	2022	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	087	0	1	02	01	H5253_087_0	4	1			2		1	08/04/2021	2022.01	08/04/2021 10:24:59 AM Central Daylight Time	08/03/2021 12:13:28 PM Central Daylight Time	07/29/2021 09:00:19 PM Central Daylight Time			08/04/2021 04:41:32 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO-POS)	01	02		1			H5253	087	0	2022	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	02	01	H5253_088_0	4	1			2		1	08/04/2021	2022.01	08/04/2021 10:26:49 AM Central Daylight Time	08/03/2021 12:14:03 PM Central Daylight Time	07/29/2021 09:00:34 PM Central Daylight Time			08/04/2021 04:41:32 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO-POS)	01	02		1			H5253	088	0	2022	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	02	01	H5253_089_0	4	1			2		1	08/04/2021	2022.01	08/04/2021 10:29:00 AM Central Daylight Time	08/03/2021 12:14:39 PM Central Daylight Time	07/29/2021 09:00:50 PM Central Daylight Time			08/04/2021 04:41:32 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	01	02		1			H5253	089	0	2022	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	097	0	1	02	01	H5253_097_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 10:37:45 AM Central Daylight Time	08/03/2021 12:15:16 PM Central Daylight Time	07/29/2021 09:01:06 PM Central Daylight Time			08/04/2021 04:48:24 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Value (HMO-POS)	01	02		1			H5253	097	0	2022	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	3	1			2		1	08/04/2021	2022.01	08/04/2021 10:40:33 AM Central Daylight Time	08/03/2021 12:15:53 PM Central Daylight Time	07/29/2021 09:01:20 PM Central Daylight Time			08/04/2021 04:48:24 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO)	01	01		1			H5253	099	0	2022	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	3	1			2		1	08/04/2021	2022.01	08/04/2021 10:42:20 AM Central Daylight Time	08/03/2021 12:16:31 PM Central Daylight Time	07/29/2021 09:01:35 PM Central Daylight Time			08/04/2021 04:48:24 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO)	01	01		1			H5253	100	0	2022	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	02	01	H5253_102_0	4	1			2		1	08/04/2021	2022.01	08/04/2021 10:30:48 AM Central Daylight Time	08/03/2021 12:17:08 PM Central Daylight Time	07/29/2021 09:01:49 PM Central Daylight Time			08/04/2021 04:41:32 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO-POS)	01	02		1			H5253	102	0	2022	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	02	01	H5253_103_0	4	1			2		1	08/04/2021	2022.01	08/04/2021 10:32:57 AM Central Daylight Time	08/03/2021 12:17:44 PM Central Daylight Time	07/29/2021 09:02:04 PM Central Daylight Time			08/04/2021 04:41:32 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO-POS)	01	02		1			H5253	103	0	2022	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	02	01	H5253_104_0	4	1			2		1	08/04/2021	2022.01	08/04/2021 10:48:14 AM Central Daylight Time	08/03/2021 12:18:18 PM Central Daylight Time	07/29/2021 09:02:18 PM Central Daylight Time			08/04/2021 04:41:32 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO-POS)	01	02		1			H5253	104	0	2022	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	02	01	H5253_105_0	4	1			2		1	08/04/2021	2022.01	08/04/2021 10:44:38 AM Central Daylight Time	08/03/2021 12:18:53 PM Central Daylight Time	07/29/2021 09:02:33 PM Central Daylight Time			08/04/2021 04:41:32 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Walgreens (HMO-POS)	01	02		1			H5253	105	0	2022	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	2			
H5253	107	1	1	02	01	H5253_107_1	3	1			2		1	08/04/2021	2022.01	08/04/2021 03:26:22 PM Central Daylight Time	08/03/2021 12:19:29 PM Central Daylight Time	07/29/2021 09:02:48 PM Central Daylight Time			08/05/2021 10:00:31 AM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO-POS)	01	02		1			H5253	107	1	2022	Select Counties in Iowa	Iowa Metro	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	107	2	1	02	01	H5253_107_2	3	1			2		1	08/04/2021	2022.01	08/04/2021 03:25:12 PM Central Daylight Time	08/03/2021 12:20:04 PM Central Daylight Time	07/29/2021 09:03:02 PM Central Daylight Time			08/05/2021 10:00:31 AM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO-POS)	01	02		1			H5253	107	2	2022	Select Counties in Iowa	Iowa Rural	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	108	1	1	02	01	H5253_108_1	3	1			2		1	08/04/2021	2022.01	08/04/2021 03:24:01 PM Central Daylight Time	08/03/2021 12:20:39 PM Central Daylight Time	07/29/2021 09:03:17 PM Central Daylight Time			08/05/2021 10:00:31 AM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	01	02		1			H5253	108	1	2022	Northwestern Illinois	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	108	2	1	02	01	H5253_108_2	3	1			2		1	08/04/2021	2022.01	08/04/2021 03:22:48 PM Central Daylight Time	08/03/2021 12:21:14 PM Central Daylight Time	07/29/2021 09:03:32 PM Central Daylight Time			08/05/2021 10:00:31 AM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	01	02		1			H5253	108	2	2022	Northwestern Illinois	Henry, Mercer and Rock Island 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	108	3	1	02	01	H5253_108_3	3	1			2		1	08/04/2021	2022.01	08/04/2021 03:21:39 PM Central Daylight Time	08/03/2021 12:21:49 PM Central Daylight Time	07/29/2021 09:03:47 PM Central Daylight Time			08/05/2021 10:00:31 AM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	01	02		1			H5253	108	3	2022	Northwestern Illinois	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	109	1	1	01	01	H5253_109_1	3	1			2		1	08/04/2021	2022.01	08/04/2021 10:44:08 AM Central Daylight Time	08/03/2021 12:22:25 PM Central Daylight Time	07/29/2021 09:04:01 PM Central Daylight Time			08/04/2021 04:48:24 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO)	01	01		1			H5253	109	1	2022	Select Counties in Ohio and Kentucky	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	109	2	1	01	01	H5253_109_2	3	1			2		1	08/04/2021	2022.01	08/04/2021 10:46:49 AM Central Daylight Time	08/03/2021 12:23:00 PM Central Daylight Time	07/29/2021 09:04:16 PM Central Daylight Time			08/04/2021 04:48:24 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO)	01	01		1			H5253	109	2	2022	Select Counties in Ohio and Kentucky	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	110	0	1	02	01	H5253_110_0	4	1			2		1	08/04/2021	2022.01	08/04/2021 10:42:53 AM Central Daylight Time	08/03/2021 12:23:34 PM Central Daylight Time	07/29/2021 09:04:31 PM Central Daylight Time			08/04/2021 04:41:32 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Walgreens (HMO-POS)	01	02		1			H5253	110	0	2022	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	111	1	1	02	01	H5253_111_1	4	1			2		1	08/04/2021	2022.01	08/04/2021 10:41:20 AM Central Daylight Time	08/03/2021 12:24:10 PM Central Daylight Time	07/29/2021 09:04:47 PM Central Daylight Time			08/04/2021 04:41:32 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO-POS)	01	02		1			H5253	111	1	2022	Roanoke/Richmond Metro Area	Roanoke	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	111	2	1	02	01	H5253_111_2	4	1			2		1	08/04/2021	2022.01	08/04/2021 10:39:37 AM Central Daylight Time	08/03/2021 12:24:44 PM Central Daylight Time	07/29/2021 09:05:03 PM Central Daylight Time			08/04/2021 04:41:32 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO-POS)	01	02		1			H5253	111	2	2022	Roanoke/Richmond Metro Area	Richmond	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	112	1	1	02	01	H5253_112_1	4	1			2		1	08/04/2021	2022.01	08/04/2021 10:37:41 AM Central Daylight Time	08/03/2021 12:25:20 PM Central Daylight Time	07/29/2021 09:05:19 PM Central Daylight Time			08/04/2021 04:41:32 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO-POS)	01	02		1			H5253	112	1	2022	Richmond and Roanoke Metro Area	Roanoke	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	112	2	1	02	01	H5253_112_2	4	1			2		1	08/04/2021	2022.01	08/04/2021 10:35:58 AM Central Daylight Time	08/03/2021 12:25:55 PM Central Daylight Time	07/29/2021 09:05:36 PM Central Daylight Time			08/04/2021 04:41:32 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO-POS)	01	02		1			H5253	112	2	2022	Richmond and Roanoke Metro Area	Richmond	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	113	0	1	01	01	H5253_113_0	2	1			2	0	0	07/14/2021	2022.01	07/14/2021 03:44:48 PM Central Daylight Time	06/03/2021 03:04:57 PM Central Daylight Time				07/15/2021 01:02:10 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (HMO)	01	01		1			H5253	113	0	2022	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										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H5253	115	0	1	01	01	H5253_115_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 10:48:20 AM Central Daylight Time	08/03/2021 12:26:30 PM Central Daylight Time	07/29/2021 09:05:51 PM Central Daylight Time			08/04/2021 04:48:24 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 8 (HMO)	01	01		1			H5253	115	0	2022	Select Counties in North Central OH		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	801	0	1	01	01	H5253_801_0	1	1						05/24/2021	2022.01	05/24/2021 04:15:52 PM Eastern Daylight Time					06/02/2021 10:28:42 AM Eastern Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H5253	801	0	2022	Milwaukee and Green Bay Area Counties		1	48	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;17a;18a;	2		1					1				
H5253	802	0	1	01	01	H5253_802_0	1	1				0	0	05/24/2021	2022.01	05/24/2021 04:58:19 PM Eastern Daylight Time					06/02/2021 10:28:42 AM Eastern Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H5253	802	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;17a;18a;	2		1					1				
H5253	805	0	1	01	01	H5253_805_0	1	1						05/24/2021	2022.01	05/24/2021 04:48:41 PM Eastern Daylight Time					06/02/2021 10:28:42 AM Eastern Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H5253	805	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;17a;18a;	2		1					1				
H5253	810	0	1	01	01	H5253_810_0	1	1						05/24/2021	2022.01	05/24/2021 04:49:11 PM Eastern Daylight Time					06/02/2021 10:28:42 AM Eastern Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H5253	810	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;17a;18a;	2		1					1				
H5253	811	0	1	01	01	H5253_811_0	1	1						05/24/2021	2022.01	05/24/2021 04:49:43 PM Eastern Daylight Time					06/02/2021 10:28:42 AM Eastern Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H5253	811	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;17a;18a;	2		1					1				
H5253	812	0	1	01	01	H5253_812_0	1	1				0	0	05/24/2021	2022.01	05/24/2021 04:58:47 PM Eastern Daylight Time					06/02/2021 10:28:42 AM Eastern Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H5253	812	0	2022	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										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;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;17a;18a;	2		1					1				
H5253	813	0	1	01	01	H5253_813_0	1	1						05/24/2021	2022.01	05/24/2021 04:50:16 PM Eastern Daylight Time					06/02/2021 10:28:42 AM Eastern Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H5253	813	0	2022	Select counties in North Carolina		1	3744	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;17a;18a;	2		1					1				
H5253	814	0	1	01	01	H5253_814_0	1	1						05/24/2021	2022.01	05/24/2021 04:50:32 PM Eastern Daylight Time					06/02/2021 10:28:42 AM Eastern Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H5253	814	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;17a;18a;	2		1					1				
H5253	815	0	1	01	01	H5253_815_0	1	1				0	0	05/24/2021	2022.01	05/24/2021 04:59:24 PM Eastern Daylight Time					06/02/2021 10:28:42 AM Eastern Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H5253	815	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;17a;18a;	2		1					1				
H5253	816	0	2	01	01	H5253_816_0	1	1						05/24/2021	2022.01	05/24/2021 04:51:34 PM Eastern Daylight Time					06/02/2021 10:28:42 AM Eastern Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		2	2		H5253	816	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;17a;18a;	2		1					1				
H5253	817	0	2	01	01	H5253_817_0	1	1						05/24/2021	2022.01	05/24/2021 04:51:47 PM Eastern Daylight Time					06/02/2021 10:28:42 AM Eastern Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		2	2		H5253	817	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;17a;18a;	2		1					1				
H5253	818	0	1	01	01	H5253_818_0	1	1						05/24/2021	2022.01	05/24/2021 04:52:02 PM Eastern Daylight Time					06/02/2021 10:28:42 AM Eastern Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H5253	818	0	2022	Select counties in IA, IL, TN, & VA		1	3492	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;17a;18a;	2		1					1				
H5253	819	0	1	01	01	H5253_819_0	1	1				0	0	05/24/2021	2022.01	05/24/2021 04:59:49 PM Eastern Daylight Time					06/02/2021 10:28:42 AM Eastern Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H5253	819	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;17a;18a;	2		1					1				
H5253	820	0	1	01	01	H5253_820_0	1	1						05/24/2021	2022.01	05/24/2021 04:53:11 PM Eastern Daylight Time					06/02/2021 10:28:42 AM Eastern Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H5253	820	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;17a;18a;	2		1					1				
H5253	821	0	1	01	01	H5253_821_0	1	1						05/24/2021	2022.01	05/24/2021 04:53:24 PM Eastern Daylight Time					06/02/2021 10:28:42 AM Eastern Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H5253	821	0	2022	Select counties in Kentucky and Ohio		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		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;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;17a;18a;	2		1					1				
H5253	822	0	1	01	01	H5253_822_0	1	1				0	0	05/24/2021	2022.01	05/24/2021 05:00:12 PM Eastern Daylight Time					06/02/2021 10:28:42 AM Eastern Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H5253	822	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;17a;18a;	2		1					1				
H5253	823	0	1	01	01	H5253_823_0	1	1						05/24/2021	2022.01	05/24/2021 04:54:02 PM Eastern Daylight Time					06/02/2021 10:28:42 AM Eastern Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H5253	823	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;17a;18a;	2		1					1				
H5253	824	0	1	01	01	H5253_824_0	1	1						05/24/2021	2022.01	05/24/2021 04:54:15 PM Eastern Daylight Time					06/02/2021 10:28:42 AM Eastern Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H5253	824	0	2022	Select AZ 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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;17a;18a;	2		1					1				
H5253	825	0	1	01	01	H5253_825_0	1	1				0	0	05/24/2021	2022.01	05/24/2021 05:00:37 PM Eastern Daylight Time					06/02/2021 10:28:42 AM Eastern Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H5253	825	0	2022	Select AZ 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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;17a;18a;	2		1					1				
H5256	001	0	1	18	06	H5256_001_0	1	2				0	0	06/04/2021	2022.01	06/04/2021 08:55:32 AM Central Daylight Time					06/04/2021 09:25:35 AM Central Daylight Time	MEDICAL ASSOCIATES CLINIC HEALTH PLAN	Medical Associates Clinic Health Plan of Wisconsin	www.mahealthplans.com	Medical Associates SmartPlan (Cost)	06	18		1			H5256	001	0	2022	Grant, Crawford, Iowa, Lafayette Counties		2	35700	2			2								www.mahealthplans.com	(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				0	0	06/04/2021	2022.01	06/04/2021 09:05:50 AM Central Daylight Time					06/04/2021 09:25:35 AM Central Daylight Time	MEDICAL ASSOCIATES CLINIC HEALTH PLAN	Medical Associates Clinic Health Plan of Wisconsin	www.mahealthplans.com	Medical Associates Community Plan (Cost)	06	18		1			H5256	002	0	2022	Grant, Crawford, Iowa, Lafayette Counties		2	4500	2			2								www.mahealthplans.com	(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				0	0	06/04/2021	2022.01	06/04/2021 09:17:08 AM Central Daylight Time					06/04/2021 09:25:35 AM Central Daylight Time	MEDICAL ASSOCIATES CLINIC HEALTH PLAN	Medical Associates Clinic Health Plan of Wisconsin	www.mahealthplans.com	Medical Associates Freedom Plan (Cost)	06	18		1			H5256	004	0	2022	Grant, Crawford, Iowa, Lafayette Counties		2	6000	2			2								www.mahealthplans.com	(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	4	1					1	08/05/2021	2022.01	08/05/2021 10:51:45 AM Central Daylight Time	08/05/2021 12:00:44 PM Central Daylight Time	08/05/2021 12:00:49 PM Central Daylight Time			08/05/2021 01:21:37 PM Central Daylight Time	QUARTZ HEALTH PLAN CORPORATION	Quartz Medicare Advantage	quartzbenefits.com/medicareadvantage	Gundersen Quartz Med Advantage Elite D (w/Rx) (HMO)	01	01		1			H5262	001	0	2022	Western Wisconsin and Northeast Iowa		2		2			2						quartzbenefits.com/MAFindaPharmacy	quartzbenefits.com/MAFormulary	quartzbenefits.com/MAFindaDoctor	(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	4	1					1	07/07/2021	2022.01	07/07/2021 09:57:09 AM Central Daylight Time	08/05/2021 12:00:45 PM Central Daylight Time	08/05/2021 12:00:50 PM Central Daylight Time			08/05/2021 01:21:37 PM Central Daylight Time	QUARTZ HEALTH PLAN CORPORATION	Quartz Medicare Advantage	quartzbenefits.com/medicareadvantage	Gundersen Quartz Med Advantage Value D (w/Rx) (HMO)	01	01		1			H5262	003	0	2022	Western Wisconsin and Northeast Iowa		2		2			2						quartzbenefits.com/MAFindaPharmacy	quartzbenefits.com/MAFormulary	quartzbenefits.com/MAFindaDoctor	(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				0	0	07/07/2021	2022.01	07/07/2021 09:57:39 AM Central Daylight Time	07/16/2021 09:00:22 AM Central Daylight Time				07/16/2021 09:22:13 AM Central Daylight Time	QUARTZ HEALTH PLAN CORPORATION	Quartz Medicare Advantage	quartzbenefits.com/medicareadvantage	Gundersen Quartz Med Advantage Value (HMO)	01	01		1			H5262	004	0	2022	Western Wisconsin and Northeast Iowa		2		2			2						quartzbenefits.com/MAFindaPharmacy	quartzbenefits.com/MAFormulary	quartzbenefits.com/MAFindaDoctor	(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				0	0	07/07/2021	2022.01	07/07/2021 09:58:14 AM Central Daylight Time	07/16/2021 09:00:22 AM Central Daylight Time				07/16/2021 09:22:13 AM Central Daylight Time	QUARTZ HEALTH PLAN CORPORATION	Quartz Medicare Advantage	quartzbenefits.com/medicareadvantage	Gundersen Quartz Med Advantage Elite (HMO)	01	01		1			H5262	005	0	2022	Western Wisconsin and Northeast Iowa		2		2			2						quartzbenefits.com/MAFindaPharmacy	quartzbenefits.com/MAFormulary	quartzbenefits.com/MAFindaDoctor	(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	3	1					1	07/07/2021	2022.01	07/07/2021 01:52:31 PM Central Daylight Time	08/05/2021 12:00:45 PM Central Daylight Time	08/05/2021 12:00:50 PM Central Daylight Time			08/05/2021 01:21:37 PM Central Daylight Time	QUARTZ HEALTH PLAN CORPORATION	Quartz Medicare Advantage	quartzbenefits.com/medicareadvantage	UW Health Quartz Med Advantage Elite D (w/Rx) (HMO)	01	01		1			H5262	007	0	2022	Southcentral Wisconsin		2		2			2						quartzbenefits.com/MAFindaPharmacy	quartzbenefits.com/MAFormulary	quartzbenefits.com/MAFindaDoctor	(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	3	1					1	07/02/2021	2022.01	07/02/2021 01:54:26 PM Central Daylight Time	08/05/2021 12:00:45 PM Central Daylight Time	08/05/2021 12:00:50 PM Central Daylight Time			08/05/2021 01:21:37 PM Central Daylight Time	QUARTZ HEALTH PLAN CORPORATION	Quartz Medicare Advantage	quartzbenefits.com/medicareadvantage	UW Health Quartz Med Advantage Value D (w/Rx) (HMO)	01	01		1			H5262	008	0	2022	Southcentral Wisconsin		2		2			2						quartzbenefits.com/MAFindaPharmacy	quartzbenefits.com/MAFormulary	quartzbenefits.com/MAFindaDoctor	(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	2	1				0	0	07/07/2021	2022.01	07/07/2021 10:00:58 AM Central Daylight Time	06/06/2021 01:19:28 PM Central Daylight Time				07/07/2021 10:09:43 AM Central Daylight Time	QUARTZ HEALTH PLAN CORPORATION	Quartz Medicare Advantage	quartzbenefits.com/medicareadvantage	UW Health Quartz Med Advantage Value (HMO)	01	01		1			H5262	009	0	2022	Southcentral Wisconsin		2		2			2						quartzbenefits.com/MAFindaPharmacy	quartzbenefits.com/MAFormulary	quartzbenefits.com/MAFindaDoctor	(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	2	1				0	0	07/07/2021	2022.01	07/07/2021 10:00:45 AM Central Daylight Time	06/06/2021 01:19:28 PM Central Daylight Time				07/07/2021 10:09:43 AM Central Daylight Time	QUARTZ HEALTH PLAN CORPORATION	Quartz Medicare Advantage	quartzbenefits.com/medicareadvantage	UW Health Quartz Med Advantage Elite (HMO)	01	01		1			H5262	010	0	2022	Southcentral Wisconsin		2		2			2						quartzbenefits.com/MAFindaPharmacy	quartzbenefits.com/MAFormulary	quartzbenefits.com/MAFindaDoctor	(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	3	1					1	07/12/2021	2022.01	07/12/2021 03:20:04 PM Central Daylight Time	08/05/2021 12:00:45 PM Central Daylight Time	08/05/2021 12:00:50 PM Central Daylight Time			08/05/2021 01:21:37 PM Central Daylight Time	QUARTZ HEALTH PLAN CORPORATION	Quartz Medicare Advantage	quartzbenefits.com/medicareadvantage	Aurora Health Quartz Med Advantage Value D (w/Rx) (HMO)	01	01		1			H5262	011	0	2022	Eastern Wisconsin		2		2			2						quartzbenefits.com/MAFindaPharmacy	quartzbenefits.com/MAFormulary	quartzbenefits.com/MAFindaDoctor	(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	3	1					1	08/05/2021	2022.01	08/05/2021 09:26:39 AM Central Daylight Time	08/05/2021 12:00:45 PM Central Daylight Time	08/05/2021 12:00:50 PM Central Daylight Time			08/05/2021 01:21:37 PM Central Daylight Time	QUARTZ HEALTH PLAN CORPORATION	Quartz Medicare Advantage	quartzbenefits.com/medicareadvantage	Aurora Health Quartz Med Advantage Core D (w/Rx) (HMO)	01	01		1			H5262	012	0	2022	Eastern Wisconsin		2		2			2						quartzbenefits.com/MAFindaPharmacy	quartzbenefits.com/MAFormulary	quartzbenefits.com/MAFindaDoctor	(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	2	1				0	0	07/07/2021	2022.01	07/07/2021 10:00:34 AM Central Daylight Time	06/06/2021 01:19:29 PM Central Daylight Time				07/07/2021 10:09:43 AM Central Daylight Time	QUARTZ HEALTH PLAN CORPORATION	Quartz Medicare Advantage	quartzbenefits.com/medicareadvantage	Aurora Health Quartz Med Advantage Value (HMO)	01	01		1			H5262	013	0	2022	Eastern Wisconsin		2		2			2						quartzbenefits.com/MAFindaPharmacy	quartzbenefits.com/MAFormulary	quartzbenefits.com/MAFindaDoctor	(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					1	07/02/2021	2022.01	07/02/2021 01:58:51 PM Central Daylight Time	08/05/2021 12:00:46 PM Central Daylight Time	08/05/2021 12:00:51 PM Central Daylight Time			08/05/2021 01:21:37 PM Central Daylight Time	QUARTZ HEALTH PLAN CORPORATION	Quartz Medicare Advantage	quartzbenefits.com/medicareadvantage	SwedishAmerican Quartz Med Advantage Value D(w/Rx) (HMO)	01	01		1			H5262	018	0	2022	Northcentral Illinois		2		2			2						quartzbenefits.com/MAFindaPharmacy	quartzbenefits.com/MAFormulary	quartzbenefits.com/MAFindaDoctor	(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	3	1					1	08/05/2021	2022.01	08/05/2021 10:52:41 AM Central Daylight Time	08/05/2021 12:00:46 PM Central Daylight Time	08/05/2021 12:00:51 PM Central Daylight Time			08/05/2021 01:21:37 PM Central Daylight Time	QUARTZ HEALTH PLAN CORPORATION	Quartz Medicare Advantage	quartzbenefits.com/medicareadvantage	SwedishAmerican Quartz Med Advantage Core D (w/Rx) (HMO)	01	01		1			H5262	019	0	2022	Northcentral Illinois		2		2			2						quartzbenefits.com/MAFindaPharmacy	quartzbenefits.com/MAFormulary	quartzbenefits.com/MAFindaDoctor	(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	2	1				0	0	07/07/2021	2022.01	07/07/2021 10:00:23 AM Central Daylight Time	06/06/2021 01:19:31 PM Central Daylight Time				07/07/2021 10:09:43 AM Central Daylight Time	QUARTZ HEALTH PLAN CORPORATION	Quartz Medicare Advantage	quartzbenefits.com/medicareadvantage	SwedishAmerican Quartz Med Advantage Value (HMO)	01	01		1			H5262	020	0	2022	Northcentral Illinois		2		2			2						quartzbenefits.com/MAFindaPharmacy	quartzbenefits.com/MAFormulary	quartzbenefits.com/MAFindaDoctor	(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	021	0	1	01	01	H5262_021_0	4	1					1	08/05/2021	2022.01	08/05/2021 09:25:17 AM Central Daylight Time	08/05/2021 12:00:46 PM Central Daylight Time	08/05/2021 12:00:51 PM Central Daylight Time			08/05/2021 01:21:37 PM Central Daylight Time	QUARTZ HEALTH PLAN CORPORATION	Quartz Medicare Advantage	quartzbenefits.com/medicareadvantage	Gundersen Quartz Med Advantage Core D (w/Rx) (HMO)	01	01		1			H5262	021	0	2022	Western Wisconsin and Northeast Iowa		2		2			2						quartzbenefits.com/MAFindaPharmacy	quartzbenefits.com/MAFormulary	quartzbenefits.com/MAFindaDoctor	(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	023	0	1	01	01	H5262_023_0	3	1					1	08/05/2021	2022.01	08/05/2021 09:28:11 AM Central Daylight Time	08/05/2021 12:00:47 PM Central Daylight Time	08/05/2021 12:00:51 PM Central Daylight Time			08/05/2021 01:21:37 PM Central Daylight Time	QUARTZ HEALTH PLAN CORPORATION	Quartz Medicare Advantage	quartzbenefits.com/medicareadvantage	UW Health Quartz Med Advantage Core D (w/Rx) (HMO)	01	01		1			H5262	023	0	2022	Southcentral Wisconsin		2		2			2						quartzbenefits.com/MAFindaPharmacy	quartzbenefits.com/MAFormulary	quartzbenefits.com/MAFindaDoctor	(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	024	0	1	01	01	H5262_024_0	3	1					1	07/02/2021	2022.01	07/02/2021 04:27:00 PM Central Daylight Time	08/05/2021 12:00:47 PM Central Daylight Time	08/05/2021 12:00:51 PM Central Daylight Time			08/05/2021 01:21:37 PM Central Daylight Time	QUARTZ HEALTH PLAN CORPORATION	Quartz Medicare Advantage	quartzbenefits.com/medicareadvantage	Aurora Health Quartz Med Advantage Elite D (w/Rx) (HMO)	01	01		1			H5262	024	0	2022	Eastern Wisconsin		2		2			2						quartzbenefits.com/MAFindaPharmacy	quartzbenefits.com/MAFormulary	quartzbenefits.com/MAFindaDoctor	(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	025	0	1	01	01	H5262_025_0	2	1				0	0	07/07/2021	2022.01	07/07/2021 09:59:05 AM Central Daylight Time	06/06/2021 01:19:32 PM Central Daylight Time				07/07/2021 10:09:43 AM Central Daylight Time	QUARTZ HEALTH PLAN CORPORATION	Quartz Medicare Advantage	quartzbenefits.com/medicareadvantage	Aurora Health Quartz Med Advantage Elite (HMO)	01	01		1			H5262	025	0	2022	Eastern Wisconsin		2		2			2						quartzbenefits.com/MAFindaPharmacy	quartzbenefits.com/MAFormulary	quartzbenefits.com/MAFindaDoctor	(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	026	0	1	01	01	H5262_026_0	3	1					1	07/02/2021	2022.01	07/02/2021 02:00:06 PM Central Daylight Time	08/05/2021 12:00:48 PM Central Daylight Time	08/05/2021 12:00:52 PM Central Daylight Time			08/05/2021 01:21:37 PM Central Daylight Time	QUARTZ HEALTH PLAN CORPORATION	Quartz Medicare Advantage	quartzbenefits.com/medicareadvantage	SwedishAmerican Quartz Med Advantage Elite D(w/Rx) (HMO)	01	01		1			H5262	026	0	2022	Northcentral Illinois		2		2			2						quartzbenefits.com/MAFindaPharmacy	quartzbenefits.com/MAFormulary	quartzbenefits.com/MAFindaDoctor	(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	027	0	1	01	01	H5262_027_0	2	1				0	0	07/07/2021	2022.01	07/07/2021 09:58:40 AM Central Daylight Time	06/06/2021 01:19:33 PM Central Daylight Time				07/07/2021 10:09:43 AM Central Daylight Time	QUARTZ HEALTH PLAN CORPORATION	Quartz Medicare Advantage	quartzbenefits.com/medicareadvantage	SwedishAmerican Quartz Med Advantage Elite (HMO)	01	01		1			H5262	027	0	2022	Northcentral Illinois		2		2			2						quartzbenefits.com/MAFindaPharmacy	quartzbenefits.com/MAFormulary	quartzbenefits.com/MAFindaDoctor	(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	1	1						05/27/2021	2022.01	05/27/2021 10:29:43 AM Central Daylight Time					06/06/2021 01:30:04 PM Central Daylight Time	QUARTZ HEALTH PLAN CORPORATION	Quartz Medicare Advantage	quartzbenefits.com/medicareadvantage	Employer Group Quartz Medicare Advantage D (w/Rx) (HMO)	01	01		1			H5262	801	0	2022	Southern WI, Northcentral IL, and Northeast IA		1	1200	2			2						quartzbenefits.com/MAFindaPharmacy	quartzbenefits.com/MAFormulary	quartzbenefits.com/MAFindaDoctor	(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;7c;7i;11a;11b;15;	2		1					1				
H5262	802	0	1	01	01	H5262_802_0	1	1				0	0	05/27/2021	2022.01	05/27/2021 10:30:05 AM Central Daylight Time					06/06/2021 01:30:04 PM Central Daylight Time	QUARTZ HEALTH PLAN CORPORATION	Quartz Medicare Advantage	quartzbenefits.com/medicareadvantage	Employer Group Quartz Medicare Advantage (HMO)	01	01		1			H5262	802	0	2022	Southern WI, Northcentral IL, and Northeast IA		1	1200	2			2						quartzbenefits.com/MAFindaPharmacy	quartzbenefits.com/MAFormulary	quartzbenefits.com/MAFindaDoctor	(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275										(800)877-8973		(711)-		(800)877-8973		(711)-										1	1	2;5;7c;7i;11a;11b;15;	2		1					1				
H5264	002	0	1	18	06	H5264_002_0	4	2				0	0	07/19/2021	2022.01	07/19/2021 01:11:31 PM Central Daylight Time					07/19/2021 03:56:33 PM Central Daylight Time	DEAN HEALTH PLAN, INC.	Dean Health Plan, Inc.	deancare.com/medicare	DeanCare Gold Enhanced (Cost)	06	18		1			H5264	002	0	2022	South Central Wisconsin		2	144446	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	6	2				0	0	05/21/2021	2022.01	05/21/2021 02:29:26 PM Central Daylight Time					07/20/2021 08:41:19 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	2022	South Central Wisconsin		2	829	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	4	2				0	0	07/19/2021	2022.01	07/19/2021 01:11:53 PM Central Daylight Time					07/19/2021 03:56:33 PM 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	2022	South Central Wisconsin		2	34058	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	7	1					0	09/27/2021	2022.01	09/27/2021 04:32:16 PM Eastern Daylight Time	08/03/2021 10:45:22 AM Eastern Daylight Time	08/02/2021 01:38:04 PM Eastern Daylight Time			09/27/2021 04:43:15 PM Eastern Daylight Time	CAREPARTNERS OF CONNECTICUT, INC.	CarePartners of Connecticut	www.carepartnersct.com	CarePartners of CT CareAdvantage Preferred (HMO)	01	01		1			H5273	001	0	2022	Most of Connecticut		2		2			2						www.carepartnersct.com/search-doctors	www.carepartnersct.com/drug-search	www.carepartnersct.com/search-doctors	(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	8	1					0	09/27/2021	2022.01	09/27/2021 04:33:03 PM Eastern Daylight Time	08/03/2021 02:32:10 PM Eastern Daylight Time	08/02/2021 01:38:26 PM Eastern Daylight Time			09/27/2021 04:43:15 PM Eastern Daylight Time	CAREPARTNERS OF CONNECTICUT, INC.	CarePartners of Connecticut	www.carepartnersct.com	CarePartners of CT CareAdvantage Prime (HMO)	01	01		1			H5273	002	0	2022	Most of Connecticut		2		2			2						www.carepartnersct.com/search-doctors	www.carepartnersct.com/drug-search	www.carepartnersct.com/search-doctors	(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	2	1						07/14/2021	2022.01	07/14/2021 04:36:25 PM Pacific Daylight Time					07/14/2021 04:39:21 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	2022	Select Counties in 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	010	0	1	01	01	H5294_010_0	5	1	2	1			0	07/06/2021	2022.01	07/06/2021 12:39:26 PM Eastern Daylight Time	08/04/2021 12:34:00 AM Eastern Daylight Time	07/30/2021 11:48:30 AM Eastern Daylight Time			08/04/2021 10:52:49 PM Eastern Daylight Time	SUPERIOR HEALTH PLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellTX	Wellcare Dual Liberty Nurture (HMO D-SNP)	01	01		1			H5294	010	0	2022	Select counties in TX		2	129577	2			1	3		1		1	www.wellcare.com/allwellTX	www.wellcare.com/allwellTX	www.wellcare.com/allwellTX	(877)935-8023		(877)935-8023		(866)277-6583		(866)277-6583		(877)935-8023		(877)935-8023		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5294	011	0	1	01	01	H5294_011_0	4	1					0	07/31/2021	2022.01	07/31/2021 03:51:48 PM Pacific Daylight Time	08/04/2021 12:34:30 AM Eastern Daylight Time	07/30/2021 11:49:06 AM Eastern Daylight Time			08/04/2021 10:52:49 PM Eastern Daylight Time	SUPERIOR HEALTH PLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellTX	Wellcare No Premium (HMO)	01	01		1			H5294	011	0	2022	Select counties in TX		2	39622	2			2						www.wellcare.com/allwellTX	www.wellcare.com/allwellTX	www.wellcare.com/allwellTX	(844)796-6811		(844)796-6811		(866)277-6583		(866)277-6583		(844)796-6811		(844)796-6811		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5294	012	0	1	01	01	H5294_012_0	4	1					0	08/02/2021	2022.01	08/02/2021 01:17:17 PM Pacific Daylight Time	08/04/2021 12:35:02 AM Eastern Daylight Time	07/30/2021 11:49:26 AM Eastern Daylight Time			08/04/2021 10:52:49 PM Eastern Daylight Time	SUPERIOR HEALTH PLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellTX	Wellcare Giveback (HMO)	01	01		1			H5294	012	0	2022	Select counties in TX		2	20320	2			2						www.wellcare.com/allwellTX	www.wellcare.com/allwellTX	www.wellcare.com/allwellTX	(844)796-6811		(844)796-6811		(866)277-6583		(866)277-6583		(844)796-6811		(844)796-6811		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5294	013	0	1	01	01	H5294_013_0	4	1					0	06/04/2021	2022.01	06/04/2021 01:25:06 PM Eastern Daylight Time	08/04/2021 12:35:30 AM Eastern Daylight Time	07/30/2021 11:49:46 AM Eastern Daylight Time			08/04/2021 10:52:49 PM Eastern Daylight Time	SUPERIOR HEALTH PLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellTX	Wellcare Complement Assist (HMO)	01	01		1			H5294	013	0	2022	Select counties in TX		2	3598	2			2						www.wellcare.com/allwellTX	www.wellcare.com/allwellTX	www.wellcare.com/allwellTX	(844)796-6811		(844)796-6811		(866)277-6583		(866)277-6583		(844)796-6811		(844)796-6811		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5294	014	0	1	01	01	H5294_014_0	3	1				0	0	06/03/2021	2022.01	06/03/2021 12:14:30 PM Pacific Daylight Time	06/04/2021 07:40:39 PM Eastern Daylight Time				07/19/2021 05:55:30 PM Eastern Daylight Time	SUPERIOR HEALTH PLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellTX	Wellcare Patriot No Premium (HMO)	01	01		1			H5294	014	0	2022	Select counties in TX		2	6588	2			2						www.wellcare.com/allwellTX	www.wellcare.com/allwellTX	www.wellcare.com/allwellTX	(844)796-6811		(844)796-6811		(866)277-6583		(866)277-6583										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H5294	015	0	1	01	01	H5294_015_0	4	1	2	1			0	06/02/2021	2022.01	06/02/2021 05:07:58 PM Pacific Daylight Time	08/04/2021 12:36:31 AM Eastern Daylight Time	07/30/2021 11:50:06 AM Eastern Daylight Time			08/04/2021 10:52:49 PM Eastern Daylight Time	SUPERIOR HEALTH PLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellTX	Wellcare Dual Access Harmony (HMO D-SNP)	01	01		1			H5294	015	0	2022	Select counties in TX		2	6464	2			1	3		1		1	www.wellcare.com/allwellTX	www.wellcare.com/allwellTX	www.wellcare.com/allwellTX	(877)935-8023		(877)935-8023		(866)277-6583		(866)277-6583		(877)935-8023		(877)935-8023		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5294	016	0	1	01	01	H5294_016_0	4	1					0	06/04/2021	2022.01	06/04/2021 01:25:49 PM Eastern Daylight Time	08/04/2021 12:37:01 AM Eastern Daylight Time	07/30/2021 11:50:48 AM Eastern Daylight Time			08/04/2021 10:52:49 PM Eastern Daylight Time	SUPERIOR HEALTH PLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellTX	Wellcare Complement Assist (HMO)	01	01		1			H5294	016	0	2022	Select counties in TX		2	25750	2			2						www.wellcare.com/allwellTX	www.wellcare.com/allwellTX	www.wellcare.com/allwellTX	(844)796-6811		(844)796-6811		(866)277-6583		(866)277-6583		(844)796-6811		(844)796-6811		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5294	017	0	1	01	01	H5294_017_0	4	1					0	07/31/2021	2022.01	07/31/2021 03:47:06 PM Pacific Daylight Time	08/04/2021 12:37:30 AM Eastern Daylight Time	07/30/2021 11:51:22 AM Eastern Daylight Time			08/04/2021 10:52:49 PM Eastern Daylight Time	SUPERIOR HEALTH PLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellTX	Wellcare No Premium (HMO)	01	01		1			H5294	017	0	2022	Select counties in TX		2	5547	2			2						www.wellcare.com/allwellTX	www.wellcare.com/allwellTX	www.wellcare.com/allwellTX	(844)796-6811		(844)796-6811		(866)277-6583		(866)277-6583		(844)796-6811		(844)796-6811		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5294	018	0	1	01	01	H5294_018_0	4	1					0	07/31/2021	2022.01	07/31/2021 03:48:39 PM Pacific Daylight Time	08/04/2021 12:37:58 AM Eastern Daylight Time	07/30/2021 11:51:44 AM Eastern Daylight Time			08/04/2021 10:52:49 PM Eastern Daylight Time	SUPERIOR HEALTH PLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellTX	Wellcare No Premium (HMO)	01	01		1			H5294	018	0	2022	Select counties in TX		2	9798	2			2						www.wellcare.com/allwellTX	www.wellcare.com/allwellTX	www.wellcare.com/allwellTX	(844)796-6811		(844)796-6811		(866)277-6583		(866)277-6583		(844)796-6811		(844)796-6811		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5294	019	0	1	01	01	H5294_019_0	4	1					0	08/02/2021	2022.01	08/02/2021 01:19:19 PM Pacific Daylight Time	08/04/2021 12:38:27 AM Eastern Daylight Time	07/30/2021 11:52:04 AM Eastern Daylight Time			08/04/2021 10:52:49 PM Eastern Daylight Time	SUPERIOR HEALTH PLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellTX	Wellcare Giveback (HMO)	01	01		1			H5294	019	0	2022	Select counties in TX		2	5370	2			2						www.wellcare.com/allwellTX	www.wellcare.com/allwellTX	www.wellcare.com/allwellTX	(844)796-6811		(844)796-6811		(866)277-6583		(866)277-6583		(844)796-6811		(844)796-6811		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5296	001	0	1	01	01	H5296_001_0	5	1					0	08/03/2021	2022.01	08/03/2021 10:33:24 PM Pacific Daylight Time	08/03/2021 04:12:08 PM Pacific Daylight Time	07/30/2021 11:05:58 AM Pacific Daylight Time			08/03/2021 10:35:06 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan NC Premier (HMO)	01	01		1			H5296	001	0	2022	Wake, Chatham, Johnston, Henderson		2	25888	2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(866)634-2247		(888)979-2247		(888)979-2247		(844)227-7616		(844)227-7616		(888)979-2247		(888)979-2247		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5296	003	0	1	02	01	H5296_003_0	5	1					0	08/03/2021	2022.01	08/03/2021 10:33:32 PM Pacific Daylight Time	08/03/2021 04:14:28 PM Pacific Daylight Time	07/30/2021 11:06:46 AM Pacific Daylight Time			08/03/2021 10:35:06 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Alignment Health Plan	www.alignmenthealthplan.com	AVA (HMO-POS)	01	02		1			H5296	003	0	2022	Mountains and Piedmont Regions		2	11049	2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(866)634-2247		(888)979-2247		(888)979-2247		(844)227-7616		(844)227-7616		(888)979-2247		(888)979-2247		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5296	004	0	1	01	01	H5296_004_0	5	1	2	1			0	07/12/2021	2022.01	07/12/2021 06:01:55 PM Pacific Daylight Time	08/03/2021 04:16:28 PM Pacific Daylight Time	07/30/2021 11:07:42 AM Pacific Daylight Time			08/03/2021 10:35:06 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan NC Duals (HMO D-SNP)	01	01		1			H5296	004	0	2022	Mountains and Piedmont Regions		2	2657	2			1	3		1		1	www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(866)634-2247		(888)979-2247		(888)979-2247		(844)227-7616		(844)227-7616		(888)979-2247		(888)979-2247		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5296	801	0	1	01	01	H5296_801_0	3	1						07/13/2021	2022.01	07/13/2021 10:51:31 AM Pacific Daylight Time					07/13/2021 12:03:32 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan Retiree Options (HMO)	01	01		1			H5296	801	0	2022	Mountains and Piedmont Regions		1	6000	2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(866)634-2247	5550	(888)979-2247	1	(888)979-2247	6	(844)227-7616		(844)227-7616		(888)979-2247	1	(888)979-2247	6	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5296	802	0	1	01	01	H5296_802_0	3	1						07/13/2021	2022.01	07/13/2021 10:51:22 AM Pacific Daylight Time					07/13/2021 12:03:32 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan Retiree Options (HMO)	01	01		1			H5296	802	0	2022	Mountains and Piedmont Regions		1	6000	2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(866)634-2247	5550	(888)979-2247	1	(888)979-2247	6	(844)227-7616		(844)227-7616		(888)979-2247	1	(888)979-2247	6	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5296	803	0	1	01	01	H5296_803_0	3	1				0	0	07/13/2021	2022.01	07/13/2021 10:51:13 AM Pacific Daylight Time					07/13/2021 12:03:32 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan Retiree Options (HMO)	01	01		1			H5296	803	0	2022	Mountains and Piedmont Regions		1	6000	2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(866)634-2247	5550	(888)979-2247	1	(888)979-2247	6									(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H5296	804	0	1	01	01	H5296_804_0	3	1				0	0	07/13/2021	2022.01	07/13/2021 10:52:04 AM Pacific Daylight Time					07/13/2021 12:03:32 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan Retiree Options (HMO)	01	01		1			H5296	804	0	2022	Mountains and Piedmont Regions		1	6000	2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(866)634-2247	5550	(888)979-2247	1	(888)979-2247	6									(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H5302	012	0	1	01	01	H5302_012_0	5	1	2	1	1		0	07/08/2021	2022.01	07/08/2021 10:15:01 AM Eastern Daylight Time	08/03/2021 11:32:36 AM Eastern Daylight Time	08/02/2021 09:43:20 AM Eastern Daylight Time			08/04/2021 05:01:48 PM Eastern Daylight Time	AETNA HEALTH INC. (GA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Dual Preferred Plan (HMO D-SNP)	01	01		1			H5302	012	0	2022	Atlanta Metro		2		2			1	3		2		2	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5302	013	0	1	01	01	H5302_013_0	5	1	2	1	1		0	07/08/2021	2022.01	07/08/2021 10:15:28 AM Eastern Daylight Time	08/03/2021 11:33:21 AM Eastern Daylight Time	08/02/2021 09:43:24 AM Eastern Daylight Time			08/04/2021 05:01:48 PM Eastern Daylight Time	AETNA HEALTH INC. (GA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Dual Preferred Plan (HMO D-SNP)	01	01		1			H5302	013	0	2022	Cobb County		2		2			1	3		2		2	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5302	014	0	1	01	01	H5302_014_0	5	1	2	1	1		0	07/08/2021	2022.01	07/08/2021 10:15:50 AM Eastern Daylight Time	08/03/2021 11:34:08 AM Eastern Daylight Time	08/02/2021 09:43:28 AM Eastern Daylight Time			08/04/2021 05:01:48 PM Eastern Daylight Time	AETNA HEALTH INC. (GA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Dual Preferred Plan (HMO D-SNP)	01	01		1			H5302	014	0	2022	Savannah		2		2			1	3		2		2	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5302	018	0	1	01	01	H5302_018_0	4	1			2		0	08/02/2021	2022.01	08/02/2021 10:46:25 AM Eastern Daylight Time	08/03/2021 11:35:04 AM Eastern Daylight Time	08/02/2021 09:43:32 AM Eastern Daylight Time			08/04/2021 05:01:48 PM Eastern Daylight Time	AETNA HEALTH INC. (GA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (HMO)	01	01		1			H5302	018	0	2022	Augusta, Savannah Markets and Surrounding Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5302	019	0	1	01	01	H5302_019_0	6	1			2		0	08/02/2021	2022.01	08/02/2021 10:36:17 AM Eastern Daylight Time	08/03/2021 11:36:18 AM Eastern Daylight Time	08/02/2021 09:43:36 AM Eastern Daylight Time			08/04/2021 05:01:48 PM Eastern Daylight Time	AETNA HEALTH INC. (GA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (HMO)	01	01		1			H5302	019	0	2022	Atlanta Metro and Surrounding Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5302	809	0	1	01	01	H5302_809_0	1	1				0	0	05/27/2021	2022.01	05/27/2021 11:33:47 PM Eastern Daylight Time					06/03/2021 01:24:36 PM Eastern Daylight Time	AETNA HEALTH INC. (GA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (HMO)	01	01		1			H5302	809	0	2022	Georgia		1	120	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H5302	810	0	1	01	01	H5302_810_0	1	1						05/27/2021	2022.01	05/27/2021 11:34:24 PM Eastern Daylight Time					06/03/2021 01:24:36 PM Eastern Daylight Time	AETNA HEALTH INC. (GA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare w/Rx Plan (HMO)	01	01		1			H5302	810	0	2022	Georgia		1	120	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H5322	001	0	1	02	01	H5322_001_0	2	1		1	2		0	08/04/2021	2022.01	08/04/2021 11:19:09 AM Central Daylight Time	08/03/2021 11:29:41 AM Central Daylight Time	07/29/2021 09:06:08 PM Central Daylight Time			08/04/2021 03:08:19 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (HMO-POS I-SNP)	01	02		1			H5322	001	0	2022	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	02	01	H5322_003_0	3	1		1	2		0	08/04/2021	2022.01	08/04/2021 11:20:42 AM Central Daylight Time	08/03/2021 11:30:04 AM Central Daylight Time	07/29/2021 09:06:24 PM Central Daylight Time			08/04/2021 03:08:19 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (HMO-POS I-SNP)	01	02		1			H5322	003	0	2022	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	2		0	08/04/2021	2022.01	08/04/2021 11:22:24 AM Central Daylight Time	08/03/2021 11:30:27 AM Central Daylight Time	07/29/2021 09:06:40 PM Central Daylight Time			08/04/2021 03:08:19 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (HMO-POS I-SNP)	01	02		1			H5322	004	0	2022	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	025	0	1	01	01	H5322_025_0	4	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 10:51:36 AM Central Daylight Time	08/03/2021 11:30:51 AM Central Daylight Time	07/29/2021 09:06:57 PM Central Daylight Time			08/04/2021 04:00:20 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO D-SNP)	01	01		1			H5322	025	0	2022	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	4	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 10:52:46 AM Central Daylight Time	08/03/2021 11:31:15 AM Central Daylight Time	07/29/2021 09:07:13 PM Central Daylight Time			08/04/2021 04:00:20 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Plan 2 (HMO D-SNP)	01	01		1			H5322	026	0	2022	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	4	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 10:50:05 AM Central Daylight Time	08/03/2021 11:31:39 AM Central Daylight Time	07/29/2021 09:07:30 PM Central Daylight Time			08/04/2021 04:48:24 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO-POS D-SNP)	01	02		1			H5322	028	0	2022	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	4	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 11:17:20 AM Central Daylight Time	08/03/2021 11:32:03 AM Central Daylight Time	07/29/2021 09:07:46 PM Central Daylight Time			08/05/2021 01:05:44 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete LP (HMO-POS D-SNP)	01	02		1			H5322	029	0	2022	Select Counties in Kansas		2		2			1	3		2		2	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	4	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 10:08:27 AM Central Daylight Time	08/03/2021 11:32:28 AM Central Daylight Time	07/29/2021 09:08:03 PM Central Daylight Time			08/04/2021 02:05:05 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO-POS D-SNP)	01	02		1			H5322	030	0	2022	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	4	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 11:18:43 AM Central Daylight Time	08/03/2021 11:32:52 AM Central Daylight Time	07/29/2021 09:08:20 PM Central Daylight Time			08/05/2021 01:05:44 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete LP (HMO D-SNP)	01	01		1			H5322	031	0	2022	Select Counites in Oklahoma		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	4	1	2	1	1		0	07/08/2021	2022.01	07/08/2021 11:29:41 AM Eastern Daylight Time	08/04/2021 10:09:03 AM Central Daylight Time	08/02/2021 08:43:40 AM Central Daylight Time			08/04/2021 03:51:37 PM Central Daylight Time	COVENTRY HEALTH CARE OF KANSAS, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Assure (HMO D-SNP)	01	01		1			H5325	001	0	2022	Eastern Kansas		2		2			1	3		1		1	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5325	002	0	1	01	01	H5325_002_0	5	1	2	1	1		0	07/08/2021	2022.01	07/08/2021 11:30:14 AM Eastern Daylight Time	08/04/2021 09:57:02 AM Central Daylight Time	08/02/2021 08:43:45 AM Central Daylight Time			08/04/2021 03:51:37 PM Central Daylight Time	COVENTRY HEALTH CARE OF KANSAS, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Assure (HMO D-SNP)	01	01		1			H5325	002	0	2022	Central Kansas		2		2			1	3		1		1	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5325	003	0	1	01	01	H5325_003_0	5	1	2	1	1		0	07/08/2021	2022.01	07/08/2021 11:30:40 AM Eastern Daylight Time	08/04/2021 09:52:49 AM Central Daylight Time	08/02/2021 08:43:49 AM Central Daylight Time			08/04/2021 03:51:37 PM Central Daylight Time	COVENTRY HEALTH CARE OF KANSAS, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Assure (HMO D-SNP)	01	01		1			H5325	003	0	2022	Kansas City Metro		2		2			1	3		1		1	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5325	004	0	1	01	01	H5325_004_0	5	1	2	1	1		0	07/08/2021	2022.01	07/08/2021 11:31:07 AM Eastern Daylight Time	08/04/2021 09:51:19 AM Central Daylight Time	08/02/2021 08:43:53 AM Central Daylight Time			08/04/2021 03:51:37 PM Central Daylight Time	COVENTRY HEALTH CARE OF KANSAS, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Assure (HMO D-SNP)	01	01		1			H5325	004	0	2022	Southwest Missouri		2		2			1	3		1		1	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5325	005	0	1	01	01	H5325_005_0	5	1	2	1	1		0	08/02/2021	2022.01	08/02/2021 02:45:57 PM Central Daylight Time	08/03/2021 10:46:58 AM Central Daylight Time	08/02/2021 08:43:57 AM Central Daylight Time			08/04/2021 12:29:03 PM Central Daylight Time	COVENTRY HEALTH CARE OF KANSAS, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Assure Gold Prime (HMO D-SNP)	01	01		1			H5325	005	0	2022	Missouri		2		2			1	3		1		1	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5325	006	0	1	01	01	H5325_006_0	5	1	2	1	1		0	07/08/2021	2022.01	07/08/2021 11:31:59 AM Eastern Daylight Time	08/03/2021 10:45:11 AM Central Daylight Time	08/02/2021 08:44:02 AM Central Daylight Time			08/04/2021 12:29:03 PM Central Daylight Time	COVENTRY HEALTH CARE OF KANSAS, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Assure (HMO D-SNP)	01	01		1			H5325	006	0	2022	Missouri		2		2			1	3		1		1	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5325	007	0	1	01	01	H5325_007_0	5	1	2	1	1		0	07/08/2021	2022.01	07/08/2021 11:32:25 AM Eastern Daylight Time	08/04/2021 09:49:33 AM Central Daylight Time	08/02/2021 08:44:06 AM Central Daylight Time			08/04/2021 03:51:37 PM Central Daylight Time	COVENTRY HEALTH CARE OF KANSAS, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Assure (HMO D-SNP)	01	01		1			H5325	007	0	2022	Arkansas		2		2			1	3		1		1	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		2					2					2	2			
H5325	008	0	1	01	01	H5325_008_0	5	1	2	1	1		0	07/08/2021	2022.01	07/08/2021 11:32:54 AM Eastern Daylight Time	08/03/2021 10:42:27 AM Central Daylight Time	08/02/2021 08:44:10 AM Central Daylight Time			08/04/2021 12:29:03 PM Central Daylight Time	COVENTRY HEALTH CARE OF KANSAS, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Assure (HMO D-SNP)	01	01		1			H5325	008	0	2022	St Louis Metro		2		2			1	3		1		1	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		2					2					2	2			
H5325	009	0	1	01	01	H5325_009_0	6	1	2	1	1		0	07/08/2021	2022.01	07/08/2021 11:33:17 AM Eastern Daylight Time	08/04/2021 09:48:11 AM Central Daylight Time	08/02/2021 08:44:14 AM Central Daylight Time			08/04/2021 03:51:37 PM Central Daylight Time	COVENTRY HEALTH CARE OF KANSAS, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Assure (HMO D-SNP)	01	01		1			H5325	009	0	2022	Western KS: Saline and surrounding counties.		2		2			1	3		1		1	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		2					2					2	2			
H5355	001	0	1	48	05	H5355_001_0	2	1						07/06/2021	2022.01	07/06/2021 06:47:11 PM Pacific Daylight Time					07/06/2021 06:50:46 PM Pacific Daylight Time	IEHP HEALTH ACCESS	IEHP DualChoice	www.iehp.org	IEHP DualChoice (Medicare-Medicaid Plan)	05	48		1			H5355	001	0	2022	Riverside and San Bernardino Counties		2	389709	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																
H5373	001	0	1	01	01	H5373_001_0	5	1					1	07/07/2021	2022.01	07/07/2021 01:57:59 PM Eastern Daylight Time	08/02/2021 11:48:28 AM Eastern Daylight Time	08/02/2021 11:32:10 AM Eastern Daylight Time			08/04/2021 04:23:28 PM Eastern Daylight Time	PARAMOUNT CARE OF INDIANA, INC.	ProMedica Medicare Plan	promedicahealthplan.com/medicare	ProMedica Medicare Essential (HMO)	01	01		1			H5373	001	0	2022	Essential Medical and Drug NE Indiana		2		2			2						promedicahealthplan.com/medicare	promedicahealthplan.com/medicare	promedicahealthplan.com/medicare	(833)554-2335		(567)585-9888		(833)554-2335		(567)585-9888		(833)554-2335		(567)585-9888		(833)554-2335		(567)585-9888		(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			
H5374	001	0	1	01	01	H5374_001_0	7	1		1			0	08/05/2021	2022.01	08/05/2021 06:12:54 PM Eastern Daylight Time	08/02/2021 04:27:39 PM Eastern Daylight Time	08/02/2021 12:51:18 PM Eastern Daylight Time			08/05/2021 06:15:19 PM Eastern Daylight Time	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Longevity Health Plan	www.longevityhealthplan.com	Longevity Health Plan (HMO I-SNP)	01	01		1			H5374	001	0	2022	NC service areas		2		2			1	1	1				www.longevityhealthplan.com	www.longevityhealthplan.com	www.longevityhealthplan.com	(888)312-5196		(888)312-5196		(888)312-5196		(888)312-5196		(888)312-5196		(888)312-5196		(888)312-5196		(888)312-5196		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5377	001	0	1	01	01	H5377_001_0	3	1			2		1	08/01/2021	2022.01	08/01/2021 12:51:00 PM Eastern Daylight Time	08/03/2021 10:08:39 PM Eastern Daylight Time	07/30/2021 11:26:02 AM Eastern Daylight Time			08/04/2021 02:09:43 PM 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	2022	Roanoke and Central Virginia		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	2	1					1	08/03/2021	2022.01	08/03/2021 04:06:32 PM Pacific Daylight Time	08/03/2021 11:19:25 AM Pacific Daylight Time	07/29/2021 01:49:50 PM Pacific Daylight Time			08/03/2021 09:01:41 PM Pacific Daylight Time	SHARP HEALTH PLAN	Sharp Health Plan	sharpmedicareadvantage.com	Sharp Direct Advantage Gold Card (HMO)	01	01		1			H5386	003	0	2022	Sharp Direct Advantage Gold San Diego County		2	52032	2			2						sharpmedicareadvantage.com	sharpmedicareadvantage.com	sharpmedicareadvantage.com	(855)562-8853		(858)499-8050		(855)562-8853		(858)499-8050		(855)222-3183		(855)222-3183		(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	4	1					1	08/03/2021	2022.01	08/03/2021 04:43:28 PM Pacific Daylight Time	08/03/2021 11:20:04 AM Pacific Daylight Time	07/29/2021 01:44:07 PM Pacific Daylight Time			08/03/2021 09:01:41 PM Pacific Daylight Time	SHARP HEALTH PLAN	Sharp Health Plan	sharpmedicareadvantage.com	Sharp Direct Advantage Platinum Card (HMO)	01	01		1			H5386	004	0	2022	Sharp Direct Advantage Platinum San Diego County		2	14568	2			2						sharpmedicareadvantage.com	sharpmedicareadvantage.com	sharpmedicareadvantage.com	(855)562-8853		(858)499-8050		(855)562-8853		(858)499-8050		(855)222-3183		(855)222-3183		(855)562-8853		(858)499-8050		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5386	005	0	1	01	01	H5386_005_0	2	1					1	08/03/2021	2022.01	08/03/2021 04:43:43 PM Pacific Daylight Time	08/03/2021 11:20:41 AM Pacific Daylight Time	07/29/2021 01:44:36 PM Pacific Daylight Time			08/03/2021 09:01:41 PM Pacific Daylight Time	SHARP HEALTH PLAN	Sharp Health Plan	sharpmedicareadvantage.com	Sharp Direct Advantage VIP Plan (HMO)	01	01		1			H5386	005	0	2022	Sharp Direct Advantage VIP San Diego County		2	13011	2			2						sharpmedicareadvantage.com	sharpmedicareadvantage.com	sharpmedicareadvantage.com	(855)562-8853		(858)499-8050		(855)562-8853		(858)499-8050		(855)222-3183		(855)222-3183		(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	2	1						06/04/2021	2022.01	06/04/2021 03:57:18 PM Pacific Daylight Time					06/04/2021 04:05:19 PM Pacific Daylight Time	SHARP HEALTH PLAN	Sharp Health Plan	sharpmedicareadvantage.com	Sharp Direct Advantage Calendar Year (HMO)	01	01		1			H5386	801	0	2022	Sharp Direct Advantage San Diego County		1	13392	2			2						sharpmedicareadvantage.com	sharpmedicareadvantage.com	sharpmedicareadvantage.com	(855)562-8853		(858)499-8050		(855)562-8853		(858)499-8050		(855)222-3183		(855)222-3183		(855)562-8853		(858)499-8050		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;18a;	1					1				
H5386	802	0	1	01	01	H5386_802_0	2	1						06/04/2021	2022.01	06/04/2021 04:03:37 PM Pacific Daylight Time					06/04/2021 04:05:19 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	2022	Sharp Direct Advantage San Diego County		1	9390	2			2						sharpmedicareadvantage.com	sharpmedicareadvantage.com	sharpmedicareadvantage.com	(855)562-8853		(858)499-8050		(855)562-8853		(858)499-8050		(855)222-3183		(855)222-3183		(855)562-8853		(858)499-8050		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;18a;	1					1				
H5386	803	0	1	01	01	H5386_803_0	2	1				0	0	06/04/2021	2022.01	06/04/2021 04:04:59 PM Pacific Daylight Time					06/04/2021 04:05:19 PM Pacific Daylight Time	SHARP HEALTH PLAN	Sharp Health Plan	sharpmedicareadvantage.com	Sharp Direct Advantage MA Only (HMO)	01	01		1			H5386	803	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;18a;	1					1				
H5398	001	0	1	01	01	H5398_001_0	4	1					0	08/02/2021	2022.01	08/02/2021 10:12:12 AM Central Daylight Time	08/03/2021 11:38:55 PM Central Daylight Time	07/30/2021 10:52:24 AM Central Daylight Time			08/04/2021 10:17:29 PM Central Daylight Time	CENTENE VENTURE COMPANY KANSAS	Ascension Complete	ascensioncomplete.com	Ascension Complete Via Christi Reward (HMO)	01	01		1			H5398	001	0	2022	Butler, Harvey and Sedgwick Counties		2	2138	2			2						ascensioncomplete.com/findadoctor	ascensioncomplete.com/formulary	ascensioncomplete.com/findadoctor	(833)816-6623		(833)816-6623		(877)831-9439		(877)831-9439		(833)816-6623		(833)816-6623		(877)831-9439		(877)831-9439		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5398	002	0	1	01	01	H5398_002_0	4	1					0	08/02/2021	2022.01	08/02/2021 10:12:44 AM Central Daylight Time	08/03/2021 11:39:23 PM Central Daylight Time	07/30/2021 10:52:44 AM Central Daylight Time			08/04/2021 10:17:29 PM Central Daylight Time	CENTENE VENTURE COMPANY KANSAS	Ascension Complete	ascensioncomplete.com	Ascension Complete Via Christi Secure (HMO)	01	01		1			H5398	002	0	2022	Butler, Harvey and Sedgwick Counties		2	11434	2			2						ascensioncomplete.com/findadoctor	ascensioncomplete.com/formulary	ascensioncomplete.com/findadoctor	(833)816-6623		(833)816-6623		(877)831-9439		(877)831-9439		(833)816-6623		(833)816-6623		(877)831-9439		(877)831-9439		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5403	001	0	1	20	08	H5403_001_0	1	1						06/06/2021	2022.01	06/06/2021 10:00:15 PM Pacific Daylight Time		06/06/2021 09:22:09 PM Pacific Daylight Time			06/06/2021 10:03:39 PM Pacific Daylight Time	ON LOK SENIOR HEALTH SERVICES	On Lok PACE	www.onlok.org/PACE	On Lok PACE (Dual Eligibles) (PACE)	08	20		1			H5403	001	0	2022	San Francisco, Alameda and Santa Clara counties		2		2			2						www.onlok.org/PACE	N/A										(888)996-6565		(415)292-8895		(888)886-6565		(888)886-6565												(711)-				(711)-																
H5403	002	0	1	20	08	H5403_002_0	1	1						06/06/2021	2022.01	06/06/2021 10:01:03 PM Pacific Daylight Time		06/06/2021 09:22:09 PM Pacific Daylight Time			06/06/2021 10:03:39 PM Pacific Daylight Time	ON LOK SENIOR HEALTH SERVICES	On Lok PACE	www.onlok.org/PACE	On Lok PACE (Medicare Only) (PACE)	08	20		1			H5403	002	0	2022	San Francisco, Alameda and Santa Clara counties		2		2			2						www.onlok.org/PACE	N/A										(888)996-6565		(415)292-8895		(888)886-6565		(888)886-6565												(711)-				(711)-																
H5405	001	0	1	20	08	H5405_001_0	1	1						06/02/2021	2022.01	06/02/2021 10:08:46 AM Pacific Daylight Time		06/01/2021 02:26:52 PM Pacific Daylight Time			06/02/2021 10:12:21 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	2022	Alameda and 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						06/02/2021	2022.01	06/02/2021 10:10:17 AM Pacific Daylight Time		06/01/2021 02:27:45 PM Pacific Daylight Time			06/02/2021 10:12:21 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	2022	Alameda and 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						06/01/2021	2022.01	06/01/2021 10:12:59 AM Pacific Daylight Time		05/26/2021 01:37:38 PM Pacific Daylight Time			06/01/2021 10:15:19 AM Pacific Daylight Time	SUTTER VALLEY HOSPITALS	Sutter SeniorCare PACE	www.sutterseniorcare.org	Sutter SeniorCare (PACE)	08	20		1			H5406	001	0	2022	Sacramento Counties		2		2			2						sutterseniorcare.org	sutterseniorcare.org										(833)560-7223		(833)560-7223	63415	(833)560-7223		(833)560-7223	63415									(916)393-1112		(916)393-1112		(916)393-1112		(916)393-1112																
H5406	002	0	1	20	08	H5406_002_0	1	1						06/01/2021	2022.01	06/01/2021 10:13:14 AM Pacific Daylight Time		05/26/2021 01:37:38 PM Pacific Daylight Time			06/01/2021 10:15:19 AM Pacific Daylight Time	SUTTER VALLEY HOSPITALS	Sutter SeniorCare PACE	www.sutterseniorcare.org	Sutter SeniorCare (PACE)	08	20		1			H5406	002	0	2022	Yolo Counties		2		2			2						sutterseniorcare.org	sutterseniorcare.org										(833)560-7223		(833)560-7223	63415	(833)560-7223		(833)560-7223	63415									(916)393-1112		(916)393-1112		(916)393-1112		(916)393-1112																
H5410	001	0	1	01	01	H5410_001_0	7	1			2		0	08/03/2021	2022.01	08/03/2021 11:00:48 AM Central Daylight Time	08/03/2021 09:39:33 AM Central Daylight Time	07/30/2021 11:54:24 AM Central Daylight Time			08/04/2021 09:32:40 AM Central Daylight Time	HEALTHSPRING OF FLORIDA, INC.	Cigna	www.lmchealthplans.com	Leon Medicare (HMO)	01	01		1			H5410	001	0	2022	Miami-Dade county		2	0	2			2						www.lmchealthplans.com	www.lmchealthplans.com		(866)393-5366		(305)559-5366		(866)393-5366		(866)393-5366		(866)393-5366		(305)559-5366		(866)393-5366		(866)393-5366		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5410	004	0	1	01	01	H5410_004_0	3	1			2	0	0	07/08/2021	2022.01	07/08/2021 03:47:29 PM Central Daylight Time	05/31/2021 09:04:47 PM Central Daylight Time				07/19/2021 04:03:19 PM Central Daylight Time	HEALTHSPRING OF FLORIDA, INC.	Cigna	www.cignamedicare.com	Cigna Fundamental Medicare (HMO)	01	01		1			H5410	004	0	2022	Northern Florida		2		2			2						www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)707-7116		(855)707-7116										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H5410	013	0	1	01	01	H5410_013_0	4	1	2	1	2		0	07/08/2021	2022.01	07/08/2021 03:47:54 PM Central Daylight Time	08/01/2021 10:53:17 PM Central Daylight Time	07/30/2021 11:54:49 AM Central Daylight Time			08/04/2021 01:21:09 PM Central Daylight Time	HEALTHSPRING OF FLORIDA, INC.	Cigna	www.cignamedicare.com	Cigna TotalCare (HMO D-SNP)	01	01		1			H5410	013	0	2022	Northern Florida		2		2			1	3		2		2	www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)707-7116		(855)707-7116		(800)668-3813		(800)668-3813		(855)707-7116		(855)707-7116		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5410	018	0	1	01	01	H5410_018_0	4	1			2		0	08/02/2021	2022.01	08/02/2021 06:58:29 PM Central Daylight Time	08/01/2021 10:56:15 PM Central Daylight Time	07/30/2021 11:55:13 AM Central Daylight Time			08/04/2021 01:21:09 PM Central Daylight Time	HEALTHSPRING OF FLORIDA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H5410	018	0	2022	Northern Florida		2		2			2						www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)707-7116		(855)707-7116		(800)668-3813		(800)668-3813		(855)707-7116		(855)707-7116		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5410	024	0	1	01	01	H5410_024_0	6	1			2		0	08/09/2021	2022.01	08/09/2021 08:03:44 AM Central Daylight Time	08/02/2021 06:15:17 PM Central Daylight Time	07/30/2021 11:55:36 AM Central Daylight Time			08/09/2021 11:33:33 AM Central Daylight Time	HEALTHSPRING OF FLORIDA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H5410	024	0	2022	Orlando Area		2		2			2						www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)980-3046		(855)980-3046		(800)668-3813		(800)668-3813		(855)980-3046		(855)980-3046		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5410	025	0	1	01	01	H5410_025_0	5	1	2	1	1		0	07/08/2021	2022.01	07/08/2021 03:49:06 PM Central Daylight Time	08/02/2021 06:18:02 PM Central Daylight Time	07/30/2021 11:56:00 AM Central Daylight Time			08/04/2021 01:21:09 PM Central Daylight Time	HEALTHSPRING OF FLORIDA, INC.	Cigna	www.cignamedicare.com	Cigna TotalCare Plus (HMO D-SNP)	01	01		1			H5410	025	0	2022	Orlando Area		2		2			1	3		1		2	www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)980-3046		(855)980-3046		(800)668-3813		(800)668-3813		(855)980-3046		(855)980-3046		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5410	026	0	1	01	01	H5410_026_0	4	1			2		0	08/03/2021	2022.01	08/03/2021 11:39:42 AM Central Daylight Time	08/02/2021 06:19:37 PM Central Daylight Time	07/30/2021 11:56:23 AM Central Daylight Time			08/04/2021 01:21:09 PM Central Daylight Time	HEALTHSPRING OF FLORIDA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Savings Medicare (HMO)	01	01		1			H5410	026	0	2022	Orlando Area		2		2			2						www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)980-3046		(855)980-3046		(800)668-3813		(800)668-3813		(855)980-3046		(855)980-3046		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5410	027	0	1	01	01	H5410_027_0	5	1			2		0	08/09/2021	2022.01	08/09/2021 08:03:58 AM Central Daylight Time	08/02/2021 06:21:41 PM Central Daylight Time	07/30/2021 11:56:47 AM Central Daylight Time			08/09/2021 11:33:33 AM Central Daylight Time	HEALTHSPRING OF FLORIDA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H5410	027	0	2022	Daytona Area		2		2			2						www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)980-3046		(855)980-3046		(800)668-3813		(800)668-3813		(855)980-3046		(855)980-3046		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5410	028	0	1	01	01	H5410_028_0	4	1			2		0	07/08/2021	2022.01	07/08/2021 03:50:24 PM Central Daylight Time	08/02/2021 06:23:49 PM Central Daylight Time	07/30/2021 11:57:10 AM Central Daylight Time			08/04/2021 01:21:09 PM Central Daylight Time	HEALTHSPRING OF FLORIDA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Savings Medicare (HMO)	01	01		1			H5410	028	0	2022	Daytona Area		2		2			2						www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)980-3046		(855)980-3046		(800)668-3813		(800)668-3813		(855)980-3046		(855)980-3046		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5410	029	0	1	01	01	H5410_029_0	6	1			2		0	08/09/2021	2022.01	08/09/2021 08:04:12 AM Central Daylight Time	08/02/2021 06:25:34 PM Central Daylight Time	07/30/2021 11:57:34 AM Central Daylight Time			08/09/2021 11:33:33 AM Central Daylight Time	HEALTHSPRING OF FLORIDA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H5410	029	0	2022	Tampa Area		2		2			2						www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)980-3046		(855)980-3046		(800)668-3813		(800)668-3813		(855)980-3046		(855)980-3046		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5410	030	0	1	01	01	H5410_030_0	5	1			2		0	08/03/2021	2022.01	08/03/2021 11:40:28 AM Central Daylight Time	08/02/2021 06:31:19 PM Central Daylight Time	07/30/2021 11:57:57 AM Central Daylight Time			08/04/2021 01:21:09 PM Central Daylight Time	HEALTHSPRING OF FLORIDA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Savings Medicare (HMO)	01	01		1			H5410	030	0	2022	Tampa Area		2		2			2						www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)980-3046		(855)980-3046		(800)668-3813		(800)668-3813		(855)980-3046		(855)980-3046		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5410	031	0	1	01	01	H5410_031_0	6	1	2	1	1		0	07/08/2021	2022.01	07/08/2021 03:51:38 PM Central Daylight Time	08/02/2021 06:34:44 PM Central Daylight Time	07/30/2021 11:58:20 AM Central Daylight Time			08/04/2021 01:21:09 PM Central Daylight Time	HEALTHSPRING OF FLORIDA, INC.	Cigna	www.cignamedicare.com	Cigna TotalCare Plus (HMO D-SNP)	01	01		1			H5410	031	0	2022	Daytona Area		2		2			1	3		1		2	www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)980-3046		(855)980-3046		(800)668-3813		(800)668-3813		(855)980-3046		(855)980-3046		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5410	032	0	1	01	01	H5410_032_0	6	1	2	1	1		0	07/08/2021	2022.01	07/08/2021 03:52:00 PM Central Daylight Time	08/02/2021 06:36:49 PM Central Daylight Time	07/30/2021 11:58:44 AM Central Daylight Time			08/04/2021 01:21:09 PM Central Daylight Time	HEALTHSPRING OF FLORIDA, INC.	Cigna	www.cignamedicare.com	Cigna TotalCare Plus (HMO D-SNP)	01	01		1			H5410	032	0	2022	Tampa Area		2		2			1	3		1		2	www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)980-3046		(855)980-3046		(800)668-3813		(800)668-3813		(855)980-3046		(855)980-3046		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5410	033	0	1	01	01	H5410_033_0	4	1			2		0	07/08/2021	2022.01	07/08/2021 03:52:23 PM Central Daylight Time	08/02/2021 06:39:10 PM Central Daylight Time	07/30/2021 11:59:07 AM Central Daylight Time			08/04/2021 01:21:09 PM Central Daylight Time	HEALTHSPRING OF FLORIDA, INC.	Cigna	www.cignamedicare.com	Cigna Primary Medicare (HMO)	01	01		1			H5410	033	0	2022	Orlando Area		2		2			2						www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)980-3046		(855)980-3046		(800)668-3813		(800)668-3813		(855)980-3046		(855)980-3046		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5410	034	0	1	01	01	H5410_034_0	4	1			2		0	07/08/2021	2022.01	07/08/2021 03:52:48 PM Central Daylight Time	08/02/2021 06:40:55 PM Central Daylight Time	07/30/2021 11:59:30 AM Central Daylight Time			08/04/2021 01:21:09 PM Central Daylight Time	HEALTHSPRING OF FLORIDA, INC.	Cigna	www.cignamedicare.com	Cigna Primary Medicare (HMO)	01	01		1			H5410	034	0	2022	Daytona Area		2		2			2						www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)980-3046		(855)980-3046		(800)668-3813		(800)668-3813		(855)980-3046		(855)980-3046		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5410	035	0	1	01	01	H5410_035_0	4	1			2		0	07/08/2021	2022.01	07/08/2021 03:53:11 PM Central Daylight Time	08/02/2021 06:42:46 PM Central Daylight Time	07/30/2021 11:59:54 AM Central Daylight Time			08/04/2021 01:21:09 PM Central Daylight Time	HEALTHSPRING OF FLORIDA, INC.	Cigna	www.cignamedicare.com	Cigna Primary Medicare (HMO)	01	01		1			H5410	035	0	2022	Tampa Area		2		2			2						www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)980-3046		(855)980-3046		(800)668-3813		(800)668-3813		(855)980-3046		(855)980-3046		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5410	037	0	1	01	01	H5410_037_0	4	1			2		0	08/02/2021	2022.01	08/02/2021 07:57:14 PM Central Daylight Time	08/04/2021 10:26:44 AM Central Daylight Time	07/30/2021 12:00:18 PM Central Daylight Time			08/04/2021 01:21:09 PM Central Daylight Time	HEALTHSPRING OF FLORIDA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H5410	037	0	2022	Treasure Coast		2		2			2						www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)707-7116		(855)707-7116		(800)668-3813		(800)668-3813		(855)707-7116		(855)707-7116		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5410	039	0	1	01	01	H5410_039_0	4	1			2		0	08/02/2021	2022.01	08/02/2021 07:58:10 PM Central Daylight Time	08/04/2021 10:30:19 AM Central Daylight Time	07/30/2021 12:00:42 PM Central Daylight Time			08/04/2021 01:21:09 PM Central Daylight Time	HEALTHSPRING OF FLORIDA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H5410	039	0	2022	Southwest FL		2		2			2						www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)707-7116		(855)707-7116		(800)668-3813		(800)668-3813		(855)707-7116		(855)707-7116		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5410	040	0	1	01	01	H5410_040_0	4	1			2		0	08/02/2021	2022.01	08/02/2021 07:58:46 PM Central Daylight Time	08/04/2021 10:32:34 AM Central Daylight Time	07/30/2021 12:01:05 PM Central Daylight Time			08/04/2021 01:21:09 PM Central Daylight Time	HEALTHSPRING OF FLORIDA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Savings Medicare (HMO)	01	01		1			H5410	040	0	2022	Treasure Coast		2		2			2						www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)707-7116		(855)707-7116		(800)668-3813		(800)668-3813		(855)707-7116		(855)707-7116		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5410	041	0	1	01	01	H5410_041_0	5	1			2		0	08/02/2021	2022.01	08/02/2021 07:59:37 PM Central Daylight Time	08/04/2021 10:35:19 AM Central Daylight Time	07/30/2021 12:01:29 PM Central Daylight Time			08/04/2021 01:21:09 PM Central Daylight Time	HEALTHSPRING OF FLORIDA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Savings Medicare (HMO)	01	01		1			H5410	041	0	2022	Southwest FL		2		2			2						www.cigna.com/medicare	www.cignamedicare.com		(800)668-3813		(800)668-3813		(855)707-7116		(855)707-7116		(800)668-3813		(800)668-3813		(855)707-7116		(855)707-7116		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5410	807	0	1	01	01	H5410_807_0	4	1						05/10/2021	2022.01	05/10/2021 10:38:19 AM Central Daylight Time					06/05/2021 05:10:16 PM Central Daylight Time	HEALTHSPRING OF FLORIDA, INC.	Cigna	www.cignahealthspring.com	Leon Medicare Group Plan (HMO)	01	01		1			H5410	807	0	2022	Statewide FL		1	879	2			2						www.cigna.com/medicare	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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H5410	808	0	1	01	01	H5410_808_0	2	1						05/10/2021	2022.01	05/10/2021 10:39:25 AM Central Daylight Time					06/02/2021 04:58:31 PM Central Daylight Time	HEALTHSPRING OF FLORIDA, INC.	Cigna	www.cignahealthspring.com	Cigna Preferred Medicare (HMO)	01	01		1			H5410	808	0	2022	Statewide FL		1	600	2			2						www.cigna.com/medicare	www.cignahealthspring.com		(888)281-7867		(888)281-7867		(888)281-7867		(888)281-7867		(888)281-7867		(888)281-7867		(888)281-7867		(888)281-7867		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H5420	001	0	1	01	01	H5420_001_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 12:40:48 PM Central Daylight Time	08/03/2021 12:20:59 PM Central Daylight Time	07/29/2021 09:08:35 PM Central Daylight Time			08/04/2021 07:39:56 PM Central Daylight Time	MEDICA HEALTHCARE PLANS, INC.	UnitedHealthcare	www.Medicaplans.com	MedicareMax (HMO)	01	01		1			H5420	001	0	2022	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	3	1			2		1	08/04/2021	2022.01	08/04/2021 12:41:00 PM Central Daylight Time	08/03/2021 12:21:27 PM Central Daylight Time	07/29/2021 09:08:51 PM Central Daylight Time			08/04/2021 07:39:56 PM Central Daylight Time	MEDICA HEALTHCARE PLANS, INC.	UnitedHealthcare	www.Medicaplans.com	MedicareMax (HMO)	01	01		1			H5420	003	0	2022	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	3	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 12:41:12 PM Central Daylight Time	08/03/2021 12:21:54 PM Central Daylight Time	07/29/2021 09:09:08 PM Central Daylight Time			08/04/2021 07:39:56 PM Central Daylight Time	MEDICA HEALTHCARE PLANS, INC.	UnitedHealthcare	www.Medicaplans.com	MedicareMax Plus 1 (HMO D-SNP)	01	01		1			H5420	006	0	2022	Miami-Dade and Broward Counties		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			
H5420	013	0	1	01	01	H5420_013_0	4	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 12:41:25 PM Central Daylight Time	08/03/2021 12:22:21 PM Central Daylight Time	07/29/2021 09:09:23 PM Central Daylight Time			08/04/2021 07:39:56 PM Central Daylight Time	MEDICA HEALTHCARE PLANS, INC.	UnitedHealthcare	www.Medicaplans.com	MedicareMax Plus 2 (HMO D-SNP)	01	01		1			H5420	013	0	2022	Miami-Dade and Broward Counties		2		2			1	3		1		1	www.UHCMedicareSolutions.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	6	1	2	1	1		0	07/18/2021	2022.01	07/18/2021 12:55:10 PM Eastern Daylight Time	08/03/2021 06:04:05 PM Eastern Daylight Time	08/03/2021 06:04:05 PM Eastern Daylight Time			08/04/2021 02:27:41 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 D-SNP)	01	01		1			H5422	007	0	2022	Select Counties in Georgia		2		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		(855)679-0552		(855)679-0552		(833)341-4611		(833)341-4611		(855)485-0968		(855)485-0968		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5422	008	0	1	01	01	H5422_008_0	6	1			2		0	07/15/2021	2022.01	07/15/2021 10:05:20 AM Eastern Daylight Time	08/03/2021 06:04:05 PM Eastern Daylight Time	08/03/2021 06:04:05 PM Eastern Daylight Time			08/04/2021 02:27:41 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	2022	Select Counties in Georgia		2		2			2						https://shop.bcbsga.com/medicare	https://shop.bcbsga.com/medicare	www.anthem.com/medicare	(855)690-7797		(855)690-7797		(855)679-0553		(855)679-0553		(833)341-4612		(833)341-4612		(855)485-0969		(855)485-0969		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5422	011	0	1	01	01	H5422_011_0	7	1			2		1	07/18/2021	2022.01	07/18/2021 12:58:29 PM Eastern Daylight Time	08/04/2021 02:06:30 PM Eastern Daylight Time	08/03/2021 06:04:05 PM Eastern Daylight Time			08/04/2021 02:27:41 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	2022	Select Counties in Georgia		2		2			2						https://shop.bcbsga.com/medicare	https://shop.bcbsga.com/medicare	www.anthem.com/medicare	(855)690-7797		(855)690-7797		(855)679-0553		(855)679-0553		(833)341-4612		(833)341-4612		(855)485-0969		(855)485-0969		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5422	013	0	1	01	01	H5422_013_0	6	1			2		0	07/18/2021	2022.01	07/18/2021 12:59:41 PM Eastern Daylight Time	08/03/2021 06:04:05 PM Eastern Daylight Time	08/03/2021 06:04:05 PM Eastern Daylight Time			08/04/2021 02:27:41 PM Eastern Daylight Time	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem MediBlue Extra (HMO)	01	01		1			H5422	013	0	2022	Select counties in Georgia		2		2			2						www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(855)690-7797		(855)690-7797		(855)679-0553		(855)679-0553		(833)341-4612		(833)341-4612		(855)485-0969		(855)485-0969		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5422	014	0	1	01	01	H5422_014_0	5	1			2	0	0	07/18/2021	2022.01	07/18/2021 01:00:37 PM Eastern Daylight Time	07/16/2021 06:59:00 PM Eastern Daylight Time				07/19/2021 03:23:11 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 Service (HMO)	01	01		1			H5422	014	0	2022	Select Counties in Georgia		2		2			2						https://shop.bcbsga.com/medicare	https://shop.bcbsga.com/medicare	www.anthem.com/medicare	(855)690-7797		(855)690-7797		(855)679-0553		(855)679-0553										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H5422	015	0	1	01	01	H5422_015_0	9	1		1	2		0	07/18/2021	2022.01	07/18/2021 04:05:16 PM Pacific Daylight Time		08/03/2021 03:04:04 PM Pacific Daylight Time		08/03/2021 03:04:04 PM Pacific Daylight Time	08/04/2021 12:07:42 PM Pacific Daylight Time	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue ESRD Care (HMO C-SNP)	01	01		1			H5422	015	0	2022	Select Counties in GA		2		2			1	4			00000000100000000000		https://shop.bcbsga.com/medicare	https://shop.bcbsga.com/medicare	www.anthem.com/medicare	(855)690-7797		(855)690-7797		(855)679-0553		(855)679-0553		(833)341-4612		(833)341-4612		(855)485-0969		(855)485-0969		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5422	016	0	1	01	01	H5422_016_0	7	1	2	1	1		0	07/18/2021	2022.01	07/18/2021 01:01:51 PM Eastern Daylight Time	08/03/2021 06:04:05 PM Eastern Daylight Time	08/03/2021 06:04:05 PM Eastern Daylight Time			08/04/2021 02:27:41 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 + Kroger Dual Advantage (HMO D-SNP)	01	01		1			H5422	016	0	2022	Select counties in Georgia		2		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		(855)679-0552		(855)679-0552		(833)341-4611		(833)341-4611		(855)485-0968		(855)485-0968		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5422	017	0	1	01	01	H5422_017_0	7	1			2		0	07/15/2021	2022.01	07/15/2021 10:30:58 AM Eastern Daylight Time	08/03/2021 06:04:05 PM Eastern Daylight Time	08/03/2021 06:04:05 PM Eastern Daylight Time			08/04/2021 02:27:41 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 + Kroger (HMO)	01	01		1			H5422	017	0	2022	Select counties in Georgia		2		2			2						https://shop.bcbsga.com/medicare	https://shop.bcbsga.com/medicare	www.anthem.com/medicare	(855)690-7797		(855)690-7797		(855)679-0553		(855)679-0553		(833)341-4612		(833)341-4612		(855)485-0969		(855)485-0969		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5422	803	0	1	01	01	H5422_803_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 03:55:47 PM Pacific Daylight Time					06/04/2021 10:37:10 AM 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	2022	Georgia Select Counties		1	600	2			2						www.bcbsga.com/medicare	www.bcbsga.com/medicare	www.bcbsga.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1					1				
H5422	804	0	1	01	01	H5422_804_0	1	1						06/02/2021	2022.01	06/02/2021 03:55:56 PM Pacific Daylight Time					06/04/2021 10:37:10 AM 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	2022	Georgia - Select Counties		1	600	2			2						www.bcbsga.com/medicare	www.bcbsga.com/medicare	www.bcbsga.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)360-3664		(833)360-3664		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1					1				
H5422	806	0	2	01	01	H5422_806_0	1	1						06/02/2021	2022.01	06/02/2021 03:56:04 PM Pacific Daylight Time					06/04/2021 10:37:10 AM 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	2022	Georgia - Select counties		1	600	2			2						www.bcbsga.com/medicare	www.bcbsga.com/medicare	www.bcbsga.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)360-3664		(833)360-3664		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1					1				
H5422	807	0	2	01	01	H5422_807_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 03:56:12 PM Pacific Daylight Time					06/04/2021 10:37:10 AM 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	2022	Select Georgia Counties		1	600	2			2						www.anthem.com/ga/medicare	www.anthem.com/ga/medicare	www.anthem.com/ga/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1					1				
H5422	809	0	1	01	01	H5422_809_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 03:56:23 PM Pacific Daylight Time					06/04/2021 10:37:10 AM 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	2022	Select Georgia Counties		1	600	2			2						www.anthem.com/ga/medicare	www.anthem.com/ga/medicare	www.anthem.com/ga/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1					1				
H5422	811	0	2	01	01	H5422_811_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 03:56:37 PM Pacific Daylight Time					06/04/2021 10:37:10 AM 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	2022	Select Georgia Counties		1	600	2			2						www.anthem.com/ga/medicare	www.anthem.com/ga/medicare	www.anthem.com/ga/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1					1				
H5425	001	0	1	01	01	H5425_001_0	5	1					1	08/05/2021	2022.01	08/05/2021 09:03:26 AM Pacific Daylight Time	08/05/2021 01:20:55 PM Pacific Daylight Time	07/29/2021 04:01:46 PM Pacific Daylight Time			08/05/2021 05:39:13 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Classic (HMO)	01	01		1			H5425	001	0	2022	Ventura County		2		2			2						www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	004	0	1	01	01	H5425_004_0	5	1					1	08/05/2021	2022.01	08/05/2021 09:06:26 AM Pacific Daylight Time	08/05/2021 01:22:54 PM Pacific Daylight Time	07/29/2021 04:02:06 PM Pacific Daylight Time			08/05/2021 05:39:13 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	2022	San Diego County		2		2			2						www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	005	0	1	01	01	H5425_005_0	5	1					1	08/05/2021	2022.01	08/05/2021 12:33:02 PM Pacific Daylight Time	08/05/2021 01:25:26 PM Pacific Daylight Time	07/29/2021 04:02:24 PM Pacific Daylight Time			08/05/2021 05:39:13 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	2022	San Diego County		2		2			2						www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	006	0	1	01	01	H5425_006_0	6	1					1	08/05/2021	2022.01	08/05/2021 09:10:45 AM Pacific Daylight Time	08/05/2021 01:27:42 PM Pacific Daylight Time	07/29/2021 04:02:46 PM Pacific Daylight Time			08/05/2021 05:39:13 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Classic (HMO)	01	01		1			H5425	006	0	2022	Los Angeles County		2		2			2						www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	007	0	1	01	01	H5425_007_0	5	1					1	08/05/2021	2022.01	08/05/2021 09:11:40 AM Pacific Daylight Time	08/05/2021 01:29:45 PM Pacific Daylight Time	07/29/2021 04:03:06 PM Pacific Daylight Time			08/05/2021 05:39:13 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Classic (HMO)	01	01		1			H5425	007	0	2022	Orange County		2		2			2						www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	008	0	1	01	01	H5425_008_0	5	1					1	08/05/2021	2022.01	08/05/2021 09:12:05 AM Pacific Daylight Time	08/05/2021 01:31:30 PM Pacific Daylight Time	07/29/2021 04:03:24 PM Pacific Daylight Time			08/05/2021 05:39:13 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Classic (HMO)	01	01		1			H5425	008	0	2022	Riverside County		2		2			2						www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	009	0	1	01	01	H5425_009_0	5	1					1	08/05/2021	2022.01	08/05/2021 09:12:36 AM Pacific Daylight Time	08/05/2021 01:33:42 PM Pacific Daylight Time	07/29/2021 04:03:46 PM Pacific Daylight Time			08/05/2021 05:39:13 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Classic (HMO)	01	01		1			H5425	009	0	2022	San Bernardino County		2		2			2						www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(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			0	08/05/2021	2022.01	08/05/2021 09:16:03 AM Pacific Daylight Time	08/05/2021 01:35:54 PM Pacific Daylight Time	07/29/2021 04:04:06 PM Pacific Daylight Time			08/05/2021 05:39:13 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Connections (HMO D-SNP)	01	01		1			H5425	010	0	2022	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		(888)315-7226		(888)315-7226		(866)722-6725		(866)722-6725		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	019	0	1	01	01	H5425_019_0	5	1					1	08/05/2021	2022.01	08/05/2021 09:24:21 AM Pacific Daylight Time	08/05/2021 01:37:50 PM Pacific Daylight Time	07/29/2021 04:04:28 PM Pacific Daylight Time			08/05/2021 05:39:13 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Classic (HMO)	01	01		1			H5425	019	0	2022	San Francisco County		2		2			2						www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	020	0	1	01	01	H5425_020_0	5	1					1	08/05/2021	2022.01	08/05/2021 10:10:52 AM Pacific Daylight Time	08/05/2021 01:41:21 PM Pacific Daylight Time	07/29/2021 04:04:50 PM Pacific Daylight Time			08/05/2021 05:39:13 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Classic (HMO)	01	01		1			H5425	020	0	2022	Santa Clara County		2		2			2						www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	028	0	1	01	01	H5425_028_0	5	1		1			1	08/05/2021	2022.01	08/05/2021 09:27:53 AM Pacific Daylight Time	08/05/2021 01:48:01 PM Pacific Daylight Time	07/29/2021 04:05:10 PM Pacific Daylight Time			08/05/2021 05:39:13 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Heart First (HMO C-SNP)	01	01		1			H5425	028	0	2022	Orange County		2		2			1	4			00000000000000010000		www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	030	0	1	01	01	H5425_030_0	5	1	2	1			0	08/05/2021	2022.01	08/05/2021 09:18:16 AM Pacific Daylight Time	08/05/2021 01:53:26 PM Pacific Daylight Time	07/29/2021 04:05:34 PM Pacific Daylight Time			08/05/2021 05:39:13 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Connections at Home (HMO D-SNP)	01	01		1			H5425	030	0	2022	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		(888)315-7226		(888)315-7226		(866)722-6725		(866)722-6725		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	033	0	1	01	01	H5425_033_0	5	1		1			1	08/05/2021	2022.01	08/05/2021 09:30:00 AM Pacific Daylight Time	08/05/2021 01:55:46 PM Pacific Daylight Time	07/29/2021 04:05:54 PM Pacific Daylight Time			08/05/2021 05:39:13 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Heart First (HMO C-SNP)	01	01		1			H5425	033	0	2022	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		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	034	0	1	01	01	H5425_034_0	5	1		1			1	08/05/2021	2022.01	08/05/2021 09:30:55 AM Pacific Daylight Time	08/05/2021 01:57:48 PM Pacific Daylight Time	07/29/2021 04:06:18 PM Pacific Daylight Time			08/05/2021 05:39:13 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Balance (HMO C-SNP)	01	01		1			H5425	034	0	2022	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		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	040	0	1	01	01	H5425_040_0	5	1					0	08/05/2021	2022.01	08/05/2021 09:19:21 AM Pacific Daylight Time	08/05/2021 01:59:57 PM Pacific Daylight Time	07/29/2021 04:06:40 PM Pacific Daylight Time			08/05/2021 05:39:13 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	2022	San Diego County		2		2			2						www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	045	0	1	01	01	H5425_045_0	5	1					0	08/05/2021	2022.01	08/05/2021 09:21:01 AM Pacific Daylight Time	08/05/2021 02:01:45 PM Pacific Daylight Time	07/29/2021 04:07:00 PM Pacific Daylight Time			08/05/2021 05:39:13 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Plus (HMO)	01	01		1			H5425	045	0	2022	Selected Southern and Northern CA Counties		2		2			2						www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	052	0	1	01	01	H5425_052_0	5	1					1	08/05/2021	2022.01	08/05/2021 09:33:44 AM Pacific Daylight Time	08/05/2021 02:03:46 PM Pacific Daylight Time	07/29/2021 04:07:24 PM Pacific Daylight Time			08/05/2021 05:39:13 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Classic (HMO)	01	01		1			H5425	052	0	2022	Napa and Sonoma Counties		2		2			2						www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	053	0	1	01	01	H5425_053_0	5	1		1			1	08/05/2021	2022.01	08/05/2021 09:35:49 AM Pacific Daylight Time	08/05/2021 02:05:38 PM Pacific Daylight Time	07/29/2021 04:07:48 PM Pacific Daylight Time			08/05/2021 05:39:13 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Heart First (HMO C-SNP)	01	01		1			H5425	053	0	2022	Napa and Sonoma Counties		2		2			1	4			00000000000000010000		www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	054	0	1	01	01	H5425_054_0	5	1		1			1	08/05/2021	2022.01	08/05/2021 09:36:48 AM Pacific Daylight Time	08/05/2021 02:07:39 PM Pacific Daylight Time	07/29/2021 04:08:14 PM Pacific Daylight Time			08/05/2021 05:39:13 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Balance (HMO C-SNP)	01	01		1			H5425	054	0	2022	Napa and Sonoma Counties		2		2			1	4			00000010000000000000		www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	055	0	1	01	01	H5425_055_0	5	1		1			1	08/05/2021	2022.01	08/05/2021 09:39:11 AM Pacific Daylight Time	08/05/2021 02:09:47 PM Pacific Daylight Time	07/29/2021 04:08:36 PM Pacific Daylight Time			08/05/2021 05:39:13 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	Scripps Heart First offered by SCAN Health Plan (HMO C-SNP)	01	01		1			H5425	055	0	2022	San Diego County		2		2			1	4			00000000000000010000		www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	065	0	1	01	01	H5425_065_0	5	1					1	08/05/2021	2022.01	08/05/2021 09:40:23 AM Pacific Daylight Time	08/05/2021 02:12:56 PM Pacific Daylight Time	07/29/2021 04:09:00 PM Pacific Daylight Time			08/05/2021 05:39:13 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Prime (HMO)	01	01		1			H5425	065	0	2022	Los Angeles County		2		2			2						www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	066	0	1	01	01	H5425_066_0	5	1					1	08/05/2021	2022.01	08/05/2021 09:40:52 AM Pacific Daylight Time	08/05/2021 02:15:00 PM Pacific Daylight Time	07/29/2021 04:09:24 PM Pacific Daylight Time			08/05/2021 05:39:13 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Prime (HMO)	01	01		1			H5425	066	0	2022	Orange County		2		2			2						www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	067	0	1	01	01	H5425_067_0	5	1					1	08/05/2021	2022.01	08/05/2021 09:41:11 AM Pacific Daylight Time	08/05/2021 02:16:42 PM Pacific Daylight Time	07/29/2021 04:09:44 PM Pacific Daylight Time			08/05/2021 05:39:13 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Prime (HMO)	01	01		1			H5425	067	0	2022	Riverside County		2		2			2						www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	068	0	1	01	01	H5425_068_0	5	1					1	08/05/2021	2022.01	08/05/2021 09:41:33 AM Pacific Daylight Time	08/05/2021 02:18:28 PM Pacific Daylight Time	07/29/2021 04:10:06 PM Pacific Daylight Time			08/05/2021 05:39:13 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Prime (HMO)	01	01		1			H5425	068	0	2022	San Bernardino County		2		2			2						www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	069	0	1	01	01	H5425_069_0	5	1					1	08/05/2021	2022.01	08/05/2021 09:45:08 AM Pacific Daylight Time	08/05/2021 02:20:36 PM Pacific Daylight Time	07/29/2021 04:10:28 PM Pacific Daylight Time			08/05/2021 05:39:13 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Classic (HMO)	01	01		1			H5425	069	0	2022	Stanislaus County		2		2			2						www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	070	0	1	01	01	H5425_070_0	5	1		1			1	08/05/2021	2022.01	08/05/2021 09:47:29 AM Pacific Daylight Time	08/05/2021 02:22:20 PM Pacific Daylight Time	07/29/2021 04:10:56 PM Pacific Daylight Time			08/05/2021 05:39:13 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Balance (HMO C-SNP)	01	01		1			H5425	070	0	2022	Stanislaus County		2		2			1	4			00000010000000000000		www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	071	0	1	01	01	H5425_071_0	5	1					0	08/05/2021	2022.01	08/05/2021 09:51:25 AM Pacific Daylight Time	08/05/2021 02:24:28 PM Pacific Daylight Time	07/29/2021 04:11:16 PM Pacific Daylight Time			08/05/2021 05:39:13 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Plus (HMO)	01	01		1			H5425	071	0	2022	Stanislaus County		2		2			2						www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	072	0	1	01	01	H5425_072_0	6	1					0	08/05/2021	2022.01	08/05/2021 09:52:00 AM Pacific Daylight Time	08/05/2021 02:26:40 PM Pacific Daylight Time	07/29/2021 04:11:38 PM Pacific Daylight Time			08/05/2021 05:39:13 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Plus (HMO)	01	01		1			H5425	072	0	2022	Santa Clara County		2		2			2						www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	073	0	1	01	01	H5425_073_0	5	1					1	08/05/2021	2022.01	08/05/2021 09:48:34 AM Pacific Daylight Time	08/05/2021 02:29:14 PM Pacific Daylight Time	07/29/2021 04:12:02 PM Pacific Daylight Time			08/05/2021 05:39:13 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Options (HMO)	01	01		1			H5425	073	0	2022	Santa Clara County		2		2			2						www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	074	0	1	01	01	H5425_074_0	5	1					1	08/05/2021	2022.01	08/05/2021 09:53:24 AM Pacific Daylight Time	08/05/2021 02:31:32 PM Pacific Daylight Time	07/29/2021 04:12:28 PM Pacific Daylight Time			08/05/2021 05:39:13 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Compass (HMO)	01	01		1			H5425	074	0	2022	Napa and Sonoma Counties		2		2			2						www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	075	0	1	01	01	H5425_075_0	5	1					1	08/05/2021	2022.01	08/05/2021 09:56:25 AM Pacific Daylight Time	08/05/2021 01:31:55 PM Pacific Daylight Time	07/29/2021 04:12:58 PM Pacific Daylight Time			08/05/2021 05:39:13 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Classic (HMO)	01	01		1			H5425	075	0	2022	Alameda County		2		2			2						https://www.scanhealthplan.com/	https://www.scanhealthplan.com/	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	076	0	1	01	01	H5425_076_0	5	1		1			1	08/05/2021	2022.01	08/05/2021 09:58:08 AM Pacific Daylight Time	08/05/2021 01:25:48 PM Pacific Daylight Time	07/29/2021 04:13:24 PM Pacific Daylight Time			08/05/2021 05:39:13 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Balance (HMO C-SNP)	01	01		1			H5425	076	0	2022	Alameda County		2		2			1	4			00000010000000000000		https://www.scanhealthplan.com/	https://www.scanhealthplan.com/	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	077	0	1	01	01	H5425_077_0	5	1		1			1	08/05/2021	2022.01	08/05/2021 09:59:48 AM Pacific Daylight Time	08/05/2021 01:27:16 PM Pacific Daylight Time	07/29/2021 04:13:54 PM Pacific Daylight Time			08/05/2021 05:39:13 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Heart First (HMO C-SNP)	01	01		1			H5425	077	0	2022	Alameda County		2		2			1	4			00000000000000010000		https://www.scanhealthplan.com/	https://www.scanhealthplan.com/	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	078	0	1	01	01	H5425_078_0	5	1					1	08/05/2021	2022.01	08/05/2021 10:01:00 AM Pacific Daylight Time	08/05/2021 01:30:11 PM Pacific Daylight Time	07/29/2021 04:14:18 PM Pacific Daylight Time			08/05/2021 05:39:13 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Classic (HMO)	01	01		1			H5425	078	0	2022	San Mateo County		2		2			2						https://www.scanhealthplan.com/	https://www.scanhealthplan.com/	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	079	0	1	01	01	H5425_079_0	5	1		1			1	08/05/2021	2022.01	08/05/2021 10:02:20 AM Pacific Daylight Time	08/05/2021 01:22:53 PM Pacific Daylight Time	07/29/2021 04:14:46 PM Pacific Daylight Time			08/05/2021 05:39:13 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Balance (HMO C-SNP)	01	01		1			H5425	079	0	2022	San Mateo County		2		2			1	4			00000010000000000000		https://www.scanhealthplan.com/	https://www.scanhealthplan.com/	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	080	0	1	01	01	H5425_080_0	5	1		1			1	08/05/2021	2022.01	08/05/2021 10:03:19 AM Pacific Daylight Time	08/05/2021 01:24:15 PM Pacific Daylight Time	07/29/2021 04:15:08 PM Pacific Daylight Time			08/05/2021 05:39:13 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Heart First (HMO C-SNP)	01	01		1			H5425	080	0	2022	San Mateo County		2		2			1	4			00000000000000010000		https://www.scanhealthplan.com/	https://www.scanhealthplan.com/	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	082	0	1	01	01	H5425_082_0	5	1					1	08/05/2021	2022.01	08/05/2021 10:03:53 AM Pacific Daylight Time	08/05/2021 01:57:25 PM Pacific Daylight Time	07/29/2021 04:15:34 PM Pacific Daylight Time			08/05/2021 05:39:13 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Alta (HMO)	01	01		1			H5425	082	0	2022	San Diego County		2		2			2						https://www.scanhealthplan.com/	https://www.scanhealthplan.com/	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	083	0	1	01	01	H5425_083_0	5	1					1	08/05/2021	2022.01	08/05/2021 10:07:19 AM Pacific Daylight Time	08/05/2021 01:55:42 PM Pacific Daylight Time	07/29/2021 04:16:06 PM Pacific Daylight Time			08/05/2021 05:39:13 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Options (HMO)	01	01		1			H5425	083	0	2022	Ventura County		2		2			2						https://www.scanhealthplan.com/	https://www.scanhealthplan.com/	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	084	0	1	01	01	H5425_084_0	5	1					1	08/05/2021	2022.01	08/05/2021 01:07:59 PM Pacific Daylight Time	08/05/2021 01:21:17 PM Pacific Daylight Time	07/29/2021 04:16:32 PM Pacific Daylight Time			08/05/2021 05:39:13 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Venture (HMO)	01	01		1			H5425	084	0	2022	Los Angeles and Orange Counties		2		2			2						https://www.scanhealthplan.com/	https://www.scanhealthplan.com/	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	085	0	1	01	01	H5425_085_0	5	1					1	08/05/2021	2022.01	08/05/2021 01:09:05 PM Pacific Daylight Time	08/05/2021 01:18:54 PM Pacific Daylight Time	07/29/2021 04:16:54 PM Pacific Daylight Time			08/05/2021 05:39:13 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Venture (HMO)	01	01		1			H5425	085	0	2022	Riverside and San Bernardino Counties		2		2			2						https://www.scanhealthplan.com/	https://www.scanhealthplan.com/	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	086	0	1	01	01	H5425_086_0	5	1		1			1	08/05/2021	2022.01	08/05/2021 10:41:31 AM Pacific Daylight Time	08/05/2021 01:54:10 PM Pacific Daylight Time	07/29/2021 04:17:30 PM Pacific Daylight Time			08/05/2021 05:39:13 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Embrace (HMO I-SNP)	01	01		1			H5425	086	0	2022	Los Angeles County		2		2			1	1	3				https://www.scanhealthplan.com/	https://www.scanhealthplan.com/	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	087	0	1	01	01	H5425_087_0	5	1		1			1	08/05/2021	2022.01	08/05/2021 12:53:49 PM Pacific Daylight Time	08/05/2021 01:52:32 PM Pacific Daylight Time	07/29/2021 04:18:00 PM Pacific Daylight Time			08/05/2021 05:39:13 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Embrace (HMO I-SNP)	01	01		1			H5425	087	0	2022	Orange County		2		2			1	1	3				https://www.scanhealthplan.com/	https://www.scanhealthplan.com/	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	803	0	1	01	01	H5425_803_0	2	1						05/21/2021	2022.01	05/21/2021 05:10:24 PM Pacific Daylight Time					06/04/2021 11:04:52 AM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Retiree Group (HMO)	01	01		1			H5425	803	0	2022	Southern and Northern California Counties		1	34813	2			2						https://www.scanhealthplan.com/	https://www.scanhealthplan.com/	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	804	0	1	01	01	H5425_804_0	2	1						05/21/2021	2022.01	05/21/2021 05:10:51 PM Pacific Daylight Time					06/04/2021 11:04:52 AM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Retiree Group (HMO)	01	01		1			H5425	804	0	2022	Southern and Northern California Counties		1	12895	2			2						https://www.scanhealthplan.com/	https://www.scanhealthplan.com/	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5427	052	0	1	01	01	H5427_052_0	6	1			2	0	0	07/13/2021	2022.01	07/13/2021 01:03:02 PM Eastern Daylight Time	07/19/2021 07:11:00 PM Eastern Daylight Time				07/19/2021 04:11:27 PM Eastern Daylight Time	FREEDOM HEALTH, INC.	Freedom Health, Inc.	www.FreedomHealth.com	Freedom Savings Plan (HMO)	01	01		1			H5427	052	0	2022	Select Counties in Florida		2	0	2			2						www.freedomhealth.com	www.freedomhealth.com	http://www.FreedomHealth.com	(800)401-2740		(800)401-2740		(888)300-9318		(813)506-6133										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H5427	059	0	1	01	01	H5427_059_0	8	1			2		0	07/13/2021	2022.01	07/13/2021 01:03:25 PM Eastern Daylight Time	08/04/2021 12:20:00 PM Eastern Daylight Time	08/04/2021 12:20:00 PM Eastern Daylight Time			08/04/2021 01:51:15 PM Eastern Daylight Time	FREEDOM HEALTH, INC.	Freedom Health, Inc.	www.FreedomHealth.com	Freedom Medicare Plan Rx (HMO)	01	01		1			H5427	059	0	2022	Select Counties in Florida		2	0	2			2						www.freedomhealth.com	www.freedomhealth.com	http://www.FreedomHealth.com	(800)401-2740		(800)401-2740		(888)300-9318		(813)506-6133		(800)401-2740		(813)506-6100		(888)300-9318		(813)506-6133		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5427	060	0	1	01	01	H5427_060_0	7	1			2		0	07/13/2021	2022.01	07/13/2021 01:03:48 PM Eastern Daylight Time	08/04/2021 12:20:00 PM Eastern Daylight Time	08/04/2021 12:20:00 PM Eastern Daylight Time			08/04/2021 01:51:15 PM Eastern Daylight Time	FREEDOM HEALTH, INC.	Freedom Health, Inc.	www.FreedomHealth.com	Freedom Medicare Plan Rx (HMO)	01	01		1			H5427	060	0	2022	Select Counties in Florida		2	0	2			2						www.freedomhealth.com	www.freedomhealth.com	http://www.FreedomHealth.com	(800)401-2740		(800)401-2740		(888)300-9318		(813)506-6133		(800)401-2740		(813)506-6100		(888)300-9318		(813)506-6133		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5427	070	0	1	01	01	H5427_070_0	8	1		1	2		1	07/13/2021	2022.01	07/13/2021 01:04:10 PM Eastern Daylight Time	08/04/2021 12:20:00 PM Eastern Daylight Time	08/04/2021 12:20:00 PM Eastern Daylight Time			08/04/2021 01:51:15 PM Eastern Daylight Time	FREEDOM HEALTH, INC.	Freedom Health, Inc.	www.FreedomHealth.com	Freedom VIP Care (HMO C-SNP)	01	01		1			H5427	070	0	2022	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		(888)300-9318		(813)506-6133		(800)401-2740		(813)506-6100		(888)300-9318		(813)506-6133		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5427	072	0	1	01	01	H5427_072_0	7	1		1	2		1	07/13/2021	2022.01	07/13/2021 01:04:47 PM Eastern Daylight Time	08/04/2021 12:20:00 PM Eastern Daylight Time	08/04/2021 12:20:00 PM Eastern Daylight Time			08/04/2021 01:51:15 PM Eastern Daylight Time	FREEDOM HEALTH, INC.	Freedom Health, Inc.	www.FreedomHealth.com	Freedom VIP Savings (HMO C-SNP)	01	01		1			H5427	072	0	2022	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		(888)300-9318		(813)506-6133		(800)401-2740		(813)506-6100		(888)300-9318		(813)506-6133		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5427	077	0	1	01	01	H5427_077_0	7	1		1	2		0	07/13/2021	2022.01	07/13/2021 01:05:11 PM Eastern Daylight Time	08/04/2021 12:20:00 PM Eastern Daylight Time	08/04/2021 12:20:00 PM Eastern Daylight Time			08/04/2021 01:51:15 PM Eastern Daylight Time	FREEDOM HEALTH, INC.	Freedom Health, Inc.	www.FreedomHealth.com	Freedom VIP Savings COPD (HMO C-SNP)	01	01		1			H5427	077	0	2022	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		(888)300-9318		(813)506-6133		(800)401-2740		(813)506-6100		(888)300-9318		(813)506-6133		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5427	078	0	1	01	01	H5427_078_0	7	1	2	1	1		0	07/13/2021	2022.01	07/13/2021 01:05:32 PM Eastern Daylight Time	08/04/2021 12:20:00 PM Eastern Daylight Time	08/04/2021 12:20:00 PM Eastern Daylight Time			08/04/2021 01:51:15 PM Eastern Daylight Time	FREEDOM HEALTH, INC.	Freedom Health, Inc.	www.FreedomHealth.com	Freedom Medi-Medi Partial (HMO D-SNP)	01	01		1			H5427	078	0	2022	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		(888)300-9318		(813)506-6133		(800)401-2740		(813)506-6100		(888)300-9318		(813)506-6133		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5427	082	0	1	01	01	H5427_082_0	7	1		1	2		0	07/13/2021	2022.01	07/13/2021 01:05:51 PM Eastern Daylight Time	08/04/2021 12:20:00 PM Eastern Daylight Time	08/04/2021 12:20:00 PM Eastern Daylight Time			08/04/2021 01:51:15 PM Eastern Daylight Time	FREEDOM HEALTH, INC.	Freedom Health, Inc.	www.FreedomHealth.com	Freedom VIP Savings (HMO C-SNP)	01	01		1			H5427	082	0	2022	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		(888)300-9318		(813)506-6133		(800)401-2740		(813)506-6100		(888)300-9318		(813)506-6133		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5427	083	0	1	01	01	H5427_083_0	7	1		1	2		0	07/13/2021	2022.01	07/13/2021 01:06:11 PM Eastern Daylight Time	08/04/2021 12:20:00 PM Eastern Daylight Time	08/04/2021 12:20:00 PM Eastern Daylight Time			08/04/2021 01:51:15 PM Eastern Daylight Time	FREEDOM HEALTH, INC.	Freedom Health, Inc.	www.FreedomHealth.com	Freedom VIP Savings COPD (HMO C-SNP)	01	01		1			H5427	083	0	2022	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		(888)300-9318		(813)506-6133		(800)401-2740		(813)506-6100		(888)300-9318		(813)506-6133		(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	1		0	07/13/2021	2022.01	07/13/2021 01:06:31 PM Eastern Daylight Time	08/04/2021 12:20:00 PM Eastern Daylight Time	08/04/2021 12:20:00 PM Eastern Daylight Time			08/04/2021 01:51:15 PM Eastern Daylight Time	FREEDOM HEALTH, INC.	Freedom Health, Inc.	www.FreedomHealth.com	Freedom Medi-Medi Full (HMO D-SNP)	01	01		1			H5427	087	0	2022	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		(888)300-9318		(813)506-6133		(800)401-2740		(813)506-6100		(888)300-9318		(813)506-6133		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5427	088	0	1	01	01	H5427_088_0	8	1			2		0	07/13/2021	2022.01	07/13/2021 01:06:48 PM Eastern Daylight Time	08/04/2021 12:20:00 PM Eastern Daylight Time	08/04/2021 12:20:00 PM Eastern Daylight Time			08/04/2021 01:51:15 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	2022	select counties in Florida		2	0	2			2						www.freedomhealth.com	www.freedomhealth.com	http://www.FreedomHealth.com	(800)401-2740		(800)401-2740		(888)300-9318		(813)506-6133		(800)401-2740		(813)506-6100		(888)300-9318		(813)506-6133		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5427	089	0	1	01	01	H5427_089_0	7	1			2		0	07/13/2021	2022.01	07/13/2021 01:07:08 PM Eastern Daylight Time	08/04/2021 12:20:00 PM Eastern Daylight Time	08/04/2021 12:20:00 PM Eastern Daylight Time			08/04/2021 01:51:15 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	2022	Select Counties in FL		2	0	2			2						www.freedomhealth.com	www.freedomhealth.com	http://www.FreedomHealth.com	(800)401-2740		(800)401-2740		(888)300-9318		(813)506-6133		(800)401-2740		(813)506-6100		(888)300-9318		(813)506-6133		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5427	091	0	1	01	01	H5427_091_0	7	1			2		0	07/13/2021	2022.01	07/13/2021 01:07:26 PM Eastern Daylight Time	08/04/2021 12:20:00 PM Eastern Daylight Time	08/04/2021 12:20:00 PM Eastern Daylight Time			08/04/2021 01:51:15 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	2022	Select Counties in FL		2	0	2			2						www.freedomhealth.com	www.freedomhealth.com	http://www.FreedomHealth.com	(800)401-2740		(800)401-2740		(888)300-9318		(813)506-6133		(800)401-2740		(813)506-6100		(888)300-9318		(813)506-6133		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5427	092	0	1	01	01	H5427_092_0	7	1			2		0	07/13/2021	2022.01	07/13/2021 01:07:46 PM Eastern Daylight Time	08/04/2021 12:20:00 PM Eastern Daylight Time	08/04/2021 12:20:00 PM Eastern Daylight Time			08/04/2021 01:51:15 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	2022	Select Counties in FL		2	0	2			2						www.freedomhealth.com	www.freedomhealth.com	http://www.FreedomHealth.com	(800)401-2740		(800)401-2740		(888)300-9318		(813)506-6133		(800)401-2740		(813)506-6100		(888)300-9318		(813)506-6133		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5427	093	0	1	01	01	H5427_093_0	9	1			2		0	07/13/2021	2022.01	07/13/2021 01:13:37 PM Eastern Daylight Time	08/04/2021 12:20:00 PM Eastern Daylight Time	08/04/2021 12:20:00 PM Eastern Daylight Time			08/04/2021 01:51:15 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	2022	Select Counties in FL		2	0	2			2						www.freedomhealth.com	www.freedomhealth.com	http://www.FreedomHealth.com	(800)401-2740		(800)401-2740		(888)300-9318		(813)506-6133		(800)401-2740		(813)506-6100		(888)300-9318		(813)506-6133		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5427	094	0	1	01	01	H5427_094_0	8	1			2		0	07/13/2021	2022.01	07/13/2021 01:13:58 PM Eastern Daylight Time	08/04/2021 12:20:00 PM Eastern Daylight Time	08/04/2021 12:20:00 PM Eastern Daylight Time			08/04/2021 01:51:15 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	2022	Select Counties in FL		2	0	2			2						www.freedomhealth.com	www.freedomhealth.com	http://www.FreedomHealth.com	(800)401-2740		(800)401-2740		(888)300-9318		(813)506-6133		(800)401-2740		(813)506-6100		(888)300-9318		(813)506-6133		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5427	096	0	1	01	01	H5427_096_0	7	1			2		0	07/13/2021	2022.01	07/13/2021 01:14:50 PM Eastern Daylight Time	08/04/2021 12:20:00 PM Eastern Daylight Time	08/04/2021 12:20:00 PM Eastern Daylight Time			08/04/2021 01:51:15 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	2022	Select Counties in Florida		2		2			2						www.freedomhealth.com	www.freedomhealth.com	http://www.FreedomHealth.com	(800)401-2740		(800)401-2740		(888)300-9318		(813)506-6133		(800)401-2740		(813)506-6100		(888)300-9318		(813)506-6133		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5427	098	0	1	01	01	H5427_098_0	7	1			2		0	07/13/2021	2022.01	07/13/2021 01:15:17 PM Eastern Daylight Time	08/04/2021 12:20:00 PM Eastern Daylight Time	08/04/2021 12:20:00 PM Eastern Daylight Time			08/04/2021 01:51:15 PM Eastern Daylight Time	FREEDOM HEALTH, INC.	Freedom Health, Inc.	www.FreedomHealth.com	Freedom Platinum Plan Rx (HMO)	01	01		1			H5427	098	0	2022	select counties in FL		2	0	2			2						www.freedomhealth.com	www.freedomhealth.com	http://www.FreedomHealth.com	(800)401-2740		(800)401-2740		(888)300-9318		(813)506-6133		(800)401-2740		(813)506-6100		(888)300-9318		(813)506-6133		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5427	099	0	1	01	01	H5427_099_0	7	1		1	2		0	07/13/2021	2022.01	07/13/2021 01:15:34 PM Eastern Daylight Time	08/04/2021 12:20:00 PM Eastern Daylight Time	08/04/2021 12:20:00 PM Eastern Daylight Time			08/04/2021 01:51:15 PM Eastern Daylight Time	FREEDOM HEALTH, INC.	Freedom Health, Inc.	www.FreedomHealth.com	Freedom VIP Rewards (HMO C-SNP)	01	01		1			H5427	099	0	2022	select counties in FL		2	0	2			1	4			00000000000000000010		www.freedomhealth.com	www.freedomhealth.com	http://www.FreedomHealth.com	(800)401-2740		(800)401-2740		(888)300-9318		(813)506-6133		(800)401-2740		(813)506-6100		(888)300-9318		(813)506-6133		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5427	102	0	1	01	01	H5427_102_0	8	1			2		0	07/13/2021	2022.01	07/13/2021 01:15:53 PM Eastern Daylight Time	08/04/2021 12:20:00 PM Eastern Daylight Time	08/04/2021 12:20:00 PM Eastern Daylight Time			08/04/2021 01:51:15 PM Eastern Daylight Time	FREEDOM HEALTH, INC.	Freedom Health, Inc.	http://www.FreedomHealth.com	Freedom Platinum Rewards Plan Rx (HMO)	01	01		1			H5427	102	0	2022	select counties in FL		2		2			2						www.freedomhealth.com	www.freedomhealth.com	http://www.FreedomHealth.com	(800)401-2740		(800)401-2740		(888)300-9318		(813)506-6133		(800)401-2740		(813)506-6100		(888)300-9318		(813)506-6133		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5427	103	0	1	01	01	H5427_103_0	7	1			2		0	07/13/2021	2022.01	07/13/2021 01:16:13 PM Eastern Daylight Time	08/04/2021 12:20:00 PM Eastern Daylight Time	08/04/2021 12:20:00 PM Eastern Daylight Time			08/04/2021 01:51:15 PM Eastern Daylight Time	FREEDOM HEALTH, INC.	Freedom Health, Inc.	http://www.FreedomHealth.com	Freedom Platinum Rewards Plan Rx (HMO)	01	01		1			H5427	103	0	2022	select counties in FL		2		2			2						www.freedomhealth.com	www.freedomhealth.com	http://www.FreedomHealth.com	(800)401-2740		(800)401-2740		(888)300-9318		(813)506-6133		(800)401-2740		(813)506-6100		(888)300-9318		(813)506-6133		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5427	104	0	1	01	01	H5427_104_0	7	1			2		0	07/13/2021	2022.01	07/13/2021 01:16:32 PM Eastern Daylight Time	08/04/2021 12:20:00 PM Eastern Daylight Time	08/04/2021 12:20:00 PM Eastern Daylight Time			08/04/2021 01:51:15 PM Eastern Daylight Time	FREEDOM HEALTH, INC.	Freedom Health, Inc.	www.FreedomHealth.com	Freedom Platinum Plus Plan Rx (HMO)	01	01		1			H5427	104	0	2022	select counties in FL		2	0	2			2						www.freedomhealth.com	www.freedomhealth.com	http://www.FreedomHealth.com	(800)401-2740		(800)401-2740		(888)300-9318		(813)506-6133		(800)401-2740		(813)506-6100		(888)300-9318		(813)506-6133		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5427	105	0	1	01	01	H5427_105_0	7	1			2		0	07/13/2021	2022.01	07/13/2021 01:16:50 PM Eastern Daylight Time	08/04/2021 12:20:00 PM Eastern Daylight Time	08/04/2021 12:20:00 PM Eastern Daylight Time			08/04/2021 01:51:15 PM Eastern Daylight Time	FREEDOM HEALTH, INC.	Freedom Health, Inc.	www.FreedomHealth.com	Freedom Platinum Rewards Plan Rx (HMO)	01	01		1			H5427	105	0	2022	select counties in FL		2		2			2						www.freedomhealth.com	www.freedomhealth.com	http://www.FreedomHealth.com	(800)401-2740		(800)401-2740		(888)300-9318		(813)506-6133		(800)401-2740		(813)506-6100		(888)300-9318		(813)506-6133		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5427	106	0	1	01	01	H5427_106_0	8	1			2		0	07/13/2021	2022.01	07/13/2021 01:17:08 PM Eastern Daylight Time	08/04/2021 12:20:00 PM Eastern Daylight Time	08/04/2021 12:20:00 PM Eastern Daylight Time			08/04/2021 01:51:15 PM Eastern Daylight Time	FREEDOM HEALTH, INC.	Freedom Health, Inc.	http://www.FreedomHealth.com	Freedom Platinum Rewards Plan Rx (HMO)	01	01		1			H5427	106	0	2022	select counties in FL		2		2			2						www.freedomhealth.com	www.FreedomHealth.com	http://www.FreedomHealth.com	(800)401-2740		(800)401-2740		(888)300-9318		(813)506-6133		(800)401-2740		(813)506-6100		(888)300-9318		(813)506-6133		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5427	107	0	1	01	01	H5427_107_0	8	1			2		0	07/13/2021	2022.01	07/13/2021 01:17:26 PM Eastern Daylight Time	08/04/2021 12:20:00 PM Eastern Daylight Time	08/04/2021 12:20:00 PM Eastern Daylight Time			08/04/2021 01:51:15 PM Eastern Daylight Time	FREEDOM HEALTH, INC.	Freedom Health, Inc.	www.FreedomHealth.com	Freedom Platinum Rewards Plan Rx (HMO)	01	01		1			H5427	107	0	2022	select counties in FL		2		2			2						www.freedomhealth.com	www.freedomhealth.com	http://www.FreedomHealth.com	(800)401-2740		(800)401-2740		(888)300-9318		(813)506-6133		(800)401-2740		(813)506-6100		(888)300-9318		(813)506-6133		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5427	108	0	1	01	01	H5427_108_0	7	1		1	2		0	07/13/2021	2022.01	07/13/2021 01:17:44 PM Eastern Daylight Time	08/04/2021 12:20:00 PM Eastern Daylight Time	08/04/2021 12:20:00 PM Eastern Daylight Time			08/04/2021 01:51:15 PM Eastern Daylight Time	FREEDOM HEALTH, INC.	Freedom Health, Inc.	www.FreedomHealth.com	Freedom VIP Rewards (HMO C-SNP)	01	01		1			H5427	108	0	2022	select counties in FL		2	0	2			1	4			00000000000000000010		www.freedomhealth.com	www.freedomhealth.com	http://www.FreedomHealth.com	(800)401-2740		(800)401-2740		(888)300-9318		(813)506-6133		(800)401-2740		(813)506-6100		(888)300-9318		(813)506-6133		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5430	805	0	1	01	01	H5430_805_0	2	1						06/02/2021	2022.01	06/02/2021 08:10:05 AM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	ONECARE BY CARE1ST HEALTH PLAN OF ARIZONA INC.	WellCare	www.wellcare.com/medicare	WellCare Group Medicare Advantage (HMO)	01	01		1			H5430	805	0	2022	Select Counties in AZ		1	100	2			2						https://www.care1st.com/az/medicare	https://www.care1st.com/az/medicare	www.wellcare.com/fap_search	(800)977-7522		(800)977-7522		(844)942-0039		(844)942-0039		(800)977-7522		(800)977-7522		(844)942-0039		(844)942-0039		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H5430	806	0	1	01	01	H5430_806_0	2	1				0	0	06/02/2021	2022.01	06/02/2021 08:11:14 AM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	ONECARE BY CARE1ST HEALTH PLAN OF ARIZONA INC.	WellCare	www.wellcare.com/medicare	WellCare Group Medicare Advantage (HMO)	01	01		1			H5430	806	0	2022	Select Counties in AZ		1	100	2			2						https://www.care1st.com/az/medicare	https://www.care1st.com/az/medicare	www.wellcare.com/fap_search	(800)977-7522		(800)977-7522		(844)942-0039		(844)942-0039										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H5430	807	0	1	01	01	H5430_807_0	2	1						06/02/2021	2022.01	06/02/2021 08:12:23 AM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	ONECARE BY CARE1ST HEALTH PLAN OF ARIZONA INC.	WellCare	www.wellcare.com/medicare	WellCare Group Medicare Advantage (HMO)	01	01		1			H5430	807	0	2022	Select Counties in AZ		1	100	2			2						https://www.care1st.com/az/medicare	https://www.care1st.com/az/medicare	www.wellcare.com/fap_search	(800)977-7522		(800)977-7522		(844)942-0039		(844)942-0039		(800)977-7522		(800)977-7522		(844)942-0039		(844)942-0039		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H5431	001	0	1	01	01	H5431_001_0	7	1			2		0	07/14/2021	2022.01	07/14/2021 05:45:40 PM Eastern Daylight Time	08/03/2021 06:04:05 PM Eastern Daylight Time	08/03/2021 06:04:05 PM Eastern Daylight Time			08/04/2021 01:42:08 PM Eastern Daylight Time	HEALTHSUN HEALTH PLANS, INC.	HealthSun Health Plans, Inc.	www.HealthSun.com	HealthSun HealthAdvantage Plan (HMO)	01	01		1			H5431	001	0	2022	Miami-Dade		2		2			2						www.HealthSun.com	www.HealthSun.com	www.HealthSun.com	(877)336-2069		(305)447-4458		(855)573-0370		(855)573-0370		(877)336-2069		(305)447-4458		(855)573-0366		(855)573-0366		(877)206-0500		(877)206-0500		(711)-		(711)-		(877)206-0500		(877)206-0500		(711)-		(711)-		2					2					2	2			
H5431	006	0	1	01	01	H5431_006_0	7	1			2		0	07/14/2021	2022.01	07/14/2021 05:47:25 PM Eastern Daylight Time	08/03/2021 06:04:05 PM Eastern Daylight Time	08/03/2021 06:04:06 PM Eastern Daylight Time			08/04/2021 01:42:08 PM Eastern Daylight Time	HEALTHSUN HEALTH PLANS, INC.	HealthSun Health Plans, Inc.	www.HealthSun.com	HealthSun MediMax (HMO)	01	01		1			H5431	006	0	2022	Broward and Miami-Dade		2		2			2						www.HealthSun.com	www.HealthSun.com	www.HealthSun.com	(877)336-2069		(305)447-4458		(855)573-0370		(855)573-0370		(877)336-2069		(305)447-4458		(855)573-0366		(855)573-0366		(877)206-0500		(877)206-0500		(711)-		(711)-		(877)206-0500		(877)206-0500		(711)-		(711)-		2					2					2	2			
H5431	012	0	1	01	01	H5431_012_0	7	1			2		0	07/14/2021	2022.01	07/14/2021 05:49:17 PM Eastern Daylight Time	08/03/2021 06:04:06 PM Eastern Daylight Time	08/03/2021 06:04:06 PM Eastern Daylight Time			08/04/2021 01:42:08 PM Eastern Daylight Time	HEALTHSUN HEALTH PLANS, INC.	HealthSun Health Plans, Inc.	www.HealthSun.com	HealthSun HealthAdvantage Plan (HMO)	01	01		1			H5431	012	0	2022	Broward		2		2			2						www.HealthSun.com	www.HealthSun.com	www.HealthSun.com	(877)336-2069		(305)447-4458		(855)573-0370		(855)573-0370		(877)336-2069		(305)447-4458		(855)573-0366		(855)573-0366		(877)206-0500		(877)206-0500		(711)-		(711)-		(877)206-0500		(877)206-0500		(711)-		(711)-		2					2					2	2			
H5431	013	0	1	01	01	H5431_013_0	7	1			2		0	07/14/2021	2022.01	07/14/2021 05:53:03 PM Eastern Daylight Time	08/03/2021 06:04:06 PM Eastern Daylight Time	08/03/2021 06:04:06 PM Eastern Daylight Time			08/04/2021 01:42:08 PM Eastern Daylight Time	HEALTHSUN HEALTH PLANS, INC.	HealthSun Health Plans, Inc.	www.HealthSun.com	HealthSun HealthAdvantage Plan (HMO)	01	01		1			H5431	013	0	2022	Palm Beach		2		2			2						www.HealthSun.com	www.HealthSun.com	www.HealthSun.com	(877)336-2069		(305)447-4458		(855)573-0370		(855)573-0370		(877)336-2069		(305)447-4458		(855)573-0366		(855)573-0366		(877)206-0500		(877)206-0500		(711)-		(711)-		(877)206-0500		(877)206-0500		(711)-		(711)-		2					2					2	2			
H5431	015	0	1	01	01	H5431_015_0	9	1	2	1	1		0	07/14/2021	2022.01	07/14/2021 05:54:04 PM Eastern Daylight Time	08/03/2021 06:04:06 PM Eastern Daylight Time	08/03/2021 06:04:06 PM Eastern Daylight Time			08/04/2021 01:42:08 PM Eastern Daylight Time	HEALTHSUN HEALTH PLANS, INC.	HealthSun Health Plans, Inc.	www.HealthSun.com	HealthSun MediSun Plus (HMO D-SNP)	01	01		1			H5431	015	0	2022	Miami-Dade, Broward		2		2			1	3		2		2	www.HealthSun.com	www.HealthSun.com	www.HealthSun.com	(877)336-2069		(305)447-4458		(855)573-0368		(855)573-0368		(877)336-2069		(305)447-4458		(855)573-0367		(855)573-0367		(877)206-0500		(877)206-0500		(711)-		(711)-		(877)206-0500		(877)206-0500		(711)-		(711)-		2					2					2	2			
H5431	016	0	1	01	01	H5431_016_0	7	1	2	1	1		0	07/14/2021	2022.01	07/14/2021 05:55:08 PM Eastern Daylight Time	08/03/2021 06:04:06 PM Eastern Daylight Time	08/03/2021 06:04:06 PM Eastern Daylight Time			08/04/2021 01:42:08 PM Eastern Daylight Time	HEALTHSUN HEALTH PLANS, INC.	HealthSun Health Plans, Inc.	www.HealthSun.com	HealthSun MediSun Plus (HMO D-SNP)	01	01		1			H5431	016	0	2022	Palm Beach		2		2			1	3		2		2	www.HealthSun.com	www.HealthSun.com	www.HealthSun.com	(877)336-2069		(305)447-4458		(855)573-0368		(855)573-0368		(877)336-2069		(305)447-4458		(855)573-0367		(855)573-0367		(877)206-0500		(877)206-0500		(711)-		(711)-		(877)206-0500		(877)206-0500		(711)-		(711)-		2					2					2	2			
H5431	017	0	1	01	01	H5431_017_0	7	1			2		0	07/14/2021	2022.01	07/14/2021 05:38:55 PM Eastern Daylight Time	08/03/2021 06:04:06 PM Eastern Daylight Time	08/03/2021 06:04:06 PM Eastern Daylight Time			08/04/2021 01:42:08 PM Eastern Daylight Time	HEALTHSUN HEALTH PLANS, INC.	HealthSun Health Plans, Inc.	www.HealthSun.com	HealthSun HealthAdvantage Plus (HMO)	01	01		1			H5431	017	0	2022	Miami-Dade		2		2			2						www.HealthSun.com	www.HealthSun.com	www.HealthSun.com	(877)336-2069		(305)447-4458		(855)573-0370		(855)573-0370		(877)336-2069		(305)447-4458		(855)573-0366		(855)573-0366		(877)206-0500		(877)206-0500		(711)-		(711)-		(877)206-0500		(877)206-0500		(711)-		(711)-		2					2					2	2			
H5431	018	0	1	01	01	H5431_018_0	7	1			2		0	07/14/2021	2022.01	07/14/2021 05:41:38 PM Eastern Daylight Time	08/03/2021 06:04:06 PM Eastern Daylight Time	08/03/2021 06:04:06 PM Eastern Daylight Time			08/04/2021 01:42:08 PM Eastern Daylight Time	HEALTHSUN HEALTH PLANS, INC.	HealthSun Health Plans, Inc.	www.HealthSun.com	HealthSun HealthAdvantage Plus (HMO)	01	01		1			H5431	018	0	2022	Broward		2		2			2						www.HealthSun.com	www.HealthSun.com	www.HealthSun.com	(877)336-2069		(305)447-4458		(855)573-0370		(855)573-0370		(877)336-2069		(305)447-4458		(855)573-0366		(855)573-0366		(877)206-0500		(877)206-0500		(711)-		(711)-		(877)206-0500		(877)206-0500		(711)-		(711)-		2					2					2	2			
H5431	019	0	1	01	01	H5431_019_0	11	1	2	1	1		0	07/14/2021	2022.01	07/14/2021 05:56:05 PM Eastern Daylight Time	08/03/2021 06:04:06 PM Eastern Daylight Time	08/03/2021 06:04:06 PM Eastern Daylight Time			08/04/2021 01:42:08 PM Eastern Daylight Time	HEALTHSUN HEALTH PLANS, INC.	HealthSun Health Plans, Inc.	www.HealthSun.com	HealthSun MediSun Extra (HMO D-SNP)	01	01		1			H5431	019	0	2022	Miami-Dade, Broward		2		2			1	3		2		2	www.HealthSun.com	www.HealthSun.com	www.HealthSun.com	(877)336-2069		(305)447-4458		(855)573-0368		(855)573-0368		(877)336-2069		(305)447-4458		(855)573-0367		(855)573-0367		(877)206-0500		(877)206-0500		(711)-		(711)-		(877)206-0500		(877)206-0500		(711)-		(711)-		2					2					2	2			
H5433	001	0	1	01	01	H5433_001_0	3	1	2	1			0	06/02/2021	2022.01	06/02/2021 08:51:04 AM Pacific Daylight Time	06/22/2021 02:03:10 PM Pacific Daylight Time	06/03/2021 09:34:20 AM Pacific Daylight Time			06/22/2021 02:21:31 PM Pacific Daylight Time	ORANGE COUNTY HEALTH AUTHORITY	OneCare	https://www.caloptima.org/en/ForMembers/OneCare	OneCare (HMO D-SNP)	01	01		1			H5433	001	0	2022	Orange County, California		2	19329	2			1	3		1		1	https://www.caloptima.org/en/ForMembers/OneCare/FindAProvider/PharmacySearch.aspx	https://www.caloptima.org/en/ForMembers/OneCare/Pharmacy.aspx	https://www.caloptima.org/en/ForMembers/OneCare/FindAProvider.aspx	(877)412-2734		(877)412-2734		(877)412-2734		(877)412-2734		(877)412-2734		(877)412-2734		(877)412-2734		(877)412-2734		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5434	002	0	1	04	01	H5434_002_0	6	1					1	07/19/2021	2022.01	07/19/2021 11:28:42 AM Eastern Daylight Time	08/05/2021 12:11:33 PM Eastern Daylight Time	08/02/2021 03:35:24 PM Eastern Daylight Time			08/05/2021 02:37:03 PM 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	2022	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	7	1					1	08/04/2021	2022.01	08/04/2021 05:41:39 PM Eastern Daylight Time	08/05/2021 12:13:01 PM Eastern Daylight Time	08/02/2021 03:44:13 PM Eastern Daylight Time			08/05/2021 02:10:12 PM 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	2022	Pinellas County		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						1	01	7a;7d;16b;17a;18a;	
H5434	024	0	1	04	01	H5434_024_0	6	1					1	08/04/2021	2022.01	08/04/2021 05:53:24 PM Eastern Daylight Time	08/05/2021 12:14:38 PM Eastern Daylight Time	08/02/2021 03:53:03 PM Eastern Daylight Time			08/05/2021 02:10:12 PM 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	2022	Highlands, Manatee & Sarasota 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						1	01	7a;7d;16b;17a;18a;	
H5434	025	0	1	04	01	H5434_025_0	6	1					1	08/05/2021	2022.01	08/05/2021 10:20:25 AM Eastern Daylight Time	08/05/2021 12:16:19 PM Eastern Daylight Time	08/02/2021 04:01:46 PM Eastern Daylight Time			08/05/2021 02:10:12 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	2022	Florida Panhandle		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	026	0	1	04	01	H5434_026_0	6	1					1	08/04/2021	2022.01	08/04/2021 06:22:53 PM Eastern Daylight Time	08/05/2021 12:18:27 PM Eastern Daylight Time	08/02/2021 04:11:25 PM Eastern Daylight Time			08/05/2021 02:10:12 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Florida Blue	FloridaBlue.com/medicare	BlueMedicare Value (PPO)	01	04		1			H5434	026	0	2022	Broward, IR, Martin, PB, & St. Lucie 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						1	01	7a;7d;16b;17a;18a;	
H5434	030	0	1	04	01	H5434_030_0	6	1					1	08/04/2021	2022.01	08/04/2021 06:42:10 PM Eastern Daylight Time	08/05/2021 12:19:57 PM Eastern Daylight Time	08/02/2021 04:24:34 PM Eastern Daylight Time			08/05/2021 02:10:12 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Florida Blue	FloridaBlue.com/medicare	BlueMedicare Value (PPO)	01	04		1			H5434	030	0	2022	Charlotte, Collier & Lee 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						1	01	7a;7d;16b;17a;18a;	
H5434	031	0	1	04	01	H5434_031_0	6	1					1	08/04/2021	2022.01	08/04/2021 07:00:02 PM Eastern Daylight Time	08/05/2021 12:21:45 PM Eastern Daylight Time	08/02/2021 04:37:17 PM Eastern Daylight Time			08/05/2021 02:10:12 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Florida Blue	FloridaBlue.com/medicare	BlueMedicare Value (PPO)	01	04		1			H5434	031	0	2022	Northeast & Central 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						1	01	7a;7d;16b;17a;18a;	
H5434	032	0	1	04	01	H5434_032_0	6	1					1	08/04/2021	2022.01	08/04/2021 07:16:04 PM Eastern Daylight Time	08/05/2021 12:23:13 PM Eastern Daylight Time	08/02/2021 04:51:41 PM Eastern Daylight Time			08/05/2021 02:10:12 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Florida Blue	FloridaBlue.com/medicare	BlueMedicare Value (PPO)	01	04		1			H5434	032	0	2022	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						1	01	7a;7d;16b;17a;18a;	
H5434	033	0	1	04	01	H5434_033_0	6	1					1	08/04/2021	2022.01	08/04/2021 07:32:38 PM Eastern Daylight Time	08/05/2021 12:24:46 PM Eastern Daylight Time	08/02/2021 05:06:05 PM Eastern Daylight Time			08/05/2021 02:10:12 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Florida Blue	FloridaBlue.com/medicare	BlueMedicare Value (PPO)	01	04		1			H5434	033	0	2022	Brevard, 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						1	01	7a;7d;16b;17a;18a;	
H5434	034	0	1	04	01	H5434_034_0	6	1					1	08/04/2021	2022.01	08/04/2021 08:37:40 PM Eastern Daylight Time	08/05/2021 12:26:25 PM Eastern Daylight Time	08/02/2021 05:14:55 PM Eastern Daylight Time			08/05/2021 02:10:12 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Florida Blue	FloridaBlue.com/medicare	BlueMedicare Value (PPO)	01	04		1			H5434	034	0	2022	Hillsborough & 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						1	01	7a;7d;16b;17a;18a;	
H5434	035	0	1	04	01	H5434_035_0	6	1					1	08/04/2021	2022.01	08/04/2021 08:43:30 PM Eastern Daylight Time	08/05/2021 12:28:08 PM Eastern Daylight Time	08/02/2021 05:23:57 PM Eastern Daylight Time			08/05/2021 02:37:03 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Florida Blue	FloridaBlue.com/medicare	BlueMedicare Value (PPO)	01	04		1			H5434	035	0	2022	Hernando & Pasco 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						1	01	7a;7d;16b;17a;18a;	
H5434	036	0	1	04	01	H5434_036_0	6	1					1	08/04/2021	2022.01	08/04/2021 08:49:59 PM Eastern Daylight Time	08/05/2021 12:29:36 PM Eastern Daylight Time	08/02/2021 05:32:32 PM Eastern Daylight Time			08/05/2021 02:37:03 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Florida Blue	FloridaBlue.com/medicare	BlueMedicare Value (PPO)	01	04		1			H5434	036	0	2022	Lake, Marion, & Sumter 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						1	01	7a;7d;16b;17a;18a;	
H5434	038	0	1	04	01	H5434_038_0	5	1				0	0	07/19/2021	2022.01	07/19/2021 03:24:43 PM Eastern Daylight Time	06/07/2021 01:55:50 PM Eastern Daylight Time				07/19/2021 06:07:57 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Florida Blue	FloridaBlue.com/medicare	BlueMedicare Patriot (PPO)	01	04		1			H5434	038	0	2022	Lake, Marion, & Sumter 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)955-8770		(800)955-8770		(800)955-8770		(800)955-8770										2					2						2			
H5434	039	0	1	04	01	H5434_039_0	6	1					1	08/05/2021	2022.01	08/05/2021 10:22:08 AM Eastern Daylight Time	08/05/2021 12:32:44 PM Eastern Daylight Time	08/02/2021 05:41:12 PM Eastern Daylight Time			08/05/2021 02:37:03 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Florida Blue	FloridaBlue.com/medicare	BlueMedicare Value (PPO)	01	04		1			H5434	039	0	2022	Alachua & Citrus 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			
H5434	040	0	1	04	01	H5434_040_0	5	1				0	0	07/19/2021	2022.01	07/19/2021 03:45:15 PM Eastern Daylight Time	06/07/2021 01:50:23 PM Eastern Daylight Time				07/19/2021 06:07:57 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Florida Blue	FloridaBlue.com/medicare	BlueMedicare Patriot (PPO)	01	04		1			H5434	040	0	2022	Florida Panhandle		2		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										2					2						2			
H5434	041	0	1	04	01	H5434_041_0	5	1				0	0	07/19/2021	2022.01	07/19/2021 03:47:54 PM Eastern Daylight Time	06/07/2021 01:26:13 PM Eastern Daylight Time				07/19/2021 06:07:57 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Florida Blue	FloridaBlue.com/medicare	BlueMedicare Patriot (PPO)	01	04		1			H5434	041	0	2022	Clay, Duval, Nassau & St. Johns 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)955-8770		(800)955-8770		(800)955-8770		(800)955-8770										2					2						2			
H5434	042	0	1	04	01	H5434_042_0	5	1				0	0	07/19/2021	2022.01	07/19/2021 03:52:12 PM Eastern Daylight Time	06/07/2021 01:25:03 PM Eastern Daylight Time				07/19/2021 06:07:57 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Florida Blue	FloridaBlue.com/medicare	BlueMedicare Patriot (PPO)	01	04		1			H5434	042	0	2022	Hillsborough, Pasco, & Pinellas 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)955-8770		(800)955-8770		(800)955-8770		(800)955-8770										2					2						2			
H5434	044	0	1	04	01	H5434_044_0	5	1				0	0	07/19/2021	2022.01	07/19/2021 03:54:28 PM Eastern Daylight Time	06/07/2021 01:23:53 PM Eastern Daylight Time				07/19/2021 06:07:57 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Florida Blue	FloridaBlue.com/medicare	BlueMedicare Patriot (PPO)	01	04		1			H5434	044	0	2022	Brevard & Orange 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)955-8770		(800)955-8770		(800)955-8770		(800)955-8770										2					2						2			
H5434	801	0	1	04	01	H5434_801_0	3	1						06/04/2021	2022.01	06/04/2021 07:24:18 PM Eastern Daylight Time					06/07/2021 04:37:14 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	2022	State of Florida with National Coverage		1	44920	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		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7c;7e;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;15;16b;	2		1									
H5434	802	0	1	04	01	H5434_802_0	3	1						06/04/2021	2022.01	06/04/2021 06:51:32 PM Eastern Daylight Time					06/07/2021 04:37:14 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	2022	State of Florida with National Coverage		1	6890	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		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7c;7e;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;15;16b;	2		1									
H5435	001	0	1	09	04	H5435_001_0	2	1				0	0	05/26/2021	2022.01	05/26/2021 12:06:43 PM Central Daylight Time	07/20/2021 12:41:52 PM Central Daylight Time				07/21/2021 03:45:34 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare MedicareDirect Patriot (PFFS)	04	09	2	1			H5435	001	0	2022	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						08/02/2021	2022.01	08/02/2021 03:03:36 PM Central Daylight Time	08/03/2021 12:22:48 PM Central Daylight Time	07/29/2021 09:09:38 PM Central Daylight Time			08/04/2021 04:19:13 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare MedicareDirect Rx (PFFS)	04	09	2	1			H5435	024	0	2022	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				0	0	07/18/2021	2022.01	07/18/2021 05:54:31 PM Eastern Daylight Time	06/06/2021 12:51:49 PM Eastern Daylight Time				07/19/2021 06:09:31 PM Eastern Daylight Time	HEALTH NET LIFE INSURANCE COMPANY	Wellcare by Health Net	www.wellcare.com/healthnetOR	Wellcare Patriot No Premium Open (PPO)	01	04		1			H5439	010	0	2022	Select counties in OR and WA		2	13370	2			2						www.wellcare.com/healthnetOR	www.wellcare.com/healthnetOR	www.wellcare.com/healthnetOR	(844)582-5177		(844)582-5177		(866)277-6583		(866)277-6583										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5439	011	0	1	04	01	H5439_011_0	4	1					0	08/02/2021	2022.01	08/02/2021 04:31:47 PM Eastern Daylight Time	08/04/2021 12:40:18 AM Eastern Daylight Time	07/30/2021 11:53:02 AM Eastern Daylight Time			08/04/2021 11:54:32 PM Eastern Daylight Time	HEALTH NET LIFE INSURANCE COMPANY	Wellcare by Health Net	www.wellcare.com/healthnetOR	Wellcare Premium Ultra Open (PPO)	01	04		1			H5439	011	0	2022	Select counties in OR and WA		2	34717	2			2						www.wellcare.com/healthnetOR	www.wellcare.com/healthnetOR	www.wellcare.com/healthnetOR	(844)582-5177		(844)582-5177		(866)277-6583		(866)277-6583		(844)582-5177		(844)582-5177		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5439	015	0	1	04	01	H5439_015_0	3	1					0	08/02/2021	2022.01	08/02/2021 02:01:08 PM Eastern Daylight Time	08/04/2021 12:40:48 AM Eastern Daylight Time	07/30/2021 11:53:30 AM Eastern Daylight Time			08/04/2021 11:54:32 PM Eastern Daylight Time	HEALTH NET LIFE INSURANCE COMPANY	Wellcare by Health Net	www.wellcare.com/healthnetOR	Wellcare Giveback Open (PPO)	01	04		1			H5439	015	0	2022	Select counties in OR and WA		2	30619	2			2						www.wellcare.com/healthnetOR	www.wellcare.com/healthnetOR	www.wellcare.com/healthnetOR	(844)582-5177		(844)582-5177		(866)277-6583		(866)277-6583		(844)582-5177		(844)582-5177		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5439	017	0	1	04	01	H5439_017_0	3	1					0	08/02/2021	2022.01	08/02/2021 04:11:51 PM Eastern Daylight Time	08/04/2021 12:41:18 AM Eastern Daylight Time	07/30/2021 11:54:34 AM Eastern Daylight Time			08/04/2021 11:54:32 PM Eastern Daylight Time	HEALTH NET LIFE INSURANCE COMPANY	Wellcare by Health Net	www.wellcare.com/healthnetOR	Wellcare No Premium Open (PPO)	01	04		1			H5439	017	0	2022	Select counties in OR		2	13596	2			2						www.wellcare.com/healthnetOR	www.wellcare.com/healthnetOR	www.wellcare.com/healthnetOR	(844)582-5177		(844)582-5177		(866)277-6583		(866)277-6583		(844)582-5177		(844)582-5177		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5439	018	0	1	04	01	H5439_018_0	4	1					0	08/03/2021	2022.01	08/03/2021 04:02:31 PM Eastern Daylight Time	08/04/2021 03:24:31 PM Eastern Daylight Time	07/30/2021 11:55:38 AM Eastern Daylight Time			08/04/2021 11:54:32 PM Eastern Daylight Time	HEALTH NET LIFE INSURANCE COMPANY	Wellcare by Health Net	www.wellcare.com/healthnetOR	Wellcare Low Premium Open (PPO)	01	04		1			H5439	018	0	2022	Select counties in OR and WA		2	72485	2			2						www.wellcare.com/healthnetOR	www.wellcare.com/healthnetOR	www.wellcare.com/healthnetOR	(844)582-5177		(844)582-5177		(866)277-6583		(866)277-6583		(844)582-5177		(844)582-5177		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5439	019	0	1	04	01	H5439_019_0	4	1					0	08/02/2021	2022.01	08/02/2021 04:59:58 PM Eastern Daylight Time	08/04/2021 12:42:16 AM Eastern Daylight Time	07/30/2021 12:15:24 PM Eastern Daylight Time			08/04/2021 11:54:32 PM Eastern Daylight Time	HEALTH NET LIFE INSURANCE COMPANY	Wellcare by Health Net	www.wellcare.com/healthnetOR	Wellcare Low Premium Open (PPO)	01	04		1			H5439	019	0	2022	Select counties in OR		2	72748	2			2						www.wellcare.com/healthnetOR	www.wellcare.com/healthnetOR	www.wellcare.com/healthnetOR	(844)582-5177		(844)582-5177		(866)277-6583		(866)277-6583		(844)582-5177		(844)582-5177		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5439	801	0	1	04	01	H5439_801_0	2	1						05/04/2021	2022.01	05/04/2021 08:41:49 AM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	HEALTH NET LIFE INSURANCE COMPANY	Wellcare by Health Net	or.healthnetadvantage.com	Health Net Medicare Advantage Employer (PPO)	01	04		1			H5439	801	0	2022	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	(888)445-8913		(888)445-8913		(844)942-0039		(844)942-0039		(888)445-8913		(888)445-8913		(844)942-0039		(844)942-0039		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H5439	802	0	1	04	01	H5439_802_0	2	1				0	0	05/04/2021	2022.01	05/04/2021 08:42:06 AM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	HEALTH NET LIFE INSURANCE COMPANY	Wellcare by Health Net	or.healthnetadvantage.com	Health Net Medicare Advantage Employer (PPO)	01	04		1			H5439	802	0	2022	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	(888)445-8913		(888)445-8913		(844)942-0039		(844)942-0039										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H5439	803	0	1	04	01	H5439_803_0	2	1						05/04/2021	2022.01	05/04/2021 08:42:21 AM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	HEALTH NET LIFE INSURANCE COMPANY	Wellcare by Health Net	or.healthnetadvantage.com	Health Net Medicare Advantage Employer (PPO)	01	04		1			H5439	803	0	2022	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	(888)445-8913		(888)445-8913		(844)942-0039		(844)942-0039		(888)445-8913		(888)445-8913		(844)942-0039		(844)942-0039		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H5439	804	0	1	04	01	H5439_804_0	2	1				0	0	05/04/2021	2022.01	05/04/2021 08:42:47 AM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	HEALTH NET LIFE INSURANCE COMPANY	Wellcare by Health Net	or.healthnetadvantage.com	Allwell Medicare (PPO)	01	04		1			H5439	804	0	2022	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	(888)445-8913		(888)445-8913		(844)942-0039		(844)942-0039										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H5439	805	0	1	04	01	H5439_805_0	2	1						05/04/2021	2022.01	05/04/2021 08:43:13 AM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	HEALTH NET LIFE INSURANCE COMPANY	Wellcare by Health Net	or.healthnetadvantage.com	Allwell Medicare (PPO)	01	04		1			H5439	805	0	2022	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	(888)445-8913		(888)445-8913		(844)942-0039		(844)942-0039		(888)445-8913		(888)445-8913		(844)942-0039		(844)942-0039		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H5447	001	0	1	01	01	H5447_001_0	7	1					1	07/06/2021	2022.01	07/06/2021 03:03:27 PM Central Daylight Time	07/31/2021 10:32:59 AM Central Daylight Time	07/31/2021 10:00:12 AM Central Daylight Time			08/03/2021 03:13:11 PM Central Daylight Time	COMMUNITY FIRST HEALTH PLANS, INC.	Community First Health Plans	https://CommunityFirstMedicare.com	Community First Medicare Advantage Alamo Plan (HMO)	01	01		1			H5447	001	0	2022	Bexar County		2		2			2						https://CommunityFirstMedicare.com	https://CommunityFirstMedicare.com	https://CommunityFirstMedicare.com	(833)434-2347		(210)358-6386		(833)434-2347		(210)358-6386		(833)434-2347		(210)358-6386		(833)434-2347		(210)358-6386		(800)390-1175		(210)358-6080		(800)390-1175		(210)358-6080		(800)390-1175		(210)358-6080		(800)390-1175		(210)358-6080		2					2					2	2			
H5447	002	0	1	01	01	H5447_002_0	6	1	2	1			0	08/03/2021	2022.01	08/03/2021 09:44:04 AM Central Daylight Time	07/31/2021 10:34:04 AM Central Daylight Time	07/31/2021 10:01:08 AM Central Daylight Time			08/03/2021 03:13:11 PM Central Daylight Time	COMMUNITY FIRST HEALTH PLANS, INC.	Community First Health Plans	https://CommunityFirstMedicare.com	Community First Medicare Advantage D-SNP (HMO D-SNP)	01	01		1			H5447	002	0	2022	South Texas		2		2			1	3		1		1	https://CommunityFirstMedicare.com	https://CommunityFirstMedicare.com	https://CommunityFirstMedicare.com	(833)434-2347		(210)358-6386		(833)434-2347		(210)358-6386		(833)434-2347		(210)358-6386		(833)434-2347		(210)358-6386		(800)390-1175		(210)358-6080		(800)390-1175		(210)358-6080		(800)390-1175		(210)358-6080		(800)390-1175		(210)358-6080		2					2					2	2			
H5454	001	0	1	01	01	H5454_001_0	5	1					1	08/05/2021	2022.01	08/05/2021 08:34:25 AM Central Daylight Time	08/05/2021 02:09:20 PM Central Daylight Time	08/05/2021 02:07:29 PM Central Daylight Time			08/05/2021 06:05:28 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	2022	Rockford, Metro St Louis		2	14922	2			2						www.clearspringhealthcare.com	www.clearspringhealthcare.com	www.clearspringhealthcare.com	(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5454	002	0	1	01	01	H5454_002_0	4	1					1	08/05/2021	2022.01	08/05/2021 08:35:41 AM Central Daylight Time	08/05/2021 02:09:21 PM Central Daylight Time	08/05/2021 02:07:34 PM Central Daylight Time			08/05/2021 06:05:28 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	2022	Metro Chicago		2	14922	2			2						www.clearspringhealthcare.com	www.clearspringhealthcare.com	www.clearspringhealthcare.com	(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	064	0	1	01	01	H5471_064_0	6	1	2	1	1		0	07/16/2021	2022.01	07/16/2021 01:07:01 PM Eastern Daylight Time	08/03/2021 06:04:06 PM Eastern Daylight Time	08/03/2021 06:04:06 PM Eastern Daylight Time			08/04/2021 01:42:08 PM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	shop.simplyhealthcareplans.com/medicare	Simply Complete (HMO D-SNP)	01	01		1			H5471	064	0	2022	Miami-Dade		2		2			1	3		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		(855)679-0554		(855)679-0554		(833)272-9771		(833)272-9771		(855)485-0970		(855)485-0970		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	065	0	1	01	01	H5471_065_0	7	1			2		0	07/18/2021	2022.01	07/18/2021 12:26:24 PM Eastern Daylight Time	08/03/2021 06:04:06 PM Eastern Daylight Time	08/10/2021 03:45:30 PM Eastern Daylight Time			08/11/2021 11:00:17 AM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	shop.simplyhealthcareplans.com/medicare	Simply More (HMO)	01	01		1			H5471	065	0	2022	Miami-Dade		2		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		(855)679-0556		(855)679-0556		(833)272-9771		(833)272-9771		(855)485-0971		(855)485-0971		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	066	0	1	01	01	H5471_066_0	6	1	2	1	1		0	07/14/2021	2022.01	07/14/2021 09:52:44 PM Eastern Daylight Time	08/03/2021 06:04:06 PM Eastern Daylight Time	08/03/2021 06:04:06 PM Eastern Daylight Time			08/04/2021 01:42:08 PM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	shop.simplyhealthcareplans.com/medicare	Simply Complete (HMO D-SNP)	01	01		1			H5471	066	0	2022	Polk		2		2			1	3		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		(855)679-0554		(855)679-0554		(833)272-9771		(833)272-9771		(855)485-0970		(855)485-0970		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	067	0	1	01	01	H5471_067_0	6	1		1	2		0	06/03/2021	2022.01	06/03/2021 09:20:35 AM Eastern Daylight Time	08/03/2021 06:04:06 PM Eastern Daylight Time	08/03/2021 06:04:06 PM Eastern Daylight Time			08/04/2021 01:42:08 PM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	shop.simplyhealthcareplans.com/medicare	Simply Care (HMO I-SNP)	01	01		1			H5471	067	0	2022	Broward, Miami-Dade, Palm Beach		2		2			1	1	1				www.simplyhealthcareplans.com/medicare/prescription-drug-benefits	www.simplyhealthcareplans.com/medicare/prescription-drug-benefits	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(855)679-0557		(855)679-0557		(833)272-9771		(833)272-9771		(855)485-0972		(855)485-0972		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	068	0	1	01	01	H5471_068_0	8	1		1	2		0	07/14/2021	2022.01	07/14/2021 10:15:50 PM Eastern Daylight Time	08/03/2021 06:04:06 PM Eastern Daylight Time	08/03/2021 06:04:06 PM Eastern Daylight Time			08/04/2021 01:42:08 PM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	shop.simplyhealthcareplans.com/medicare	Simply Comfort (HMO I-SNP)	01	01		1			H5471	068	0	2022	Broward, Miami-Dade, Palm Beach		2		2			1	1	2				www.simplyhealthcareplans.com/medicare/prescription-drug-benefits	www.simplyhealthcareplans.com/medicare/prescription-drug-benefits	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(855)679-0557		(855)679-0557		(833)272-9771		(833)272-9771		(855)485-0972		(855)485-0972		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	069	0	1	01	01	H5471_069_0	6	1		1	2		0	07/18/2021	2022.01	07/18/2021 12:51:24 PM Eastern Daylight Time	08/03/2021 06:04:06 PM Eastern Daylight Time	08/03/2021 06:04:06 PM Eastern Daylight Time			08/04/2021 01:42:08 PM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	shop.simplyhealthcareplans.com/medicare	Simply Level (HMO C-SNP)	01	01		1			H5471	069	0	2022	Miami-Dade		2		2			1	4			00000000000000000010		www.simplyhealthcareplans.com/medicare/prescription-drug-benefits	www.simplyhealthcareplans.com/medicare/prescription-drug-benefits	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(855)679-0558		(855)679-0558		(833)272-9771		(833)272-9771		(855)485-0973		(855)485-0973		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	070	0	1	01	01	H5471_070_0	6	1		1	2		0	07/18/2021	2022.01	07/18/2021 12:27:12 PM Eastern Daylight Time	08/03/2021 06:04:06 PM Eastern Daylight Time	08/03/2021 06:04:06 PM Eastern Daylight Time			08/04/2021 01:42:08 PM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	shop.simplyhealthcareplans.com/medicare	Simply Level (HMO C-SNP)	01	01		1			H5471	070	0	2022	Polk		2		2			1	4			00000000000000000010		www.simplyhealthcareplans.com/medicare/prescription-drug-benefits	www.simplyhealthcareplans.com/medicare/prescription-drug-benefits	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(855)679-0558		(855)679-0558		(833)272-9771		(833)272-9771		(855)485-0973		(855)485-0973		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	071	0	1	01	01	H5471_071_0	6	1			2		0	07/18/2021	2022.01	07/18/2021 12:27:27 PM Eastern Daylight Time	08/03/2021 06:04:06 PM Eastern Daylight Time	08/03/2021 06:04:06 PM Eastern Daylight Time			08/04/2021 01:42:08 PM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	shop.simplyhealthcareplans.com/medicare	Simply More (HMO)	01	01		1			H5471	071	0	2022	Polk		2		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		(855)679-0556		(855)679-0556		(833)272-9771		(833)272-9771		(855)485-0971		(855)485-0971		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	072	0	1	01	01	H5471_072_0	6	1	2	1	1		0	07/14/2021	2022.01	07/14/2021 10:23:17 PM Eastern Daylight Time	08/03/2021 06:04:06 PM Eastern Daylight Time	08/03/2021 06:04:06 PM Eastern Daylight Time			08/04/2021 01:42:08 PM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	shop.simplyhealthcareplans.com/medicare	Simply Complete (HMO D-SNP)	01	01		1			H5471	072	0	2022	Orange, Osceola, Seminole		2		2			1	3		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		(855)679-0554		(855)679-0554		(833)272-9771		(833)272-9771		(855)485-0970		(855)485-0970		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	073	0	1	01	01	H5471_073_0	6	1		1	2		0	07/18/2021	2022.01	07/18/2021 12:28:00 PM Eastern Daylight Time	08/03/2021 06:04:06 PM Eastern Daylight Time	08/03/2021 06:04:06 PM Eastern Daylight Time			08/04/2021 01:42:08 PM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	shop.simplyhealthcareplans.com/medicare	Simply Level (HMO C-SNP)	01	01		1			H5471	073	0	2022	Orange, Osceola, Seminole		2		2			1	4			00000000000000000010		www.simplyhealthcareplans.com/medicare/prescription-drug-benefits	www.simplyhealthcareplans.com/medicare/prescription-drug-benefits	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(855)679-0558		(855)679-0558		(833)272-9771		(833)272-9771		(855)485-0973		(855)485-0973		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	074	0	1	01	01	H5471_074_0	6	1			2		0	07/18/2021	2022.01	07/18/2021 12:46:57 PM Eastern Daylight Time	08/03/2021 06:04:06 PM Eastern Daylight Time	08/03/2021 06:04:06 PM Eastern Daylight Time			08/04/2021 01:42:08 PM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	shop.simplyhealthcareplans.com/medicare	Simply More (HMO)	01	01		1			H5471	074	0	2022	Orange, Osceola, Seminole		2		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		(855)679-0556		(855)679-0556		(833)272-9771		(833)272-9771		(855)485-0971		(855)485-0971		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	075	0	1	01	01	H5471_075_0	8	1		1	2		0	07/18/2021	2022.01	07/18/2021 12:28:40 PM Eastern Daylight Time	08/03/2021 06:04:06 PM Eastern Daylight Time	08/03/2021 06:04:06 PM Eastern Daylight Time			08/04/2021 01:42:08 PM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	shop.simplyhealthcareplans.com/medicare	Simply Level (HMO C-SNP)	01	01		1			H5471	075	0	2022	Hernando, Hillsborough, Pasco, Pinellas		2		2			1	4			00000000000000000010		www.simplyhealthcareplans.com/medicare/prescription-drug-benefits	www.simplyhealthcareplans.com/medicare/prescription-drug-benefits	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(855)679-0558		(855)679-0558		(833)272-9771		(833)272-9771		(855)485-0973		(855)485-0973		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	076	0	1	01	01	H5471_076_0	6	1	2	1	1		0	07/14/2021	2022.01	07/14/2021 10:26:46 PM Eastern Daylight Time	08/03/2021 06:04:07 PM Eastern Daylight Time	08/03/2021 06:04:07 PM Eastern Daylight Time			08/04/2021 01:42:08 PM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	shop.simplyhealthcareplans.com/medicare	Simply Complete (HMO D-SNP)	01	01		1			H5471	076	0	2022	Broward		2		2			1	3		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		(855)679-0554		(855)679-0554		(833)272-9771		(833)272-9771		(855)485-0970		(855)485-0970		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	077	0	1	01	01	H5471_077_0	6	1			2		0	07/18/2021	2022.01	07/18/2021 12:29:09 PM Eastern Daylight Time	08/03/2021 06:04:07 PM Eastern Daylight Time	08/03/2021 06:04:07 PM Eastern Daylight Time			08/04/2021 01:42:08 PM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	shop.simplyhealthcareplans.com/medicare	Simply More (HMO)	01	01		1			H5471	077	0	2022	Broward		2		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		(855)679-0556		(855)679-0556		(833)272-9771		(833)272-9771		(855)485-0971		(855)485-0971		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	078	0	1	01	01	H5471_078_0	6	1			2		0	07/18/2021	2022.01	07/18/2021 12:29:32 PM Eastern Daylight Time	08/03/2021 06:04:07 PM Eastern Daylight Time	08/03/2021 06:04:07 PM Eastern Daylight Time			08/04/2021 01:42:08 PM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	shop.simplyhealthcareplans.com/medicare	Simply More (HMO)	01	01		1			H5471	078	0	2022	Hernando, Hillsborough, Pasco, Pinellas		2		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		(855)679-0556		(855)679-0556		(833)272-9771		(833)272-9771		(855)485-0971		(855)485-0971		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	080	0	1	01	01	H5471_080_0	6	1		1	2		0	07/18/2021	2022.01	07/18/2021 12:29:50 PM Eastern Daylight Time	08/03/2021 06:04:07 PM Eastern Daylight Time	08/03/2021 06:04:07 PM Eastern Daylight Time			08/04/2021 01:42:08 PM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	shop.simplyhealthcareplans.com/medicare	Simply Level (HMO C-SNP)	01	01		1			H5471	080	0	2022	Broward		2		2			1	4			00000000000000000010		www.simplyhealthcareplans.com/medicare/prescription-drug-benefits	www.simplyhealthcareplans.com/medicare/prescription-drug-benefits	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(855)679-0558		(855)679-0558		(833)272-9771		(833)272-9771		(855)485-0973		(855)485-0973		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	082	0	1	01	01	H5471_082_0	6	1	2	1	1		0	07/14/2021	2022.01	07/14/2021 10:30:34 PM Eastern Daylight Time	08/03/2021 06:04:07 PM Eastern Daylight Time	08/03/2021 06:04:07 PM Eastern Daylight Time			08/04/2021 01:42:08 PM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	shop.simplyhealthcareplans.com/medicare	Simply Complete (HMO D-SNP)	01	01		1			H5471	082	0	2022	Hernando, Hillsborough, Pasco, Pinellas		2		2			1	3		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		(855)679-0554		(855)679-0554		(833)272-9771		(833)272-9771		(855)485-0970		(855)485-0970		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	083	0	1	01	01	H5471_083_0	6	1			2		0	07/18/2021	2022.01	07/18/2021 12:31:50 PM Eastern Daylight Time	08/03/2021 06:04:07 PM Eastern Daylight Time	08/03/2021 06:04:07 PM Eastern Daylight Time			08/04/2021 01:42:08 PM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	shop.simplyhealthcareplans.com/medicare	Simply More (HMO)	01	01		1			H5471	083	0	2022	Palm Beach		2		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		(855)679-0556		(855)679-0556		(833)272-9771		(833)272-9771		(855)485-0971		(855)485-0971		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	084	0	1	01	01	H5471_084_0	6	1	2	1	1		0	07/14/2021	2022.01	07/14/2021 10:31:52 PM Eastern Daylight Time	08/03/2021 06:04:07 PM Eastern Daylight Time	08/03/2021 06:04:07 PM Eastern Daylight Time			08/04/2021 01:42:08 PM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	shop.simplyhealthcareplans.com/medicare	Simply Complete (HMO D-SNP)	01	01		1			H5471	084	0	2022	Palm Beach		2		2			1	3		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		(855)679-0554		(855)679-0554		(833)272-9771		(833)272-9771		(855)485-0970		(855)485-0970		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	085	0	1	01	01	H5471_085_0	6	1		1	2		0	07/18/2021	2022.01	07/18/2021 12:32:08 PM Eastern Daylight Time	08/03/2021 06:04:07 PM Eastern Daylight Time	08/03/2021 06:04:07 PM Eastern Daylight Time			08/04/2021 01:42:08 PM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	shop.simplyhealthcareplans.com/medicare	Simply Level (HMO C-SNP)	01	01		1			H5471	085	0	2022	Palm Beach		2		2			1	4			00000000000000000010		www.simplyhealthcareplans.com/medicare/prescription-drug-benefits	www.simplyhealthcareplans.com/medicare/prescription-drug-benefits	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(855)679-0558		(855)679-0558		(833)272-9771		(833)272-9771		(855)485-0973		(855)485-0973		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	092	0	1	01	01	H5471_092_0	6	1		1	2		0	06/03/2021	2022.01	06/03/2021 09:19:35 AM Eastern Daylight Time	08/03/2021 06:04:07 PM Eastern Daylight Time	08/03/2021 06:04:07 PM Eastern Daylight Time			08/04/2021 01:42:08 PM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	shop.simplyhealthcareplans.com/medicare	Simply Care (HMO I-SNP)	01	01		1			H5471	092	0	2022	Select Counties in Central Florida		2		2			1	1	1				www.simplyhealthcareplans.com/medicare/prescription-drug-benefits	www.simplyhealthcareplans.com/medicare/prescription-drug-benefits	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(855)679-0557		(855)679-0557		(833)272-9771		(833)272-9771		(855)485-0972		(855)485-0972		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	093	0	1	01	01	H5471_093_0	6	1		1	2		0	07/14/2021	2022.01	07/14/2021 10:33:38 PM Eastern Daylight Time	08/03/2021 06:04:07 PM Eastern Daylight Time	08/03/2021 06:04:07 PM Eastern Daylight Time			08/04/2021 01:42:08 PM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	shop.simplyhealthcareplans.com/medicare	Simply Comfort (HMO I-SNP)	01	01		1			H5471	093	0	2022	Select Counties in Central Florida		2		2			1	1	2				www.simplyhealthcareplans.com/medicare/prescription-drug-benefits	www.simplyhealthcareplans.com/medicare/prescription-drug-benefits	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(855)679-0557		(855)679-0557		(833)272-9771		(833)272-9771		(855)485-0972		(855)485-0972		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	103	0	1	01	01	H5471_103_0	6	1			2		0	07/14/2021	2022.01	07/14/2021 10:36:05 PM Eastern Daylight Time	08/03/2021 06:04:07 PM Eastern Daylight Time	08/03/2021 06:04:07 PM Eastern Daylight Time			08/04/2021 01:42:08 PM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	shop.simplyhealthcareplans.com/medicare	Simply Extra (HMO)	01	01		1			H5471	103	0	2022	Miami-Dade		2		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		(855)679-0556		(855)679-0556		(833)272-9771		(833)272-9771		(855)485-0971		(855)485-0971		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	104	0	1	01	01	H5471_104_0	6	1			2		0	07/30/2021	2022.01	07/30/2021 12:49:01 PM Eastern Daylight Time	08/03/2021 06:04:07 PM Eastern Daylight Time	08/03/2021 06:04:07 PM Eastern Daylight Time			08/04/2021 01:42:08 PM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	shop.simplyhealthcareplans.com/medicare	Simply Extra (HMO)	01	01		1			H5471	104	0	2022	Broward		2		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		(855)679-0556		(855)679-0556		(833)272-9771		(833)272-9771		(855)485-0971		(855)485-0971		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	105	0	1	01	01	H5471_105_0	6	1			2		0	07/30/2021	2022.01	07/30/2021 12:23:03 PM Eastern Daylight Time	08/03/2021 06:04:07 PM Eastern Daylight Time	08/03/2021 06:04:07 PM Eastern Daylight Time			08/04/2021 01:42:08 PM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	shop.simplyhealthcareplans.com/medicare	Simply Extra (HMO)	01	01		1			H5471	105	0	2022	Palm Beach		2		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		(855)679-0556		(855)679-0556		(833)272-9771		(833)272-9771		(855)485-0971		(855)485-0971		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	106	0	1	01	01	H5471_106_0	6	1			2		0	07/30/2021	2022.01	07/30/2021 12:23:47 PM Eastern Daylight Time	08/03/2021 06:04:07 PM Eastern Daylight Time	08/03/2021 06:04:07 PM Eastern Daylight Time			08/04/2021 01:42:08 PM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	shop.simplyhealthcareplans.com/medicare	Simply Extra (HMO)	01	01		1			H5471	106	0	2022	Polk		2		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		(855)679-0556		(855)679-0556		(833)272-9771		(833)272-9771		(855)485-0971		(855)485-0971		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	107	0	1	01	01	H5471_107_0	6	1			2		0	07/30/2021	2022.01	07/30/2021 12:24:14 PM Eastern Daylight Time	08/03/2021 06:04:07 PM Eastern Daylight Time	08/03/2021 06:04:07 PM Eastern Daylight Time			08/04/2021 01:42:08 PM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	shop.simplyhealthcareplans.com/medicare	Simply Extra (HMO)	01	01		1			H5471	107	0	2022	Orange, Osceola, Seminole		2		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		(855)679-0556		(855)679-0556		(833)272-9771		(833)272-9771		(855)485-0971		(855)485-0971		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	108	0	1	01	01	H5471_108_0	6	1			2		0	07/30/2021	2022.01	07/30/2021 12:24:43 PM Eastern Daylight Time	08/03/2021 06:04:07 PM Eastern Daylight Time	08/03/2021 06:04:07 PM Eastern Daylight Time			08/04/2021 01:42:08 PM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	shop.simplyhealthcareplans.com/medicare	Simply Extra (HMO)	01	01		1			H5471	108	0	2022	Hernando, Hillsborough, Pasco, Pinellas		2		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		(855)679-0556		(855)679-0556		(833)272-9771		(833)272-9771		(855)485-0971		(855)485-0971		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5475	001	0	1	02	01	H5475_001_0	4	1	2	1			0	05/31/2021	2022.01	05/31/2021 09:35:17 AM Eastern Daylight Time	08/04/2021 12:42:45 AM Eastern Daylight Time	07/30/2021 12:34:18 PM Eastern Daylight Time			08/04/2021 09:45:33 PM Eastern Daylight Time	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Access (HMO-POS D-SNP)	01	02		1			H5475	001	0	2022	Select counties in MI		2	193486	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5475	005	0	1	02	01	H5475_005_0	4	1					0	08/03/2021	2022.01	08/03/2021 10:56:24 AM Eastern Daylight Time	08/04/2021 12:43:14 AM Eastern Daylight Time	07/30/2021 12:35:14 PM Eastern Daylight Time			08/04/2021 09:45:33 PM Eastern Daylight Time	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium Essential (HMO-POS)	01	02		1			H5475	005	0	2022	Select counties in MI		2	50573	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5475	010	0	1	02	01	H5475_010_0	4	1	2	1			0	05/31/2021	2022.01	05/31/2021 09:28:55 AM Eastern Daylight Time	08/04/2021 12:43:43 AM Eastern Daylight Time	07/30/2021 12:36:22 PM Eastern Daylight Time			08/04/2021 09:45:33 PM Eastern Daylight Time	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Access Extra (HMO-POS D-SNP)	01	02		1			H5475	010	0	2022	Select counties in OH		2	2971	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5475	011	0	1	02	01	H5475_011_0	4	1					0	08/03/2021	2022.01	08/03/2021 10:26:53 AM Eastern Daylight Time	08/04/2021 12:44:13 AM Eastern Daylight Time	07/30/2021 12:37:26 PM Eastern Daylight Time			08/04/2021 09:45:33 PM Eastern Daylight Time	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium Essential (HMO-POS)	01	02		1			H5475	011	0	2022	Select counties in OH		2	15178	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5475	021	0	1	02	01	H5475_021_0	4	1	2	1			0	05/31/2021	2022.01	05/31/2021 09:26:13 AM Eastern Daylight Time	08/04/2021 12:44:44 AM Eastern Daylight Time	07/30/2021 12:44:14 PM Eastern Daylight Time			08/04/2021 09:45:33 PM Eastern Daylight Time	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Access Extra (HMO-POS D-SNP)	01	02		1			H5475	021	0	2022	Select counties in OH		2	1949	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5475	022	0	1	02	01	H5475_022_0	4	1					0	08/03/2021	2022.01	08/03/2021 11:04:07 AM Eastern Daylight Time	08/04/2021 12:45:13 AM Eastern Daylight Time	07/30/2021 12:45:20 PM Eastern Daylight Time			08/04/2021 09:45:33 PM Eastern Daylight Time	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium Essential (HMO-POS)	01	02		1			H5475	022	0	2022	Select counties in OH		2	12588	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5475	024	0	1	02	01	H5475_024_0	4	1					0	05/31/2021	2022.01	05/31/2021 09:22:58 AM Eastern Daylight Time	08/04/2021 12:45:42 AM Eastern Daylight Time	07/30/2021 12:45:44 PM Eastern Daylight Time			08/04/2021 09:45:33 PM Eastern Daylight Time	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Low Premium (HMO-POS)	01	02		1			H5475	024	0	2022	Select counties in MI		2	38246	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5475	026	0	1	02	01	H5475_026_0	4	1					0	08/03/2021	2022.01	08/03/2021 11:01:57 AM Eastern Daylight Time	08/04/2021 12:46:11 AM Eastern Daylight Time	07/30/2021 12:46:10 PM Eastern Daylight Time			08/04/2021 09:45:33 PM Eastern Daylight Time	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO-POS)	01	02		1			H5475	026	0	2022	Select counties in MI		2	185350	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5475	029	0	1	02	01	H5475_029_0	4	1		1			1	08/03/2021	2022.01	08/03/2021 11:12:27 AM Eastern Daylight Time	08/04/2021 12:46:39 AM Eastern Daylight Time	07/30/2021 12:46:34 PM Eastern Daylight Time			08/04/2021 09:45:33 PM Eastern Daylight Time	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Specialty No Premium (HMO-POS C-SNP)	01	02		1			H5475	029	0	2022	Select counties in MI		2	591	2			1	4			00000010000000000000		www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5475	031	0	1	01	01	H5475_031_0	5	1					0	09/27/2021	2022.01	09/27/2021 09:43:47 AM Eastern Daylight Time	08/04/2021 12:47:08 AM Eastern Daylight Time	07/30/2021 12:46:58 PM Eastern Daylight Time			09/28/2021 01:31:51 PM Eastern Daylight Time	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Giveback (HMO)	01	01		1			H5475	031	0	2022	Select counties in MI		2	36520	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5475	032	0	1	01	01	H5475_032_0	5	1					0	09/27/2021	2022.01	09/27/2021 09:46:53 AM Eastern Daylight Time	08/04/2021 12:47:36 AM Eastern Daylight Time	07/30/2021 12:47:56 PM Eastern Daylight Time			09/28/2021 01:31:51 PM Eastern Daylight Time	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Dividend Giveback (HMO)	01	01		1			H5475	032	0	2022	Select counties in OH		2	9087	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5475	033	0	1	01	01	H5475_033_0	4	1					0	08/03/2021	2022.01	08/03/2021 11:18:54 AM Eastern Daylight Time	08/04/2021 12:48:05 AM Eastern Daylight Time	07/30/2021 12:48:48 PM Eastern Daylight Time			08/04/2021 09:45:33 PM Eastern Daylight Time	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium Exclusive (HMO)	01	01		1			H5475	033	0	2022	Select counties in MI		2	22899	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	7a;7d;7f;7g;7k;16b;17a;18a;	
H5475	034	0	1	01	01	H5475_034_0	4	1					0	08/03/2021	2022.01	08/03/2021 11:05:33 AM Eastern Daylight Time	08/04/2021 12:48:31 AM Eastern Daylight Time	07/30/2021 12:49:12 PM Eastern Daylight Time			08/04/2021 09:45:33 PM Eastern Daylight Time	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium Exclusive (HMO)	01	01		1			H5475	034	0	2022	Select counties in OH		2	1097	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	7a;7d;7f;7g;7k;16b;17a;18a;	
H5475	035	0	1	02	01	H5475_035_0	5	1	2	1			0	07/06/2021	2022.01	07/06/2021 01:21:45 PM Eastern Daylight Time	08/04/2021 12:49:00 AM Eastern Daylight Time	07/30/2021 12:49:34 PM Eastern Daylight Time			08/04/2021 09:45:33 PM Eastern Daylight Time	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Access Extra (HMO-POS D-SNP)	01	02		1			H5475	035	0	2022	Select counties in OH		2	290	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5475	036	0	1	02	01	H5475_036_0	4	1					0	08/04/2021	2022.01	08/04/2021 09:42:58 AM Eastern Daylight Time	08/04/2021 12:49:29 AM Eastern Daylight Time	07/30/2021 12:50:12 PM Eastern Daylight Time			08/04/2021 09:45:33 PM Eastern Daylight Time	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium Essential (HMO-POS)	01	02		1			H5475	036	0	2022	Select counties in OH		2	307	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5475	038	0	1	01	01	H5475_038_0	4	1					0	06/04/2021	2022.01	06/04/2021 01:10:41 PM Eastern Daylight Time	08/04/2021 03:39:55 PM Eastern Daylight Time	07/30/2021 12:50:52 PM Eastern Daylight Time			08/04/2021 09:45:33 PM Eastern Daylight Time	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Assist (HMO)	01	01		1			H5475	038	0	2022	Select counties in MI		2	10197	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5493	001	0	1	20	08	H5493_001_0	2	1						05/14/2021	2022.01	05/14/2021 12:44:35 PM Eastern Daylight Time		06/02/2021 01:53:49 PM Eastern Daylight Time			06/02/2021 01:54:56 PM Eastern Daylight Time	LIFE AT ST. FRANCIS HEALTHCARE, INC.	Saint Francis LIFE	trinityhealthpace.org	LIFE at St. Francis Healthcare, Inc (PACE)	08	20		1			H5493	001	0	2022	New Castle County, Delaware		2		2			2						www.carekinesis.com/	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	2	1						05/14/2021	2022.01	05/14/2021 12:44:50 PM Eastern Daylight Time		06/02/2021 01:53:49 PM Eastern Daylight Time			06/02/2021 01:54:56 PM Eastern Daylight Time	LIFE AT ST. FRANCIS HEALTHCARE, INC.	Saint Francis LIFE	trinityhealthpace.org	LIFE at St. Francis Healthcare, Inc (PACE)	08	20		1			H5493	002	0	2022	New Castle County, Delaware		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	8	1		1			1	08/04/2021	2022.01	08/04/2021 03:14:16 PM Pacific Daylight Time	08/04/2021 08:34:11 AM Mountain Daylight Time	08/05/2021 02:06:54 PM Mountain Daylight Time			08/05/2021 07:58:54 PM Mountain Daylight Time	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Imperial Health Plan of California, Inc.	www.imperialhealthplan.com	Imperial Senior Value (HMO C-SNP)	01	01		1			H5496	005	0	2022	Northern, Central and Southern California		2	18000	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5496	007	0	1	01	01	H5496_007_0	8	1					1	08/04/2021	2022.01	08/04/2021 03:14:31 PM Pacific Daylight Time	08/04/2021 08:35:04 AM Mountain Daylight Time	08/05/2021 07:45:49 PM Mountain Daylight Time			08/05/2021 07:58:54 PM Mountain 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	2022	Northern, Central and Southern California		2	42000	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	8	1					0	08/04/2021	2022.01	08/04/2021 03:20:16 PM Pacific Daylight Time	08/04/2021 08:35:55 AM Mountain Daylight Time	08/05/2021 02:09:13 PM Mountain Daylight Time			08/05/2021 07:58:54 PM Mountain 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	2022	Northern, Central and Southern California		2	7800	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	011	0	1	01	01	H5496_011_0	8	1	2	1			0	08/04/2021	2022.01	08/04/2021 03:21:00 PM Pacific Daylight Time	08/04/2021 08:36:59 AM Mountain Daylight Time	08/05/2021 02:10:02 PM Mountain Daylight Time			08/05/2021 07:58:54 PM Mountain Daylight Time	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Imperial Health Plan of California, Inc.	www.imperialhealthplan.com	Imperial Dual Plan (HMO D-SNP)	01	01		1			H5496	011	0	2022	Northern, Central and Southern California		2	3000	2			1	3		1		1	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	012	0	1	01	01	H5496_012_0	8	1					1	08/04/2021	2022.01	08/04/2021 03:14:47 PM Pacific Daylight Time	08/04/2021 08:37:43 AM Mountain Daylight Time	08/05/2021 02:11:35 PM Mountain Daylight Time			08/05/2021 07:58:54 PM Mountain Daylight Time	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Imperial Health Plan of California, Inc.	www.imperialhealthplan.com	Imperial Dynamic Plan (HMO)	01	01		1			H5496	012	0	2022	SoCal and Sacramento		2	10800	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	014	0	1	01	01	H5496_014_0	8	1					0	08/04/2021	2022.01	08/04/2021 03:21:21 PM Pacific Daylight Time	08/04/2021 08:28:56 AM Mountain Daylight Time	08/05/2021 02:12:17 PM Mountain Daylight Time			08/05/2021 07:58:54 PM Mountain Daylight Time	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Imperial Health Plan of California, Inc.	www.imperialhealthplan.com	Imperial Strong (HMO)	01	01		1			H5496	014	0	2022	Northern, Central and Southern California		2	9000	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					1	2			
H5521	013	0	1	04	01	H5521_013_0	3	1					0	08/02/2021	2022.01	08/02/2021 04:13:57 PM Eastern Daylight Time	08/02/2021 04:39:19 PM Eastern Daylight Time	08/02/2021 09:44:18 AM Eastern Daylight Time			08/04/2021 01:33:15 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Explorer Premier Plan (PPO)	01	04		1			H5521	013	0	2022	Connecticut		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	015	0	1	04	01	H5521_015_0	2	1					0	06/02/2021	2022.01	06/02/2021 08:34:51 AM Central Daylight Time	08/03/2021 12:53:49 PM Central Daylight Time	08/02/2021 08:44:22 AM Central Daylight Time			08/04/2021 02:07:30 PM Central Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	015	0	2022	District of Columbia		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(833)859-6031		(833)859-6031		(800)282-5366		(800)282-5366		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	016	0	1	04	01	H5521_016_0	7	1					0	08/02/2021	2022.01	08/02/2021 03:51:50 PM Eastern Daylight Time	08/03/2021 12:55:00 PM Eastern Daylight Time	08/02/2021 09:44:27 AM Eastern Daylight Time			08/04/2021 05:22:10 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plus (PPO)	01	04		1			H5521	016	0	2022	Chicagoland		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	020	0	1	04	01	H5521_020_0	2	1					0	05/26/2021	2022.01	05/26/2021 02:44:40 PM Eastern Daylight Time	08/03/2021 12:52:01 PM Eastern Daylight Time	08/02/2021 09:44:31 AM Eastern Daylight Time			08/04/2021 01:24:40 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier 2 (PPO)	01	04		1			H5521	020	0	2022	Select Counties in OH & KY		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	022	0	1	04	01	H5521_022_0	2	1					0	08/03/2021	2022.01	08/03/2021 07:50:56 AM Eastern Daylight Time	08/02/2021 03:16:42 PM Eastern Daylight Time	08/02/2021 09:44:35 AM Eastern Daylight Time			08/04/2021 01:48:44 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (PPO)	01	04		1			H5521	022	0	2022	Clark and Nye Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	027	0	1	04	01	H5521_027_0	2	1					0	06/02/2021	2022.01	06/02/2021 08:29:35 AM Central Daylight Time	08/03/2021 12:55:07 PM Central Daylight Time	08/02/2021 08:44:39 AM Central Daylight Time			08/04/2021 02:07:30 PM Central Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H5521	027	0	2022	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		(833)859-6031		(833)859-6031		(800)282-5366		(800)282-5366		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	033	0	1	04	01	H5521_033_0	3	1					0	08/02/2021	2022.01	08/02/2021 03:04:32 PM Eastern Daylight Time	08/03/2021 11:58:52 AM Eastern Daylight Time	08/02/2021 09:44:43 AM Eastern Daylight Time			08/04/2021 01:18:39 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (PPO)	01	04		1			H5521	033	0	2022	North, Central, West, NW, SW, TC, South FL		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	037	0	1	04	01	H5521_037_0	2	1					0	06/02/2021	2022.01	06/02/2021 12:10:57 PM Eastern Daylight Time	08/02/2021 04:09:16 PM Eastern Daylight Time	08/02/2021 09:44:48 AM Eastern Daylight Time			08/04/2021 04:37:28 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Explorer Premier (PPO)	01	04		1			H5521	037	0	2022	Counties: BR, ES, HD, MR, MX, MN, MO, ON, PS, UN		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	040	0	1	04	01	H5521_040_0	4	1					0	08/02/2021	2022.01	08/02/2021 03:29:36 PM Eastern Daylight Time	08/03/2021 11:14:13 AM Eastern Daylight Time	08/02/2021 09:44:52 AM Eastern Daylight Time			08/04/2021 04:37:28 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	040	0	2022	Metro Area: NYC, Queens, Brooklyn, SI, Nassau		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	053	0	1	04	01	H5521_053_0	2	1					0	06/02/2021	2022.01	06/02/2021 12:28:35 PM Eastern Daylight Time	08/02/2021 03:06:17 PM Eastern Daylight Time	08/02/2021 09:44:56 AM Eastern Daylight Time			08/04/2021 04:37:28 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H5521	053	0	2022	San Diego County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	055	0	1	04	01	H5521_055_0	2	1					0	08/03/2021	2022.01	08/03/2021 07:51:26 AM Eastern Daylight Time	08/02/2021 03:17:33 PM Eastern Daylight Time	08/02/2021 09:45:00 AM Eastern Daylight Time			08/04/2021 01:48:44 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H5521	055	0	2022	Clark and Nye Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	056	0	1	04	01	H5521_056_0	2	1					0	06/02/2021	2022.01	06/02/2021 12:28:11 PM Eastern Daylight Time	08/02/2021 03:07:06 PM Eastern Daylight Time	08/02/2021 09:45:05 AM Eastern Daylight Time			08/04/2021 04:37:28 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H5521	056	0	2022	Orange County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	057	0	1	04	01	H5521_057_0	2	1					0	06/02/2021	2022.01	06/02/2021 10:56:31 AM Central Daylight Time	08/03/2021 01:20:26 PM Central Daylight Time	08/02/2021 08:45:09 AM Central Daylight Time			08/04/2021 01:00:17 PM Central Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime (PPO)	01	04		1			H5521	057	0	2022	Denver Metro & Northern Colorado		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(833)859-6031		(833)859-6031		(800)282-5366		(800)282-5366		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	076	0	1	04	01	H5521_076_0	4	1					0	07/14/2021	2022.01	07/14/2021 11:25:31 AM Eastern Daylight Time	08/03/2021 11:17:07 AM Eastern Daylight Time	08/02/2021 09:45:13 AM Eastern Daylight Time			08/04/2021 04:37:28 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	076	0	2022	Greater Rochester Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	077	0	1	04	01	H5521_077_0	3	1					0	08/02/2021	2022.01	08/02/2021 03:30:20 PM Eastern Daylight Time	08/03/2021 11:19:52 AM Eastern Daylight Time	08/02/2021 09:45:17 AM Eastern Daylight Time			08/04/2021 04:37:28 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	077	0	2022	Northern Central Upstate New York		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	081	0	1	04	01	H5521_081_0	3	1					0	08/02/2021	2022.01	08/02/2021 09:48:12 AM Eastern Daylight Time	08/03/2021 02:51:37 AM Eastern Daylight Time	08/02/2021 09:45:22 AM Eastern Daylight Time			08/04/2021 02:51:20 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	081	0	2022	North Carolina		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	082	0	1	04	01	H5521_082_0	4	1					0	07/14/2021	2022.01	07/14/2021 11:05:39 AM Central Daylight Time	08/03/2021 12:58:57 PM Central Daylight Time	08/02/2021 08:45:26 AM Central Daylight Time			08/04/2021 02:07:30 PM Central Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Essential Plan (PPO)	01	04		1			H5521	082	0	2022	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		(833)859-6031		(833)859-6031		(800)282-5366		(800)282-5366		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	083	0	1	04	01	H5521_083_0	4	1					0	07/14/2021	2022.01	07/14/2021 11:06:17 AM Central Daylight Time	08/03/2021 01:01:59 PM Central Daylight Time	08/02/2021 08:45:30 AM Central Daylight Time			08/04/2021 02:07:30 PM Central Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Essential Plan (PPO)	01	04		1			H5521	083	0	2022	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		(833)859-6031		(833)859-6031		(800)282-5366		(800)282-5366		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	084	0	1	04	01	H5521_084_0	2	1					0	06/01/2021	2022.01	06/01/2021 05:00:16 PM Eastern Daylight Time	08/03/2021 01:15:37 PM Central Daylight Time	08/02/2021 08:45:34 AM Central Daylight Time			08/04/2021 02:07:30 PM Central Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Essential Plan (PPO)	01	04		1			H5521	084	0	2022	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		(833)859-6031		(833)859-6031		(800)282-5366		(800)282-5366		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	085	0	1	04	01	H5521_085_0	2	1					0	08/02/2021	2022.01	08/02/2021 01:18:37 PM Eastern Daylight Time	08/03/2021 12:53:22 PM Eastern Daylight Time	08/02/2021 09:45:38 AM Eastern Daylight Time			08/04/2021 01:24:40 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	085	0	2022	Northern Kentucky Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	086	0	1	04	01	H5521_086_0	7	1					0	08/02/2021	2022.01	08/02/2021 03:52:29 PM Eastern Daylight Time	08/03/2021 12:56:05 PM Eastern Daylight Time	08/02/2021 09:45:43 AM Eastern Daylight Time			08/04/2021 05:22:10 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value (PPO)	01	04		1			H5521	086	0	2022	Chicagoland		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	087	0	1	04	01	H5521_087_0	3	1					0	08/02/2021	2022.01	08/02/2021 01:19:13 PM Eastern Daylight Time	08/03/2021 12:54:38 PM Eastern Daylight Time	08/02/2021 09:45:47 AM Eastern Daylight Time			08/04/2021 01:24:40 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	087	0	2022	Cincinnati Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	088	0	1	04	01	H5521_088_0	2	1					0	08/02/2021	2022.01	08/02/2021 01:19:46 PM Eastern Daylight Time	08/03/2021 12:55:55 PM Eastern Daylight Time	08/02/2021 09:45:51 AM Eastern Daylight Time			08/04/2021 01:24:40 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	088	0	2022	Cleveland and Toledo Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	089	0	1	04	01	H5521_089_0	2	1					0	08/02/2021	2022.01	08/02/2021 01:21:28 PM Eastern Daylight Time	08/03/2021 12:57:14 PM Eastern Daylight Time	08/02/2021 09:45:55 AM Eastern Daylight Time			08/04/2021 01:24:40 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	089	0	2022	Central Ohio Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	090	0	1	04	01	H5521_090_0	2	1					0	08/02/2021	2022.01	08/02/2021 01:21:57 PM Eastern Daylight Time	08/03/2021 12:58:39 PM Eastern Daylight Time	08/02/2021 09:46:00 AM Eastern Daylight Time			08/04/2021 01:24:40 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	090	0	2022	Dayton Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	091	0	1	04	01	H5521_091_0	4	1					0	08/02/2021	2022.01	08/02/2021 10:22:52 AM Eastern Daylight Time	08/03/2021 11:40:08 AM Eastern Daylight Time	08/02/2021 09:46:04 AM Eastern Daylight Time			08/04/2021 05:12:11 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Essential Plan (PPO)	01	04		1			H5521	091	0	2022	Atlanta GA and Southeast AL area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	095	0	1	04	01	H5521_095_0	3	1					0	07/14/2021	2022.01	07/14/2021 12:05:35 PM Eastern Daylight Time	08/02/2021 05:51:00 PM Eastern Daylight Time	08/02/2021 09:46:08 AM Eastern Daylight Time			08/04/2021 01:24:40 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plus (PPO)	01	04		1			H5521	095	0	2022	New Castle, Kent and Sussex Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	099	0	1	04	01	H5521_099_0	5	1					0	08/02/2021	2022.01	08/02/2021 04:22:40 PM Eastern Daylight Time	08/03/2021 12:58:15 PM Eastern Daylight Time	08/02/2021 09:46:12 AM Eastern Daylight Time			08/04/2021 05:22:10 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value (PPO)	01	04		1			H5521	099	0	2022	Northeast Indiana		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	100	0	1	04	01	H5521_100_0	2	1					0	08/02/2021	2022.01	08/02/2021 04:14:03 PM Eastern Daylight Time	08/03/2021 01:23:21 PM Eastern Daylight Time	08/02/2021 09:46:16 AM Eastern Daylight Time			08/04/2021 04:37:28 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	01	04		1			H5521	100	0	2022	Maricopa, Pima and Pinal Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	101	0	1	04	01	H5521_101_0	2	1					0	06/02/2021	2022.01	06/02/2021 04:32:22 PM Eastern Daylight Time	08/02/2021 03:18:23 PM Eastern Daylight Time	08/02/2021 09:46:21 AM Eastern Daylight Time			08/04/2021 03:16:36 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H5521	101	0	2022	Greater Salt Lake Metro		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(833)859-6031		(833)859-6031		(800)282-5366		(800)282-5366		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	102	0	1	04	01	H5521_102_0	2	1					0	06/02/2021	2022.01	06/02/2021 08:30:20 AM Central Daylight Time	08/03/2021 01:16:59 PM Central Daylight Time	08/02/2021 08:46:25 AM Central Daylight Time			08/04/2021 02:07:30 PM Central Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Essential Plan (PPO)	01	04		1			H5521	102	0	2022	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		(833)859-6031		(833)859-6031		(800)282-5366		(800)282-5366		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	110	0	1	04	01	H5521_110_0	4	1					0	07/14/2021	2022.01	07/14/2021 11:26:58 AM Eastern Daylight Time	08/03/2021 11:22:43 AM Eastern Daylight Time	08/02/2021 09:46:29 AM Eastern Daylight Time			08/04/2021 04:37:28 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	110	0	2022	Capital Region and Hudson Valley Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	116	0	1	04	01	H5521_116_0	4	1					0	08/02/2021	2022.01	08/02/2021 10:24:04 AM Eastern Daylight Time	08/03/2021 11:06:10 AM Eastern Daylight Time	08/02/2021 09:46:33 AM Eastern Daylight Time			08/04/2021 05:12:11 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	01	04		1			H5521	116	0	2022	Southwest Alabama		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	117	0	1	04	01	H5521_117_0	4	1					0	08/02/2021	2022.01	08/02/2021 03:31:06 PM Eastern Daylight Time	08/03/2021 11:24:30 AM Eastern Daylight Time	08/02/2021 09:46:38 AM Eastern Daylight Time			08/04/2021 04:37:28 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	117	0	2022	Suffolk County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	118	0	1	04	01	H5521_118_0	4	1					0	08/02/2021	2022.01	08/02/2021 03:32:05 PM Eastern Daylight Time	08/03/2021 11:26:09 AM Eastern Daylight Time	08/02/2021 09:46:42 AM Eastern Daylight Time			08/04/2021 04:37:28 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite Plan (PPO)	01	04		1			H5521	118	0	2022	Greater Rochester Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	119	0	1	04	01	H5521_119_0	4	1					0	08/02/2021	2022.01	08/02/2021 03:32:50 PM Eastern Daylight Time	08/03/2021 11:28:21 AM Eastern Daylight Time	08/02/2021 09:46:46 AM Eastern Daylight Time			08/04/2021 04:37:28 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite Plan (PPO)	01	04		1			H5521	119	0	2022	Capital Region and Hudson Valley Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	120	0	1	04	01	H5521_120_0	4	1					0	08/02/2021	2022.01	08/02/2021 03:34:28 PM Eastern Daylight Time	08/03/2021 11:30:55 AM Eastern Daylight Time	08/02/2021 09:46:50 AM Eastern Daylight Time			08/04/2021 04:37:28 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite Plan (PPO)	01	04		1			H5521	120	0	2022	Metro Area: LI, 5 Boroughs, Westchester/Rockland		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	121	0	1	04	01	H5521_121_0	3	1					0	08/02/2021	2022.01	08/02/2021 03:35:18 PM Eastern Daylight Time	08/03/2021 11:50:06 AM Eastern Daylight Time	08/02/2021 09:46:54 AM Eastern Daylight Time			08/04/2021 04:37:28 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	121	0	2022	Westchester, Rockland, Bronx Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	122	0	1	04	01	H5521_122_0	2	1					0	06/02/2021	2022.01	06/02/2021 10:46:37 AM Eastern Daylight Time	08/02/2021 05:51:51 PM Eastern Daylight Time	08/02/2021 09:46:58 AM Eastern Daylight Time			08/04/2021 01:24:40 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Gold Plan (PPO)	01	04		1			H5521	122	0	2022	Pennsylvania		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	123	0	1	04	01	H5521_123_0	2	1					0	08/02/2021	2022.01	08/02/2021 03:08:14 PM Eastern Daylight Time	08/02/2021 04:10:07 PM Eastern Daylight Time	08/02/2021 09:47:03 AM Eastern Daylight Time			08/04/2021 04:37:28 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare SNJ Prime Elite (PPO)	01	04		1			H5521	123	0	2022	SNJ Counties: AL, BR, CM, CP, CU, GL, ON, SM		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	124	0	1	04	01	H5521_124_0	2	1					0	06/02/2021	2022.01	06/02/2021 12:26:36 PM Eastern Daylight Time	08/02/2021 04:10:58 PM Eastern Daylight Time	08/02/2021 09:47:07 AM Eastern Daylight Time			08/04/2021 04:37:28 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Explorer Premier 2 (PPO)	01	04		1			H5521	124	0	2022	SNJ Counties: ATL, BUR, CAM, CPM, CUM, GLO, SLM		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	125	0	1	04	01	H5521_125_0	2	1					0	06/02/2021	2022.01	06/02/2021 12:25:58 PM Eastern Daylight Time	08/02/2021 03:07:59 PM Eastern Daylight Time	08/02/2021 09:47:11 AM Eastern Daylight Time			08/04/2021 04:37:28 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H5521	125	0	2022	Los Angeles County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	127	0	1	04	01	H5521_127_0	2	1					0	08/02/2021	2022.01	08/02/2021 01:32:43 PM Eastern Daylight Time	08/02/2021 02:54:53 PM Eastern Daylight Time	08/02/2021 09:47:15 AM Eastern Daylight Time			08/04/2021 01:48:44 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H5521	127	0	2022	Puget Sound Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	128	0	1	04	01	H5521_128_0	2	1					0	08/02/2021	2022.01	08/02/2021 01:34:23 PM Eastern Daylight Time	08/02/2021 02:56:44 PM Eastern Daylight Time	08/02/2021 09:47:19 AM Eastern Daylight Time			08/04/2021 01:48:44 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (PPO)	01	04		1			H5521	128	0	2022	Puget Sound Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	134	0	1	04	01	H5521_134_0	3	1					0	07/14/2021	2022.01	07/14/2021 12:21:06 PM Eastern Daylight Time	08/03/2021 12:59:58 PM Eastern Daylight Time	08/02/2021 09:47:24 AM Eastern Daylight Time			08/04/2021 01:24:40 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier 1 (PPO)	01	04		1			H5521	134	0	2022	Select Counties in Ohio		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	139	0	1	04	01	H5521_139_0	3	1					0	08/02/2021	2022.01	08/02/2021 09:48:46 AM Eastern Daylight Time	08/03/2021 02:53:53 AM Eastern Daylight Time	08/02/2021 09:47:28 AM Eastern Daylight Time			08/04/2021 02:51:20 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	139	0	2022	North Carolina		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	140	0	1	04	01	H5521_140_0	3	1					0	08/02/2021	2022.01	08/02/2021 09:49:11 AM Eastern Daylight Time	08/03/2021 02:53:44 AM Eastern Daylight Time	08/02/2021 09:47:32 AM Eastern Daylight Time			08/04/2021 02:51:20 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	140	0	2022	Greenville/Spartanburg SC and Surrounding Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	141	0	1	04	01	H5521_141_0	2	1					0	08/02/2021	2022.01	08/02/2021 09:49:33 AM Eastern Daylight Time	08/03/2021 02:55:27 AM Eastern Daylight Time	08/02/2021 09:47:36 AM Eastern Daylight Time			08/04/2021 02:51:20 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	141	0	2022	Nashville TN and Surrounding Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	142	0	1	04	01	H5521_142_0	3	1					1	08/02/2021	2022.01	08/02/2021 03:11:53 PM Eastern Daylight Time	08/02/2021 04:41:03 PM Eastern Daylight Time	08/02/2021 09:47:40 AM Eastern Daylight Time			08/04/2021 01:33:15 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Explorer Plan (PPO)	01	04		1			H5521	142	0	2022	Southern Maine		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	143	0	1	04	01	H5521_143_0	3	1					1	08/02/2021	2022.01	08/02/2021 04:15:26 PM Eastern Daylight Time	08/02/2021 04:42:46 PM Eastern Daylight Time	08/02/2021 09:47:45 AM Eastern Daylight Time			08/04/2021 01:33:15 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Explorer Plan (PPO)	01	04		1			H5521	143	0	2022	Mid Maine		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	144	0	1	04	01	H5521_144_0	3	1					1	08/02/2021	2022.01	08/02/2021 03:12:22 PM Eastern Daylight Time	08/02/2021 04:44:22 PM Eastern Daylight Time	08/02/2021 09:47:49 AM Eastern Daylight Time			08/04/2021 01:33:15 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Explorer Plan (PPO)	01	04		1			H5521	144	0	2022	Northern and Additional Maine		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	150	0	1	04	01	H5521_150_0	5	1					0	05/26/2021	2022.01	05/26/2021 02:27:12 PM Eastern Daylight Time	08/03/2021 12:59:24 PM Eastern Daylight Time	08/02/2021 09:47:53 AM Eastern Daylight Time			08/04/2021 05:22:10 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (PPO)	01	04		1			H5521	150	0	2022	Milwaukee Metropolitan area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	154	0	1	04	01	H5521_154_0	3	1					0	08/02/2021	2022.01	08/02/2021 09:50:01 AM Eastern Daylight Time	08/03/2021 02:55:12 AM Eastern Daylight Time	08/02/2021 09:47:57 AM Eastern Daylight Time			08/04/2021 02:51:20 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	154	0	2022	Memphis TN and Surrounding Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	156	0	1	04	01	H5521_156_0	3	1					0	07/14/2021	2022.01	07/14/2021 12:22:46 PM Eastern Daylight Time	08/03/2021 01:01:15 PM Eastern Daylight Time	08/02/2021 09:48:02 AM Eastern Daylight Time			08/04/2021 01:24:40 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	156	0	2022	Lexington Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	157	0	1	04	01	H5521_157_0	3	1					0	08/02/2021	2022.01	08/02/2021 03:19:08 PM Eastern Daylight Time	08/02/2021 04:47:17 PM Eastern Daylight Time	08/02/2021 09:48:06 AM Eastern Daylight Time			08/04/2021 01:33:15 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite Plan (PPO)	01	04		1			H5521	157	0	2022	Connecticut		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	159	0	1	04	01	H5521_159_0	3	1					0	08/02/2021	2022.01	08/02/2021 03:12:49 PM Eastern Daylight Time	08/02/2021 04:48:18 PM Eastern Daylight Time	08/02/2021 09:48:10 AM Eastern Daylight Time			08/04/2021 01:33:15 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Explorer Plan (PPO)	01	04		1			H5521	159	0	2022	Eastern Massachusetts		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	160	0	1	04	01	H5521_160_0	3	1					0	08/02/2021	2022.01	08/02/2021 03:13:15 PM Eastern Daylight Time	08/02/2021 04:49:29 PM Eastern Daylight Time	08/02/2021 09:48:14 AM Eastern Daylight Time			08/04/2021 01:33:15 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Explorer Plan (PPO)	01	04		1			H5521	160	0	2022	Central Massachusetts		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	168	0	1	04	01	H5521_168_0	3	1					0	08/02/2021	2022.01	08/02/2021 09:50:53 AM Eastern Daylight Time	08/03/2021 02:58:43 AM Eastern Daylight Time	08/02/2021 09:48:19 AM Eastern Daylight Time			08/04/2021 02:51:20 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Essential Plan (PPO)	01	04		1			H5521	168	0	2022	Wake and Durham Counties NC		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	169	0	1	04	01	H5521_169_0	3	1					0	08/02/2021	2022.01	08/02/2021 09:51:19 AM Eastern Daylight Time	08/03/2021 02:58:37 AM Eastern Daylight Time	08/02/2021 09:48:23 AM Eastern Daylight Time			08/04/2021 02:51:20 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	169	0	2022	Sandhills and Southeastern NC		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	170	0	1	04	01	H5521_170_0	3	1					0	08/02/2021	2022.01	08/02/2021 10:03:58 AM Eastern Daylight Time	08/03/2021 03:02:00 AM Eastern Daylight Time	08/02/2021 09:48:27 AM Eastern Daylight Time			08/04/2021 02:51:20 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plus Plan (PPO)	01	04		1			H5521	170	0	2022	North Carolina		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	171	0	1	04	01	H5521_171_0	4	1					0	08/02/2021	2022.01	08/02/2021 10:24:36 AM Eastern Daylight Time	08/03/2021 11:41:45 AM Eastern Daylight Time	08/02/2021 09:48:31 AM Eastern Daylight Time			08/04/2021 05:12:11 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	01	04		1			H5521	171	0	2022	Central Alabama		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	177	0	1	04	01	H5521_177_0	4	1					0	08/02/2021	2022.01	08/02/2021 12:39:26 PM Central Daylight Time	08/03/2021 11:07:10 AM Eastern Daylight Time	08/02/2021 09:48:36 AM Eastern Daylight Time			08/04/2021 05:12:11 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	01	04		1			H5521	177	0	2022	Cherokee County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	178	0	1	04	01	H5521_178_0	4	1					0	08/02/2021	2022.01	08/02/2021 10:25:10 AM Eastern Daylight Time	08/03/2021 11:07:56 AM Eastern Daylight Time	08/02/2021 09:48:40 AM Eastern Daylight Time			08/04/2021 05:12:11 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	01	04		1			H5521	178	0	2022	Select Louisiana Parishes		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	184	0	1	04	01	H5521_184_0	2	1					0	06/02/2021	2022.01	06/02/2021 12:25:24 PM Eastern Daylight Time	08/03/2021 01:24:13 PM Eastern Daylight Time	08/02/2021 09:48:45 AM Eastern Daylight Time			08/04/2021 04:37:28 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Platinum Plan (PPO)	01	04		1			H5521	184	0	2022	Maricopa, Pima and Pinal Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	190	0	1	04	01	H5521_190_0	5	1					0	08/02/2021	2022.01	08/02/2021 03:39:51 PM Eastern Daylight Time	08/03/2021 01:00:29 PM Eastern Daylight Time	08/02/2021 09:48:49 AM Eastern Daylight Time			08/04/2021 05:22:10 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (PPO)	01	04		1			H5521	190	0	2022	Northeast Indiana		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	194	0	1	04	01	H5521_194_0	5	1					0	05/26/2021	2022.01	05/26/2021 02:28:08 PM Eastern Daylight Time	08/03/2021 01:02:01 PM Eastern Daylight Time	08/02/2021 09:48:53 AM Eastern Daylight Time			08/04/2021 05:22:10 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (PPO)	01	04		1			H5521	194	0	2022	Southwest Michigan		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	195	0	1	04	01	H5521_195_0	5	1					0	08/02/2021	2022.01	08/02/2021 03:40:35 PM Eastern Daylight Time	08/03/2021 01:03:07 PM Eastern Daylight Time	08/02/2021 09:48:58 AM Eastern Daylight Time			08/04/2021 05:22:10 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value (PPO)	01	04		1			H5521	195	0	2022	Milwaukee Metropolitan area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	196	0	1	04	01	H5521_196_0	2	1					0	06/02/2021	2022.01	06/02/2021 04:32:47 PM Eastern Daylight Time	08/02/2021 03:19:14 PM Eastern Daylight Time	08/02/2021 09:49:02 AM Eastern Daylight Time			08/04/2021 03:16:36 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H5521	196	0	2022	Southern Utah		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	197	0	1	04	01	H5521_197_0	2	1					0	06/02/2021	2022.01	06/02/2021 04:33:05 PM Eastern Daylight Time	08/02/2021 03:20:04 PM Eastern Daylight Time	08/02/2021 09:49:06 AM Eastern Daylight Time			08/04/2021 03:16:36 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	197	0	2022	Northern Utah		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	200	0	1	04	01	H5521_200_0	2	1					0	06/02/2021	2022.01	06/02/2021 12:25:03 PM Eastern Daylight Time	08/03/2021 01:25:05 PM Eastern Daylight Time	08/02/2021 09:49:10 AM Eastern Daylight Time			08/04/2021 04:37:28 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Platinum Plan (PPO)	01	04		1			H5521	200	0	2022	Counties COH, COC, GIL, GRA, MOH, SC, YAV, YUM		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	205	0	1	04	01	H5521_205_0	2	1					0	06/02/2021	2022.01	06/02/2021 12:24:33 PM Eastern Daylight Time	08/02/2021 03:08:47 PM Eastern Daylight Time	08/02/2021 09:49:14 AM Eastern Daylight Time			08/04/2021 04:37:28 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H5521	205	0	2022	Kern County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	206	0	1	04	01	H5521_206_0	2	1					0	06/02/2021	2022.01	06/02/2021 12:24:12 PM Eastern Daylight Time	08/02/2021 03:09:35 PM Eastern Daylight Time	08/02/2021 09:49:18 AM Eastern Daylight Time			08/04/2021 04:37:28 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H5521	206	0	2022	Fresno County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	207	0	1	04	01	H5521_207_0	2	1					0	08/02/2021	2022.01	08/02/2021 03:15:41 PM Central Daylight Time	08/03/2021 01:21:27 PM Central Daylight Time	08/02/2021 08:49:23 AM Central Daylight Time			08/04/2021 01:00:17 PM Central Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime (PPO)	01	04		1			H5521	207	0	2022	Southern & Western Colorado		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(833)859-6031		(833)859-6031		(800)282-5366		(800)282-5366		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	211	0	1	04	01	H5521_211_0	5	1					0	08/02/2021	2022.01	08/02/2021 03:41:13 PM Eastern Daylight Time	08/03/2021 01:04:23 PM Eastern Daylight Time	08/02/2021 09:49:27 AM Eastern Daylight Time			08/04/2021 05:22:10 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value (PPO)	01	04		1			H5521	211	0	2022	Southwest Indiana		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	214	0	1	04	01	H5521_214_0	5	1					0	08/02/2021	2022.01	08/02/2021 03:41:49 PM Eastern Daylight Time	08/03/2021 01:05:33 PM Eastern Daylight Time	08/02/2021 09:49:31 AM Eastern Daylight Time			08/04/2021 05:22:10 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value (PPO)	01	04		1			H5521	214	0	2022	Southeast Michigan		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	215	0	1	04	01	H5521_215_0	3	1					0	08/02/2021	2022.01	08/02/2021 03:36:12 PM Eastern Daylight Time	08/03/2021 12:32:20 PM Eastern Daylight Time	08/02/2021 09:49:35 AM Eastern Daylight Time			08/04/2021 04:37:28 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	215	0	2022	Western New York		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	216	0	1	04	01	H5521_216_0	4	1					0	08/02/2021	2022.01	08/02/2021 10:25:44 AM Eastern Daylight Time	08/03/2021 11:08:47 AM Eastern Daylight Time	08/02/2021 09:49:40 AM Eastern Daylight Time			08/04/2021 05:12:11 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	01	04		1			H5521	216	0	2022	Tuscaloosa and Surrounding Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	217	0	1	04	01	H5521_217_0	5	1					0	08/02/2021	2022.01	08/02/2021 03:42:39 PM Eastern Daylight Time	08/03/2021 01:06:39 PM Eastern Daylight Time	08/02/2021 09:49:44 AM Eastern Daylight Time			08/04/2021 05:22:10 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plus (PPO)	01	04		1			H5521	217	0	2022	Southeast Michigan		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	218	0	1	04	01	H5521_218_0	4	1					0	08/02/2021	2022.01	08/02/2021 10:27:54 AM Eastern Daylight Time	08/03/2021 11:09:36 AM Eastern Daylight Time	08/02/2021 09:49:48 AM Eastern Daylight Time			08/04/2021 05:12:11 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	01	04		1			H5521	218	0	2022	Northern Mississippi		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	219	0	1	04	01	H5521_219_0	5	1					0	08/02/2021	2022.01	08/02/2021 04:24:39 PM Eastern Daylight Time	08/03/2021 01:07:43 PM Eastern Daylight Time	08/02/2021 09:49:52 AM Eastern Daylight Time			08/04/2021 05:22:10 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value (PPO)	01	04		1			H5521	219	0	2022	Southwest Michigan		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	220	0	1	04	01	H5521_220_0	4	1					0	08/02/2021	2022.01	08/02/2021 10:28:33 AM Eastern Daylight Time	08/03/2021 11:10:31 AM Eastern Daylight Time	08/02/2021 09:49:57 AM Eastern Daylight Time			08/04/2021 05:12:11 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	01	04		1			H5521	220	0	2022	Southern Mississippi		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	222	0	1	04	01	H5521_222_0	4	1					0	08/02/2021	2022.01	08/02/2021 10:29:06 AM Eastern Daylight Time	08/03/2021 11:11:20 AM Eastern Daylight Time	08/02/2021 09:50:01 AM Eastern Daylight Time			08/04/2021 05:12:11 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	01	04		1			H5521	222	0	2022	Southeast Alabama		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	223	0	1	04	01	H5521_223_0	5	1					0	08/02/2021	2022.01	08/02/2021 03:46:35 PM Eastern Daylight Time	08/03/2021 01:08:52 PM Eastern Daylight Time	08/02/2021 09:50:05 AM Eastern Daylight Time			08/04/2021 05:22:10 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value (PPO)	01	04		1			H5521	223	0	2022	Northwest Indiana		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	224	0	1	04	01	H5521_224_0	4	1					0	08/02/2021	2022.01	08/02/2021 10:29:39 AM Eastern Daylight Time	08/03/2021 11:12:09 AM Eastern Daylight Time	08/02/2021 09:50:09 AM Eastern Daylight Time			08/04/2021 05:12:11 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	01	04		1			H5521	224	0	2022	Montgomery and Surrounding Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	226	0	1	04	01	H5521_226_0	5	1					0	08/02/2021	2022.01	08/02/2021 03:47:54 PM Eastern Daylight Time	08/03/2021 01:10:02 PM Eastern Daylight Time	08/02/2021 09:50:14 AM Eastern Daylight Time			08/04/2021 05:22:10 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (PPO)	01	04		1			H5521	226	0	2022	Northwest Indiana		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	227	0	1	04	01	H5521_227_0	4	1					0	08/02/2021	2022.01	08/02/2021 10:30:23 AM Eastern Daylight Time	08/03/2021 11:12:53 AM Eastern Daylight Time	08/02/2021 09:50:18 AM Eastern Daylight Time			08/04/2021 05:12:11 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	01	04		1			H5521	227	0	2022	Northern Alabama		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	228	0	1	04	01	H5521_228_0	3	1					0	08/02/2021	2022.01	08/02/2021 03:49:12 PM Eastern Daylight Time	08/03/2021 01:11:14 PM Eastern Daylight Time	08/02/2021 09:50:22 AM Eastern Daylight Time			08/04/2021 02:16:38 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Explorer Value (PPO)	01	04		1			H5521	228	0	2022	Northern/Northwestern Illinois		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	229	0	1	04	01	H5521_229_0	1	1				0	0	05/26/2021	2022.01	05/26/2021 02:30:37 PM Eastern Daylight Time	06/02/2021 03:13:22 PM Eastern Daylight Time				06/03/2021 12:45:08 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Eagle Plan (PPO)	01	04		1			H5521	229	0	2022	Select Alabama Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5521	230	0	1	04	01	H5521_230_0	4	1					0	08/02/2021	2022.01	08/02/2021 10:31:59 AM Eastern Daylight Time	08/03/2021 11:14:31 AM Eastern Daylight Time	08/02/2021 09:50:26 AM Eastern Daylight Time			08/04/2021 05:12:11 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	01	04		1			H5521	230	0	2022	Monroe Metro and Surrounding Parishes		2		2			2						www.aetnamedicare.com/findpharmacy	http://www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	231	0	1	04	01	H5521_231_0	3	1					0	08/02/2021	2022.01	08/02/2021 03:50:32 PM Eastern Daylight Time	08/03/2021 01:12:30 PM Eastern Daylight Time	08/02/2021 09:50:31 AM Eastern Daylight Time			08/04/2021 02:16:38 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value (PPO)	01	04		1			H5521	231	0	2022	Central Indiana		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	232	0	1	04	01	H5521_232_0	4	1					0	08/02/2021	2022.01	08/02/2021 10:32:33 AM Eastern Daylight Time	08/03/2021 11:46:53 AM Eastern Daylight Time	08/02/2021 09:50:35 AM Eastern Daylight Time			08/04/2021 05:12:11 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	01	04		1			H5521	232	0	2022	Alexandria Metro and Surrounding Parishes		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	233	0	1	04	01	H5521_233_0	4	1					0	08/02/2021	2022.01	08/02/2021 10:33:17 AM Eastern Daylight Time	08/03/2021 11:15:32 AM Eastern Daylight Time	08/02/2021 09:50:39 AM Eastern Daylight Time			08/04/2021 05:12:11 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	01	04		1			H5521	233	0	2022	Lake Charles Metro and Surrounding Parishes		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	234	0	1	04	01	H5521_234_0	4	1					0	08/02/2021	2022.01	08/02/2021 10:48:03 AM Eastern Daylight Time	08/03/2021 11:16:24 AM Eastern Daylight Time	08/02/2021 09:50:43 AM Eastern Daylight Time			08/04/2021 05:12:11 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	01	04		1			H5521	234	0	2022	Lafayette Metro and Surrounding Parishes		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	235	0	1	04	01	H5521_235_0	1	1				0	0	05/26/2021	2022.01	05/26/2021 02:31:41 PM Eastern Daylight Time	06/02/2021 02:52:59 PM Eastern Daylight Time				06/03/2021 12:45:08 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Eagle Plan (PPO)	01	04		1			H5521	235	0	2022	Select Louisiana Parishes		2		2			2						www.aetnamedicare.com/findpharmacy	http://www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5521	236	0	1	04	01	H5521_236_0	3	1					0	08/02/2021	2022.01	08/02/2021 10:04:24 AM Eastern Daylight Time	08/03/2021 03:01:06 AM Eastern Daylight Time	08/02/2021 09:50:48 AM Eastern Daylight Time			08/04/2021 02:51:20 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	236	0	2022	Western North Carolina		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	239	0	1	04	01	H5521_239_0	3	1					0	08/02/2021	2022.01	08/02/2021 10:04:51 AM Eastern Daylight Time	08/03/2021 03:04:10 AM Eastern Daylight Time	08/02/2021 09:50:52 AM Eastern Daylight Time			08/04/2021 02:51:20 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	239	0	2022	Western North Carolina		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	241	0	1	04	01	H5521_241_0	2	1				0	0	05/25/2021	2022.01	05/25/2021 07:19:13 PM Eastern Daylight Time	06/01/2021 09:55:17 PM Eastern Daylight Time				06/03/2021 12:48:25 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Eagle Plan (PPO)	01	04		1			H5521	241	0	2022	North Carolina		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5521	243	0	1	04	01	H5521_243_0	3	1					0	08/02/2021	2022.01	08/02/2021 10:05:18 AM Eastern Daylight Time	08/03/2021 03:03:57 AM Eastern Daylight Time	08/02/2021 09:50:56 AM Eastern Daylight Time			08/04/2021 02:51:20 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	243	0	2022	Rocky Mount North Carolina		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	245	0	1	04	01	H5521_245_0	3	1					0	08/02/2021	2022.01	08/02/2021 10:06:10 AM Eastern Daylight Time	08/03/2021 03:05:55 AM Eastern Daylight Time	08/02/2021 09:51:00 AM Eastern Daylight Time			08/04/2021 02:51:20 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	245	0	2022	Midland and Surrounding Area South Carolina		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	246	0	1	04	01	H5521_246_0	2	1					0	08/02/2021	2022.01	08/02/2021 01:48:26 PM Eastern Daylight Time	08/02/2021 03:20:54 PM Eastern Daylight Time	08/02/2021 09:51:04 AM Eastern Daylight Time			08/04/2021 01:48:44 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite Plan (PPO)	01	04		1			H5521	246	0	2022	Greater Salt Lake Metro Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	247	0	1	04	01	H5521_247_0	3	1					0	08/02/2021	2022.01	08/02/2021 10:06:35 AM Eastern Daylight Time	08/03/2021 03:05:34 AM Eastern Daylight Time	08/02/2021 09:51:09 AM Eastern Daylight Time			08/04/2021 02:51:20 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	247	0	2022	Charleston Metro and Hilton Head South Carolina		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	249	0	1	04	01	H5521_249_0	3	1					0	08/02/2021	2022.01	08/02/2021 10:06:59 AM Eastern Daylight Time	08/03/2021 03:07:43 AM Eastern Daylight Time	08/02/2021 09:51:13 AM Eastern Daylight Time			08/04/2021 02:51:20 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	249	0	2022	Pee Dee South Carolina		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	250	0	1	04	01	H5521_250_0	2	1					0	08/02/2021	2022.01	08/02/2021 03:16:05 PM Central Daylight Time	08/03/2021 01:22:26 PM Central Daylight Time	08/02/2021 08:51:17 AM Central Daylight Time			08/04/2021 01:00:17 PM Central Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime 1 (PPO)	01	04		1			H5521	250	0	2022	Denver Metro		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(833)859-6031		(833)859-6031		(800)282-5366		(800)282-5366		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	251	0	1	04	01	H5521_251_0	3	1					0	08/02/2021	2022.01	08/02/2021 10:07:25 AM Eastern Daylight Time	08/03/2021 03:09:29 AM Eastern Daylight Time	08/02/2021 09:51:21 AM Eastern Daylight Time			08/04/2021 02:51:20 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	251	0	2022	Midlands South Carolina		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	252	0	1	04	01	H5521_252_0	4	1					0	08/02/2021	2022.01	08/02/2021 10:07:52 AM Eastern Daylight Time	08/03/2021 03:09:19 AM Eastern Daylight Time	08/02/2021 09:51:26 AM Eastern Daylight Time			08/04/2021 02:51:20 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	252	0	2022	Hilton Head, Augusta and Surrounding Area SC		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	254	0	1	04	01	H5521_254_0	3	1					0	08/02/2021	2022.01	08/02/2021 10:08:12 AM Eastern Daylight Time	08/03/2021 03:12:58 AM Eastern Daylight Time	08/02/2021 09:51:30 AM Eastern Daylight Time			08/04/2021 02:51:20 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	254	0	2022	Middle Tennessee		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	259	0	1	04	01	H5521_259_0	2	1					0	05/28/2021	2022.01	05/28/2021 09:52:41 AM Eastern Daylight Time	08/03/2021 01:02:56 PM Eastern Daylight Time	08/02/2021 09:51:34 AM Eastern Daylight Time			08/04/2021 01:24:40 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	259	0	2022	Louisville Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	260	0	1	04	01	H5521_260_0	3	1					0	07/14/2021	2022.01	07/14/2021 12:24:12 PM Eastern Daylight Time	08/03/2021 01:04:16 PM Eastern Daylight Time	08/02/2021 09:51:38 AM Eastern Daylight Time			08/04/2021 01:24:40 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	260	0	2022	Bowling Green/Southwest KY Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	261	0	1	04	01	H5521_261_0	3	1					0	08/02/2021	2022.01	08/02/2021 12:57:15 PM Eastern Daylight Time	08/02/2021 05:52:39 PM Eastern Daylight Time	08/02/2021 09:51:43 AM Eastern Daylight Time			08/04/2021 01:24:40 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value (PPO)	01	04		1			H5521	261	0	2022	Western Pennsylvania		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	262	0	1	04	01	H5521_262_0	2	1					0	08/02/2021	2022.01	08/02/2021 12:57:46 PM Eastern Daylight Time	08/02/2021 05:53:25 PM Eastern Daylight Time	08/02/2021 09:51:47 AM Eastern Daylight Time			08/04/2021 01:24:40 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value (PPO)	01	04		1			H5521	262	0	2022	New Castle, Kent and Sussex Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	263	0	1	04	01	H5521_263_0	2	1					0	08/02/2021	2022.01	08/02/2021 12:58:16 PM Eastern Daylight Time	08/02/2021 05:54:12 PM Eastern Daylight Time	08/02/2021 09:51:51 AM Eastern Daylight Time			08/04/2021 01:24:40 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value (PPO)	01	04		1			H5521	263	0	2022	Central and Eastern Pennsylvania		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	266	0	1	04	01	H5521_266_0	3	1					0	07/14/2021	2022.01	07/14/2021 12:24:56 PM Eastern Daylight Time	08/03/2021 01:05:36 PM Eastern Daylight Time	08/02/2021 09:51:55 AM Eastern Daylight Time			08/04/2021 01:24:40 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	266	0	2022	Ashland Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	267	0	1	04	01	H5521_267_0	3	1					0	07/14/2021	2022.01	07/14/2021 12:26:31 PM Eastern Daylight Time	08/03/2021 01:06:50 PM Eastern Daylight Time	08/02/2021 09:52:00 AM Eastern Daylight Time			08/04/2021 01:24:40 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	267	0	2022	Eastern Kentucky Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	268	0	1	04	01	H5521_268_0	3	1					0	08/02/2021	2022.01	08/02/2021 03:05:19 PM Eastern Daylight Time	08/03/2021 12:00:41 PM Eastern Daylight Time	08/02/2021 09:52:04 AM Eastern Daylight Time			08/04/2021 01:18:39 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plus (PPO)	01	04		1			H5521	268	0	2022	Central FL		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	269	0	1	04	01	H5521_269_0	3	1					0	08/02/2021	2022.01	08/02/2021 03:05:51 PM Eastern Daylight Time	08/03/2021 12:03:08 PM Eastern Daylight Time	08/02/2021 09:52:08 AM Eastern Daylight Time			08/04/2021 01:18:39 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plus (PPO)	01	04		1			H5521	269	0	2022	North FL, Central FL		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	270	0	1	04	01	H5521_270_0	3	1					0	08/02/2021	2022.01	08/02/2021 03:06:24 PM Eastern Daylight Time	08/03/2021 12:05:12 PM Eastern Daylight Time	08/02/2021 09:52:12 AM Eastern Daylight Time			08/04/2021 01:18:39 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plus (PPO)	01	04		1			H5521	270	0	2022	West FL		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	271	0	1	04	01	H5521_271_0	3	1					0	08/02/2021	2022.01	08/02/2021 03:06:55 PM Eastern Daylight Time	08/03/2021 12:07:07 PM Eastern Daylight Time	08/02/2021 09:52:17 AM Eastern Daylight Time			08/04/2021 01:18:39 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plus (PPO)	01	04		1			H5521	271	0	2022	Central FL, North FL		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	272	0	1	04	01	H5521_272_0	3	1					0	08/02/2021	2022.01	08/02/2021 03:07:21 PM Eastern Daylight Time	08/03/2021 12:09:14 PM Eastern Daylight Time	08/02/2021 09:52:21 AM Eastern Daylight Time			08/04/2021 01:18:39 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plus (PPO)	01	04		1			H5521	272	0	2022	Southwest FL		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	273	0	1	04	01	H5521_273_0	3	1					0	08/02/2021	2022.01	08/02/2021 03:07:56 PM Eastern Daylight Time	08/03/2021 12:11:10 PM Eastern Daylight Time	08/02/2021 09:52:25 AM Eastern Daylight Time			08/04/2021 01:18:39 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plus (PPO)	01	04		1			H5521	273	0	2022	South FL, Treasure Coast FL		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	275	0	1	04	01	H5521_275_0	2	1					0	08/02/2021	2022.01	08/02/2021 03:18:53 PM Eastern Daylight Time	08/02/2021 04:11:48 PM Eastern Daylight Time	08/02/2021 09:52:30 AM Eastern Daylight Time			08/04/2021 04:37:28 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime Premier (PPO)	01	04		1			H5521	275	0	2022	Counties: BR, HT, MR, MN, MO, PS, SM, SX, UN, WR		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	277	0	1	04	01	H5521_277_0	2	1					0	08/02/2021	2022.01	08/02/2021 03:20:06 PM Eastern Daylight Time	08/02/2021 04:12:39 PM Eastern Daylight Time	08/02/2021 09:52:34 AM Eastern Daylight Time			08/04/2021 04:37:28 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime Credit (PPO)	01	04		1			H5521	277	0	2022	Counties: BR, HT, MR, MN, MO, PS, SM, SX, UN, WR		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	278	0	1	04	01	H5521_278_0	2	1					0	06/02/2021	2022.01	06/02/2021 12:22:44 PM Eastern Daylight Time	08/02/2021 04:13:32 PM Eastern Daylight Time	08/02/2021 09:52:38 AM Eastern Daylight Time			08/04/2021 04:37:28 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Explorer Premier Plus (PPO)	01	04		1			H5521	278	0	2022	Northern and Southern NJ		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	279	0	1	04	01	H5521_279_0	2	1				0	0	06/02/2021	2022.01	06/02/2021 10:08:29 AM Eastern Daylight Time	06/01/2021 09:57:46 PM Eastern Daylight Time				06/03/2021 12:48:25 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Eagle Plan (PPO)	01	04		1			H5521	279	0	2022	South Carolina		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5521	280	0	1	04	01	H5521_280_0	3	1					0	08/02/2021	2022.01	08/02/2021 10:09:30 AM Eastern Daylight Time	08/03/2021 03:12:49 AM Eastern Daylight Time	08/02/2021 09:52:43 AM Eastern Daylight Time			08/04/2021 02:51:20 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	280	0	2022	Chattanooga TN and Surrounding Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	281	0	1	04	01	H5521_281_0	3	1					0	08/02/2021	2022.01	08/02/2021 10:10:09 AM Eastern Daylight Time	08/03/2021 03:14:16 AM Eastern Daylight Time	08/02/2021 09:52:47 AM Eastern Daylight Time			08/04/2021 02:51:20 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	281	0	2022	Chattanooga TN and Surrounding Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	282	0	1	04	01	H5521_282_0	3	1					0	05/26/2021	2022.01	05/26/2021 02:31:50 PM Eastern Daylight Time	08/03/2021 01:13:39 PM Eastern Daylight Time	08/02/2021 09:52:51 AM Eastern Daylight Time			08/04/2021 02:16:38 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (PPO)	01	04		1			H5521	282	0	2022	Green Bay metro		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	283	0	1	04	01	H5521_283_0	4	1					0	08/02/2021	2022.01	08/02/2021 04:23:48 PM Eastern Daylight Time	08/03/2021 01:15:03 PM Eastern Daylight Time	08/02/2021 09:52:55 AM Eastern Daylight Time			08/04/2021 02:16:38 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value (PPO)	01	04		1			H5521	283	0	2022	Green Bay metro		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	284	0	1	04	01	H5521_284_0	3	1					0	08/02/2021	2022.01	08/02/2021 04:17:04 PM Eastern Daylight Time	08/03/2021 01:16:29 PM Eastern Daylight Time	08/02/2021 09:53:00 AM Eastern Daylight Time			08/04/2021 02:16:38 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (PPO)	01	04		1			H5521	284	0	2022	Northwest Michigan		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	285	0	1	04	01	H5521_285_0	3	1					0	08/02/2021	2022.01	08/02/2021 04:25:20 PM Eastern Daylight Time	08/03/2021 01:17:41 PM Eastern Daylight Time	08/02/2021 09:53:04 AM Eastern Daylight Time			08/04/2021 02:16:38 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value (PPO)	01	04		1			H5521	285	0	2022	Northwest Michigan		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	286	0	1	04	01	H5521_286_0	2	1				0	0	05/26/2021	2022.01	05/26/2021 02:21:03 PM Eastern Daylight Time	06/01/2021 11:35:20 PM Eastern Daylight Time				06/03/2021 01:25:19 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Eagle (PPO)	01	04		1			H5521	286	0	2022	IL, IN, MI, WI		2		2			2						www.aetnamedicare.com/findpharmacy	http://www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5521	288	0	1	04	01	H5521_288_0	3	1					0	08/02/2021	2022.01	08/02/2021 07:51:34 PM Eastern Daylight Time	08/03/2021 01:18:49 PM Eastern Daylight Time	08/02/2021 09:53:08 AM Eastern Daylight Time			08/04/2021 02:16:38 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value (PPO)	01	04		1			H5521	288	0	2022	Midland area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	289	0	1	04	01	H5521_289_0	3	1					0	08/02/2021	2022.01	08/02/2021 04:19:34 PM Eastern Daylight Time	08/03/2021 01:20:01 PM Eastern Daylight Time	08/02/2021 09:53:12 AM Eastern Daylight Time			08/04/2021 02:16:38 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value (PPO)	01	04		1			H5521	289	0	2022	Green and Rock counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	290	0	1	04	01	H5521_290_0	2	1					0	08/02/2021	2022.01	08/02/2021 11:45:44 AM Eastern Daylight Time	08/03/2021 01:25:56 PM Eastern Daylight Time	08/02/2021 09:53:16 AM Eastern Daylight Time			08/04/2021 04:37:28 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite Plan (PPO)	01	04		1			H5521	290	0	2022	Coconino, Mohave and Yavapai Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	292	0	1	04	01	H5521_292_0	2	1					0	06/02/2021	2022.01	06/02/2021 12:22:03 PM Eastern Daylight Time	08/02/2021 03:10:24 PM Eastern Daylight Time	08/02/2021 09:53:21 AM Eastern Daylight Time			08/04/2021 04:37:28 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H5521	292	0	2022	Ventura County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	293	0	1	04	01	H5521_293_0	2	1					0	08/02/2021	2022.01	08/02/2021 10:42:36 AM Eastern Daylight Time	08/02/2021 03:11:14 PM Eastern Daylight Time	08/02/2021 09:53:25 AM Eastern Daylight Time			08/04/2021 04:37:28 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite Plan (PPO)	01	04		1			H5521	293	0	2022	Northern California		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	294	0	1	04	01	H5521_294_0	3	1					0	08/02/2021	2022.01	08/02/2021 12:58:51 PM Eastern Daylight Time	08/02/2021 05:54:57 PM Eastern Daylight Time	08/02/2021 09:53:29 AM Eastern Daylight Time			08/04/2021 01:24:40 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare The Valley Plan (PPO)	01	04		1			H5521	294	0	2022	Allentown Metro Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	295	0	1	04	01	H5521_295_0	2	1					0	08/02/2021	2022.01	08/02/2021 03:21:16 PM Eastern Daylight Time	08/02/2021 04:14:22 PM Eastern Daylight Time	08/02/2021 09:53:33 AM Eastern Daylight Time			08/04/2021 04:37:28 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Explorer Elite (PPO)	01	04		1			H5521	295	0	2022	NNJ West Counties: HUT, SOM, SUX, WAR		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	296	0	1	04	01	H5521_296_0	1	1				0	0	05/25/2021	2022.01	05/25/2021 08:41:38 PM Eastern Daylight Time	06/01/2021 05:03:21 PM Eastern Daylight Time				06/03/2021 11:23:10 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Eagle Plan (PPO)	01	04		1			H5521	296	0	2022	Massachusetts		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5521	298	0	1	04	01	H5521_298_0	2	1					0	06/02/2021	2022.01	06/02/2021 12:20:12 PM Eastern Daylight Time	08/02/2021 04:15:12 PM Eastern Daylight Time	08/02/2021 09:53:37 AM Eastern Daylight Time			08/04/2021 04:37:28 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Explorer Premier (PPO)	01	04		1			H5521	298	0	2022	NNJ West Counties: HUT, SOM, SUX, WAR		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	299	0	1	04	01	H5521_299_0	4	1					0	08/03/2021	2022.01	08/03/2021 07:52:08 AM Eastern Daylight Time	08/02/2021 03:21:43 PM Eastern Daylight Time	08/02/2021 09:53:41 AM Eastern Daylight Time			08/04/2021 05:39:11 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite Plan (PPO)	01	04		1			H5521	299	0	2022	Clark and Nye Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	300	0	1	04	01	H5521_300_0	2	1					0	08/03/2021	2022.01	08/03/2021 07:52:45 AM Eastern Daylight Time	08/02/2021 03:22:33 PM Eastern Daylight Time	08/02/2021 09:53:46 AM Eastern Daylight Time			08/04/2021 01:48:44 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (PPO)	01	04		1			H5521	300	0	2022	Northern Nevada		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	301	0	1	04	01	H5521_301_0	2	1					0	08/03/2021	2022.01	08/03/2021 07:53:20 AM Eastern Daylight Time	08/02/2021 03:23:22 PM Eastern Daylight Time	08/02/2021 09:53:50 AM Eastern Daylight Time			08/04/2021 01:48:44 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H5521	301	0	2022	Northern Nevada		2		2			2						www.aetnamedicare.com/formulary	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	302	0	1	04	01	H5521_302_0	3	1					0	05/26/2021	2022.01	05/26/2021 02:21:34 PM Eastern Daylight Time	08/03/2021 01:21:31 PM Eastern Daylight Time	08/02/2021 09:53:54 AM Eastern Daylight Time			08/04/2021 02:16:38 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (PPO)	01	04		1			H5521	302	0	2022	Central Indiana		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	303	0	1	04	01	H5521_303_0	2	1					0	08/03/2021	2022.01	08/03/2021 07:53:55 AM Eastern Daylight Time	08/02/2021 03:24:13 PM Eastern Daylight Time	08/02/2021 09:53:59 AM Eastern Daylight Time			08/04/2021 01:48:44 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite Plan (PPO)	01	04		1			H5521	303	0	2022	Northern Nevada		2		2			2						www.aetnamedicare.com/formulary	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	304	0	1	04	01	H5521_304_0	3	1					0	05/26/2021	2022.01	05/26/2021 02:21:52 PM Eastern Daylight Time	08/03/2021 01:22:45 PM Eastern Daylight Time	08/02/2021 09:54:03 AM Eastern Daylight Time			08/04/2021 02:16:38 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (PPO)	01	04		1			H5521	304	0	2022	Southwest Indiana		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	305	0	1	04	01	H5521_305_0	3	1					0	08/02/2021	2022.01	08/02/2021 03:08:27 PM Eastern Daylight Time	08/03/2021 12:12:26 PM Eastern Daylight Time	08/02/2021 09:54:07 AM Eastern Daylight Time			08/04/2021 01:18:39 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plus (PPO)	01	04		1			H5521	305	0	2022	Panhandle/Northwest FL		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	306	0	1	04	01	H5521_306_0	3	1				0	0	05/25/2021	2022.01	05/25/2021 05:49:49 PM Central Daylight Time	07/27/2021 12:57:28 PM Eastern Daylight Time				07/27/2021 04:13:46 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Eagle (PPO)	01	04		1			H5521	306	0	2022	Southwest FL		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5521	307	0	1	04	01	H5521_307_0	3	1					0	05/26/2021	2022.01	05/26/2021 02:22:03 PM Eastern Daylight Time	08/03/2021 01:23:52 PM Eastern Daylight Time	08/02/2021 09:54:11 AM Eastern Daylight Time			08/04/2021 02:16:38 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (PPO)	01	04		1			H5521	307	0	2022	Upper Peninsula Michigan		2		2			2						www.aetnamdicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	308	0	1	04	01	H5521_308_0	3	1				0	0	05/25/2021	2022.01	05/25/2021 07:19:28 PM Eastern Daylight Time	07/27/2021 12:59:08 PM Eastern Daylight Time				07/27/2021 04:13:46 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Eagle (PPO)	01	04		1			H5521	308	0	2022	West FL		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5521	309	0	1	04	01	H5521_309_0	4	1					0	07/14/2021	2022.01	07/14/2021 11:40:32 AM Eastern Daylight Time	08/03/2021 12:34:28 PM Eastern Daylight Time	08/02/2021 09:54:15 AM Eastern Daylight Time			08/04/2021 04:37:28 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite Plan 2 (PPO)	01	04		1			H5521	309	0	2022	Westchester, Rockland, Bronx Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	310	0	1	04	01	H5521_310_0	3	1					0	06/02/2021	2022.01	06/02/2021 12:19:25 PM Eastern Daylight Time	08/03/2021 12:39:14 PM Eastern Daylight Time	08/02/2021 09:54:19 AM Eastern Daylight Time			08/04/2021 04:37:28 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite Plan 3 (PPO)	01	04		1			H5521	310	0	2022	Metro Area: Brooklyn, NYC, Queens, Staten Island		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	311	0	1	04	01	H5521_311_0	3	1					0	08/02/2021	2022.01	08/02/2021 04:20:32 PM Eastern Daylight Time	08/03/2021 01:25:00 PM Eastern Daylight Time	08/02/2021 09:54:24 AM Eastern Daylight Time			08/04/2021 02:16:38 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value (PPO)	01	04		1			H5521	311	0	2022	Upper Peninsula Michigan		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	312	0	1	04	01	H5521_312_0	3	1					0	06/02/2021	2022.01	06/02/2021 12:19:05 PM Eastern Daylight Time	08/03/2021 12:42:23 PM Eastern Daylight Time	08/02/2021 09:54:28 AM Eastern Daylight Time			08/04/2021 04:37:28 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Discover Value Plan (PPO)	01	04		1			H5521	312	0	2022	Metro Area: Brooklyn, NYC, Queens		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	313	0	1	04	01	H5521_313_0	4	1					0	08/02/2021	2022.01	08/02/2021 03:23:57 PM Eastern Daylight Time	08/03/2021 12:44:29 PM Eastern Daylight Time	08/02/2021 09:54:32 AM Eastern Daylight Time			08/04/2021 04:37:28 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Credit Plan (PPO)	01	04		1			H5521	313	0	2022	Upstate NY Area: HV, Capital, CNY, Rochester, WNY		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	314	0	1	04	01	H5521_314_0	5	1					0	08/02/2021	2022.01	08/02/2021 04:21:40 PM Eastern Daylight Time	08/03/2021 01:26:05 PM Eastern Daylight Time	08/02/2021 09:54:36 AM Eastern Daylight Time			08/04/2021 02:16:38 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare DMG Prime (PPO)	01	04		1			H5521	314	0	2022	Chicagoland		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	318	0	1	04	01	H5521_318_0	3	1					0	06/02/2021	2022.01	06/02/2021 12:18:29 PM Eastern Daylight Time	08/03/2021 12:46:48 PM Eastern Daylight Time	08/02/2021 09:54:40 AM Eastern Daylight Time			08/04/2021 04:37:28 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Discover Value Plan (PPO)	01	04		1			H5521	318	0	2022	Greater Rochester Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	319	0	1	04	01	H5521_319_0	3	1					0	08/02/2021	2022.01	08/02/2021 10:10:36 AM Eastern Daylight Time	08/03/2021 03:14:07 AM Eastern Daylight Time	08/02/2021 09:54:44 AM Eastern Daylight Time			08/04/2021 02:51:20 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plus Plan (PPO)	01	04		1			H5521	319	0	2022	Greenville/Spartanburg SC and Surrounding Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	320	0	1	04	01	H5521_320_0	2	1				0	0	06/02/2021	2022.01	06/02/2021 12:18:04 PM Eastern Daylight Time	06/01/2021 05:47:52 PM Eastern Daylight Time				06/03/2021 03:36:50 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Eagle Plan (PPO)	01	04		1			H5521	320	0	2022	Metro Area: LI, 5 Boroughs, Westchester/Rockland		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5521	321	0	1	04	01	H5521_321_0	3	1					0	08/02/2021	2022.01	08/02/2021 10:11:18 AM Eastern Daylight Time	08/03/2021 03:15:39 AM Eastern Daylight Time	08/02/2021 09:54:49 AM Eastern Daylight Time			08/04/2021 02:51:20 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plus Plan (PPO)	01	04		1			H5521	321	0	2022	Nashville TN and Surrounding Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	322	0	1	04	01	H5521_322_0	1	1				0	0	06/01/2021	2022.01	06/01/2021 05:45:41 PM Eastern Daylight Time	06/01/2021 03:53:52 PM Central Daylight Time				06/03/2021 11:53:35 AM Central Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Eagle (PPO)	01	04		1			H5521	322	0	2022	Newport News and Surrounding Area		2		2			2						www.aetnamedicare.com/findpharmacy	http://www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5521	323	0	1	04	01	H5521_323_0	2	1				0	0	06/02/2021	2022.01	06/02/2021 12:17:44 PM Eastern Daylight Time	06/01/2021 05:49:07 PM Eastern Daylight Time				06/03/2021 03:36:50 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Eagle Plan (PPO)	01	04		1			H5521	323	0	2022	Upstate NY Area: HV, Capital, CNY, Rochester, WNY		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5521	324	0	1	04	01	H5521_324_0	1	1				0	0	05/26/2021	2022.01	05/26/2021 02:22:47 PM Eastern Daylight Time	06/02/2021 02:53:25 PM Eastern Daylight Time				06/03/2021 12:45:08 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Eagle Plan (PPO)	01	04		1			H5521	324	0	2022	Mississippi		2		2			2						www.aetnamedicare.com/findpharmacy	http://www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5521	326	0	1	04	01	H5521_326_0	5	1					0	08/02/2021	2022.01	08/02/2021 10:45:10 AM Eastern Daylight Time	08/03/2021 11:18:52 AM Eastern Daylight Time	08/02/2021 09:54:53 AM Eastern Daylight Time			08/04/2021 05:12:11 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plus Plan (PPO)	01	04		1			H5521	326	0	2022	New Orleans		2		2			2						www.aetnamedicare.com/findprovider	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	328	0	1	04	01	H5521_328_0	5	1					0	08/02/2021	2022.01	08/02/2021 07:59:08 PM Eastern Daylight Time	08/03/2021 11:19:35 AM Eastern Daylight Time	08/02/2021 09:54:57 AM Eastern Daylight Time			08/04/2021 05:12:11 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H5521	328	0	2022	Atlanta Metro		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	329	0	1	04	01	H5521_329_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 12:17:07 PM Eastern Daylight Time	06/01/2021 10:49:05 PM Eastern Daylight Time				06/03/2021 02:10:12 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Eagle Plan (PPO)	01	04		1			H5521	329	0	2022	Arizona		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5521	330	0	1	04	01	H5521_330_0	1	1				0	0	06/01/2021	2022.01	06/01/2021 12:05:05 PM Eastern Daylight Time	06/01/2021 07:30:20 PM Eastern Daylight Time				06/03/2021 01:58:25 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Eagle Plan (PPO)	01	04		1			H5521	330	0	2022	Washington		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5521	331	0	1	04	01	H5521_331_0	3	1					0	08/10/2021	2022.01	08/10/2021 08:28:18 AM Eastern Daylight Time	08/03/2021 01:27:39 PM Eastern Daylight Time	08/02/2021 09:55:01 AM Eastern Daylight Time			08/10/2021 08:29:43 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite Plan (PPO)	01	04		1			H5521	331	0	2022	Counties COH, GIL, GRA, SC, YUM		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	332	0	1	04	01	H5521_332_0	2	1					0	08/02/2021	2022.01	08/02/2021 10:43:58 AM Eastern Daylight Time	08/02/2021 03:12:02 PM Eastern Daylight Time	08/02/2021 09:55:05 AM Eastern Daylight Time			08/04/2021 04:37:28 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite Plan (PPO)	01	04		1			H5521	332	0	2022	Madera County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	333	0	1	04	01	H5521_333_0	2	1					0	06/02/2021	2022.01	06/02/2021 12:30:26 PM Eastern Daylight Time	08/02/2021 03:12:52 PM Eastern Daylight Time	08/02/2021 09:55:09 AM Eastern Daylight Time			08/04/2021 04:37:28 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H5521	333	0	2022	Riverside and San Bernardino Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	340	0	1	04	01	H5521_340_0	4	1					0	07/14/2021	2022.01	07/14/2021 11:37:47 AM Eastern Daylight Time	08/03/2021 12:49:06 PM Eastern Daylight Time	08/02/2021 09:55:14 AM Eastern Daylight Time			08/04/2021 04:37:28 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Discover Value Plan (PPO)	01	04		1			H5521	340	0	2022	Northern Central Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	341	0	1	04	01	H5521_341_0	4	1					0	07/14/2021	2022.01	07/14/2021 11:44:23 AM Eastern Daylight Time	08/03/2021 12:52:09 PM Eastern Daylight Time	08/02/2021 09:55:18 AM Eastern Daylight Time			08/04/2021 04:37:28 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plus Plan (PPO)	01	04		1			H5521	341	0	2022	Nassau & Suffolk counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	344	0	1	04	01	H5521_344_0	3	1					0	08/04/2021	2022.01	08/04/2021 11:06:34 AM Central Daylight Time	08/03/2021 01:26:09 PM Central Daylight Time	08/02/2021 08:55:22 AM Central Daylight Time			08/04/2021 02:07:30 PM Central Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	344	0	2022	Fairfax County and Surrounding Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		2					2						2			
H5521	345	0	1	04	01	H5521_345_0	4	1					0	08/02/2021	2022.01	08/02/2021 09:21:10 PM Central Daylight Time	08/03/2021 01:27:39 PM Central Daylight Time	08/02/2021 08:55:26 AM Central Daylight Time			08/04/2021 02:07:30 PM Central Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	345	0	2022	Richmond and Surrounding Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		2					2						2			
H5521	346	0	1	04	01	H5521_346_0	3	1				0	0	06/01/2021	2022.01	06/01/2021 08:42:29 PM Eastern Daylight Time	07/27/2021 01:01:02 PM Eastern Daylight Time				07/27/2021 04:13:46 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Eagle (PPO)	01	04		1			H5521	346	0	2022	South FL		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5521	347	0	1	04	01	H5521_347_0	3	1				0	0	06/01/2021	2022.01	06/01/2021 08:43:08 PM Eastern Daylight Time	07/27/2021 01:03:50 PM Eastern Daylight Time				07/27/2021 04:13:46 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Eagle (PPO)	01	04		1			H5521	347	0	2022	North FL		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5521	348	0	1	04	01	H5521_348_0	3	1					0	08/02/2021	2022.01	08/02/2021 10:11:42 AM Eastern Daylight Time	08/03/2021 03:15:20 AM Eastern Daylight Time	08/02/2021 09:55:30 AM Eastern Daylight Time			08/04/2021 02:51:20 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Essential Plan (PPO)	01	04		1			H5521	348	0	2022	Eastern and Sandhills NC		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	349	0	1	04	01	H5521_349_0	3	1				0	0	07/15/2021	2022.01	07/15/2021 02:48:31 PM Eastern Daylight Time	06/01/2021 05:05:14 PM Eastern Daylight Time				07/15/2021 03:19:49 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Eagle Plan (PPO)	01	04		1			H5521	349	0	2022	Maine		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5521	350	0	1	04	01	H5521_350_0	3	1				0	0	07/15/2021	2022.01	07/15/2021 02:49:16 PM Eastern Daylight Time	06/01/2021 05:06:27 PM Eastern Daylight Time				07/15/2021 03:19:49 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Eagle Plan (PPO)	01	04		1			H5521	350	0	2022	Connecticut		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5521	351	0	1	04	01	H5521_351_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 04:44:50 PM Eastern Daylight Time	06/03/2021 12:04:53 AM Eastern Daylight Time				06/03/2021 01:58:25 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Eagle Plan (PPO)	01	04		1			H5521	351	0	2022	Utah		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5521	352	0	1	04	01	H5521_352_0	6	1					0	08/09/2021	2022.01	08/09/2021 05:50:02 PM Eastern Daylight Time	08/02/2021 04:53:07 PM Eastern Daylight Time	08/02/2021 09:55:35 AM Eastern Daylight Time			08/09/2021 06:12:13 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Essential Elite Plan (PPO)	01	04		1			H5521	352	0	2022	Connecticut		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	353	0	1	04	01	H5521_353_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 04:48:31 PM Eastern Daylight Time	06/03/2021 12:05:19 AM Eastern Daylight Time				06/03/2021 01:58:25 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Eagle Plan (PPO)	01	04		1			H5521	353	0	2022	Nevada		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5521	354	0	1	04	01	H5521_354_0	3	1					0	08/02/2021	2022.01	08/02/2021 10:12:09 AM Eastern Daylight Time	08/03/2021 09:33:03 AM Eastern Daylight Time	08/02/2021 09:55:39 AM Eastern Daylight Time			08/04/2021 02:51:20 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Essential Plan (PPO)	01	04		1			H5521	354	0	2022	Charlotte Metro and Piedmont Area NC		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	355	0	1	04	01	H5521_355_0	3	1				0	0	05/25/2021	2022.01	05/25/2021 07:33:50 PM Eastern Daylight Time	06/01/2021 09:33:43 PM Eastern Daylight Time				06/03/2021 12:48:25 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Eagle Plan (PPO)	01	04		1			H5521	355	0	2022	Tennessee		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5521	801	0	1	04	01	H5521_801_0	1	1				0	0	05/27/2021	2022.01	05/27/2021 11:35:26 PM Eastern Daylight Time					06/03/2021 01:38:04 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (PPO)	01	04		1			H5521	801	0	2022	National		1	10119610	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H5521	802	0	1	04	01	H5521_802_0	1	1						05/27/2021	2022.01	05/27/2021 11:36:31 PM Eastern Daylight Time					06/03/2021 01:38:04 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan w/Rx (PPO)	01	04		1			H5521	802	0	2022	National		1	3383090	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H5521	805	0	2	04	01	H5521_805_0	1	1				0	0	05/27/2021	2022.01	05/27/2021 11:37:37 PM Eastern Daylight Time					06/03/2021 01:38:04 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Part B Only Plan (PPO)	01	04		2	1		H5521	805	0	2022	National		1	136250	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H5521	806	0	2	04	01	H5521_806_0	1	1						05/27/2021	2022.01	05/27/2021 11:39:07 PM Eastern Daylight Time					06/03/2021 01:38:04 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Part B Only Plan w/Rx (PPO)	01	04		2	1		H5521	806	0	2022	National		1	5910	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H5521	809	0	1	04	01	H5521_809_0	1	1				0	0	05/27/2021	2022.01	05/27/2021 11:39:37 PM Eastern Daylight Time					06/03/2021 01:38:04 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare $10 Buy-Down Plan (PPO)	01	04		1			H5521	809	0	2022	National		1	120	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H5521	810	0	1	04	01	H5521_810_0	1	1						06/03/2021	2022.01	06/03/2021 10:04:44 AM Eastern Daylight Time					06/03/2021 01:38:04 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare $10 Buy-Down Plan w/Rx (PPO)	01	04		1			H5521	810	0	2022	National		1	120	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H5521	812	0	1	04	01	H5521_812_0	1	1						06/03/2021	2022.01	06/03/2021 10:29:12 AM Eastern Daylight Time					06/03/2021 01:38:04 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare $75 Buy-Down w/Rx Plan (PPO)	01	04		1			H5521	812	0	2022	National		1	25340	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H5521	814	0	2	04	01	H5521_814_0	1	1				0	0	05/27/2021	2022.01	05/27/2021 11:43:05 PM Eastern Daylight Time					06/03/2021 01:38:04 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Part B Only $10 Buy-Down Plan (PPO)	01	04		2	1		H5521	814	0	2022	National		1	120	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H5521	815	0	2	04	01	H5521_815_0	1	1						05/27/2021	2022.01	05/27/2021 11:44:09 PM Eastern Daylight Time					06/03/2021 01:38:04 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Part B Only $10 Buy-Down Plan w/Rx (PPO)	01	04		2	1		H5521	815	0	2022	National		1	120	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H5521	816	0	2	04	01	H5521_816_0	1	1						05/27/2021	2022.01	05/27/2021 11:45:01 PM Eastern Daylight Time					06/03/2021 01:38:04 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Part B Only $75 Buy-Down Plan w/Rx (PPO)	01	04		2	1		H5521	816	0	2022	National		1	120	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H5521	817	0	1	04	01	H5521_817_0	1	1				0	0	05/27/2021	2022.01	05/27/2021 11:46:35 PM Eastern Daylight Time					06/03/2021 01:38:04 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare $75 Buy-Down Plan (PPO)	01	04		1			H5521	817	0	2022	National		1	120	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H5521	818	0	2	04	01	H5521_818_0	1	1				0	0	05/27/2021	2022.01	05/27/2021 11:46:57 PM Eastern Daylight Time					06/03/2021 01:38:04 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Part B Only $75 Buy-Down Plan (PPO)	01	04		2	1		H5521	818	0	2022	National		1	120	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H5521	819	0	1	04	01	H5521_819_0	1	1						05/27/2021	2022.01	05/27/2021 11:47:41 PM Eastern Daylight Time					06/03/2021 01:38:04 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan w/ Rx Copper (PPO)	01	04		1			H5521	819	0	2022	National		1	120	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H5521	820	0	1	04	01	H5521_820_0	1	1						05/27/2021	2022.01	05/27/2021 11:48:32 PM Eastern Daylight Time					06/03/2021 01:38:04 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan w/ Rx PIF (PPO)	01	04		1			H5521	820	0	2022	National		1	120	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H5521	821	0	1	04	01	H5521_821_0	1	1				0	0	05/27/2021	2022.01	05/27/2021 11:49:17 PM Eastern Daylight Time					06/03/2021 01:38:04 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare $25 Buy-Down Plan (PPO)	01	04		1			H5521	821	0	2022	National		1	120	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H5521	822	0	1	04	01	H5521_822_0	1	1						05/27/2021	2022.01	05/27/2021 11:50:27 PM Eastern Daylight Time					06/03/2021 01:38:04 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare $25 Buy-Down Plan w/ Rx (PPO)	01	04		1			H5521	822	0	2022	National		1	120	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H5521	823	0	2	04	01	H5521_823_0	1	1				0	0	05/27/2021	2022.01	05/27/2021 11:50:51 PM Eastern Daylight Time					06/03/2021 01:38:04 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Part B Only $25 Buy-Down Plan (PPO)	01	04		2	1		H5521	823	0	2022	National		1	120	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H5521	824	0	2	04	01	H5521_824_0	1	1						05/27/2021	2022.01	05/27/2021 11:51:56 PM Eastern Daylight Time					06/03/2021 01:38:04 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Part B Only $25 Buy-Down Plan w/ Rx (PPO)	01	04		2	1		H5521	824	0	2022	National		1	120	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H5521	825	0	1	04	01	H5521_825_0	1	1				0	0	05/27/2021	2022.01	05/27/2021 11:52:18 PM Eastern Daylight Time					06/03/2021 01:38:04 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare $50 Buy-Down Plan (PPO)	01	04		1			H5521	825	0	2022	National		1	120	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H5521	826	0	1	04	01	H5521_826_0	1	1						05/27/2021	2022.01	05/27/2021 11:53:22 PM Eastern Daylight Time					06/03/2021 01:38:04 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare $50 Buy-Down Plan w/ Rx (PPO)	01	04		1			H5521	826	0	2022	National		1	120	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H5521	827	0	2	04	01	H5521_827_0	1	1				0	0	05/27/2021	2022.01	05/27/2021 11:54:02 PM Eastern Daylight Time					06/03/2021 01:38:04 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Part B Only $50 Buy-Down Plan (PPO)	01	04		2	1		H5521	827	0	2022	National		1	120	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H5521	828	0	2	04	01	H5521_828_0	1	1						05/27/2021	2022.01	05/27/2021 11:55:09 PM Eastern Daylight Time					06/03/2021 01:38:04 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Part B Only $50 Buy-Down Plan w/ Rx (PPO)	01	04		2	1		H5521	828	0	2022	National		1	120	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;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		1	07/14/2021	2022.01	07/14/2021 12:29:57 PM Eastern Daylight Time	08/02/2021 05:55:41 PM Eastern Daylight Time	08/02/2021 09:55:43 AM Eastern Daylight Time			08/04/2021 01:24:40 PM Eastern Daylight Time	HEALTHASSURANCE PENNSYLVANIA, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Premier Plus (PPO)	01	04		1			H5522	001	0	2022	Allegheny County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5522	002	0	1	04	01	H5522_002_0	3	1			1		1	07/14/2021	2022.01	07/14/2021 12:31:07 PM Eastern Daylight Time	08/02/2021 05:56:29 PM Eastern Daylight Time	08/02/2021 09:55:47 AM Eastern Daylight Time			08/04/2021 01:24:40 PM Eastern Daylight Time	HEALTHASSURANCE PENNSYLVANIA, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Premier Plus (PPO)	01	04		1			H5522	002	0	2022	Central Pennsylvania		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5522	004	0	1	04	01	H5522_004_0	2	1			2		0	08/02/2021	2022.01	08/02/2021 12:59:51 PM Eastern Daylight Time	08/02/2021 05:57:17 PM Eastern Daylight Time	08/02/2021 09:55:51 AM Eastern Daylight Time			08/04/2021 01:24:40 PM Eastern Daylight Time	HEALTHASSURANCE PENNSYLVANIA, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Silver (PPO)	01	04		1			H5522	004	0	2022	Central Pennsylvania		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5522	005	0	1	04	01	H5522_005_0	2	1			1		1	06/01/2021	2022.01	06/01/2021 04:10:54 PM Eastern Daylight Time	08/02/2021 05:58:03 PM Eastern Daylight Time	08/02/2021 09:55:56 AM Eastern Daylight Time			08/04/2021 01:24:40 PM Eastern Daylight Time	HEALTHASSURANCE PENNSYLVANIA, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Silver (PPO)	01	04		1			H5522	005	0	2022	Western Pennsylvania		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5522	013	0	1	04	01	H5522_013_0	3	1			2		1	07/14/2021	2022.01	07/14/2021 12:31:58 PM Eastern Daylight Time	08/02/2021 05:58:51 PM Eastern Daylight Time	08/02/2021 09:56:00 AM Eastern Daylight Time			08/04/2021 01:24:40 PM Eastern Daylight Time	HEALTHASSURANCE PENNSYLVANIA, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Silver Plus (PPO)	01	04		1			H5522	013	0	2022	Central Pennsylvania		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5522	014	0	1	04	01	H5522_014_0	3	1			2		1	07/14/2021	2022.01	07/14/2021 12:32:36 PM Eastern Daylight Time	08/02/2021 05:59:36 PM Eastern Daylight Time	08/02/2021 09:56:04 AM Eastern Daylight Time			08/04/2021 01:24:40 PM Eastern Daylight Time	HEALTHASSURANCE PENNSYLVANIA, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Premier Plus (PPO)	01	04		1			H5522	014	0	2022	Southeastern Pennsylvania		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5522	017	0	1	04	01	H5522_017_0	2	1			2		0	06/01/2021	2022.01	06/01/2021 04:11:56 PM Eastern Daylight Time	08/02/2021 06:00:25 PM Eastern Daylight Time	08/02/2021 09:56:08 AM Eastern Daylight Time			08/04/2021 01:24:40 PM Eastern Daylight Time	HEALTHASSURANCE PENNSYLVANIA, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Credit Value (PPO)	01	04		1			H5522	017	0	2022	Pennsylvania		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5522	018	0	1	04	01	H5522_018_0	3	1			2		1	07/14/2021	2022.01	07/14/2021 12:44:19 PM Eastern Daylight Time	08/02/2021 06:01:08 PM Eastern Daylight Time	08/02/2021 09:56:13 AM Eastern Daylight Time			08/04/2021 01:24:40 PM Eastern Daylight Time	HEALTHASSURANCE PENNSYLVANIA, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Premier (PPO)	01	04		1			H5522	018	0	2022	Allegheny		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5522	020	0	1	04	01	H5522_020_0	4	1			2		0	08/02/2021	2022.01	08/02/2021 01:00:32 PM Eastern Daylight Time	08/02/2021 06:01:55 PM Eastern Daylight Time	08/02/2021 09:56:17 AM Eastern Daylight Time			08/04/2021 01:24:40 PM Eastern Daylight Time	HEALTHASSURANCE PENNSYLVANIA, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Central Value (PPO)	01	04		1			H5522	020	0	2022	Altoona Johnstown Huntingdon State College area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5522	802	0	1	04	01	H5522_802_0	1	1				0	0	05/28/2021	2022.01	05/28/2021 01:07:56 PM Eastern Daylight Time					06/03/2021 01:53:09 PM Eastern Daylight Time	HEALTHASSURANCE PENNSYLVANIA, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (PPO)	01	04		1			H5522	802	0	2022	Pennsylvania		1	120	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H5522	803	0	1	04	01	H5522_803_0	1	1						05/28/2021	2022.01	05/28/2021 01:09:37 PM Eastern Daylight Time					06/03/2021 01:53:09 PM Eastern Daylight Time	HEALTHASSURANCE PENNSYLVANIA, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan w/Rx (PPO)	01	04		1			H5522	803	0	2022	Pennsylvania		1	120	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H5525	004	0	1	04	01	H5525_004_0	4	1			1		1	08/03/2021	2022.01	08/03/2021 10:55:27 AM Eastern Daylight Time	08/03/2021 07:48:14 PM Eastern Daylight Time	07/30/2021 11:26:14 AM Eastern Daylight Time			08/04/2021 05:50:55 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	HumanaChoice H5525-004 (PPO)	01	04		1			H5525	004	0	2022	Peoria Illinois area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		1	07/23/2021	2022.01	07/23/2021 01:41:33 PM Eastern Daylight Time	08/03/2021 05:26:10 PM Eastern Daylight Time	07/30/2021 11:26:26 AM Eastern Daylight Time			08/04/2021 02:02:31 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	HumanaChoice H5525-005 (PPO)	01	04		1			H5525	005	0	2022	Greater Philadelphia Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		1	07/15/2021	2022.01	07/15/2021 01:16:54 PM Eastern Daylight Time	08/03/2021 05:24:31 PM Eastern Daylight Time	07/30/2021 11:26:38 AM Eastern Daylight Time			08/04/2021 02:02:31 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	HumanaChoice H5525-006 (PPO)	01	04		1			H5525	006	0	2022	South Central Pennsylvania area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		1	07/15/2021	2022.01	07/15/2021 01:18:14 PM Eastern Daylight Time	08/03/2021 05:22:21 PM Eastern Daylight Time	07/30/2021 11:26:52 AM Eastern Daylight Time			08/04/2021 02:02:31 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	HumanaChoice H5525-007 (PPO)	01	04		1			H5525	007	0	2022	North Central Pennsylvania area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		0	07/15/2021	2022.01	07/15/2021 05:12:56 PM Eastern Daylight Time	08/03/2021 06:12:33 PM Eastern Daylight Time	07/30/2021 11:27:04 AM Eastern Daylight Time			08/04/2021 02:15:03 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	HumanaChoice H5525-008 (PPO)	01	04		1			H5525	008	0	2022	Select counties in Suburban Indiana		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	08/03/2021	2022.01	08/03/2021 02:16:11 PM Eastern Daylight Time	08/03/2021 06:00:51 PM Eastern Daylight Time	07/30/2021 11:27:14 AM Eastern Daylight Time			08/04/2021 02:44:49 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	HumanaChoice H5525-015 (PPO)	01	04		1			H5525	015	0	2022	Select Louisiana Parishes		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	08/01/2021	2022.01	08/01/2021 01:08:23 PM Eastern Daylight Time	08/03/2021 05:35:06 PM Eastern Daylight Time	07/30/2021 11:27:26 AM Eastern Daylight Time			08/04/2021 02:02:31 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	HumanaChoice H5525-017 (PPO)	01	04		1			H5525	017	0	2022	Western Pennsylvania Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	08/01/2021	2022.01	08/01/2021 12:46:38 PM Eastern Daylight Time	08/03/2021 06:44:05 PM Eastern Daylight Time	07/30/2021 11:27:38 AM Eastern Daylight Time			08/04/2021 01:41:24 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	HumanaChoice H5525-020 (PPO)	01	04		1			H5525	020	0	2022	Mobile Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	08/04/2021	2022.01	08/04/2021 01:44:00 PM Eastern Daylight Time	08/03/2021 05:38:03 PM Eastern Daylight Time	07/30/2021 11:27:50 AM Eastern Daylight Time			08/04/2021 01:49:58 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	HumanaChoice H5525-022 (PPO)	01	04		1			H5525	022	0	2022	Select counties in Kentucky		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		1	07/15/2021	2022.01	07/15/2021 01:19:26 PM Eastern Daylight Time	08/03/2021 05:37:42 PM Eastern Daylight Time	07/30/2021 11:28:02 AM Eastern Daylight Time			08/04/2021 02:02:31 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	HumanaChoice H5525-023 (PPO)	01	04		1			H5525	023	0	2022	Select counties in West Virginia		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		0	07/22/2021	2022.01	07/22/2021 04:26:55 PM Eastern Daylight Time	08/03/2021 05:46:32 PM Eastern Daylight Time	07/30/2021 11:28:12 AM Eastern Daylight Time			08/04/2021 02:06:50 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	HumanaChoice H5525-024 (PPO)	01	04		1			H5525	024	0	2022	Select Counties in Georgia and South Carolina		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		1	08/02/2021	2022.01	08/02/2021 12:33:15 PM Eastern Daylight Time	08/03/2021 10:04:18 PM Eastern Daylight Time	07/30/2021 11:28:24 AM Eastern Daylight Time			08/04/2021 02:18:12 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	HumanaChoice H5525-026 (PPO)	01	04		1			H5525	026	0	2022	Select Counties in North Carolina		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	08/04/2021	2022.01	08/04/2021 02:18:25 PM Eastern Daylight Time	08/03/2021 06:42:31 PM Eastern Daylight Time	07/30/2021 11:28:36 AM Eastern Daylight Time			08/04/2021 02:25:33 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	HumanaChoice H5525-027 (PPO)	01	04		1			H5525	027	0	2022	Select Counties in Montana		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		0	07/15/2021	2022.01	07/15/2021 03:44:05 PM Eastern Daylight Time	08/03/2021 06:14:01 PM Eastern Daylight Time	07/30/2021 11:28:48 AM Eastern Daylight Time			08/04/2021 01:22:33 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	HumanaChoice H5525-030 (PPO)	01	04		1			H5525	030	0	2022	Ohio & N KY		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1			2	0	0	07/28/2021	2022.01	07/28/2021 10:11:11 AM Eastern Daylight Time	07/23/2021 04:28:25 PM Eastern Daylight Time				07/28/2021 01:05:49 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	Humana Honor (PPO)	01	04		1			H5525	031	0	2022	Select Counties in Montana		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_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	034	0	1	04	01	H5525_034_0	4	1			1		0	08/02/2021	2022.01	08/02/2021 03:05:43 PM Eastern Daylight Time	08/03/2021 09:48:25 PM Eastern Daylight Time	07/30/2021 11:29:00 AM Eastern Daylight Time			08/04/2021 02:08:22 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	HumanaChoice H5525-034 (PPO)	01	04		1			H5525	034	0	2022	Wilmington Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		1	08/02/2021	2022.01	08/02/2021 12:29:59 PM Eastern Daylight Time	08/03/2021 10:07:52 PM Eastern Daylight Time	07/30/2021 11:29:12 AM Eastern Daylight Time			08/04/2021 02:18:12 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	HumanaChoice H5525-035 (PPO)	01	04		1			H5525	035	0	2022	Select Counties in North Carolina		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	6	1	2	1	1		0	08/02/2021	2022.01	08/02/2021 12:31:43 PM Eastern Daylight Time	08/03/2021 10:08:14 PM Eastern Daylight Time	07/30/2021 11:29:22 AM Eastern Daylight Time			08/04/2021 02:18:12 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	HumanaChoice SNP-DE H5525-036 (PPO D-SNP)	01	04		1			H5525	036	0	2022	Greater North Carolina Area		2		2			1	3		2		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		0	07/23/2021	2022.01	07/23/2021 09:46:45 AM Eastern Daylight Time	08/03/2021 06:44:06 PM Eastern Daylight Time	07/30/2021 11:29:34 AM Eastern Daylight Time			08/04/2021 02:44:49 PM 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	2022	Select Louisiana Parishes		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		0	07/08/2021	2022.01	07/08/2021 05:50:14 PM Eastern Daylight Time	08/03/2021 05:47:12 PM Eastern Daylight Time	07/30/2021 11:29:46 AM Eastern Daylight Time			08/04/2021 02:02:31 PM 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	2022	Pennsylvania		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		0	08/04/2021	2022.01	08/04/2021 01:44:10 PM Eastern Daylight Time	08/03/2021 05:54:34 PM Eastern Daylight Time	07/30/2021 11:29:58 AM Eastern Daylight Time			08/04/2021 01:49:58 PM 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	2022	Select Counties in Kentucky		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		0	07/08/2021	2022.01	07/08/2021 03:36:50 PM Eastern Daylight Time	08/03/2021 06:15:47 PM Eastern Daylight Time	07/30/2021 11:30:10 AM Eastern Daylight Time			08/04/2021 01:22:33 PM 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	2022	Select counties in Ohio		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		0	07/31/2021	2022.01	07/31/2021 02:51:54 PM Eastern Daylight Time	08/03/2021 06:08:02 PM Eastern Daylight Time	07/30/2021 11:30:22 AM Eastern Daylight Time			08/04/2021 01:22:33 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	HumanaChoice H5525-042 (PPO)	01	04		1			H5525	042	0	2022	Select counties in Ohio		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	044	0	1	04	01	H5525_044_0	4	1			1		1	07/31/2021	2022.01	07/31/2021 07:10:03 PM Eastern Daylight Time	08/03/2021 05:49:01 PM Eastern Daylight Time	07/30/2021 11:30:34 AM Eastern Daylight Time			08/04/2021 01:49:58 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	HumanaChoice H5525-044 (PPO)	01	04		1			H5525	044	0	2022	Select Counties in Kentucky		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	045	0	1	04	01	H5525_045_0	7	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 01:44:27 PM Eastern Daylight Time	08/03/2021 05:59:35 PM Eastern Daylight Time	07/30/2021 11:30:44 AM Eastern Daylight Time			08/04/2021 01:49:58 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	HumanaChoice SNP-DE H5525-045 (PPO D-SNP)	01	04		1			H5525	045	0	2022	Select Counties in Kentucky		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	046	0	1	04	01	H5525_046_0	4	1	2	1	1		0	07/08/2021	2022.01	07/08/2021 03:39:08 PM Eastern Daylight Time	08/03/2021 06:20:38 PM Eastern Daylight Time	07/30/2021 11:30:56 AM Eastern Daylight Time			08/04/2021 01:22:33 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	HumanaChoice SNP-DE H5525-046 (PPO D-SNP)	01	04		1			H5525	046	0	2022	Select counties in Ohio		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	048	0	1	04	01	H5525_048_0	4	1	2	1	1		0	07/08/2021	2022.01	07/08/2021 03:59:08 PM Eastern Daylight Time	08/03/2021 06:21:39 PM Eastern Daylight Time	07/30/2021 11:31:08 AM Eastern Daylight Time			08/04/2021 02:15:03 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	HumanaChoice SNP-DE H5525-048 (PPO D-SNP)	01	04		1			H5525	048	0	2022	Select counties in Indiana		2		2			1	3		2		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	049	0	1	04	01	H5525_049_0	5	1			1		0	07/15/2021	2022.01	07/15/2021 02:09:51 PM Eastern Daylight Time	08/03/2021 10:12:57 PM Eastern Daylight Time	07/30/2021 11:31:20 AM Eastern Daylight Time			08/04/2021 02:08:22 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	HumanaChoice H5525-049 (PPO)	01	04		1			H5525	049	0	2022	Eastern North Carolina		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	050	0	1	04	01	H5525_050_0	3	1			2		0	08/02/2021	2022.01	08/02/2021 12:22:33 PM Eastern Daylight Time	08/03/2021 10:14:34 PM Eastern Daylight Time	07/30/2021 11:31:32 AM Eastern Daylight Time			08/04/2021 02:08:22 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	HumanaChoice H5525-050 (PPO)	01	04		1			H5525	050	0	2022	Eastern and Northwest North Carolina		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	051	1	1	04	01	H5525_051_1	5	1			1		1	07/31/2021	2022.01	07/31/2021 05:53:10 PM Eastern Daylight Time	08/03/2021 06:03:26 PM Eastern Daylight Time	07/30/2021 11:31:42 AM Eastern Daylight Time			08/04/2021 02:02:31 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	HumanaChoice H5525-051 (PPO)	01	04		1			H5525	051	1	2022	Pennsylvania	Pennsylvania	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	051	2	1	04	01	H5525_051_2	5	1			1		1	08/01/2021	2022.01	08/01/2021 01:09:23 PM Eastern Daylight Time	08/03/2021 06:03:46 PM Eastern Daylight Time	07/30/2021 11:31:54 AM Eastern Daylight Time			08/04/2021 02:02:31 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	HumanaChoice H5525-051 (PPO)	01	04		1			H5525	051	2	2022	Pennsylvania	Greater Philadelphia	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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						05/24/2021	2022.01	05/24/2021 03:41:30 PM Eastern Daylight Time					06/03/2021 01:38:12 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	2022	Select Counties in Multi-States		1	228524	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242		(866)396-8810		(866)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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H5525	810	0	1	04	01	H5525_810_0	1	1				0	0	05/24/2021	2022.01	05/24/2021 03:46:10 PM Eastern Daylight Time					06/03/2021 01:38:12 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	2022	Select Counties in Multi-States		1	10897	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H5525	812	0	2	04	01	H5525_812_0	1	1						05/24/2021	2022.01	05/24/2021 03:50:37 PM Eastern Daylight Time					06/03/2021 01:38:12 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	2022	Select Counties in Multi-States		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242		(866)396-8810		(866)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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H5525	813	0	2	04	01	H5525_813_0	1	1				0	0	05/24/2021	2022.01	05/24/2021 03:55:21 PM Eastern Daylight Time					06/03/2021 01:38:12 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	2022	Select Counties in Multi-States		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H5525	816	0	1	04	01	H5525_816_0	1	1						05/24/2021	2022.01	05/24/2021 04:04:30 PM Eastern Daylight Time					06/03/2021 01:38:12 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H5525	816	0	2022	Select Counties in Multi-States		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242		(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242		(711)-	711	(711)-	711	(711)-	711	(711)-	711	(711)-	711	(711)-	711	(711)-	711	(711)-	711	1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H5525	817	0	1	04	01	H5525_817_0	1	1				0	0	05/25/2021	2022.01	05/25/2021 10:26:15 AM Eastern Daylight Time					06/03/2021 01:38:12 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H5525	817	0	2022	Select Counties in Multi-States		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H5525	818	0	1	04	01	H5525_818_0	1	1						05/25/2021	2022.01	05/25/2021 10:33:20 AM Eastern Daylight Time					06/03/2021 01:38:12 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H5525	818	0	2022	Select Counties in Multi-States		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242		(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242		(711)-	711	(711)-	711	(711)-	711	(711)-	711	(711)-	711	(711)-	711	(711)-	711	(711)-	711	1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H5525	819	0	1	04	01	H5525_819_0	1	1				0	0	05/25/2021	2022.01	05/25/2021 10:41:34 AM Eastern Daylight Time					06/03/2021 01:38:12 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H5525	819	0	2022	Select Counties in Multi-States		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H5525	820	0	1	04	01	H5525_820_0	1	1						05/25/2021	2022.01	05/25/2021 10:47:53 AM Eastern Daylight Time					06/03/2021 01:38:12 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H5525	820	0	2022	Select Counties in Multi-States		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242		(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242		(711)-	711	(711)-	711	(711)-	711	(711)-	711	(711)-	711	(711)-	711	(711)-	711	(711)-	711	1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H5525	821	0	1	04	01	H5525_821_0	1	1				0	0	05/25/2021	2022.01	05/25/2021 10:51:49 AM Eastern Daylight Time					06/03/2021 01:38:12 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H5525	821	0	2022	Select Counties in Multi-States		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H5526	004	0	1	04	01	H5526_004_0	6	1					1	07/16/2021	2022.01	07/16/2021 12:37:19 PM Eastern Daylight Time	08/05/2021 10:58:11 AM Eastern Daylight Time	08/05/2021 11:05:57 AM Eastern Daylight Time			08/05/2021 11:34:20 AM Eastern Daylight Time	Highmark Western and Northeastern New York Inc.	BlueCross BlueShield of WNY and BlueShield of NENY	www.bcbswny.com/medicare	Highmark Blue Cross Blue Shield Forever Blue 751 (PPO)	01	04		1			H5526	004	0	2022	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	5	1					1	07/16/2021	2022.01	07/16/2021 12:37:23 PM Eastern Daylight Time	08/05/2021 10:58:17 AM Eastern Daylight Time	08/05/2021 11:05:59 AM Eastern Daylight Time			08/05/2021 11:34:20 AM Eastern Daylight Time	Highmark Western and Northeastern New York Inc.	BlueCross BlueShield of WNY and BlueShield of NENY	www.bcbswny.com/medicare	Highmark Blue Cross Blue Shield Forever Blue Value (PPO)	01	04		1			H5526	016	0	2022	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	5	1					1	07/16/2021	2022.01	07/16/2021 12:37:26 PM Eastern Daylight Time	08/05/2021 10:58:23 AM Eastern Daylight Time	08/05/2021 11:05:32 AM Eastern Daylight Time			08/05/2021 11:34:20 AM Eastern Daylight Time	Highmark Western and Northeastern New York Inc.	BlueCross BlueShield of WNY and BlueShield of NENY	www.bsneny.com/medicare	Highmark Blue Shield Forever Blue 770 (PPO)	01	04		1			H5526	018	0	2022	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	020	0	1	04	01	H5526_020_0	5	1					1	07/16/2021	2022.01	07/16/2021 12:37:30 PM Eastern Daylight Time	08/05/2021 10:58:29 AM Eastern Daylight Time	08/05/2021 11:05:34 AM Eastern Daylight Time			08/05/2021 11:34:20 AM Eastern Daylight Time	Highmark Western and Northeastern New York Inc.	BlueCross BlueShield of WNY and BlueShield of NENY	www.bcbswny.com/medicare	Highmark Blue Cross Blue Shield Freedom Nation (PPO)	01	04		1			H5526	020	0	2022	Western New York		2	500	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	021	0	1	04	01	H5526_021_0	5	1					1	08/03/2021	2022.01	08/03/2021 05:49:08 PM Eastern Daylight Time	08/05/2021 10:58:34 AM Eastern Daylight Time	08/05/2021 11:05:36 AM Eastern Daylight Time			08/05/2021 11:34:20 AM Eastern Daylight Time	Highmark Western and Northeastern New York Inc.	BlueCross BlueShield of WNY and BlueShield of NENY	www.bsneny.com/medicare	Highmark Blue Shield Freedom Nation (PPO)	01	04		1			H5526	021	0	2022	Northeastern New York		2	500	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	022	0	1	04	01	H5526_022_0	5	1					0	08/03/2021	2022.01	08/03/2021 05:52:49 PM Eastern Daylight Time	08/05/2021 10:58:40 AM Eastern Daylight Time	08/05/2021 11:05:38 AM Eastern Daylight Time			08/05/2021 11:34:20 AM Eastern Daylight Time	Highmark Western and Northeastern New York Inc.	BlueCross BlueShield of WNY and BlueShield of NENY	www.bsneny.com/medicare	Highmark Blue Shield Freedom Basic (PPO)	01	04		1			H5526	022	0	2022	Northeastern New York		2		2			2						www.bcbswny.com	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	1	1				0	0	06/07/2021	2022.01	06/07/2021 01:50:15 PM Eastern Daylight Time					06/07/2021 02:10:18 PM Eastern Daylight Time	Highmark Western and Northeastern 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	2022	Western and Northeastern New York		1	14920	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;8a;8b1;8b2;9a1;9b;10a;11a;11b;11c;15;	2		1									
H5526	808	0	1	04	01	H5526_808_0	1	1						06/07/2021	2022.01	06/07/2021 01:50:50 PM Eastern Daylight Time					06/07/2021 02:10:18 PM Eastern Daylight Time	Highmark Western and Northeastern 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	2022	Western and Northeastern New York		1	101396	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;8a;8b1;8b2;9a1;9b;10a;11a;11b;11c;15;	2		1									
H5528	807	0	1	04	01	H5528_807_0	2	1						06/06/2021	2022.01	06/06/2021 05:45:24 PM Eastern Daylight Time					06/07/2021 04:16:18 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	2022	United States		1	456	2			2						www.emblemhealth.com	www.emblemhealth.com		(866)557-7300		(866)557-7300		(800)447-9169		(800)447-9169		(866)557-7300		(866)557-7300		(800)447-9169		(800)447-9169		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5528	815	0	1	04	01	H5528_815_0	2	1				0	0	06/03/2021	2022.01	06/03/2021 08:05:43 AM Eastern Daylight Time					06/07/2021 04:16:18 PM Eastern Daylight Time	GROUP HEALTH INCORPORATED	EmblemHealth Medicare PPO	www.emblemhealth.com/our-plans/medicare	EmblemHealth Group Access Rx Carveout (PPO)	01	04		1			H5528	815	0	2022	United States		1	600	2			2						www.emblemhealth.com	www.emblemhealth.com		(866)557-7300		(866)557-7300		(800)447-9169		(800)447-9169										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5533	003	0	1	04	01	H5533_003_0	8	1					1	08/04/2021	2022.01	08/04/2021 02:53:29 PM Eastern Daylight Time	08/05/2021 08:15:10 AM Eastern Daylight Time	08/05/2021 12:27:19 PM Eastern Daylight Time			08/05/2021 01:57:30 PM Eastern Daylight Time	UPMC HEALTH NETWORK, INC.	UPMC for Life	https://www.upmchealthplan.com/medicare/	UPMC for Life PPO High Deductible Rx (PPO)	01	04		1			H5533	003	0	2022	Western and Central Pennsylvania		2	43126	2			2						https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/	https://findcare.upmchealthplan.com/browse?caretype=Medical	(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						1	11	7b;	7b1;
H5533	005	0	1	04	01	H5533_005_0	8	1					1	08/04/2021	2022.01	08/04/2021 02:54:27 PM Eastern Daylight Time	08/05/2021 08:15:12 AM Eastern Daylight Time	08/05/2021 12:27:21 PM Eastern Daylight Time			08/05/2021 01:57:30 PM Eastern Daylight Time	UPMC HEALTH NETWORK, INC.	UPMC for Life	https://www.upmchealthplan.com/medicare/	UPMC for Life PPO Rx Enhanced (PPO)	01	04		1			H5533	005	0	2022	Western Pennsylvania		2	36005	2			2						https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/	https://findcare.upmchealthplan.com/browse?caretype=Medical	(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						1	11	7b;	7b1;
H5533	007	0	1	04	01	H5533_007_0	7	1					1	08/04/2021	2022.01	08/04/2021 02:55:33 PM Eastern Daylight Time	08/05/2021 08:15:14 AM Eastern Daylight Time	08/05/2021 12:27:23 PM Eastern Daylight Time			08/05/2021 01:57:30 PM Eastern Daylight Time	UPMC HEALTH NETWORK, INC.	UPMC for Life	https://www.upmchealthplan.com/medicare/	UPMC for Life PPO Rx Enhanced (PPO)	01	04		1			H5533	007	0	2022	Berks County		2	3105	2			2						https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/	https://findcare.upmchealthplan.com/browse?caretype=Medical	(844)870-2231		(844)870-2231		(877)381-3765		(877)381-3765		(844)870-2231		(844)870-2231		(877)381-3765		(877)381-3765		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						1	11	7b;	7b1;
H5533	008	0	1	04	01	H5533_008_0	8	1					1	08/04/2021	2022.01	08/04/2021 03:09:34 PM Eastern Daylight Time	08/05/2021 08:15:16 AM Eastern Daylight Time	08/05/2021 12:27:25 PM Eastern Daylight Time			08/05/2021 01:57:30 PM Eastern Daylight Time	UPMC HEALTH NETWORK, INC.	UPMC for Life	https://www.upmchealthplan.com/medicare/	UPMC for Life PPO Rx Enhanced (PPO)	01	04		1			H5533	008	0	2022	South Central Pennsylvania		2	5787	2			2						https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/	https://findcare.upmchealthplan.com/browse?caretype=Medical	(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						1	11	7b;	7b1;
H5533	009	0	1	04	01	H5533_009_0	6	1					1	08/04/2021	2022.01	08/04/2021 03:00:50 PM Eastern Daylight Time	08/05/2021 08:15:18 AM Eastern Daylight Time	08/05/2021 12:27:27 PM Eastern Daylight Time			08/05/2021 01:57:30 PM Eastern Daylight Time	UPMC HEALTH NETWORK, INC.	UPMC for Life	https://www.upmchealthplan.com/medicare/	UPMC for Life PPO Rx Choice (PPO)	01	04		1			H5533	009	0	2022	Lehigh Capital		2	5664	2			2						https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/	https://findcare.upmchealthplan.com/browse?caretype=Medical	(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						1	01	7b;	
H5533	010	0	1	04	01	H5533_010_0	7	1					1	08/04/2021	2022.01	08/04/2021 03:02:56 PM Eastern Daylight Time	08/05/2021 08:15:20 AM Eastern Daylight Time	08/05/2021 12:27:29 PM Eastern Daylight Time			08/05/2021 01:57:30 PM Eastern Daylight Time	UPMC HEALTH NETWORK, INC.	UPMC for Life	https://www.upmchealthplan.com/medicare/	UPMC for Life PPO Flex Rx (PPO)	01	04		1			H5533	010	0	2022	North Central Pennsylvania		2	6522	2			2						https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/	https://findcare.upmchealthplan.com/browse?caretype=Medical	(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						1	01	7b;	
H5533	011	0	1	04	01	H5533_011_0	6	1					1	08/04/2021	2022.01	08/04/2021 03:04:15 PM Eastern Daylight Time	08/05/2021 08:15:22 AM Eastern Daylight Time	08/05/2021 12:27:30 PM Eastern Daylight Time			08/05/2021 01:57:30 PM Eastern Daylight Time	UPMC HEALTH NETWORK, INC.	UPMC for Life	https://www.upmchealthplan.com/medicare/	UPMC for Life PPO Flex Rx (PPO)	01	04		1			H5533	011	0	2022	Lehigh Capital		2	8196	2			2						https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/	https://findcare.upmchealthplan.com/browse?caretype=Medical	(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						1	01	7b;	
H5533	801	0	1	04	01	H5533_801_0	1	1				0	0	05/26/2021	2022.01	05/26/2021 11:09:37 AM Eastern Daylight Time					06/02/2021 08:16:51 AM Eastern Daylight Time	UPMC HEALTH NETWORK, INC.	UPMC for Life	http://www.upmchealthplan.com/medicare/	UPMC Employer Group (PPO)	01	04		1			H5533	801	0	2022	Western Pennsylvania		1	36	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										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;6;7b;7c;7d;7i;7k;8a;8b1;8b2;9a1;9a2;9b;10a;11a;11b;15;	2		1									
H5533	802	0	1	04	01	H5533_802_0	1	1						05/26/2021	2022.01	05/26/2021 11:13:49 AM Eastern Daylight Time					06/02/2021 08:16:51 AM Eastern Daylight Time	UPMC HEALTH NETWORK, INC.	UPMC for Life	http://www.upmchealthplan.com/medicare/	UPMC Employer Group Rx (PPO)	01	04		1			H5533	802	0	2022	Western Pennsylvania		1	6179	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;6;7b;7c;7d;7i;7k;8a;8b1;8b2;9a1;9a2;9b;10a;11a;11b;15;	2		1									
H5533	803	0	1	04	01	H5533_803_0	1	1						05/26/2021	2022.01	05/26/2021 11:17:21 AM Eastern Daylight Time					06/02/2021 08:16:51 AM Eastern Daylight Time	UPMC HEALTH NETWORK, INC.	UPMC for Life	http://www.upmchealthplan.com/medicare/	UPMC Employer Group Rx (PPO)	01	04		1			H5533	803	0	2022	Western Pennsylvania		1	0	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;6;7b;7c;7d;7i;7k;8a;8b1;8b2;9a1;9a2;9b;10a;11a;11b;15;	2		1									
H5549	003	0	1	01	01	H5549_003_0	10	1	2	1	1		0	08/05/2021	2022.01	08/05/2021 05:10:44 PM Eastern Daylight Time	08/05/2021 04:58:36 PM Eastern Daylight Time	08/05/2021 04:58:36 PM Eastern Daylight Time			08/05/2021 05:37:19 PM Eastern Daylight Time	VNS CHOICE	VNSNY CHOICE Medicare	www.vnsnychoice.org	VNSNY CHOICE Total (HMO D-SNP)	01	01		1			H5549	003	0	2022	New York Metro Area		2	42930	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			
H5549	011	0	1	01	01	H5549_011_0	8	1	2	1	1		0	08/05/2021	2022.01	08/05/2021 05:10:49 PM Eastern Daylight Time	08/05/2021 04:58:36 PM Eastern Daylight Time	08/05/2021 04:58:36 PM Eastern Daylight Time			08/05/2021 05:37:19 PM Eastern Daylight Time	VNS CHOICE	VNSNY CHOICE Medicare	www.vnsnychoice.org	VNSNY CHOICE EasyCare Plus (HMO D-SNP)	01	01		1			H5549	011	0	2022	New York Metro Area		2	17525	2			1	3		2		2	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			
H5549	012	0	1	01	01	H5549_012_0	7	1			1		0	08/05/2021	2022.01	08/05/2021 05:10:54 PM Eastern Daylight Time	08/05/2021 04:58:36 PM Eastern Daylight Time	08/05/2021 04:58:36 PM Eastern Daylight Time			08/05/2021 05:37:19 PM Eastern Daylight Time	VNS CHOICE	VNSNY CHOICE Medicare	www.vnsnychoice.org	VNSNY CHOICE EasyCare (HMO)	01	01		1			H5549	012	0	2022	New York Metro Area		2	8870	2			2						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	017	1	1	02	01	H5576_017_1	11	1					1	07/14/2021	2022.01	07/14/2021 05:15:03 PM Central Daylight Time	07/30/2021 05:11:58 PM Central Daylight Time	07/29/2021 08:20:46 PM Central Daylight Time			08/04/2021 04:19:41 PM Central Daylight Time	VANTAGE HEALTH PLAN, INC.	Vantage Health Plan	www.VantageMedicare.com	Vantage STANDARD (HMO-POS)	01	02		1			H5576	017	1	2022	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	3-4;7c;7d;7e1;7e2;7f;7g;7h1;7h2;7i;7j;8b1;9a1;9c;11c1;14e2;17a;	
H5576	017	2	1	02	01	H5576_017_2	11	1					1	08/01/2021	2022.01	08/01/2021 06:25:01 PM Central Daylight Time	07/30/2021 05:13:06 PM Central Daylight Time	07/29/2021 08:21:22 PM Central Daylight Time			08/04/2021 10:51:39 AM Central Daylight Time	VANTAGE HEALTH PLAN, INC.	Vantage Health Plan	www.VantageMedicare.com	Vantage STANDARD (HMO-POS)	01	02		1			H5576	017	2	2022	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	11	1					1	07/15/2021	2022.01	07/15/2021 10:27:36 AM Central Daylight Time	07/30/2021 05:16:02 PM Central Daylight Time	07/29/2021 08:21:52 PM Central Daylight Time			08/04/2021 10:51:39 AM Central Daylight Time	VANTAGE HEALTH PLAN, INC.	Vantage Health Plan	www.VantageMedicare.com	Vantage PREMIUM (HMO-POS)	01	02		1			H5576	018	1	2022	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	3-4;7c;7d;7e1;7e2;7f;7g;7h1;7h2;7i;7j;8b1;9a1;9c;11c1;14e2;17a;	
H5576	018	2	1	02	01	H5576_018_2	11	1					1	07/15/2021	2022.01	07/15/2021 10:28:40 AM Central Daylight Time	07/30/2021 05:19:14 PM Central Daylight Time	07/29/2021 08:22:16 PM Central Daylight Time			08/04/2021 10:51:39 AM Central Daylight Time	VANTAGE HEALTH PLAN, INC.	Vantage Health Plan	www.VantageMedicare.com	Vantage PREMIUM (HMO-POS)	01	02		1			H5576	018	2	2022	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	10	1	2	1			0	08/01/2021	2022.01	08/01/2021 06:35:13 PM Central Daylight Time	07/30/2021 05:22:04 PM Central Daylight Time	07/29/2021 08:22:42 PM Central Daylight Time			08/04/2021 10:51:39 AM Central Daylight Time	VANTAGE HEALTH PLAN, INC.	Vantage Health Plan	www.VantageMedicare.com	Vantage DUAL PLUS (HMO-POS D-SNP)	01	02		1			H5576	019	0	2022	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	11	1					1	08/01/2021	2022.01	08/01/2021 06:44:04 PM Central Daylight Time	07/30/2021 05:22:54 PM Central Daylight Time	07/29/2021 08:23:42 PM Central Daylight Time			08/04/2021 10:51:39 AM Central Daylight Time	VANTAGE HEALTH PLAN, INC.	Vantage Health Plan	www.VantageMedicare.com	Vantage BASIC (HMO-POS)	01	02		1			H5576	020	1	2022	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	3-4;7c;7d;7e1;7e2;7f;7g;7h1;7h2;7i;7j;8b1;9a1;9c;11c1;14e2;17a;	
H5576	020	2	1	02	01	H5576_020_2	11	1					1	08/01/2021	2022.01	08/01/2021 06:53:11 PM Central Daylight Time	07/30/2021 05:23:50 PM Central Daylight Time	07/29/2021 08:24:10 PM Central Daylight Time			08/04/2021 10:51:39 AM Central Daylight Time	VANTAGE HEALTH PLAN, INC.	Vantage Health Plan	www.VantageMedicare.com	Vantage BASIC (HMO-POS)	01	02		1			H5576	020	2	2022	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	11	1					1	07/14/2021	2022.01	07/14/2021 10:50:01 AM Central Daylight Time	07/30/2021 05:24:42 PM Central Daylight Time	07/29/2021 08:24:54 PM Central Daylight Time			08/04/2021 10:51:39 AM Central Daylight Time	VANTAGE HEALTH PLAN, INC.	Vantage Health Plan	www.VantageMedicare.com	Vantage 100 (HMO-POS)	01	02		1			H5576	022	0	2022	Central and North 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	801	0	1	02	01	H5576_801_0	7	1						05/12/2021	2022.01	05/12/2021 08:06:34 PM Central Daylight Time					06/06/2021 07:04:41 PM Central Daylight Time	VANTAGE HEALTH PLAN, INC.	Vantage Health Plan	www.VantageMedicare.com	Vantage - MAPD Employer Calendar (HMO-POS)	01	02		1			H5576	801	0	2022	Louisiana		1	17772	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	7	1						04/12/2021	2022.01	04/12/2021 05:01:11 PM Central Daylight Time					06/06/2021 07:04:41 PM Central Daylight Time	VANTAGE HEALTH PLAN, INC.	Vantage Health Plan	www.VantageMedicare.com	Vantage - MAPD Emp Non-Calendar (HMO-POS)	01	02		1			H5576	802	0	2022	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	7	1				0	0	04/19/2021	2022.01	04/19/2021 01:42:57 PM Central Daylight Time					06/06/2021 07:04:41 PM Central Daylight Time	VANTAGE HEALTH PLAN, INC.	Vantage Health Plan	www.VantageMedicare.com	Vantage - MA Employer Calendar (HMO-POS)	01	02		1			H5576	803	0	2022	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	3	1	1	1	1		0	08/04/2021	2022.01	08/04/2021 01:23:41 PM SA Western Standard Time	08/05/2021 12:48:05 PM SA Western Standard Time	08/05/2021 12:48:05 PM SA Western Standard Time			08/05/2021 01:16:12 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare Platino Ideal (HMO D-SNP)	01	01		1			H5577	002	0	2022	Puerto Rico		2	519875	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			1		1	08/04/2021	2022.01	08/04/2021 01:24:04 PM SA Western Standard Time	08/05/2021 12:48:05 PM SA Western Standard Time	08/05/2021 12:48:05 PM SA Western Standard Time			08/05/2021 01:16:12 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare Efectivo (HMO)	01	01		1			H5577	005	0	2022	Puerto Rico		2	282985	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	8a2;	
H5577	008	0	1	02	01	H5577_008_0	4	1			1		1	08/04/2021	2022.01	08/04/2021 01:24:18 PM SA Western Standard Time	08/05/2021 12:48:06 PM SA Western Standard Time	08/05/2021 12:48:06 PM SA Western Standard Time			08/05/2021 01:16:12 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare Essential (HMO-POS)	01	02		1			H5577	008	0	2022	Puerto Rico		2	190643	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	8a2;	
H5577	014	0	1	01	01	H5577_014_0	3	1			1		0	08/04/2021	2022.01	08/04/2021 01:24:35 PM SA Western Standard Time	08/05/2021 12:48:06 PM SA Western Standard Time	08/05/2021 12:48:06 PM SA Western Standard Time			08/05/2021 01:16:12 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare MediCa$h (HMO)	01	01		1			H5577	014	0	2022	Puerto Rico		2	8688	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	2	1			1	0	0	07/16/2021	2022.01	07/16/2021 02:55:11 PM SA Western Standard Time	06/07/2021 04:59:40 PM SA Western Standard Time				07/16/2021 05:03:07 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare MediOnly (HMO)	01	01		1			H5577	016	0	2022	Puerto Rico		2	6909	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	8a2;	
H5577	017	0	1	01	01	H5577_017_0	3	1	1	1	1		0	08/04/2021	2022.01	08/04/2021 01:24:58 PM SA Western Standard Time	08/05/2021 12:48:06 PM SA Western Standard Time	08/05/2021 12:48:07 PM SA Western Standard Time			08/05/2021 01:16:12 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare Platino Progreso (HMO D-SNP)	01	01		1			H5577	017	0	2022	Puerto Rico		2	329349	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	3	1	1	1	1		0	08/04/2021	2022.01	08/04/2021 01:25:20 PM SA Western Standard Time	08/05/2021 12:48:07 PM SA Western Standard Time	08/05/2021 12:48:07 PM SA Western Standard Time			08/05/2021 01:16:12 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare Platino MsCa$h (HMO D-SNP)	01	01		1			H5577	029	0	2022	Puerto Rico		2	92365	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	031	0	1	01	01	H5577_031_0	4	1			1		1	08/04/2021	2022.01	08/04/2021 01:25:36 PM SA Western Standard Time	08/05/2021 12:48:07 PM SA Western Standard Time	08/05/2021 12:48:07 PM SA Western Standard Time			08/05/2021 01:16:12 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare Activo (HMO)	01	01		1			H5577	031	0	2022	Puerto Rico		2	230500	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	8a2;	
H5577	036	0	1	01	01	H5577_036_0	3	1	1	1	1		0	08/04/2021	2022.01	08/04/2021 01:25:54 PM SA Western Standard Time	08/05/2021 12:48:08 PM SA Western Standard Time	08/05/2021 12:48:08 PM SA Western Standard Time			08/05/2021 01:16:12 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare Platino Recarga (HMO D-SNP)	01	01		1			H5577	036	0	2022	Puerto Rico		2	112750	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	037	0	1	01	01	H5577_037_0	3	1	1	1	1		0	08/04/2021	2022.01	08/04/2021 01:26:16 PM SA Western Standard Time	08/05/2021 12:48:08 PM SA Western Standard Time	08/05/2021 12:48:08 PM SA Western Standard Time			08/05/2021 01:16:12 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare Platino @Home (HMO D-SNP)	01	01		1			H5577	037	0	2022	Puerto Rico		2	23615	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	038	0	1	01	01	H5577_038_0	4	1		1	1		1	08/04/2021	2022.01	08/04/2021 01:26:34 PM SA Western Standard Time	08/05/2021 12:48:08 PM SA Western Standard Time	08/05/2021 12:48:09 PM SA Western Standard Time			08/05/2021 01:16:12 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare Primero (HMO C-SNP)	01	01		1			H5577	038	0	2022	Puerto Rico		2	16455	2			1	4			00000000000000000010		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	8a2;	
H5577	039	0	1	01	01	H5577_039_0	4	1			1		1	08/04/2021	2022.01	08/04/2021 01:26:56 PM SA Western Standard Time	08/05/2021 12:48:09 PM SA Western Standard Time	08/05/2021 12:48:09 PM SA Western Standard Time			08/05/2021 01:16:12 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare SuperRx (HMO)	01	01		1			H5577	039	0	2022	Puerto Rico		2	7090	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	8a2;	
H5577	041	0	1	01	01	H5577_041_0	3	1	1	1	1		0	08/04/2021	2022.01	08/04/2021 01:27:16 PM SA Western Standard Time	08/05/2021 12:48:09 PM SA Western Standard Time	08/05/2021 12:48:09 PM SA Western Standard Time			08/05/2021 01:16:12 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare Platino Solido (HMO D-SNP)	01	01		1			H5577	041	0	2022	Puerto Rico West 39		2	99150	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	042	0	1	01	01	H5577_042_0	4	1			1		1	08/04/2021	2022.01	08/04/2021 01:27:33 PM SA Western Standard Time	08/05/2021 12:48:09 PM SA Western Standard Time	08/05/2021 12:48:10 PM SA Western Standard Time			08/05/2021 01:16:12 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare Firme (HMO)	01	01		1			H5577	042	0	2022	Puerto Rico West 39		2	50180	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	8a2;	
H5577	043	0	1	01	01	H5577_043_0	4	1			1		1	08/04/2021	2022.01	08/04/2021 01:27:52 PM SA Western Standard Time	08/05/2021 12:48:10 PM SA Western Standard Time	08/05/2021 12:48:10 PM SA Western Standard Time			08/05/2021 01:16:12 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare En Tu Hogar (HMO)	01	01		1			H5577	043	0	2022	Puerto Rico		2	12825	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	8a2;	
H5577	044	0	1	01	01	H5577_044_0	4	1			1		1	08/04/2021	2022.01	08/04/2021 01:28:08 PM SA Western Standard Time	08/05/2021 12:48:10 PM SA Western Standard Time	08/05/2021 12:48:10 PM SA Western Standard Time			08/05/2021 01:16:12 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare Hero (HMO)	01	01		1			H5577	044	0	2022	Puerto Rico		2	34400	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	8a2;	
H5577	045	0	1	01	01	H5577_045_0	4	1		1	1		1	08/04/2021	2022.01	08/04/2021 01:28:27 PM SA Western Standard Time	08/05/2021 12:48:11 PM SA Western Standard Time	08/05/2021 12:48:11 PM SA Western Standard Time			08/05/2021 01:16:12 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare CeroCeroCero (HMO C-SNP)	01	01		1			H5577	045	0	2022	Puerto Rico West 39		2	16455	2			1	4			00000000000000000010		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	8a2;	
H5577	801	0	1	01	01	H5577_801_0	3	1				0	0	06/05/2021	2022.01	06/05/2021 08:57:15 PM SA Western Standard Time					06/07/2021 05:13:57 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare MA Group (HMO)	01	01		1			H5577	801	0	2022	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;10a;11a;11b;11c;15;16b;	2		2					2				
H5577	802	0	1	01	01	H5577_802_0	3	1						06/05/2021	2022.01	06/05/2021 08:40:30 PM SA Western Standard Time					06/07/2021 05:13:57 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	2022	Puerto Rico		1	75000	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;10a;11a;11b;11c;15;16b;	2		2					2				
H5577	809	0	1	01	01	H5577_809_0	3	1						06/05/2021	2022.01	06/05/2021 08:40:53 PM SA Western Standard Time					06/07/2021 05:13:57 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	2022	Puerto Rico		1	11000	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;10a;11a;11b;11c;15;16b;	2		2					2				
H5577	816	0	1	01	01	H5577_816_0	3	1						06/05/2021	2022.01	06/05/2021 08:42:02 PM SA Western Standard Time					06/07/2021 05:13:57 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare MA-PD Group 2A (HMO)	01	01		1			H5577	816	0	2022	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)627-8183		(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;10a;11a;11b;11c;15;16b;	2		2					2				
H5577	817	0	1	01	01	H5577_817_0	3	1						06/05/2021	2022.01	06/05/2021 08:42:45 PM SA Western Standard Time					06/07/2021 05:13:57 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare MA-PD Group 2B (HMO)	01	01		1			H5577	817	0	2022	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)627-8183		(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;10a;11a;11b;11c;15;16b;	2		2					2				
H5577	818	0	1	01	01	H5577_818_0	3	1						06/05/2021	2022.01	06/05/2021 08:42:54 PM SA Western Standard Time					06/07/2021 05:13:57 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare MA-PD Group 2C (HMO)	01	01		1			H5577	818	0	2022	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)627-8183		(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;10a;11a;11b;11c;15;16b;	2		2					2				
H5577	819	0	1	01	01	H5577_819_0	3	1						06/05/2021	2022.01	06/05/2021 08:43:16 PM SA Western Standard Time					06/07/2021 05:13:57 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare MA-PD Group 2D (HMO)	01	01		1			H5577	819	0	2022	Puerto Rico		1	12000	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;10a;11a;11b;11c;15;16b;	2		2					2				
H5577	820	0	1	01	01	H5577_820_0	3	1						06/05/2021	2022.01	06/05/2021 08:43:40 PM SA Western Standard Time					06/07/2021 05:13:57 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare MA-PD Group 2E (HMO)	01	01		1			H5577	820	0	2022	Puerto Rico		1	54000	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;10a;11a;11b;11c;15;16b;	2		2					2				
H5577	821	0	1	01	01	H5577_821_0	3	1						06/05/2021	2022.01	06/05/2021 08:44:07 PM SA Western Standard Time					06/07/2021 05:13:57 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare MA-PD Group 2F (HMO)	01	01		1			H5577	821	0	2022	Puerto Rico		1	153000	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;10a;11a;11b;11c;15;16b;	2		2					2				
H5577	822	0	1	01	01	H5577_822_0	3	1						06/05/2021	2022.01	06/05/2021 08:44:22 PM SA Western Standard Time					06/07/2021 05:13:57 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare MA-PD Group 2G (HMO)	01	01		1			H5577	822	0	2022	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)627-8183		(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;10a;11a;11b;11c;15;16b;	2		2					2				
H5577	823	0	1	01	01	H5577_823_0	3	1						06/05/2021	2022.01	06/05/2021 08:12:35 PM SA Western Standard Time					06/07/2021 05:13:57 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare MA-PD Group 2H (HMO)	01	01		1			H5577	823	0	2022	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)627-8183		(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;10a;11a;11b;11c;15;16b;	2		2					2				
H5577	824	0	1	01	01	H5577_824_0	3	1						06/05/2021	2022.01	06/05/2021 08:12:52 PM SA Western Standard Time					06/07/2021 05:13:57 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare MA-PD Group 2I (HMO)	01	01		1			H5577	824	0	2022	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)627-8183		(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;10a;11a;11b;11c;15;16b;	2		2					2				
H5577	825	0	1	01	01	H5577_825_0	3	1						06/05/2021	2022.01	06/05/2021 08:13:09 PM SA Western Standard Time					06/07/2021 05:13:57 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare MA-PD Group 2J (HMO)	01	01		1			H5577	825	0	2022	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)627-8183		(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;10a;11a;11b;11c;15;16b;	2		2					2				
H5577	826	0	1	01	01	H5577_826_0	3	1						06/05/2021	2022.01	06/05/2021 08:13:31 PM SA Western Standard Time					06/07/2021 05:13:57 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare MA-PD Group 2K (HMO)	01	01		1			H5577	826	0	2022	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)627-8183		(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;10a;11a;11b;11c;15;16b;	2		2					2				
H5577	827	0	1	01	01	H5577_827_0	3	1						06/05/2021	2022.01	06/05/2021 08:44:44 PM SA Western Standard Time					06/07/2021 05:13:57 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare MA-PD Group 2L (HMO)	01	01		1			H5577	827	0	2022	Puerto Rico		1	28000	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;10a;11a;11b;11c;15;16b;	2		2					2				
H5577	828	0	1	01	01	H5577_828_0	3	1						06/05/2021	2022.01	06/05/2021 08:14:16 PM SA Western Standard Time					06/07/2021 05:13:57 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare MA-PD Group 2M (HMO)	01	01		1			H5577	828	0	2022	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)627-8183		(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;10a;11a;11b;11c;15;16b;	2		2					2				
H5577	829	0	1	01	01	H5577_829_0	3	1						06/05/2021	2022.01	06/05/2021 08:14:32 PM SA Western Standard Time					06/07/2021 05:13:57 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare MA-PD Group 2N (HMO)	01	01		1			H5577	829	0	2022	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)627-8183		(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;10a;11a;11b;11c;15;16b;	2		2					2				
H5577	830	0	1	01	01	H5577_830_0	3	1						06/05/2021	2022.01	06/05/2021 08:14:50 PM SA Western Standard Time					06/07/2021 05:13:57 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare MA-PD Group 2O (HMO)	01	01		1			H5577	830	0	2022	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)627-8183		(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;10a;11a;11b;11c;15;16b;	2		2					2				
H5577	831	0	1	01	01	H5577_831_0	3	1						06/05/2021	2022.01	06/05/2021 08:15:13 PM SA Western Standard Time					06/07/2021 05:13:57 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare MA-PD Group 2P (HMO)	01	01		1			H5577	831	0	2022	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)627-8183		(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;10a;11a;11b;11c;15;16b;	2		2					2				
H5580	001	0	1	01	01	H5580_001_0	7	1	2	1			0	08/03/2021	2022.01	08/03/2021 07:39:39 AM Pacific Daylight Time	08/02/2021 07:51:52 AM Pacific Daylight Time	07/30/2021 05:51:48 PM Pacific Daylight Time			08/03/2021 07:41:05 AM Pacific Daylight Time	MERCY CARE	Mercy Care Advantage	www.MercyCareAz.org	Mercy Care Advantage (HMO D-SNP)	01	01		1			H5580	001	0	2022	Maricopa, Pinal, and Gila Counties		2	127917	2			1	3		1		1	www.MercyCareAz.org	www.MercyCareAz.org	www.MercyCareAz.org	(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	4	1	2	1			0	08/02/2021	2022.01	08/02/2021 01:32:24 PM Pacific Daylight Time	08/02/2021 07:52:34 AM Pacific Daylight Time	07/30/2021 05:52:42 PM Pacific Daylight Time			08/03/2021 07:41:05 AM Pacific Daylight Time	MERCY CARE	Mercy Care Advantage	www.MercyCareAz.org	Mercy Care Advantage (HMO D-SNP)	01	01		1			H5580	004	0	2022	Maricopa, Gila, Pinal, and Pima Counties		2	54632	2			1	3		1		1	www.MercyCareAz.org	www.MercyCareAz.org	www.MercyCareAz.org	(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	4	1	2	1			0	08/02/2021	2022.01	08/02/2021 01:32:38 PM Pacific Daylight Time	08/02/2021 07:53:15 AM Pacific Daylight Time	07/30/2021 05:53:59 PM Pacific Daylight Time			08/03/2021 07:41:05 AM Pacific Daylight Time	MERCY CARE	Mercy Care Advantage	www.MercyCareAz.org	Mercy Care Advantage (HMO D-SNP)	01	01		1			H5580	005	0	2022	Arizona Statewide		2	16186	2			1	3		1		1	www.MercyCareAz.org	www.MercyCareAz.org	www.MercyCareAz.org	(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	5	1	2	1			0	08/04/2021	2022.01	08/04/2021 02:37:32 PM Pacific Daylight Time	08/04/2021 02:35:45 PM Pacific Daylight Time	08/04/2021 02:35:49 PM Pacific Daylight Time			08/04/2021 02:38:03 PM Pacific Daylight Time	HEALTH CHOICE ARIZONA, INC.	Health Choice Arizona	https://www.healthchoicepathway.com	Health Choice Pathway (HMO D-SNP)	01	01		1			H5587	002	0	2022	Arizona: APA, CCN, GIL, MAR, MOH, NAV, PIN, YAV		2	117281	2			1	3		2		2	https://www.healthchoicepathway.com/members/prescription-drug-information/	https://www.healthchoicepathway.com/members/prescription-drug-information/	https://www.healthchoicepathway.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			
H5590	005	0	1	01	01	H5590_005_0	4	1					0	08/03/2021	2022.01	08/03/2021 02:05:35 PM Central Daylight Time	08/04/2021 08:38:22 AM Eastern Daylight Time	07/30/2021 12:51:52 PM Eastern Daylight Time			08/04/2021 10:40:50 PM Eastern Daylight Time	Bridgeway Health Solutions of Arizona, Inc.	Wellcare by Allwell	www.wellcare.com/allwellAZ	Wellcare No Premium Essentials (HMO)	01	01		1			H5590	005	0	2022	Select counties in AZ		2	26385	2			2						www.wellcare.com/allwellAZ	www.wellcare.com/allwellAZ	www.wellcare.com/allwellAZ	(800)977-7522		(800)977-7522		(866)277-6583		(866)277-6583		(800)977-7522		(800)977-7522		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5590	007	0	1	01	01	H5590_007_0	4	1					0	05/30/2021	2022.01	05/30/2021 11:21:27 AM Eastern Daylight Time	08/04/2021 03:46:06 PM Eastern Daylight Time	07/30/2021 12:52:48 PM Eastern Daylight Time			08/04/2021 10:40:50 PM Eastern Daylight Time	Bridgeway Health Solutions of Arizona, Inc.	Wellcare by Allwell	www.wellcare.com/allwellAZ	Wellcare Assist (HMO)	01	01		1			H5590	007	0	2022	Select counties in AZ		2	11612	2			2						www.wellcare.com/allwellAZ	www.wellcare.com/allwellAZ	www.wellcare.com/allwellAZ	(800)977-7522		(800)977-7522		(866)277-6583		(866)277-6583		(800)977-7522		(800)977-7522		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5590	008	0	1	01	01	H5590_008_0	4	1	2	1			0	08/03/2021	2022.01	08/03/2021 02:59:54 PM Central Daylight Time	08/04/2021 08:39:14 AM Eastern Daylight Time	07/30/2021 12:53:14 PM Eastern Daylight Time			08/04/2021 10:40:50 PM Eastern Daylight Time	Bridgeway Health Solutions of Arizona, Inc.	Wellcare by Allwell	www.wellcare.com/allwellAZ	Wellcare Dual Liberty (HMO D-SNP)	01	01		1			H5590	008	0	2022	Select counties in AZ		2	136825	2			1	3		1		1	www.wellcare.com/allwellAZ	www.wellcare.com/allwellAZ	www.wellcare.com/allwellAZ	(800)977-7522		(800)977-7522		(866)277-6583		(866)277-6583		(800)977-7522		(800)977-7522		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5590	009	0	1	01	01	H5590_009_0	4	1	2	1			0	08/03/2021	2022.01	08/03/2021 03:14:53 PM Central Daylight Time	08/04/2021 08:33:10 AM Eastern Daylight Time	07/30/2021 12:54:22 PM Eastern Daylight Time			08/04/2021 10:40:50 PM Eastern Daylight Time	Bridgeway Health Solutions of Arizona, Inc.	Wellcare by Allwell	www.wellcare.com/allwellAZ	Wellcare Dual Liberty (HMO D-SNP)	01	01		1			H5590	009	0	2022	Select counties in AZ		2	24100	2			1	3		1		1	www.wellcare.com/allwellAZ	www.wellcare.com/allwellAZ	www.wellcare.com/allwellAZ	(800)977-7522		(800)977-7522		(866)277-6583		(866)277-6583		(800)977-7522		(800)977-7522		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5591	003	0	1	01	01	H5591_003_0	4	1				0	0	07/16/2021	2022.01	07/16/2021 12:24:29 PM Eastern Daylight Time	07/09/2021 03:31:21 PM Eastern Daylight Time				07/16/2021 03:12:26 PM Eastern Daylight Time	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Martin's Point Generations Advantage	MartinsPoint.org/Advantage	Martin's Point Generations Advantage Alliance (HMO)	01	01		1			H5591	003	0	2022	All Maine & NH Counties		2		2			2						MartinsPoint.org/Advantage	MartinsPoint.org/Advantage	MartinsPoint.org/Advantage	(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	5	1					1	08/03/2021	2022.01	08/03/2021 11:37:41 AM Eastern Daylight Time	08/05/2021 12:36:39 PM Eastern Daylight Time	08/05/2021 12:36:51 PM Eastern Daylight Time			08/05/2021 03:08:14 PM Eastern Daylight Time	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Martin's Point Generations Advantage	MartinsPoint.org/Advantage	Martin's Point Generations Advantage Prime (HMO-POS)	01	02		1			H5591	005	0	2022	Southern NH Counties		2		2			2						MartinsPoint.org/Advantage	MartinsPoint.org/Advantage	MartinsPoint.org/Advantage	(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	5	1					1	08/03/2021	2022.01	08/03/2021 10:14:32 AM Eastern Daylight Time	08/05/2021 12:37:05 PM Eastern Daylight Time	08/05/2021 12:37:19 PM Eastern Daylight Time			08/05/2021 03:08:14 PM Eastern Daylight Time	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Martin's Point Generations Advantage	MartinsPoint.org/Advantage	Martin's Point Generations Advantage Prime (HMO-POS)	01	02		1			H5591	006	1	2022	Southern Maine: Andr, Cumb, Kenn, Saga, York	Cumberland County	2		2			2						MartinsPoint.org/Advantage	MartinsPoint.org/Advantage	MartinsPoint.org/Advantage	(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	5	1					1	08/03/2021	2022.01	08/03/2021 10:15:49 AM Eastern Daylight Time	08/05/2021 12:37:32 PM Eastern Daylight Time	08/05/2021 12:37:45 PM Eastern Daylight Time			08/05/2021 03:08:14 PM Eastern Daylight Time	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Martin's Point Generations Advantage	MartinsPoint.org/Advantage	Martin's Point Generations Advantage Prime (HMO-POS)	01	02		1			H5591	006	2	2022	Southern Maine: Andr, Cumb, Kenn, Saga, York	Kennebec & Sagadahoc Counties	2		2			2						MartinsPoint.org/Advantage	MartinsPoint.org/Advantage	MartinsPoint.org/Advantage	(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	4	1	02	01	H5591_006_4	5	1					1	08/03/2021	2022.01	08/03/2021 10:18:03 AM Eastern Daylight Time	08/05/2021 12:37:59 PM Eastern Daylight Time	08/05/2021 12:38:12 PM Eastern Daylight Time			08/05/2021 03:08:14 PM Eastern Daylight Time	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Martin's Point Generations Advantage	MartinsPoint.org/Advantage	Martin's Point Generations Advantage Prime (HMO-POS)	01	02		1			H5591	006	4	2022	Southern Maine: Andr, Cumb, Kenn, Saga, York	York County	2		2			2						MartinsPoint.org/Advantage	MartinsPoint.org/Advantage	MartinsPoint.org/Advantage	(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	5	1	02	01	H5591_006_5	6	1					1	08/03/2021	2022.01	08/03/2021 10:19:06 AM Eastern Daylight Time	08/05/2021 12:38:25 PM Eastern Daylight Time	08/05/2021 12:38:38 PM Eastern Daylight Time			08/05/2021 03:08:14 PM Eastern Daylight Time	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Martin's Point Generations Advantage	MartinsPoint.org/Advantage	Martin's Point Generations Advantage Prime (HMO-POS)	01	02		1			H5591	006	5	2022	Southern Maine: Andr, Cumb, Kenn, Saga, York	Androscoggin County	2		2			2						MartinsPoint.org/Advantage	MartinsPoint.org/Advantage	MartinsPoint.org/Advantage	(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	5	1		1			1	08/03/2021	2022.01	08/03/2021 10:05:51 AM Eastern Daylight Time	08/05/2021 12:38:51 PM Eastern Daylight Time	08/05/2021 12:39:04 PM Eastern Daylight Time			08/05/2021 03:08:14 PM Eastern Daylight Time	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Martin's Point Generations Advantage	MartinsPoint.org/Advantage	Martin's Point Generations Advantage Focus DC (HMO C-SNP)	01	01		1			H5591	007	0	2022	Cumberland County		2		2			1	4			00000010000000000000		MartinsPoint.org/Advantage	MartinsPoint.org/Advantage	MartinsPoint.org/Advantage	(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	5	1					1	08/03/2021	2022.01	08/03/2021 10:07:50 AM Eastern Daylight Time	08/05/2021 12:39:18 PM Eastern Daylight Time	08/05/2021 12:39:30 PM Eastern Daylight Time			08/05/2021 03:08:14 PM Eastern Daylight Time	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Martin's Point Generations Advantage	MartinsPoint.org/Advantage	Martin's Point Generations Advantage Value Plus (HMO)	01	01		1			H5591	009	0	2022	Northern, Central, and Midcoast Maine		2		2			2						MartinsPoint.org/Advantage	MartinsPoint.org/Advantage	MartinsPoint.org/Advantage	(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					1	08/03/2021	2022.01	08/03/2021 10:09:08 AM Eastern Daylight Time	08/05/2021 12:39:44 PM Eastern Daylight Time	08/05/2021 12:39:58 PM Eastern Daylight Time			08/05/2021 03:08:14 PM Eastern Daylight Time	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Martin's Point Generations Advantage	MartinsPoint.org/Advantage	Martin's Point Generations Advantage Value Plus (HMO)	01	01		1			H5591	013	0	2022	Southern ME Counties and NH Counties		2		2			2						MartinsPoint.org/Advantage	MartinsPoint.org/Advantage	MartinsPoint.org/Advantage	(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	015	1	1	02	01	H5591_015_1	5	1					1	08/03/2021	2022.01	08/03/2021 10:21:28 AM Eastern Daylight Time	08/05/2021 12:40:12 PM Eastern Daylight Time	08/05/2021 12:40:25 PM Eastern Daylight Time			08/05/2021 03:08:14 PM Eastern Daylight Time	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Martin's Point Generations Advantage	Martinspoint.org/Advantage	Martin's Point Generations Advantage Prime (HMO-POS)	01	02		1			H5591	015	1	2022	Northern ME & Northern NH	Linc, Ox, Pisc, Some, Wald, Belk, Carr, Coos, Graf	2		2			2						Martinspoint.org/Advantage	Martinspoint.org/Advantage	Martinspoint.org/Advantage	(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	015	2	1	02	01	H5591_015_2	5	1					1	08/03/2021	2022.01	08/03/2021 10:38:37 AM Eastern Daylight Time	08/05/2021 12:40:38 PM Eastern Daylight Time	08/05/2021 12:40:51 PM Eastern Daylight Time			08/05/2021 03:08:14 PM Eastern Daylight Time	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Martin's Point Generations Advantage	Martinspoint.org/Advantage	Martin's Point Generations Advantage Prime (HMO-POS)	01	02		1			H5591	015	2	2022	Northern ME & Northern NH	Aroo, Frank, Hanc, Knox, Penob, Wash Counties	2		2			2						Martinspoint.org/Advantage	Martinspoint.org/Advantage	Martinspoint.org/Advantage	(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	3	1						05/21/2021	2022.01	05/21/2021 01:51:43 PM Eastern Daylight Time					07/16/2021 03:12:26 PM Eastern Daylight Time	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Martin's Point Generations Advantage	MartinsPoint.org/Advantage	Martin's Point Generations Advantage Prime Group (HMO-POS)	01	02		1			H5591	801	0	2022	National		1	0	2			2						MartinsPoint.org/Advantage	MartinsPoint.org/Advantage	MartinsPoint.org/Advantage	(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	3	1						05/21/2021	2022.01	05/21/2021 01:56:08 PM Eastern Daylight Time					07/16/2021 03:12:26 PM Eastern Daylight Time	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Martin's Point Generations Advantage	MartinsPoint.org/Advantage	Martin's Point Generations Advantage Prime Group (HMO-POS)	01	02		1			H5591	802	0	2022	National		1	0	2			2						MartinsPoint.org/Advantage	MartinsPoint.org/Advantage	MartinsPoint.org/Advantage	(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			
H5593	001	0	1	01	01	H5593_001_0	4	1	2	1	1		0	07/08/2021	2022.01	07/08/2021 11:33:46 AM Eastern Daylight Time	08/03/2021 01:23:33 PM Central Daylight Time	08/02/2021 08:56:21 AM Central Daylight Time			08/04/2021 01:00:17 PM Central Daylight Time	AETNA HEALTH OF IOWA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Assure Premier (HMO D-SNP)	01	01		1			H5593	001	0	2022	Partial State of Iowa		2		2			1	3		1		1	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5593	801	0	1	01	01	H5593_801_0	1	1				0	0	05/28/2021	2022.01	05/28/2021 01:11:48 PM Eastern Daylight Time					06/03/2021 01:53:09 PM Eastern Daylight Time	AETNA HEALTH OF IOWA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (HMO)	01	01		1			H5593	801	0	2022	Iowa		1	120	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H5593	802	0	1	01	01	H5593_802_0	1	1						05/28/2021	2022.01	05/28/2021 01:12:11 PM Eastern Daylight Time					06/03/2021 01:53:09 PM Eastern Daylight Time	AETNA HEALTH OF IOWA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan w/Rx (HMO)	01	01		1			H5593	802	0	2022	Iowa		1	120	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H5594	001	0	1	01	01	H5594_001_0	7	1			2		0	07/13/2021	2022.01	07/13/2021 01:18:02 PM Eastern Daylight Time	08/04/2021 12:20:00 PM Eastern Daylight Time	08/04/2021 12:20:00 PM Eastern Daylight Time			08/04/2021 01:51:15 PM Eastern Daylight Time	OPTIMUM HEALTHCARE, INC.	Optimum HealthCare, Inc.	www.YourOptimumHealthcare.com	Optimum Gold Rewards Plan (HMO)	01	01		1			H5594	001	0	2022	Select Counties in Florida		2	0	2			2						www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	(866)245-5360		(866)245-5360		(888)300-9317		(813)506-6132		(866)245-5360		(813)506-6099		(888)300-9317		(813)506-6132		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5594	002	0	1	01	01	H5594_002_0	7	1			2		0	07/13/2021	2022.01	07/13/2021 01:18:26 PM Eastern Daylight Time	08/04/2021 12:20:00 PM Eastern Daylight Time	08/04/2021 12:20:00 PM Eastern Daylight Time			08/04/2021 01:51:15 PM Eastern Daylight Time	OPTIMUM HEALTHCARE, INC.	Optimum HealthCare, Inc.	www.YourOptimumHealthcare.com	Optimum Platinum Plan (HMO)	01	01		1			H5594	002	0	2022	Select Counties in Florida		2	0	2			2						www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	(866)245-5360		(866)245-5360		(888)300-9317		(813)506-6132		(866)245-5360		(813)506-6099		(888)300-9317		(813)506-6132		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5594	016	0	1	01	01	H5594_016_0	8	1	2	1	1		0	07/13/2021	2022.01	07/13/2021 01:18:43 PM Eastern Daylight Time	08/04/2021 12:20:00 PM Eastern Daylight Time	08/04/2021 12:20:00 PM Eastern Daylight Time			08/04/2021 01:51:15 PM Eastern Daylight Time	OPTIMUM HEALTHCARE, INC.	Optimum HealthCare, Inc.	www.YourOptimumHealthcare.com	Optimum Emerald Partial (HMO D-SNP)	01	01		1			H5594	016	0	2022	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		(888)300-9317		(813)506-6132		(866)245-5360		(813)506-6099		(888)300-9317		(813)506-6132		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5594	017	0	1	01	01	H5594_017_0	8	1	2	1	1		0	07/13/2021	2022.01	07/13/2021 01:19:07 PM Eastern Daylight Time	08/04/2021 12:20:00 PM Eastern Daylight Time	08/04/2021 12:20:00 PM Eastern Daylight Time			08/04/2021 01:51:15 PM Eastern Daylight Time	OPTIMUM HEALTHCARE, INC.	Optimum HealthCare, Inc.	www.YourOptimumHealthcare.com	Optimum Emerald Full (HMO D-SNP)	01	01		1			H5594	017	0	2022	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		(888)300-9317		(813)506-6132		(866)245-5360		(813)506-6099		(888)300-9317		(813)506-6132		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5594	019	0	1	01	01	H5594_019_0	7	1			2		0	07/13/2021	2022.01	07/13/2021 01:19:24 PM Eastern Daylight Time	08/04/2021 12:20:00 PM Eastern Daylight Time	08/04/2021 12:20:00 PM Eastern Daylight Time			08/04/2021 01:51:15 PM Eastern Daylight Time	OPTIMUM HEALTHCARE, INC.	Optimum HealthCare, Inc.	www.YourOptimumHealthcare.com	Optimum Platinum Plan (HMO)	01	01		1			H5594	019	0	2022	Select Counties in Florida		2	0	2			2						www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	(866)245-5360		(866)245-5360		(888)300-9317		(813)506-6132		(866)245-5360		(813)506-6099		(888)300-9317		(813)506-6132		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5594	022	0	1	01	01	H5594_022_0	7	1			2		0	07/13/2021	2022.01	07/13/2021 01:19:42 PM Eastern Daylight Time	08/04/2021 12:20:00 PM Eastern Daylight Time	08/04/2021 12:20:00 PM Eastern Daylight Time			08/04/2021 01:51:15 PM Eastern Daylight Time	OPTIMUM HEALTHCARE, INC.	Optimum HealthCare, Inc.	www.YourOptimumHealthcare.com	Optimum Gold Rewards Plan (HMO)	01	01		1			H5594	022	0	2022	Select Counties in Florida		2	0	2			2						www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	(866)245-5360		(866)245-5360		(888)300-9317		(813)506-6132		(866)245-5360		(813)506-6099		(888)300-9317		(813)506-6132		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5594	026	0	1	01	01	H5594_026_0	8	1			2		0	07/13/2021	2022.01	07/13/2021 01:19:59 PM Eastern Daylight Time	08/04/2021 12:20:00 PM Eastern Daylight Time	08/04/2021 12:20:00 PM Eastern Daylight Time			08/04/2021 01:51:15 PM Eastern Daylight Time	OPTIMUM HEALTHCARE, INC.	Optimum HealthCare, Inc.	www.YourOptimumHealthcare.com	Optimum Gold Rewards Plan (HMO)	01	01		1			H5594	026	0	2022	Select Counties in Florida		2	0	2			2						www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	(866)245-5360		(866)245-5360		(888)300-9317		(813)506-6132		(866)245-5360		(813)506-6099		(888)300-9317		(813)506-6132		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5594	028	0	1	01	01	H5594_028_0	7	1		1	2		1	07/13/2021	2022.01	07/13/2021 01:20:20 PM Eastern Daylight Time	08/04/2021 12:20:00 PM Eastern Daylight Time	08/04/2021 12:20:00 PM Eastern Daylight Time			08/04/2021 01:51:15 PM Eastern Daylight Time	OPTIMUM HEALTHCARE, INC.	Optimum HealthCare, Inc.	www.YourOptimumHealthcare.com	Optimum Diamond Rewards (HMO C-SNP)	01	01		1			H5594	028	0	2022	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		(888)300-9317		(813)506-6132		(866)245-5360		(813)506-6099		(888)300-9317		(813)506-6132		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5594	029	0	1	01	01	H5594_029_0	7	1		1	2		0	07/13/2021	2022.01	07/13/2021 01:20:37 PM Eastern Daylight Time	08/04/2021 12:20:00 PM Eastern Daylight Time	08/04/2021 12:20:00 PM Eastern Daylight Time			08/04/2021 01:51:15 PM Eastern Daylight Time	OPTIMUM HEALTHCARE, INC.	Optimum HealthCare, Inc.	www.YourOptimumHealthcare.com	Optimum Diamond Rewards COPD (HMO C-SNP)	01	01		1			H5594	029	0	2022	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		(888)300-9317		(813)506-6132		(866)245-5360		(813)506-6099		(888)300-9317		(813)506-6132		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5594	030	0	1	01	01	H5594_030_0	7	1		1	2		0	07/13/2021	2022.01	07/13/2021 01:20:53 PM Eastern Daylight Time	08/04/2021 12:20:00 PM Eastern Daylight Time	08/04/2021 12:20:00 PM Eastern Daylight Time			08/04/2021 01:51:15 PM Eastern Daylight Time	OPTIMUM HEALTHCARE, INC.	Optimum HealthCare, Inc.	www.YourOptimumHealthcare.com	Optimum Diamond Rewards (HMO C-SNP)	01	01		1			H5594	030	0	2022	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		(888)300-9317		(813)506-6132		(866)245-5360		(813)506-6099		(888)300-9317		(813)506-6132		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5594	031	0	1	01	01	H5594_031_0	8	1		1	2		0	07/13/2021	2022.01	07/13/2021 01:21:11 PM Eastern Daylight Time	08/04/2021 12:20:00 PM Eastern Daylight Time	08/04/2021 12:20:00 PM Eastern Daylight Time			08/04/2021 01:51:15 PM Eastern Daylight Time	OPTIMUM HEALTHCARE, INC.	Optimum HealthCare, Inc.	www.YourOptimumHealthcare.com	Optimum Diamond Rewards COPD (HMO C-SNP)	01	01		1			H5594	031	0	2022	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		(888)300-9317		(813)506-6132		(866)245-5360		(813)506-6099		(888)300-9317		(813)506-6132		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5594	032	0	1	01	01	H5594_032_0	7	1			2		0	07/13/2021	2022.01	07/13/2021 01:21:31 PM Eastern Daylight Time	08/04/2021 12:20:00 PM Eastern Daylight Time	08/04/2021 12:20:00 PM Eastern Daylight Time			08/04/2021 01:51:15 PM Eastern Daylight Time	OPTIMUM HEALTHCARE, INC.	Optimum HealthCare, Inc.	www.YourOptimumHealthcare.com	Optimum Gold Plus Plan (HMO)	01	01		1			H5594	032	0	2022	Select Counties in Florida		2	0	2			2						www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	(866)245-5360		(866)245-5360		(888)300-9317		(813)506-6132		(866)245-5360		(813)506-6099		(888)300-9317		(813)506-6132		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5594	034	0	1	01	01	H5594_034_0	8	1		1	2		0	07/13/2021	2022.01	07/13/2021 01:21:49 PM Eastern Daylight Time	08/04/2021 12:20:00 PM Eastern Daylight Time	08/04/2021 12:20:00 PM Eastern Daylight Time			08/04/2021 01:51:15 PM Eastern Daylight Time	OPTIMUM HEALTHCARE, INC.	Optimum HealthCare, Inc.	www.YourOptimumHealthcare.com	Optimum Diamond Rewards (HMO C-SNP)	01	01		1			H5594	034	0	2022	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		(888)300-9317		(813)506-6132		(866)245-5360		(813)506-6099		(888)300-9317		(813)506-6132		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5594	035	0	1	01	01	H5594_035_0	9	1		1	2		0	07/13/2021	2022.01	07/13/2021 01:22:09 PM Eastern Daylight Time	08/04/2021 12:20:00 PM Eastern Daylight Time	08/04/2021 12:20:00 PM Eastern Daylight Time			08/04/2021 01:51:15 PM Eastern Daylight Time	OPTIMUM HEALTHCARE, INC.	Optimum HealthCare, Inc.	www.YourOptimumHealthcare.com	Optimum Diamond Rewards COPD (HMO C-SNP)	01	01		1			H5594	035	0	2022	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		(888)300-9317		(813)506-6132		(866)245-5360		(813)506-6099		(888)300-9317		(813)506-6132		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5599	001	0	1	01	01	H5599_001_0	5	1	2	1			0	06/02/2021	2022.01	06/02/2021 07:47:24 PM Eastern Daylight Time	08/04/2021 12:51:28 AM Eastern Daylight Time	07/30/2021 01:14:04 PM Eastern Daylight Time			08/04/2021 11:02:27 PM Eastern Daylight Time	NEW YORK QUALITY HEALTHCARE CORPORATION	Wellcare by Fidelis Care	www.fideliscare.org/wellcaremedicare	Wellcare Fidelis Dual Access (HMO D-SNP)	01	01		1			H5599	001	0	2022	Select counties in NY		2	515749	2			1	3		1		1	www.fideliscare.org/wellcaremedicare	www.fideliscare.org/wellcaremedicare	www.fideliscare.org/wellcaremedicare	(800)247-1447		(800)247-1447		(844)917-0174		(844)917-0174		(800)247-1447		(800)247-1447		(844)917-0174		(844)917-0174		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5599	002	0	1	02	01	H5599_002_0	5	1					0	06/04/2021	2022.01	06/04/2021 02:28:22 PM Eastern Daylight Time	08/04/2021 12:51:55 AM Eastern Daylight Time	07/30/2021 01:14:48 PM Eastern Daylight Time			08/04/2021 11:02:27 PM Eastern Daylight Time	NEW YORK QUALITY HEALTHCARE CORPORATION	Wellcare by Fidelis Care	www.fideliscare.org/wellcaremedicare	Wellcare Fidelis Assist (HMO-POS)	01	02		1			H5599	002	0	2022	Select counties in NY		2	80686	2			2						www.fideliscare.org/wellcaremedicare	www.fideliscare.org/wellcaremedicare	www.fideliscare.org/wellcaremedicare	(800)247-1447		(800)247-1447		(844)917-0174		(844)917-0174		(800)247-1447		(800)247-1447		(844)917-0174		(844)917-0174		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5599	003	0	1	01	01	H5599_003_0	5	1	2	1			0	07/19/2021	2022.01	07/19/2021 10:35:13 AM Eastern Daylight Time	08/04/2021 12:52:24 AM Eastern Daylight Time	07/30/2021 01:15:10 PM Eastern Daylight Time			08/04/2021 11:02:27 PM Eastern Daylight Time	NEW YORK QUALITY HEALTHCARE CORPORATION	Wellcare by Fidelis Care	www.fideliscare.org/wellcaremedicare	Wellcare Fidelis Dual Plus (HMO D-SNP)	01	01		1			H5599	003	0	2022	Select counties in NY		2	254	2			1	3		1		1	www.fideliscare.org/wellcaremedicare	www.fideliscare.org/wellcaremedicare	www.fideliscare.org/wellcaremedicare	(800)247-1447		(800)247-1447		(844)917-0174		(844)917-0174		(800)247-1447		(800)247-1447		(844)917-0174		(844)917-0174		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5599	004	0	1	01	01	H5599_004_0	5	1					0	08/02/2021	2022.01	08/02/2021 05:19:29 PM Eastern Daylight Time	08/04/2021 12:52:53 AM Eastern Daylight Time	07/30/2021 01:15:34 PM Eastern Daylight Time			08/04/2021 11:02:27 PM Eastern Daylight Time	NEW YORK QUALITY HEALTHCARE CORPORATION	Wellcare by Fidelis Care	www.fideliscare.org/wellcaremedicare	Wellcare Fidelis No Premium (HMO)	01	01		1			H5599	004	0	2022	Select counties in NY		2	37117	2			2						www.fideliscare.org/wellcaremedicare	www.fideliscare.org/wellcaremedicare	www.fideliscare.org/wellcaremedicare	(800)247-1447		(800)247-1447		(844)917-0174		(844)917-0174		(800)247-1447		(800)247-1447		(844)917-0174		(844)917-0174		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5599	005	0	1	02	01	H5599_005_0	6	1				0	0	05/31/2021	2022.01	05/31/2021 10:51:28 AM Eastern Daylight Time	06/06/2021 12:53:35 PM Eastern Daylight Time				07/19/2021 04:15:23 PM Eastern Daylight Time	NEW YORK QUALITY HEALTHCARE CORPORATION	Wellcare by Fidelis Care	www.fideliscare.org/wellcaremedicare	Wellcare Fidelis Patriot No Premium (HMO-POS)	01	02		1			H5599	005	0	2022	Select counties in NY		2	126	2			2						www.fideliscare.org/wellcaremedicare	www.fideliscare.org/wellcaremedicare	www.fideliscare.org/wellcaremedicare	(800)247-1447		(800)247-1447		(844)917-0174		(844)917-0174										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H5599	008	0	1	01	01	H5599_008_0	5	1	2	1			0	07/18/2021	2022.01	07/18/2021 06:27:45 PM Eastern Daylight Time	08/04/2021 12:53:53 AM Eastern Daylight Time	07/30/2021 01:15:56 PM Eastern Daylight Time			08/04/2021 11:02:27 PM Eastern Daylight Time	NEW YORK QUALITY HEALTHCARE CORPORATION	Wellcare by Fidelis Care	www.fideliscare.org/wellcaremedicare	Wellcare Fidelis Dual Plus (HMO D-SNP)	01	01		1			H5599	008	0	2022	Select counties in NY		2	212	2			1	3		1		1	www.fideliscare.org/wellcaremedicare	www.fideliscare.org/wellcaremedicare	www.fideliscare.org/wellcaremedicare	(800)247-1447		(800)247-1447		(844)917-0174		(844)917-0174		(800)247-1447		(800)247-1447		(844)917-0174		(844)917-0174		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5599	801	0	1	02	01	H5599_801_0	2	1				0	0	05/03/2021	2022.01	05/03/2021 02:04:42 PM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	NEW YORK QUALITY HEALTHCARE CORPORATION	Wellcare by Fidelis Care	fideliscare.org/	Fidelis Medicare Advantage Employer without RX (HMO-POS)	01	02		1			H5599	801	0	2022	New York Counties		1	100	2			2						fideliscare.org/Find-A-Doctor	fideliscare.org/Member/Medicare-Information/Prescription-Drug-Information	fideliscare.org/Find-A-Doctor	(800)247-1447		(800)247-1447		(844)942-0040		(844)942-0040										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1				
H5599	802	0	1	02	01	H5599_802_0	2	1						05/03/2021	2022.01	05/03/2021 02:05:09 PM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	NEW YORK QUALITY HEALTHCARE CORPORATION	Wellcare by Fidelis Care	fideliscare.org/	Fidelis Medicare Advantage Employer (HMO-POS)	01	02		1			H5599	802	0	2022	New York Counties		1	100	2			2						fideliscare.org/Find-A-Doctor	fideliscare.org/Member/Medicare-Information/Prescription-Drug-Information	fideliscare.org/Find-A-Doctor	(800)247-1447		(800)247-1447		(844)942-0040		(844)942-0040		(800)247-1447		(800)247-1447		(844)942-0040		(844)942-0040		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1				
H5599	803	0	1	02	01	H5599_803_0	2	1						05/03/2021	2022.01	05/03/2021 02:05:35 PM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	NEW YORK QUALITY HEALTHCARE CORPORATION	Wellcare by Fidelis Care	fideliscare.org/	Fidelis Medicare Advantage Employer (HMO-POS)	01	02		1			H5599	803	0	2022	New York Counties		1	100	2			2						fideliscare.org/Find-A-Doctor	fideliscare.org/Member/Medicare-Information/Prescription-Drug-Information	fideliscare.org/Find-A-Doctor	(800)247-1447		(800)247-1447		(844)942-0040		(844)942-0040		(800)247-1447		(800)247-1447		(844)942-0040		(844)942-0040		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1				
H5608	001	0	1	01	01	H5608_001_0	7	1	2	1			0	08/03/2021	2022.01	08/03/2021 06:05:48 PM Central Daylight Time	08/03/2021 10:57:17 AM Central Daylight Time	08/04/2021 09:22:57 AM Central Daylight Time			08/04/2021 03:11:28 PM Central Daylight Time	DENVER HEALTH MEDICAL PLAN, INC.	Denver Health Medical Plan, Inc.	www.denverhealthmedicalplan.org	Elevate Medicare Choice (HMO D-SNP)	01	01		1			H5608	001	0	2022	Denver, Jefferson and Adams Counties		2		1	1		1	3		1		1	www.denverhealthmedicalplan.org	www.denverhealthmedicalplan.org	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	9	1					1	08/03/2021	2022.01	08/03/2021 06:06:37 PM Central Daylight Time	08/03/2021 10:58:13 AM Central Daylight Time	08/04/2021 09:23:35 AM Central Daylight Time			08/04/2021 03:11:28 PM Central Daylight Time	DENVER HEALTH MEDICAL PLAN, INC.	Denver Health Medical Plan, Inc.	www.denverhealthmedicalplan.org	Elevate Medicare Select (HMO)	01	01		1			H5608	002	0	2022	Adams, Denver, and Jefferson counties		2		1	1		2						www.denverhealthmedicalplan.org	www.denverhealthmedicalplan.org	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						06/02/2021	2022.01	06/02/2021 01:10:26 PM Eastern Daylight Time		06/02/2021 01:02:52 PM Eastern Daylight Time			06/02/2021 01:12:21 PM Eastern Daylight Time	CARE RESOURCES	Care Resources	www.careresources.org	Care Resources (PACE)	08	20		1			H5610	001	0	2022	Kent County		2		2			2						www.careresources.org	www.careresources.org										(800)610-6299		(616)913-2006		(800)610-6299		(616)913-2006										(800)649-3777		(711)-		(800)649-3777		(711)-																
H5610	003	0	1	20	08	H5610_003_0	1	1						06/02/2021	2022.01	06/02/2021 01:10:40 PM Eastern Daylight Time		06/02/2021 01:03:01 PM Eastern Daylight Time			06/02/2021 01:12:21 PM Eastern Daylight Time	CARE RESOURCES	Care Resources	www.careresources.org	Care Resources (PACE)	08	20		1			H5610	003	0	2022	Kent County		2		2			2						www.careresources.org	www.careresources.org										(800)610-6299		(616)913-2006		(800)610-6299		(616)913-2006										(800)649-3777		(711)-		(800)649-3777		(711)-																
H5613	002	0		07	02	H5613_002_0	2	2				0	0	05/23/2021	2022.01	05/23/2021 08:32:38 PM Eastern Daylight Time			06/06/2021 03:18:24 PM Eastern Daylight Time		06/06/2021 08:29:07 PM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP HEALTH CARE	mvphealthcare.com	MVP SmartFund (MSA)	02	07	2				H5613	002	0	2022	Eastern NY		2	1980	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				0	0	06/02/2021	2022.01	06/02/2021 12:02:22 PM Eastern Daylight Time					06/05/2021 06:23:18 PM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP HEALTH CARE	mvphealthcare.com	MVP SmartFund EG (MSA)	02	07	2				H5613	801	0	2022	Western NY		1	0	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				0	0	06/02/2021	2022.01	06/02/2021 12:03:22 PM Eastern Daylight Time					06/05/2021 06:23:18 PM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP HEALTH CARE	mvphealthcare.com	MVP SmartFund EG (MSA)	02	07	2				H5613	802	0	2022	Eastern NY		1	360	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			1		1	08/01/2021	2022.01	08/01/2021 12:58:13 PM Eastern Daylight Time	08/03/2021 05:44:15 PM Eastern Daylight Time	07/30/2021 11:32:06 AM Eastern Daylight Time			08/04/2021 02:26:09 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-001 (HMO)	01	01		1			H5619	001	0	2022	Southern Maine		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	1		0	07/22/2021	2022.01	07/22/2021 02:20:32 PM Eastern Daylight Time	08/03/2021 05:42:16 PM Eastern Daylight Time	07/30/2021 11:32:18 AM Eastern Daylight Time			08/04/2021 02:26:09 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H5619-003 (HMO D-SNP)	01	01		1			H5619	003	0	2022	Maine		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		1	07/31/2021	2022.01	07/31/2021 12:58:11 PM Eastern Daylight Time	08/03/2021 07:11:56 PM Eastern Daylight Time	07/30/2021 11:32:30 AM Eastern Daylight Time			08/04/2021 03:22:26 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-012 (HMO)	01	01		1			H5619	012	0	2022	Fresno County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		1	07/31/2021	2022.01	07/31/2021 12:58:43 PM Eastern Daylight Time	08/03/2021 07:36:38 PM Eastern Daylight Time	07/30/2021 11:32:42 AM Eastern Daylight Time			08/04/2021 03:22:26 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-013 (HMO)	01	01		1			H5619	013	0	2022	Madera County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		1	07/31/2021	2022.01	07/31/2021 01:33:54 PM Eastern Daylight Time	08/03/2021 07:12:21 PM Eastern Daylight Time	07/30/2021 11:32:52 AM Eastern Daylight Time			08/04/2021 03:34:25 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-015 (HMO)	01	01		1			H5619	015	0	2022	Tulare and Kings counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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;3-4;4b;7c;7d;7e1;7e2;7f;7g;7h1;7h2;7i;7k;8a1;8b1;8b2;8b3;9c;16b;17a;18a;	
H5619	016	0	1	01	01	H5619_016_0	4	1			1		1	07/31/2021	2022.01	07/31/2021 12:59:13 PM Eastern Daylight Time	08/03/2021 07:13:09 PM Eastern Daylight Time	07/30/2021 11:33:04 AM Eastern Daylight Time			08/04/2021 03:22:26 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-016 (HMO)	01	01		1			H5619	016	0	2022	San Diego County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	07/31/2021	2022.01	07/31/2021 12:59:43 PM Eastern Daylight Time	08/03/2021 07:36:06 PM Eastern Daylight Time	07/30/2021 11:33:16 AM Eastern Daylight Time			08/04/2021 03:22:26 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-021 (HMO)	01	01		1			H5619	021	0	2022	Los Angeles and Orange counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		0	07/08/2021	2022.01	07/08/2021 04:27:40 PM Eastern Daylight Time	08/03/2021 07:13:33 PM Eastern Daylight Time	07/30/2021 11:33:28 AM Eastern Daylight Time			08/04/2021 03:22:26 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-026 (HMO)	01	01		1			H5619	026	0	2022	San Joaquin County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		0	07/08/2021	2022.01	07/08/2021 04:28:19 PM Eastern Daylight Time	08/03/2021 07:13:58 PM Eastern Daylight Time	07/30/2021 11:33:40 AM Eastern Daylight Time			08/04/2021 03:22:26 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-029 (HMO)	01	01		1			H5619	029	0	2022	Contra Costa County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		1	07/31/2021	2022.01	07/31/2021 01:00:16 PM Eastern Daylight Time	08/03/2021 07:12:45 PM Eastern Daylight Time	07/30/2021 11:33:50 AM Eastern Daylight Time			08/04/2021 03:22:26 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-032 (HMO)	01	01		1			H5619	032	0	2022	Stanislaus County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		0	07/08/2021	2022.01	07/08/2021 03:41:23 PM Eastern Daylight Time	08/03/2021 07:50:41 PM Eastern Daylight Time	07/30/2021 11:34:02 AM Eastern Daylight Time			08/04/2021 03:34:25 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Value Plus H5619-037 (HMO)	01	01		1			H5619	037	0	2022	Select Counties in California		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1	2	1	1		0	07/08/2021	2022.01	07/08/2021 04:29:50 PM Eastern Daylight Time	08/03/2021 07:57:21 PM Eastern Daylight Time	07/30/2021 11:34:14 AM Eastern Daylight Time			08/04/2021 03:28:56 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H5619-038 (HMO D-SNP)	01	01		1			H5619	038	0	2022	Select Counties in California		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	07/31/2021	2022.01	07/31/2021 01:34:24 PM Eastern Daylight Time	08/03/2021 07:37:03 PM Eastern Daylight Time	07/30/2021 11:34:26 AM Eastern Daylight Time			08/04/2021 03:34:25 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-039 (HMO)	01	01		1			H5619	039	1	2022	Riverside and San Bernardino counties	Riverside and San Bernardino counties	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	08/02/2021	2022.01	08/02/2021 10:21:36 AM Eastern Daylight Time	08/03/2021 07:37:28 PM Eastern Daylight Time	07/30/2021 11:34:38 AM Eastern Daylight Time			08/04/2021 03:34:25 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-039 (HMO)	01	01		1			H5619	039	2	2022	Riverside and San Bernardino counties	Riverside and San Bernardino counties	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	6	1			1		1	07/22/2021	2022.01	07/22/2021 04:16:03 PM Eastern Daylight Time	08/03/2021 09:42:58 PM Eastern Daylight Time	07/30/2021 11:34:50 AM Eastern Daylight Time			08/04/2021 02:18:12 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-041 (HMO)	01	01		1			H5619	041	0	2022	Albemarle and Charlottesville City Counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	7	1		1	1		1	08/01/2021	2022.01	08/01/2021 01:00:57 PM Eastern Daylight Time	08/03/2021 09:43:19 PM Eastern Daylight Time	07/30/2021 11:35:02 AM Eastern Daylight Time			08/04/2021 02:18:12 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus - Diabetes and Heart (HMO C-SNP)	01	01		1			H5619	046	0	2022	Richmond - Tidewater Area		2		2			1	4			00000000000000000010		https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	7	1			1		1	08/04/2021	2022.01	08/04/2021 09:27:05 AM Eastern Daylight Time	08/03/2021 09:43:42 PM Eastern Daylight Time	07/30/2021 11:35:12 AM Eastern Daylight Time			08/04/2021 02:18:12 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-047 (HMO)	01	01		1			H5619	047	0	2022	Northern Virginia Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	049	0	1	01	01	H5619_049_0	5	1			1		1	07/31/2021	2022.01	07/31/2021 02:54:10 PM Eastern Daylight Time	08/03/2021 05:52:53 PM Eastern Daylight Time	07/30/2021 11:35:24 AM Eastern Daylight Time			08/04/2021 02:15:03 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-049 (HMO)	01	01		1			H5619	049	0	2022	Indianapolis Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		1	07/31/2021	2022.01	07/31/2021 02:54:19 PM Eastern Daylight Time	08/03/2021 05:59:40 PM Eastern Daylight Time	07/30/2021 11:35:36 AM Eastern Daylight Time			08/04/2021 02:15:03 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-050 (HMO)	01	01		1			H5619	050	0	2022	Evansville Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		1	07/31/2021	2022.01	07/31/2021 02:54:27 PM Eastern Daylight Time	08/03/2021 05:58:32 PM Eastern Daylight Time	07/30/2021 11:35:48 AM Eastern Daylight Time			08/04/2021 02:15:03 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-051 (HMO)	01	01		1			H5619	051	0	2022	Fort Wayne Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		1	07/31/2021	2022.01	07/31/2021 02:54:36 PM Eastern Daylight Time	08/03/2021 06:05:12 PM Eastern Daylight Time	07/30/2021 11:36:00 AM Eastern Daylight Time			08/04/2021 02:15:03 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-052 (HMO)	01	01		1			H5619	052	0	2022	South Bend Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		1	07/31/2021	2022.01	07/31/2021 02:54:46 PM Eastern Daylight Time	08/03/2021 06:18:45 PM Eastern Daylight Time	07/30/2021 11:36:12 AM Eastern Daylight Time			08/04/2021 02:15:03 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-053 (HMO)	01	01		1			H5619	053	0	2022	Lake and Porter County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1	2	1	1		0	07/08/2021	2022.01	07/08/2021 04:07:15 PM Eastern Daylight Time	08/03/2021 06:06:31 PM Eastern Daylight Time	07/30/2021 11:36:22 AM Eastern Daylight Time			08/04/2021 01:32:44 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H5619-054 (HMO D-SNP)	01	01		1			H5619	054	0	2022	Select counties in Indiana		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	1		1	07/15/2021	2022.01	07/15/2021 04:30:55 PM Eastern Daylight Time	08/03/2021 06:11:09 PM Eastern Daylight Time	07/30/2021 11:36:34 AM Eastern Daylight Time			08/04/2021 01:32:44 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus - Diabetes and Heart (HMO C-SNP)	01	01		1			H5619	055	0	2022	Select counties in Kentucky and Indiana		2		2			1	4			00000000000000000010		https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	08/02/2021	2022.01	08/02/2021 02:36:18 PM Eastern Daylight Time	08/03/2021 06:08:09 PM Eastern Daylight Time	07/30/2021 11:36:46 AM Eastern Daylight Time			08/04/2021 03:07:42 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-056 (HMO)	01	01		1			H5619	056	0	2022	Clark and Cowlitz Counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	7	1			1		1	08/02/2021	2022.01	08/02/2021 05:51:41 PM Eastern Daylight Time	08/03/2021 06:19:45 PM Eastern Daylight Time	07/30/2021 11:36:58 AM Eastern Daylight Time			08/04/2021 03:07:42 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-057 (HMO)	01	01		1			H5619	057	0	2022	King County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	6	1			1		1	08/04/2021	2022.01	08/04/2021 02:18:45 PM Eastern Daylight Time	08/03/2021 06:10:21 PM Eastern Daylight Time	07/30/2021 11:37:10 AM Eastern Daylight Time			08/04/2021 02:25:33 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-059 (HMO)	01	01		1			H5619	059	0	2022	Snohomish County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	08/02/2021	2022.01	08/02/2021 02:49:39 PM Eastern Daylight Time	08/03/2021 06:12:00 PM Eastern Daylight Time	07/30/2021 11:37:20 AM Eastern Daylight Time			08/04/2021 03:07:42 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-060 (HMO)	01	01		1			H5619	060	0	2022	Spokane County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	7	1			1		1	08/04/2021	2022.01	08/04/2021 03:01:33 PM Eastern Daylight Time	08/03/2021 06:25:34 PM Eastern Daylight Time	07/30/2021 11:37:32 AM Eastern Daylight Time			08/04/2021 03:07:42 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-061 (HMO)	01	01		1			H5619	061	0	2022	Pierce County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	08/04/2021	2022.01	08/04/2021 03:01:42 PM Eastern Daylight Time	08/03/2021 06:27:20 PM Eastern Daylight Time	07/30/2021 11:37:44 AM Eastern Daylight Time			08/04/2021 03:07:42 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-062 (HMO)	01	01		1			H5619	062	0	2022	Thurston County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	6	1			1		1	08/01/2021	2022.01	08/01/2021 10:42:07 AM Eastern Daylight Time	08/03/2021 06:45:54 PM Eastern Daylight Time	07/30/2021 11:37:56 AM Eastern Daylight Time			08/04/2021 03:07:42 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-063 (HMO)	01	01		1			H5619	063	0	2022	Snohomish County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		1	08/02/2021	2022.01	08/02/2021 03:00:09 PM Eastern Daylight Time	08/03/2021 06:47:23 PM Eastern Daylight Time	07/30/2021 11:38:06 AM Eastern Daylight Time			08/04/2021 03:07:42 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-064 (HMO)	01	01		1			H5619	064	0	2022	Thurston County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		0	07/22/2021	2022.01	07/22/2021 02:20:39 PM Eastern Daylight Time	08/03/2021 05:44:35 PM Eastern Daylight Time	07/30/2021 11:38:18 AM Eastern Daylight Time			08/04/2021 02:26:09 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Value Plus H5619-065 (HMO)	01	01		1			H5619	065	0	2022	New Hampshire		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	6	1			1		0	08/01/2021	2022.01	08/01/2021 12:58:27 PM Eastern Daylight Time	08/03/2021 05:45:34 PM Eastern Daylight Time	07/30/2021 11:38:30 AM Eastern Daylight Time			08/04/2021 02:26:09 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-066 (HMO)	01	01		1			H5619	066	0	2022	Maine		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	08/01/2021	2022.01	08/01/2021 01:20:52 PM Eastern Daylight Time	08/03/2021 05:51:55 PM Eastern Daylight Time	07/30/2021 11:38:42 AM Eastern Daylight Time			08/04/2021 02:23:59 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-069 (HMO)	01	01		1			H5619	069	0	2022	Select Counties in Arkansas		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	6	1			1		1	07/31/2021	2022.01	07/31/2021 06:55:53 PM Eastern Daylight Time	08/03/2021 05:25:27 PM Eastern Daylight Time	07/30/2021 11:38:54 AM Eastern Daylight Time			08/04/2021 01:36:45 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-071 (HMO)	01	01		1			H5619	071	0	2022	Lexington Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	7	1			1		1	08/04/2021	2022.01	08/04/2021 10:13:50 AM Eastern Daylight Time	08/03/2021 05:24:51 PM Eastern Daylight Time	07/30/2021 11:39:06 AM Eastern Daylight Time			08/04/2021 01:36:45 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-073 (HMO)	01	01		1			H5619	073	0	2022	Louisville Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	7	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 10:35:45 AM Eastern Daylight Time	08/03/2021 05:38:57 PM Eastern Daylight Time	07/30/2021 11:39:18 AM Eastern Daylight Time			08/04/2021 01:36:45 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H5619-075 (HMO D-SNP)	01	01		1			H5619	075	0	2022	Central Kentucky Area		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	7	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 10:35:53 AM Eastern Daylight Time	08/03/2021 05:39:29 PM Eastern Daylight Time	07/30/2021 11:39:28 AM Eastern Daylight Time			08/04/2021 01:36:45 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H5619-076 (HMO D-SNP)	01	01		1			H5619	076	0	2022	Clark, Floyd and Harrison counties		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		1	08/04/2021	2022.01	08/04/2021 02:42:03 PM Eastern Daylight Time	08/03/2021 05:55:08 PM Eastern Daylight Time	07/30/2021 11:39:42 AM Eastern Daylight Time			08/04/2021 02:56:32 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-077 (HMO)	01	01		1			H5619	077	0	2022	Ada, Canyon and Payette counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		1	08/04/2021	2022.01	08/04/2021 02:42:16 PM Eastern Daylight Time	08/03/2021 06:05:24 PM Eastern Daylight Time	07/30/2021 11:39:52 AM Eastern Daylight Time			08/04/2021 02:56:32 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-078 (HMO)	01	01		1			H5619	078	0	2022	Bonner and Kootenai counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		1	07/22/2021	2022.01	07/22/2021 04:41:00 PM Eastern Daylight Time	08/03/2021 05:32:21 PM Eastern Daylight Time	07/30/2021 11:40:04 AM Eastern Daylight Time			08/04/2021 02:27:53 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-080 (HMO)	01	01		1			H5619	080	0	2022	Richland County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1	2	1	1		0	07/22/2021	2022.01	07/22/2021 04:41:07 PM Eastern Daylight Time	08/03/2021 05:30:05 PM Eastern Daylight Time	07/30/2021 11:40:16 AM Eastern Daylight Time			08/04/2021 02:27:53 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H5619-082 (HMO D-SNP)	01	01		1			H5619	082	0	2022	South Carolina		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	07/22/2021	2022.01	07/22/2021 04:41:14 PM Eastern Daylight Time	08/03/2021 05:30:23 PM Eastern Daylight Time	07/30/2021 11:40:28 AM Eastern Daylight Time			08/04/2021 02:27:53 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-083 (HMO)	01	01		1			H5619	083	0	2022	Charleston Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(833)502-2012		(833)502-2012		(800)833-2364		(800)833-2364		(833)502-2012		(833)502-2012		(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	1		1	07/31/2021	2022.01	07/31/2021 03:10:05 PM Eastern Daylight Time	08/03/2021 05:31:07 PM Eastern Daylight Time	07/30/2021 11:40:40 AM Eastern Daylight Time			08/04/2021 02:27:53 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus - Diabetes and Heart (HMO C-SNP)	01	01		1			H5619	087	0	2022	Upstate South Carolina		2		2			1	4			00000000000000000010		https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		1	08/01/2021	2022.01	08/01/2021 12:55:36 PM Eastern Daylight Time	08/03/2021 06:45:05 PM Eastern Daylight Time	07/30/2021 11:40:52 AM Eastern Daylight Time			08/04/2021 02:08:28 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-088 (HMO)	01	01		1			H5619	088	0	2022	Birmingham Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		1	07/31/2021	2022.01	07/31/2021 01:51:50 PM Eastern Daylight Time	08/03/2021 06:45:33 PM Eastern Daylight Time	07/30/2021 11:41:04 AM Eastern Daylight Time			08/04/2021 02:08:28 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-089 (HMO)	01	01		1			H5619	089	0	2022	Mobile Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	08/01/2021	2022.01	08/01/2021 12:55:59 PM Eastern Daylight Time	08/03/2021 06:46:03 PM Eastern Daylight Time	07/30/2021 11:41:14 AM Eastern Daylight Time			08/04/2021 02:08:28 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-090 (HMO)	01	01		1			H5619	090	0	2022	Select VA Counties in the Tri-Cities Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	08/01/2021	2022.01	08/01/2021 12:56:14 PM Eastern Daylight Time	08/03/2021 06:46:33 PM Eastern Daylight Time	07/30/2021 11:41:26 AM Eastern Daylight Time			08/04/2021 02:08:28 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-091 (HMO)	01	01		1			H5619	091	0	2022	Select VA Counties in the Tri-Cities Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	1		0	08/02/2021	2022.01	08/02/2021 03:58:12 PM Eastern Daylight Time	08/03/2021 06:47:02 PM Eastern Daylight Time	07/30/2021 11:41:40 AM Eastern Daylight Time			08/04/2021 01:41:24 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H5619-093 (HMO D-SNP)	01	01		1			H5619	093	0	2022	Greater Alabama		2		2			1	3		2		2	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		1	08/02/2021	2022.01	08/02/2021 10:52:14 AM Eastern Daylight Time	08/03/2021 06:47:33 PM Eastern Daylight Time	07/30/2021 11:41:50 AM Eastern Daylight Time			08/04/2021 01:41:24 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-094 (HMO)	01	01		1			H5619	094	0	2022	Huntsville Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	08/01/2021	2022.01	08/01/2021 12:47:59 PM Eastern Daylight Time	08/03/2021 06:50:39 PM Eastern Daylight Time	07/30/2021 11:42:02 AM Eastern Daylight Time			08/04/2021 01:41:24 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-095 (HMO)	01	01		1			H5619	095	0	2022	Select VA Counties in the Tri-Cities Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	8	1			1		1	08/04/2021	2022.01	08/04/2021 02:18:58 PM Eastern Daylight Time	08/03/2021 06:48:47 PM Eastern Daylight Time	07/30/2021 11:42:14 AM Eastern Daylight Time			08/04/2021 02:25:33 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-097 (HMO)	01	01		1			H5619	097	0	2022	King County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		1	08/01/2021	2022.01	08/01/2021 10:44:49 AM Eastern Daylight Time	08/03/2021 06:54:15 PM Eastern Daylight Time	07/30/2021 11:42:26 AM Eastern Daylight Time			08/04/2021 03:07:42 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-099 (HMO)	01	01		1			H5619	099	0	2022	Kitsap County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	8	1			1		1	08/02/2021	2022.01	08/02/2021 03:04:16 PM Eastern Daylight Time	08/03/2021 06:51:22 PM Eastern Daylight Time	07/30/2021 11:42:38 AM Eastern Daylight Time			08/04/2021 03:15:34 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-100 (HMO)	01	01		1			H5619	100	0	2022	Pierce County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		1	08/04/2021	2022.01	08/04/2021 03:02:15 PM Eastern Daylight Time	08/03/2021 06:52:44 PM Eastern Daylight Time	07/30/2021 11:42:48 AM Eastern Daylight Time			08/04/2021 03:15:34 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-101 (HMO)	01	01		1			H5619	101	0	2022	Clark and Cowlitz counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		0	08/02/2021	2022.01	08/02/2021 12:23:32 PM Eastern Daylight Time	08/03/2021 06:28:12 PM Eastern Daylight Time	07/30/2021 11:43:00 AM Eastern Daylight Time			08/04/2021 02:23:59 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Value Plus H5619-109 (HMO)	01	01		1			H5619	109	0	2022	Select Counties in Arkansas		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	6	1			1		1	08/01/2021	2022.01	08/01/2021 01:22:02 PM Eastern Daylight Time	08/03/2021 06:35:26 PM Eastern Daylight Time	07/30/2021 11:43:12 AM Eastern Daylight Time			08/04/2021 02:23:59 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-111 (HMO)	01	01		1			H5619	111	0	2022	Northwest Arkansas		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		1	08/01/2021	2022.01	08/01/2021 12:48:23 PM Eastern Daylight Time	08/03/2021 06:52:32 PM Eastern Daylight Time	07/30/2021 11:43:24 AM Eastern Daylight Time			08/04/2021 01:41:24 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-112 (HMO)	01	01		1			H5619	112	0	2022	Select Counties in Alabama		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	6	1			1		1	07/31/2021	2022.01	07/31/2021 06:17:10 PM Eastern Daylight Time	08/03/2021 05:55:50 PM Eastern Daylight Time	07/30/2021 11:43:36 AM Eastern Daylight Time			08/04/2021 01:53:48 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-113 (HMO)	01	01		1			H5619	113	0	2022	Select Counties in West Virginia and Kentucky		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	08/02/2021	2022.01	08/02/2021 03:06:15 PM Eastern Daylight Time	08/03/2021 06:58:48 PM Eastern Daylight Time	07/30/2021 11:43:48 AM Eastern Daylight Time			08/04/2021 03:15:34 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-114 (HMO)	01	01		1			H5619	114	0	2022	Whatcom and Skagit Counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	08/04/2021	2022.01	08/04/2021 03:02:24 PM Eastern Daylight Time	08/03/2021 07:00:11 PM Eastern Daylight Time	07/30/2021 11:44:00 AM Eastern Daylight Time			08/04/2021 03:15:34 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-115 (HMO)	01	01		1			H5619	115	0	2022	Whatcom and Skagit Counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	07/31/2021	2022.01	07/31/2021 01:36:18 PM Eastern Daylight Time	08/03/2021 07:38:48 PM Eastern Daylight Time	07/30/2021 11:44:10 AM Eastern Daylight Time			08/04/2021 03:34:25 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-116 (HMO)	01	01		1			H5619	116	0	2022	Kern County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	119	0	1	01	01	H5619_119_0	4	1			1		1	07/31/2021	2022.01	07/31/2021 01:37:01 PM Eastern Daylight Time	08/03/2021 07:40:17 PM Eastern Daylight Time	07/30/2021 11:44:22 AM Eastern Daylight Time			08/04/2021 03:34:25 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-119 (HMO)	01	01		1			H5619	119	0	2022	San Luis Obispo County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	120	0	1	01	01	H5619_120_0	2	1			2	0	0	06/03/2021	2022.01	06/03/2021 02:21:00 PM Eastern Daylight Time	07/22/2021 09:07:46 AM Eastern Daylight Time				07/22/2021 01:54:44 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Honor (HMO)	01	01		1			H5619	120	0	2022	Los Angeles, Orange and San Diego counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_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			
H5619	121	0	1	01	01	H5619_121_0	2	1			2	0	0	06/03/2021	2022.01	06/03/2021 02:21:59 PM Eastern Daylight Time	07/22/2021 09:15:21 AM Eastern Daylight Time				07/22/2021 01:54:44 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Honor (HMO)	01	01		1			H5619	121	0	2022	Select Counties in California		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_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			
H5619	122	0	1	01	01	H5619_122_0	4	1			1		1	07/08/2021	2022.01	07/08/2021 07:35:45 PM Eastern Daylight Time	08/03/2021 06:01:20 PM Eastern Daylight Time	07/30/2021 11:44:34 AM Eastern Daylight Time			08/04/2021 02:23:59 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-122 (HMO)	01	01		1			H5619	122	0	2022	Select Counties in Arkansas		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	123	0	1	01	01	H5619_123_0	6	1	2	1	1		0	07/19/2021	2022.01	07/19/2021 05:00:26 PM Eastern Daylight Time	08/03/2021 06:02:14 PM Eastern Daylight Time	07/30/2021 11:44:46 AM Eastern Daylight Time			08/04/2021 02:23:59 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H5619-123 (HMO D-SNP)	01	01		1			H5619	123	0	2022	Select Counties in Arkansas		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	124	0	1	01	01	H5619_124_0	5	1			1		1	07/15/2021	2022.01	07/15/2021 05:16:20 PM Eastern Daylight Time	08/03/2021 06:16:39 PM Eastern Daylight Time	07/30/2021 11:44:58 AM Eastern Daylight Time			08/04/2021 02:15:03 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-124 (HMO)	01	01		1			H5619	124	0	2022	Indianapolis Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	126	0	1	01	01	H5619_126_0	7	1	2	1	1		0	07/20/2021	2022.01	07/20/2021 01:34:14 PM Eastern Daylight Time	08/03/2021 05:49:51 PM Eastern Daylight Time	07/30/2021 11:45:08 AM Eastern Daylight Time			08/04/2021 01:53:48 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H5619-126 (HMO D-SNP)	01	01		1			H5619	126	0	2022	Select Counties in West Virginia		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	128	0	1	01	01	H5619_128_0	6	1			1		1	08/05/2021	2022.01	08/05/2021 01:45:06 PM Eastern Daylight Time	08/03/2021 05:48:40 PM Eastern Daylight Time	07/30/2021 11:45:20 AM Eastern Daylight Time			08/05/2021 03:32:00 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-128 (HMO)	01	01		1			H5619	128	0	2022	Bowling Green Kentucky		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	130	1	1	01	01	H5619_130_1	4	1			1		1	07/08/2021	2022.01	07/08/2021 04:30:42 PM Eastern Daylight Time	08/03/2021 07:43:30 PM Eastern Daylight Time	07/30/2021 11:45:34 AM Eastern Daylight Time			08/04/2021 03:28:56 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-130 (HMO)	01	01		1			H5619	130	1	2022	Santa Barbara (partial) and Ventura counties	Santa Barbara (partial) County	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	130	2	1	01	01	H5619_130_2	4	1			1		1	07/31/2021	2022.01	07/31/2021 01:00:48 PM Eastern Daylight Time	08/03/2021 07:43:56 PM Eastern Daylight Time	07/30/2021 11:45:44 AM Eastern Daylight Time			08/04/2021 03:28:56 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-130 (HMO)	01	01		1			H5619	130	2	2022	Santa Barbara (partial) and Ventura counties	Ventura County	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	131	0	1	01	01	H5619_131_0	4	1			1		1	07/31/2021	2022.01	07/31/2021 01:01:19 PM Eastern Daylight Time	08/03/2021 07:41:07 PM Eastern Daylight Time	07/30/2021 11:45:56 AM Eastern Daylight Time			08/04/2021 03:28:56 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	UC San Diego Health Humana (HMO)	01	01		1			H5619	131	0	2022	San Diego County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	133	0	1	01	01	H5619_133_0	5	1			1		1	08/04/2021	2022.01	08/04/2021 03:02:34 PM Eastern Daylight Time	08/03/2021 07:06:09 PM Eastern Daylight Time	07/30/2021 11:46:08 AM Eastern Daylight Time			08/04/2021 03:15:34 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-133 (HMO)	01	01		1			H5619	133	0	2022	Benton, Franklin and Walla Walla counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	134	0	1	01	01	H5619_134_0	7	1			1		0	08/04/2021	2022.01	08/04/2021 03:02:41 PM Eastern Daylight Time	08/03/2021 07:09:03 PM Eastern Daylight Time	07/30/2021 11:46:20 AM Eastern Daylight Time			08/04/2021 03:15:34 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Value Plus H5619-134 (HMO)	01	01		1			H5619	134	0	2022	Select counties in Washington		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	135	0	1	01	01	H5619_135_0	7	1			1		1	08/01/2021	2022.01	08/01/2021 01:03:57 PM Eastern Daylight Time	08/03/2021 10:13:26 PM Eastern Daylight Time	07/30/2021 11:46:32 AM Eastern Daylight Time			08/04/2021 02:18:12 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-135 (HMO)	01	01		1			H5619	135	0	2022	Roanoke Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	136	1	1	01	01	H5619_136_1	6	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 02:19:27 PM Eastern Daylight Time	08/03/2021 07:16:06 PM Eastern Daylight Time	07/30/2021 11:46:44 AM Eastern Daylight Time			08/04/2021 02:25:33 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H5619-136 (HMO D-SNP)	01	01		1			H5619	136	1	2022	Select counties in Washington	Clark County	2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	136	2	1	01	01	H5619_136_2	5	1	2	1	1		0	08/02/2021	2022.01	08/02/2021 05:57:55 PM Eastern Daylight Time	08/03/2021 07:17:33 PM Eastern Daylight Time	07/30/2021 11:46:56 AM Eastern Daylight Time			08/04/2021 02:25:33 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H5619-136 (HMO D-SNP)	01	01		1			H5619	136	2	2022	Select counties in Washington	Snohomish County	2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	136	3	1	01	01	H5619_136_3	6	1	2	1	1		0	08/02/2021	2022.01	08/02/2021 01:05:26 PM Eastern Daylight Time	08/03/2021 07:18:56 PM Eastern Daylight Time	07/30/2021 11:47:08 AM Eastern Daylight Time			08/04/2021 02:25:33 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H5619-136 (HMO D-SNP)	01	01		1			H5619	136	3	2022	Select counties in Washington	Skagit and Whatcom counties	2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	136	4	1	01	01	H5619_136_4	7	1	2	1	1		0	08/02/2021	2022.01	08/02/2021 05:59:51 PM Eastern Daylight Time	08/03/2021 07:20:19 PM Eastern Daylight Time	07/30/2021 11:47:20 AM Eastern Daylight Time			08/04/2021 02:25:33 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H5619-136 (HMO D-SNP)	01	01		1			H5619	136	4	2022	Select counties in Washington	Select counties in Washington	2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	137	0	1	01	01	H5619_137_0	4	1			1		1	07/22/2021	2022.01	07/22/2021 02:20:54 PM Eastern Daylight Time	08/03/2021 05:51:32 PM Eastern Daylight Time	07/30/2021 11:47:32 AM Eastern Daylight Time			08/04/2021 02:26:09 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-137 (HMO)	01	01		1			H5619	137	0	2022	New Hampshire and Select Counties in Maine		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	138	0	1	01	01	H5619_138_0	4	1			2		1	08/02/2021	2022.01	08/02/2021 02:42:56 PM Eastern Daylight Time	08/03/2021 07:44:20 PM Eastern Daylight Time	07/30/2021 11:47:42 AM Eastern Daylight Time			08/04/2021 03:28:56 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Community (HMO)	01	01		1			H5619	138	0	2022	Contra Costa County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	139	1	1	01	01	H5619_139_1	6	1			1		1	08/01/2021	2022.01	08/01/2021 01:05:16 PM Eastern Daylight Time	08/03/2021 10:15:18 PM Eastern Daylight Time	07/30/2021 11:47:54 AM Eastern Daylight Time			08/04/2021 02:18:12 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-139 (HMO)	01	01		1			H5619	139	1	2022	Richmond	Richmond Collar	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	139	2	1	01	01	H5619_139_2	6	1			1		1	08/01/2021	2022.01	08/01/2021 02:22:48 PM Eastern Daylight Time	08/03/2021 10:18:43 PM Eastern Daylight Time	07/30/2021 11:48:08 AM Eastern Daylight Time			08/04/2021 02:18:12 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-139 (HMO)	01	01		1			H5619	139	2	2022	Richmond	Richmond Core	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	140	1	1	01	01	H5619_140_1	7	1			1		1	08/01/2021	2022.01	08/01/2021 01:06:37 PM Eastern Daylight Time	08/03/2021 10:19:04 PM Eastern Daylight Time	07/30/2021 11:48:18 AM Eastern Daylight Time			08/04/2021 02:18:12 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-140 (HMO)	01	01		1			H5619	140	1	2022	Tidewater	Tidewater Collar	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	140	2	1	01	01	H5619_140_2	7	1			1		1	08/01/2021	2022.01	08/01/2021 01:07:53 PM Eastern Daylight Time	08/03/2021 10:20:30 PM Eastern Daylight Time	07/30/2021 11:48:30 AM Eastern Daylight Time			08/04/2021 02:18:12 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-140 (HMO)	01	01		1			H5619	140	2	2022	Tidewater	Tidewater Core	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	141	0	1	01	01	H5619_141_0	5	1		1	2		1	08/01/2021	2022.01	08/01/2021 04:08:22 PM Eastern Daylight Time	08/03/2021 06:16:18 PM Eastern Daylight Time	07/30/2021 11:48:42 AM Eastern Daylight Time			08/04/2021 02:23:59 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus - Diabetes and Heart (HMO C-SNP)	01	01		1			H5619	141	0	2022	Select Counties in Arkansas		2		2			1	4			00000000000000000010		https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	143	0	1	01	01	H5619_143_0	5	1			1		1	08/02/2021	2022.01	08/02/2021 03:15:12 PM Eastern Daylight Time	08/03/2021 07:26:19 PM Eastern Daylight Time	07/30/2021 11:48:54 AM Eastern Daylight Time			08/04/2021 03:15:34 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-143 (HMO)	01	01		1			H5619	143	0	2022	Spokane County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	144	1	1	01	01	H5619_144_1	6	1			1		1	08/02/2021	2022.01	08/02/2021 12:58:50 PM Eastern Daylight Time	08/03/2021 06:00:05 PM Eastern Daylight Time	07/30/2021 11:49:06 AM Eastern Daylight Time			08/04/2021 02:27:53 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-144 (HMO)	01	01		1			H5619	144	1	2022	Select Counties in South Carolina	Select counties in South Carolina	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	144	2	1	01	01	H5619_144_2	6	1			1		1	08/02/2021	2022.01	08/02/2021 01:01:08 PM Eastern Daylight Time	08/03/2021 06:00:21 PM Eastern Daylight Time	07/30/2021 11:49:18 AM Eastern Daylight Time			08/04/2021 02:27:53 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus H5619-144 (HMO)	01	01		1			H5619	144	2	2022	Select Counties in South Carolina	Charleston Metro Area	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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						05/25/2021	2022.01	05/25/2021 03:47:44 PM Eastern Daylight Time					06/04/2021 08:33:40 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H5619	802	0	2022	Select Counties in Multi States		1	1142	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242		(866)396-8810		(866)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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H5619	803	0	1	01	01	H5619_803_0	1	1				0	0	05/25/2021	2022.01	05/25/2021 03:50:12 PM Eastern Daylight Time					06/04/2021 08:33:40 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H5619	803	0	2022	Select Counties in Multi States		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H5619	805	0	1	01	01	H5619_805_0	1	1						05/27/2021	2022.01	05/27/2021 04:03:35 PM Eastern Daylight Time					06/04/2021 08:33:40 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H5619	805	0	2022	Select Counties in Multi States		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242		(866)396-8810		(866)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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					2				
H5619	806	0	1	01	01	H5619_806_0	1	1				0	0	05/27/2021	2022.01	05/27/2021 04:05:09 PM Eastern Daylight Time					06/04/2021 08:33:40 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H5619	806	0	2022	Select Counties in Multi States		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					2				
H5628	001	0	1	01	01	H5628_001_0	5	1	2	1			0	08/05/2021	2022.01	08/05/2021 02:26:19 PM Pacific Daylight Time	08/04/2021 05:36:22 PM Pacific Daylight Time	08/04/2021 04:36:52 PM Pacific Daylight Time			08/05/2021 03:02:36 PM Pacific Daylight Time	MOLINA HEALTHCARE OF UTAH, INC.	Molina Healthcare of Utah & Idaho	www.molinahealthcare.com/medicare	Molina Medicare Complete Care (HMO D-SNP)	01	01		1			H5628	001	0	2022	Select Counties in Utah		2		2			1	3		1		1	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	007	0	1	01	01	H5628_007_0	5	1					1	08/05/2021	2022.01	08/05/2021 02:18:20 PM Pacific Daylight Time	08/04/2021 05:38:34 PM Pacific Daylight Time	08/04/2021 04:37:20 PM Pacific Daylight Time			08/05/2021 03:02:36 PM Pacific Daylight Time	MOLINA HEALTHCARE OF UTAH, INC.	Molina Healthcare of Utah & Idaho	www.molinahealthcare.com/medicare	Molina Medicare Choice Care (HMO)	01	01		1			H5628	007	0	2022	Wasatch Front and Cache, Tooele, Summit Counties		2		2			2						www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	(877)644-0344		(877)644-0344		(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	008	0	1	01	01	H5628_008_0	5	1	2	1			0	08/05/2021	2022.01	08/05/2021 02:23:32 PM Pacific Daylight Time	08/04/2021 05:48:52 PM Pacific Daylight Time	08/04/2021 04:37:48 PM Pacific Daylight Time			08/05/2021 03:02:36 PM Pacific Daylight Time	MOLINA HEALTHCARE OF UTAH, INC.	Molina Healthcare of Utah & Idaho	www.molinahealthcare.com/medicare	Molina Medicare Complete Care (HMO D-SNP)	01	01		1			H5628	008	0	2022	Select Counties in Idaho		2		2			1	3		1		1	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	6	1					1	08/05/2021	2022.01	08/05/2021 02:24:02 PM Pacific Daylight Time	08/04/2021 05:49:28 PM Pacific Daylight Time	08/04/2021 04:38:16 PM Pacific Daylight Time			08/05/2021 03:02:36 PM Pacific Daylight Time	MOLINA HEALTHCARE OF UTAH, INC.	Molina Healthcare of Utah & Idaho	www.molinahealthcare.com/medicare	Molina Medicare Choice Care (HMO)	01	01		1			H5628	009	0	2022	Ada and Canyon Counties		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	6	1					1	08/05/2021	2022.01	08/05/2021 02:24:35 PM Pacific Daylight Time	08/04/2021 05:50:08 PM Pacific Daylight Time	08/04/2021 04:38:48 PM Pacific Daylight Time			08/05/2021 03:02:36 PM Pacific Daylight Time	MOLINA HEALTHCARE OF UTAH, INC.	Molina Healthcare of Utah & Idaho	www.molinahealthcare.com/medicare	Molina Medicare Choice Care (HMO)	01	01		1			H5628	010	0	2022	Twin Falls County		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	011	0	1	01	01	H5628_011_0	5	1	2	1			0	08/05/2021	2022.01	08/05/2021 02:25:36 PM Pacific Daylight Time	08/04/2021 05:50:46 PM Pacific Daylight Time	08/04/2021 04:39:20 PM Pacific Daylight Time			08/05/2021 03:02:36 PM Pacific Daylight Time	MOLINA HEALTHCARE OF UTAH, INC.	Molina Healthcare of Utah & Idaho	www.molinahealthcare.com/medicare	Molina Medicare Complete Care Select (HMO D-SNP)	01	01		1			H5628	011	0	2022	Select Counties in Idaho		2		2			1	3		2		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	012	0	1	01	01	H5628_012_0	5	1	2	1			0	08/05/2021	2022.01	08/05/2021 02:26:06 PM Pacific Daylight Time	08/04/2021 05:51:28 PM Pacific Daylight Time	08/04/2021 04:39:48 PM Pacific Daylight Time			08/05/2021 03:02:36 PM Pacific Daylight Time	MOLINA HEALTHCARE OF UTAH, INC.	Molina Healthcare of Utah & Idaho	www.molinahealthcare.com/medicare	Molina Medicare Complete Care Select (HMO D-SNP)	01	01		1			H5628	012	0	2022	Select Counties in Utah		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			
H5629	001	0	1	20	08	H5629_001_0	1	1						06/04/2021	2022.01	06/04/2021 10:17:26 AM Pacific Daylight Time		06/04/2021 10:25:04 AM Pacific Daylight Time			06/04/2021 10:29:00 AM 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	2022	San Diego County		2		2			2						stpaulspace.org	stpaulspace.org												(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						06/04/2021	2022.01	06/04/2021 10:18:17 AM Pacific Daylight Time		06/04/2021 10:25:04 AM Pacific Daylight Time			06/04/2021 10:29:00 AM 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	2022	San Diego County, South County		2		2			2						stpaulspace.org	stpaulspace.org												(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	8	1					0	08/04/2021	2022.01	08/04/2021 03:30:58 PM Eastern Daylight Time	07/31/2021 02:27:02 PM Eastern Daylight Time	08/04/2021 12:42:27 PM Eastern Daylight Time			08/04/2021 04:38:21 PM Eastern Daylight Time	NETWORK HEALTH INSURANCE CORPORATION	Network Health Medicare Advantage Plans	https://networkhealth.com/	Network Health Medicare Explore (HMO)	01	01		1			H5644	002	0	2022	Southeast Wisconsin		2		2			2						https://networkhealth.com/find-a-pharmacy.html	https://networkhealth.com/look-up-medications.html	https://networkhealth.com/find-a-doctor/	(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	6	1					0	07/21/2021	2022.01	07/21/2021 02:49:21 PM Eastern Daylight Time	07/30/2021 11:57:24 AM Eastern Daylight Time	07/30/2021 11:33:52 AM Eastern Daylight Time			08/04/2021 01:44:03 PM 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	2022	Counties:  LA, SB, RS, OC		2	302427	2			2						www.centralhealthplan.com/Benefits/PharmacyList.aspx	www.centralhealthplan.com/PartD/Formulary	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5649	002	0	1	01	01	H5649_002_0	6	1	2	1			0	07/21/2021	2022.01	07/21/2021 02:48:26 PM Eastern Daylight Time	07/30/2021 11:57:53 AM Eastern Daylight Time	07/30/2021 11:39:01 AM Eastern Daylight Time			08/04/2021 01:44:03 PM Eastern Daylight Time	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Central Health Medicare Plan	www.centralhealthplan.com	Central Health Medi-Medi Plan (HMO D-SNP)	01	01		1			H5649	002	0	2022	Counties: LA and SB		2	33933	2			1	3		1		2	www.centralhealthplan.com/Benefits/PharmacyList.aspx	www.centralhealthplan.com/PartD/Formulary	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5649	004	0	1	01	01	H5649_004_0	6	1					0	07/21/2021	2022.01	07/21/2021 02:45:39 PM Eastern Daylight Time	07/30/2021 11:58:24 AM Eastern Daylight Time	07/30/2021 11:43:55 AM Eastern Daylight Time			08/04/2021 01:44:03 PM 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	2022	Counties:  LA, SB, RS, OC		2	107397	2			2						www.centralhealthplan.com/Benefits/PharmacyList.aspx	www.centralhealthplan.com/PartD/Formulary	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5649	006	0	1	01	01	H5649_006_0	6	1		1			1	07/21/2021	2022.01	07/21/2021 02:46:00 PM Eastern Daylight Time	07/30/2021 11:58:54 AM Eastern Daylight Time	07/30/2021 11:49:04 AM Eastern Daylight Time			08/04/2021 01:44:03 PM Eastern Daylight Time	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Central Health Medicare Plan	www.centralhealthplan.com	Central Health Focus Plan (HMO C-SNP)	01	01		1			H5649	006	0	2022	Counties:  LA, SB, OC		2	26904	2			1	4			00000000000000000010		www.centralhealthplan.com/Benefits/PharmacyList.aspx	www.centralhealthplan.com/PartD/Formulary	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5649	008	0	1	01	01	H5649_008_0	6	1					0	07/21/2021	2022.01	07/21/2021 02:46:17 PM Eastern Daylight Time	07/30/2021 11:59:22 AM Eastern Daylight Time	07/30/2021 11:53:51 AM Eastern Daylight Time			08/04/2021 01:44:03 PM 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	2022	Ventura County		2	13083	2			2						www.centralhealthplan.com/Benefits/PharmacyList.aspx	www.centralhealthplan.com/PartD/Formulary	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5649	009	0	1	01	01	H5649_009_0	6	1	2	1			0	07/21/2021	2022.01	07/21/2021 02:46:35 PM Eastern Daylight Time	07/30/2021 11:59:53 AM Eastern Daylight Time	07/30/2021 11:58:35 AM Eastern Daylight Time			08/04/2021 01:44:03 PM Eastern Daylight Time	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Central Health Medicare Plan	www.centralhealthplan.com	Central Health Ventura Medi-Medi Plan (HMO D-SNP)	01	01		1			H5649	009	0	2022	Ventura County		2	4905	2			1	3		1		2	www.centralhealthplan.com/Benefits/Pharmacy.aspx	www.centralhealthplan.com/PartD/Formulary	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5649	018	0	1	01	01	H5649_018_0	6	1					0	07/21/2021	2022.01	07/21/2021 02:47:12 PM Eastern Daylight Time	07/30/2021 12:00:27 PM Eastern Daylight Time	07/30/2021 12:03:39 PM Eastern Daylight Time			08/04/2021 01:44:03 PM Eastern Daylight Time	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Central Health Medicare Plan	www.centralhealthplan.com	Central Health San Mateo Medicare Plan (HMO)	01	01		1			H5649	018	0	2022	San Mateo County		2	12996	2			2						www.centralhealthplan.com/Benefits/Pharmacy.aspx	www.centralhealthplan.com/PartD/Formulary	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5649	019	0	1	01	01	H5649_019_0	6	1					0	07/21/2021	2022.01	07/21/2021 02:51:11 PM Eastern Daylight Time	07/30/2021 12:00:57 PM Eastern Daylight Time	07/30/2021 12:08:21 PM Eastern Daylight Time			08/04/2021 01:44:03 PM Eastern Daylight Time	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Central Health Medicare Plan	www.centralhealthplan.com/	Central Health Savings Plan (HMO)	01	01		1			H5649	019	0	2022	Counties: LA, SB, RS, OC		2	29400	2			2						www.centralhealthplan.com/Benefits/PharmacyList.aspx	www.centralhealthplan.com/PartD/Formulary	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5652	001	0	1	02	01	H5652_001_0	3	1					1	08/05/2021	2022.01	08/05/2021 09:23:43 AM Central Daylight Time	08/03/2021 12:04:29 PM Central Daylight Time	07/29/2021 09:09:54 PM Central Daylight Time			08/05/2021 04:24:44 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	2022	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	2	1				0	0	07/15/2021	2022.01	07/15/2021 11:50:55 AM Central Daylight Time	06/03/2021 03:52:09 PM Central Daylight Time				07/16/2021 01:39:42 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.EricksonAdvantage.com	Erickson Advantage Liberty without Drugs (HMO-POS)	01	02		1			H5652	002	0	2022	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			1	08/05/2021	2022.01	08/05/2021 11:04:40 AM Central Daylight Time	08/03/2021 12:05:05 PM Central Daylight Time	07/29/2021 09:10:10 PM Central Daylight Time			08/05/2021 04:24:44 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.EricksonAdvantage.com	Erickson Advantage Guardian (HMO-POS I-SNP)	01	02		1			H5652	003	0	2022	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	3	1		1			1	08/04/2021	2022.01	08/04/2021 05:30:52 PM Central Daylight Time	08/03/2021 12:05:42 PM Central Daylight Time	07/29/2021 09:10:26 PM Central Daylight Time			08/05/2021 04:24:44 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.EricksonAdvantage.com	Erickson Advantage Champion (HMO-POS C-SNP)	01	02		1			H5652	004	0	2022	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					1	08/04/2021	2022.01	08/04/2021 05:34:35 PM Central Daylight Time	08/03/2021 12:06:17 PM Central Daylight Time	07/29/2021 09:10:41 PM Central Daylight Time			08/05/2021 04:24:44 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	2022	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	008	0	1	02	01	H5652_008_0	3	1					1	08/04/2021	2022.01	08/04/2021 03:54:00 PM Central Daylight Time	08/03/2021 12:06:53 PM Central Daylight Time	07/29/2021 09:10:57 PM Central Daylight Time			08/05/2021 04:24:44 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.EricksonAdvantage.com	Erickson Advantage Liberty with Drugs (HMO-POS)	01	02		1			H5652	008	0	2022	CO/KS/MD/MA/MI/NJ/NC/PA/TX/VA		2		1	1		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			
H5703	001	0	1	01	01	H5703_001_0	8	1	2	1			0	07/13/2021	2022.01	07/13/2021 11:49:29 AM Central Daylight Time	08/02/2021 03:42:54 PM Central Daylight Time	08/02/2021 03:36:23 PM Central Daylight Time			08/02/2021 03:59:12 PM Central Daylight Time	SOUTH COUNTRY HEALTH ALLIANCE	South Country Health Alliance	www.mnscha.org	AbilityCare (HMO D-SNP)	01	01		1			H5703	001	0	2022	Select Counties in Minnesota		2		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			
H5746	016	0	1	01	01	H5746_016_0	8	1					0	07/16/2021	2022.01	07/16/2021 10:51:32 AM Pacific Daylight Time	08/03/2021 03:04:04 PM Pacific Daylight Time	08/03/2021 03:04:04 PM Pacific Daylight Time			08/04/2021 12:07:42 PM Pacific Daylight Time	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Amerigroup Community Care of New Mexico	https://shop.amerigroup.com/medicare/	Amerivantage Care Access (HMO)	01	01		1			H5746	016	0	2022	Greater Albuquerque Area		2		2			2						www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare/	(866)805-4589		(866)805-4589		(855)679-0559		(855)679-0559		(833)343-4754		(833)343-4754		(855)485-0974		(855)485-0974		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5746	018	0	1	01	01	H5746_018_0	8	1					0	07/31/2021	2022.01	07/31/2021 05:07:20 PM Pacific Daylight Time	08/03/2021 03:04:04 PM Pacific Daylight Time	08/03/2021 03:04:04 PM Pacific Daylight Time			08/04/2021 12:07:42 PM Pacific Daylight Time	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Amerigroup Community Care of New Mexico	https://shop.amerigroup.com/medicare/	Amerivantage Plus (HMO)	01	01		1			H5746	018	0	2022	Greater Albuquerque area		2		2			2						www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare/	(866)805-4589		(866)805-4589		(855)679-0559		(855)679-0559		(833)343-4754		(833)343-4754		(855)485-0974		(855)485-0974		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5746	019	0	1	01	01	H5746_019_0	8	1		1			0	06/04/2021	2022.01	06/04/2021 08:00:09 AM Pacific Daylight Time		08/03/2021 03:04:04 PM Pacific Daylight Time		08/03/2021 03:04:04 PM Pacific Daylight Time	08/04/2021 12:07:42 PM Pacific Daylight Time	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Amerigroup Community Care of New Mexico	https://shop.amerigroup.com/medicare/	Amerivantage ESRD Care (HMO C-SNP)	01	01		1			H5746	019	0	2022	Greater Albuquerque MSA		2		2			1	4			00000000100000000000		www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare/	(866)805-4589		(866)805-4589		(855)679-0559		(855)679-0559		(833)343-4754		(833)343-4754		(855)485-0974		(855)485-0974		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5774	003	0	1	01	01	H5774_003_0	7	1			1	0	0	07/10/2021	2022.01	07/10/2021 04:31:39 PM SA Western Standard Time	06/07/2021 03:49:57 PM SA Western Standard Time				07/11/2021 01:30:01 PM SA Western Standard Time	TRIPLE S ADVANTAGE, INC.	Triple S Advantage	www.sssadvantage.com	Basic (HMO)	01	01		1			H5774	003	0	2022	Puerto Rico		2	3672	2			2						www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(833)221-2234		(833)221-2234										(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520										2					2					2	1	11	8a1;8a2;8b1;	7f;
H5774	005	0	1	01	01	H5774_005_0	8	1			1		1	08/04/2021	2022.01	08/04/2021 10:24:54 AM SA Western Standard Time	08/04/2021 10:32:37 AM SA Western Standard Time	07/30/2021 11:16:11 AM SA Western Standard Time			08/05/2021 09:01:04 AM SA Western Standard Time	TRIPLE S ADVANTAGE, INC.	Triple S Advantage	www.sssadvantage.com	Real (HMO)	01	01		1			H5774	005	0	2022	Puerto Rico		2	190452	2			2						www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(833)221-2234		(833)221-2234		(888)620-1919		(888)620-1919		(833)221-2234		(833)221-2234		(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	8	1		1	1		1	08/04/2021	2022.01	08/04/2021 10:52:29 AM SA Western Standard Time	08/04/2021 10:33:00 AM SA Western Standard Time	07/30/2021 11:16:25 AM SA Western Standard Time			08/05/2021 09:01:04 AM SA Western Standard Time	TRIPLE S ADVANTAGE, INC.	Triple S Advantage	www.sssadvantage.com	Contigo Plus (HMO C-SNP)	01	01		1			H5774	022	0	2022	Puerto Rico		2	20400	2			1	4			00000000000000000010		www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(833)221-2234		(833)221-2234		(888)620-1919		(888)620-1919		(833)221-2234		(833)221-2234		(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	024	0	1	01	01	H5774_024_0	10	1	1	1	1		0	08/04/2021	2022.01	08/04/2021 10:30:48 AM SA Western Standard Time	08/12/2021 06:48:56 PM SA Western Standard Time	07/30/2021 11:16:41 AM SA Western Standard Time			08/12/2021 06:51:58 PM SA Western Standard Time	TRIPLE S ADVANTAGE, INC.	Triple S Advantage	www.sssadvantage.com	Platino Plus (HMO D-SNP)	01	01		1			H5774	024	0	2022	Puerto Rico		2	328296	2		1	1	3		2		2	www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(833)221-2234		(833)221-2234		(888)620-1919		(888)620-1919		(833)221-2234		(833)221-2234		(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	8	1	1	1	1		0	08/04/2021	2022.01	08/04/2021 10:38:53 AM SA Western Standard Time	08/04/2021 10:33:44 AM SA Western Standard Time	07/30/2021 11:16:56 AM SA Western Standard Time			08/05/2021 09:01:04 AM SA Western Standard Time	TRIPLE S ADVANTAGE, INC.	Triple S Advantage	www.sssadvantage.com	Platino Ultra (HMO D-SNP)	01	01		1			H5774	025	0	2022	Puerto Rico		2	69456	2		1	1	3		2		2	www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(833)221-2234		(833)221-2234		(888)620-1919		(888)620-1919		(833)221-2234		(833)221-2234		(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	7	1	1	1	1		0	08/04/2021	2022.01	08/04/2021 10:44:08 AM SA Western Standard Time	08/04/2021 10:34:06 AM SA Western Standard Time	07/30/2021 11:17:11 AM SA Western Standard Time			08/05/2021 09:01:04 AM SA Western Standard Time	TRIPLE S ADVANTAGE, INC.	Triple S Advantage	www.sssadvantage.com	Platino Advance (HMO D-SNP)	01	01		1			H5774	026	0	2022	Puerto Rico		2	66468	2		1	1	3		2		2	www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(833)221-2234		(833)221-2234		(888)620-1919		(888)620-1919		(833)221-2234		(833)221-2234		(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	7f;	
H5774	027	0	1	02	01	H5774_027_0	8	1			1		1	08/04/2021	2022.01	08/04/2021 09:13:07 AM SA Western Standard Time	08/04/2021 10:34:28 AM SA Western Standard Time	07/30/2021 11:17:26 AM SA Western Standard Time			08/05/2021 09:01:04 AM SA Western Standard Time	TRIPLE S ADVANTAGE, INC.	Triple S Advantage	www.sssadvantage.com	Magno (HMO-POS)	01	02		1			H5774	027	0	2022	Puerto Rico		2	200124	2			2						www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(833)221-2234		(833)221-2234		(888)620-1919		(888)620-1919		(833)221-2234		(833)221-2234		(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;7g;8b1;	
H5774	028	0	1	01	01	H5774_028_0	9	1	1	1	1		0	08/04/2021	2022.01	08/04/2021 09:14:24 AM SA Western Standard Time	08/04/2021 10:34:49 AM SA Western Standard Time	07/30/2021 11:17:41 AM SA Western Standard Time			08/05/2021 09:01:04 AM SA Western Standard Time	TRIPLE S ADVANTAGE, INC.	Triple S Advantage	www.sssadvantage.com	Platino Blindao (HMO D-SNP)	01	01		1			H5774	028	0	2022	Puerto Rico		2	144756	2		1	1	3		2		2	www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(833)221-2234		(833)221-2234		(888)620-1919		(888)620-1919		(833)221-2234		(833)221-2234		(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	031	0	1	02	01	H5774_031_0	8	1			1		1	08/04/2021	2022.01	08/04/2021 10:27:44 AM SA Western Standard Time	08/04/2021 10:35:11 AM SA Western Standard Time	07/30/2021 11:17:56 AM SA Western Standard Time			08/05/2021 09:01:04 AM SA Western Standard Time	TRIPLE S ADVANTAGE, INC.	Triple S Advantage	www.sssadvantage.com	Brillante (HMO-POS)	01	02		1			H5774	031	0	2022	Puerto Rico		2	194700	2			2						www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(833)221-2234		(833)221-2234		(888)620-1919		(888)620-1919		(833)221-2234		(833)221-2234		(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;7g;8b1;	
H5774	035	0	1	01	01	H5774_035_0	8	1	1	1	1		0	08/04/2021	2022.01	08/04/2021 10:47:25 AM SA Western Standard Time	08/04/2021 10:35:33 AM SA Western Standard Time	07/30/2021 11:18:11 AM SA Western Standard Time			08/05/2021 09:01:04 AM SA Western Standard Time	TRIPLE S ADVANTAGE, INC.	Triple S Advantage	www.sssadvantage.com	Platino Alcance (HMO D-SNP)	01	01		1			H5774	035	0	2022	Puerto Rico		2	4608	2		1	1	3		2		2	www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(833)221-2234		(833)221-2234		(888)620-1919		(888)620-1919		(833)221-2234		(833)221-2234		(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	802	0	1	01	01	H5774_802_0	5	1				0	0	05/20/2021	2022.01	05/20/2021 09:44:46 AM SA Western Standard Time					06/07/2021 04:51:39 PM SA Western Standard Time	TRIPLE S ADVANTAGE, INC.	Triple S Advantage	www.sssadvantage.com	Royal A (HMO)	01	01		1			H5774	802	0	2022	Puerto Rico		1	120	2			2						www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(833)221-2234		(833)221-2234										(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520										1	1	2;3-1;3-2;3-3;3-4;5;6;7c;7d;7i;8a;8b1;8b2;9a1;9b;10a;11a;11b;16b;	2		1					1				
H5774	806	0	1	01	01	H5774_806_0	5	1						05/20/2021	2022.01	05/20/2021 09:50:04 AM SA Western Standard Time					06/07/2021 04:51:39 PM SA Western Standard Time	TRIPLE S ADVANTAGE, INC.	Triple S Advantage	www.sssadvantage.com	Royal B (HMO)	01	01		1			H5774	806	0	2022	Puerto Rico		1	120	2			2						www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(833)221-2234		(833)221-2234		(888)620-1919		(888)620-1919		(833)221-2234		(833)221-2234		(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;3-4;5;6;7c;7d;7i;8a;8b1;8b2;9a1;9b;10a;11a;11b;16b;	2		1					1				
H5774	808	0	1	01	01	H5774_808_0	5	1						05/20/2021	2022.01	05/20/2021 10:05:46 AM SA Western Standard Time					06/07/2021 04:51:39 PM SA Western Standard Time	TRIPLE S ADVANTAGE, INC.	Triple S Advantage	www.sssadvantage.com	Royal C (HMO)	01	01		1			H5774	808	0	2022	Puerto Rico		1	7800	2			2						www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(833)221-2234		(833)221-2234		(888)620-1919		(888)620-1919		(833)221-2234		(833)221-2234		(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;3-4;5;6;7c;7d;7i;8a;8b1;8b2;9a1;9b;10a;11a;11b;16b;	2		1					1				
H5774	809	0	1	02	01	H5774_809_0	5	1						05/20/2021	2022.01	05/20/2021 10:18:52 AM SA Western Standard Time					06/07/2021 04:51:39 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	2022	Puerto Rico		1	336000	2			2						www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(833)221-2234		(833)221-2234		(888)620-1919		(888)620-1919		(833)221-2234		(833)221-2234		(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;3-4;5;7c;7d;7g;7i;8a;8b1;8b2;9a1;9b;10a;11a;11b;16b;	2		1	1	2;3-1;3-2;3-3;3-4;5;6;7c;7d;7i;8a;8b1;8b2;9a1;10a;11a;11b;16b;	2		1				
H5774	810	0	1	01	01	H5774_810_0	5	1						05/21/2021	2022.01	05/21/2021 11:51:38 AM SA Western Standard Time					06/07/2021 04:51:39 PM SA Western Standard Time	TRIPLE S ADVANTAGE, INC.	Triple S Advantage	www.sssadvantage.com	Royal E (HMO)	01	01		1			H5774	810	0	2022	Puerto Rico		1	120	2			2						www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(833)221-2234		(833)221-2234		(888)620-1919		(888)620-1919		(833)221-2234		(833)221-2234		(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;7d;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	5	1						05/17/2021	2022.01	05/17/2021 10:35:26 AM SA Western Standard Time					06/07/2021 04:51:39 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	2022	Puerto Rico		1	120	2			2						www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(833)221-2234		(833)221-2234		(888)620-1919		(888)620-1919		(833)221-2234		(833)221-2234		(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;3-4;5;6;7c;7d;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;16b;	2		1	1	2;3-1;3-2;3-3;3-4;5;6;7c;7d;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;16b;	2		1				
H5774	812	0	1	02	01	H5774_812_0	5	1						05/17/2021	2022.01	05/17/2021 01:45:16 PM SA Western Standard Time					06/07/2021 04:51:39 PM SA Western Standard Time	TRIPLE S ADVANTAGE, INC.	Triple S Advantage	www.sssadvantage.com	Employer BD 1 (HMO-POS)	01	02		1			H5774	812	0	2022	Puerto Rico		1	120	2			2						www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(833)221-2234		(833)221-2234		(888)620-1919		(888)620-1919		(833)221-2234		(833)221-2234		(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;3-4;5;6;7c;7d;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;16b;	2		1	1	2;3-1;3-2;3-3;3-4;5;6;7c;7d;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;16b;	2		2				
H5774	814	0	1	02	01	H5774_814_0	5	1						05/17/2021	2022.01	05/17/2021 01:52:37 PM SA Western Standard Time					06/07/2021 04:51:39 PM SA Western Standard Time	TRIPLE S ADVANTAGE, INC.	Triple S Advantage	www.sssadvantage.com	Employer BD 3 (HMO-POS)	01	02		1			H5774	814	0	2022	Puerto Rico		1	47340	2			2						www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(833)221-2234		(833)221-2234		(888)620-1919		(888)620-1919		(833)221-2234		(833)221-2234		(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;3-4;5;6;7c;7d;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;16b;	2		1	1	2;3-1;3-2;3-3;3-4;5;6;7c;7d;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;16b;	2		2				
H5774	816	0	1	02	01	H5774_816_0	5	1						05/20/2021	2022.01	05/20/2021 09:07:11 AM SA Western Standard Time					06/07/2021 04:51:39 PM SA Western Standard Time	TRIPLE S ADVANTAGE, INC.	Triple S Advantage	www.sssadvantage.com	Employer BD 5 (HMO-POS)	01	02		1			H5774	816	0	2022	Puerto Rico		1	120	2			2						www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(833)221-2234		(833)221-2234		(888)620-1919		(888)620-1919		(833)221-2234		(833)221-2234		(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;3-4;5;6;7c;7d;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;16b;	2		1	1	2;3-1;3-2;3-3;3-4;5;6;7c;7d;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;16b;	2		2				
H5774	818	0	1	02	01	H5774_818_0	5	1						05/20/2021	2022.01	05/20/2021 09:12:39 AM SA Western Standard Time					06/07/2021 04:51:39 PM SA Western Standard Time	TRIPLE S ADVANTAGE, INC.	Triple S Advantage	www.sssadvantage.com	Employer BD 7 (HMO-POS)	01	02		1			H5774	818	0	2022	Puerto Rico		1	20760	2			2						www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(833)221-2234		(833)221-2234		(888)620-1919		(888)620-1919		(833)221-2234		(833)221-2234		(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;3-4;5;6;7c;7d;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;16b;	2		1	1	2;3-1;3-2;3-3;3-4;5;6;7c;7d;7i;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;16b;	2		2				
H5774	820	0	1	02	01	H5774_820_0	5	1						05/20/2021	2022.01	05/20/2021 09:16:52 AM SA Western Standard Time					06/07/2021 04:51:39 PM SA Western Standard Time	TRIPLE S ADVANTAGE, INC.	Triple S Advantage	www.sssadvantage.com	Employer BD 8 (HMO-POS)	01	02		1			H5774	820	0	2022	Puerto Rico		1	6000	2			2						www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(833)221-2234		(833)221-2234		(888)620-1919		(888)620-1919		(833)221-2234		(833)221-2234		(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;3-4;5;6;7c;7d;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;16b;	2		1	1	2;3-1;3-2;3-3;3-4;5;6;7c;7d;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;11a;11b;15;16b;	2		2				
H5774	821	0	1	02	01	H5774_821_0	5	1						06/05/2021	2022.01	06/05/2021 03:21:58 PM SA Western Standard Time					06/07/2021 04:51:39 PM SA Western Standard Time	TRIPLE S ADVANTAGE, INC.	Triple S Advantage	www.sssadvantage.com	Employer BD 9 (HMO-POS)	01	02		1			H5774	821	0	2022	Puerto Rico		1	120	2			2						www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(833)221-2234		(833)221-2234		(888)620-1919		(888)620-1919		(833)221-2234		(833)221-2234		(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;3-4;5;6;7c;7d;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;16b;	2		1	1	2;3-1;3-2;3-3;3-4;5;6;7c;7d;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;16b;	2		2				
H5779	002	0	1	01	01	H5779_002_0	4	1					0	08/01/2021	2022.01	08/01/2021 10:34:11 AM Eastern Daylight Time	08/04/2021 12:54:23 AM Eastern Daylight Time	07/30/2021 01:16:18 PM Eastern Daylight Time			08/04/2021 11:43:06 PM Eastern Daylight Time	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium Essential (HMO)	01	01		1			H5779	002	0	2022	Select counties in IL		2	8255	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5779	005	0	1	01	01	H5779_005_0	4	1					0	08/01/2021	2022.01	08/01/2021 10:36:55 AM Eastern Daylight Time	08/04/2021 12:54:52 AM Eastern Daylight Time	07/30/2021 01:16:46 PM Eastern Daylight Time			08/04/2021 11:43:06 PM Eastern Daylight Time	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium Essential (HMO)	01	01		1			H5779	005	0	2022	Select counties in IL		2	9198	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5779	006	0	1	01	01	H5779_006_0	5	1					0	07/06/2021	2022.01	07/06/2021 03:33:58 PM Eastern Daylight Time	08/04/2021 12:55:21 AM Eastern Daylight Time	07/30/2021 01:17:08 PM Eastern Daylight Time			08/04/2021 11:43:06 PM Eastern Daylight Time	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Edge Plus (HMO)	01	01		1			H5779	006	0	2022	Select counties in IL		2	26398	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5779	007	0	1	01	01	H5779_007_0	4	1					0	08/01/2021	2022.01	08/01/2021 10:40:12 AM Eastern Daylight Time	08/04/2021 12:55:50 AM Eastern Daylight Time	07/30/2021 01:17:36 PM Eastern Daylight Time			08/04/2021 11:43:06 PM Eastern Daylight Time	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium Exclusive (HMO)	01	01		1			H5779	007	0	2022	Select counties in IL		2	33215	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	7a;7d;7f;7g;7j;7k;16b;17a;18a;	
H5779	008	0	1	01	01	H5779_008_0	4	1					0	05/31/2021	2022.01	05/31/2021 07:08:28 AM Pacific Daylight Time	08/04/2021 03:40:31 PM Eastern Daylight Time	07/30/2021 01:17:58 PM Eastern Daylight Time			08/04/2021 11:43:06 PM Eastern Daylight Time	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Assist (HMO)	01	01		1			H5779	008	0	2022	Select counties in IL		2	7479	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5793	001	0	1	01	01	H5793_001_0	3	1			2		0	08/02/2021	2022.01	08/02/2021 03:13:49 PM Eastern Daylight Time	08/03/2021 11:40:45 AM Eastern Daylight Time	08/02/2021 09:56:25 AM Eastern Daylight Time			08/04/2021 01:33:15 PM Eastern Daylight Time	AETNA HEALTH INC. (CT)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H5793	001	0	2022	Connecticut		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5793	010	0	1	01	01	H5793_010_0	3	1			2		0	08/02/2021	2022.01	08/02/2021 03:21:46 PM Eastern Daylight Time	08/03/2021 12:04:41 PM Eastern Daylight Time	08/02/2021 09:56:29 AM Eastern Daylight Time			08/04/2021 01:33:15 PM Eastern Daylight Time	AETNA HEALTH INC. (CT)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite Plan (HMO)	01	01		1			H5793	010	0	2022	Connecticut		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5793	014	0	1	01	01	H5793_014_0	3	1			2		0	08/02/2021	2022.01	08/02/2021 03:22:15 PM Eastern Daylight Time	08/03/2021 12:06:52 PM Eastern Daylight Time	08/02/2021 09:56:34 AM Eastern Daylight Time			08/04/2021 01:33:15 PM Eastern Daylight Time	AETNA HEALTH INC. (CT)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H5793	014	0	2022	Central Massachusetts		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5793	015	0	1	01	01	H5793_015_0	3	1			2		0	08/02/2021	2022.01	08/02/2021 03:22:57 PM Eastern Daylight Time	08/03/2021 12:09:57 PM Eastern Daylight Time	08/02/2021 09:56:38 AM Eastern Daylight Time			08/04/2021 01:33:15 PM Eastern Daylight Time	AETNA HEALTH INC. (CT)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite Plan (HMO)	01	01		1			H5793	015	0	2022	New Hampshire		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5793	016	0	1	01	01	H5793_016_0	3	1			2		0	08/02/2021	2022.01	08/02/2021 03:23:30 PM Eastern Daylight Time	08/03/2021 12:12:18 PM Eastern Daylight Time	08/02/2021 09:56:42 AM Eastern Daylight Time			08/04/2021 01:33:15 PM Eastern Daylight Time	AETNA HEALTH INC. (CT)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H5793	016	0	2022	Rhode Island		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5793	017	0	1	02	01	H5793_017_0	4	1	2	1	1		0	07/08/2021	2022.01	07/08/2021 10:26:21 AM Eastern Daylight Time	08/03/2021 12:13:29 PM Eastern Daylight Time	08/02/2021 09:56:46 AM Eastern Daylight Time			08/04/2021 01:33:15 PM Eastern Daylight Time	AETNA HEALTH INC. (CT)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Assure Plan (HMO-POS D-SNP)	01	02		1			H5793	017	0	2022	Connecticut		2		2			1	3		1		1	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5793	018	0	1	01	01	H5793_018_0	4	1			2		0	08/02/2021	2022.01	08/02/2021 03:24:02 PM Eastern Daylight Time	08/03/2021 12:14:18 PM Eastern Daylight Time	08/02/2021 09:56:50 AM Eastern Daylight Time			08/04/2021 01:33:15 PM Eastern Daylight Time	AETNA HEALTH INC. (CT)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H5793	018	0	2022	Eastern Massachusetts		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5793	801	0	1	01	01	H5793_801_0	1	1				0	0	05/28/2021	2022.01	05/28/2021 01:12:34 PM Eastern Daylight Time					06/03/2021 01:53:09 PM Eastern Daylight Time	AETNA HEALTH INC. (CT)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (HMO)	01	01		1			H5793	801	0	2022	Connecticut		1	240	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H5793	802	0	1	01	01	H5793_802_0	1	1						05/28/2021	2022.01	05/28/2021 01:13:12 PM Eastern Daylight Time					06/03/2021 01:53:09 PM Eastern Daylight Time	AETNA HEALTH INC. (CT)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan w/Rx (HMO)	01	01		1			H5793	802	0	2022	Connecticut		1	120	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H5810	001	0	1	01	01	H5810_001_0	5	1	2	1			0	08/05/2021	2022.01	08/05/2021 11:17:33 AM Pacific Daylight Time	08/04/2021 05:52:06 PM Pacific Daylight Time	08/04/2021 04:40:16 PM Pacific Daylight Time			08/05/2021 03:02:36 PM Pacific Daylight Time	MOLINA HEALTHCARE OF CALIFORNIA	Molina Healthcare of California	www.molinahealthcare.com/medicare	Molina Medicare Complete Care (HMO D-SNP)	01	01		1			H5810	001	0	2022	Counties: LA, SD, parts of Riv. and S. Bernardino		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			
H5810	013	0	1	01	01	H5810_013_0	5	1	2	1			0	08/05/2021	2022.01	08/05/2021 11:18:36 AM Pacific Daylight Time	08/04/2021 05:52:46 PM Pacific Daylight Time	08/04/2021 04:40:44 PM Pacific Daylight Time			08/05/2021 03:02:36 PM Pacific Daylight Time	MOLINA HEALTHCARE OF CALIFORNIA	Molina Healthcare of California	www.molinahealthcare.com/medicare	Molina Medicare Complete Care (HMO D-SNP)	01	01		1			H5810	013	0	2022	Imperial County		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			
H5810	014	0	1	01	01	H5810_014_0	5	1					1	08/05/2021	2022.01	08/05/2021 11:19:33 AM Pacific Daylight Time	08/04/2021 05:53:36 PM Pacific Daylight Time	08/04/2021 04:41:10 PM Pacific Daylight Time			08/05/2021 03:02:36 PM Pacific Daylight Time	MOLINA HEALTHCARE OF CALIFORNIA	Molina Healthcare of California	www.molinahealthcare.com/medicare	Molina Medicare Choice Care (HMO)	01	01		1			H5810	014	0	2022	Select Counties in California		2		2			2						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			
H5810	015	0	1	01	01	H5810_015_0	5	1					0	07/20/2021	2022.01	07/20/2021 04:16:13 PM Pacific Daylight Time	08/04/2021 05:54:28 PM Pacific Daylight Time	08/04/2021 04:41:34 PM Pacific Daylight Time			08/05/2021 03:02:36 PM Pacific Daylight Time	MOLINA HEALTHCARE OF CALIFORNIA	Molina Healthcare of California	www.molinahealthcare.com/medicare	Molina Medicare Choice Care Select (HMO)	01	01		1			H5810	015	0	2022	Select Counties in California		2		2			2						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	1	1						06/04/2021	2022.01	06/04/2021 03:10:01 PM Central Daylight Time		06/04/2021 03:04:25 PM Central Daylight Time			06/04/2021 03:13:51 PM Central Daylight Time	MIDLAND CARE CONNECTION	Midland Care PACE	www.midlandcareconnection.org	Midland Care Connection - Dual Eligibles (PACE)	08	20		1			H5822	001	0	2022	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	1	1						06/04/2021	2022.01	06/04/2021 03:10:29 PM Central Daylight Time		06/04/2021 03:05:02 PM Central Daylight Time			06/04/2021 03:13:51 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	2022	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			0	08/05/2021	2022.01	08/05/2021 02:26:50 PM Pacific Daylight Time	08/04/2021 05:55:20 PM Pacific Daylight Time	08/04/2021 04:42:00 PM Pacific Daylight Time			08/05/2021 03:02:36 PM Pacific Daylight Time	MOLINA HEALTHCARE OF WASHINGTON, INC.	Molina Healthcare of Washington, Inc.	www.molinahealthcare.com/medicare	Molina Medicare Complete Care (HMO D-SNP)	01	01		1			H5823	006	0	2022	Select Counties in Washington		2		2			1	3		1		1	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			
H5823	010	0	1	01	01	H5823_010_0	5	1	2	1			0	08/05/2021	2022.01	08/05/2021 02:27:25 PM Pacific Daylight Time	08/04/2021 05:56:18 PM Pacific Daylight Time	08/04/2021 04:42:26 PM Pacific Daylight Time			08/05/2021 03:02:36 PM Pacific Daylight Time	MOLINA HEALTHCARE OF WASHINGTON, INC.	Molina Healthcare of Washington, Inc.	www.molinahealthcare.com/medicare	Molina Medicare Complete Care Select (HMO D-SNP)	01	01		1			H5823	010	0	2022	Select Counties in Washington		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			
H5823	011	0	1	01	01	H5823_011_0	5	1					1	08/05/2021	2022.01	08/05/2021 02:28:00 PM Pacific Daylight Time	08/04/2021 05:57:00 PM Pacific Daylight Time	08/04/2021 04:42:50 PM Pacific Daylight Time			08/05/2021 03:02:36 PM Pacific Daylight Time	MOLINA HEALTHCARE OF WASHINGTON, INC.	Molina Healthcare of Washington, Inc.	www.molinahealthcare.com/medicare	Molina Medicare Choice Care (HMO)	01	01		1			H5823	011	0	2022	Select Counties in Washington		2		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	4	1				0	0	07/16/2021	2022.01	07/16/2021 04:48:11 PM Pacific Daylight Time	06/02/2021 01:34:22 PM Pacific Daylight Time				07/19/2021 02:45:00 PM Pacific Daylight Time	COMMUNITY HEALTH PLAN OF WASHINGTON	Community Health Plan of WA Medicare Advantage	www.medicare.chpw.org	Community Health Plan of WA MA No Rx Plan (HMO)	01	01		1			H5826	006	0	2022	Western Washington and Spokane Counties		2	1187	2			2						www.medicare.chpw.org	www.medicare.chpw.org	www.medicare.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	5	1					0	07/16/2021	2022.01	07/16/2021 03:33:36 PM Pacific Daylight Time	08/04/2021 01:18:57 PM Pacific Daylight Time	07/29/2021 02:00:04 PM Pacific Daylight Time			08/05/2021 03:17:45 PM Pacific Daylight Time	COMMUNITY HEALTH PLAN OF WASHINGTON	Community Health Plan of WA Medicare Advantage	www.medicare.chpw.org	Community Health Plan of WA MA Plan 3 (HMO)	01	01		1			H5826	008	0	2022	Western Washington and Spokane Counties		2	16672	2			2						www.medicare.chpw.org	www.medicare.chpw.org	www.medicare.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	5	1					0	07/16/2021	2022.01	07/16/2021 03:36:52 PM Pacific Daylight Time	08/04/2021 01:20:27 PM Pacific Daylight Time	07/29/2021 02:01:02 PM Pacific Daylight Time			08/05/2021 03:17:45 PM Pacific Daylight Time	COMMUNITY HEALTH PLAN OF WASHINGTON	Community Health Plan of WA Medicare Advantage	www.medicare.chpw.org	Community Health Plan of WA MA Plan 4 (HMO)	01	01		1			H5826	009	0	2022	Eastern and Western Washington State		2	9504	2			2						www.medicare.chpw.org	www.medicare.chpw.org	www.medicare.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	7	1					0	09/28/2021	2022.01	09/28/2021 01:02:15 PM Pacific Daylight Time	08/04/2021 01:22:00 PM Pacific Daylight Time	07/29/2021 02:01:38 PM Pacific Daylight Time			09/28/2021 01:52:51 PM Pacific Daylight Time	COMMUNITY HEALTH PLAN OF WASHINGTON	Community Health Plan of WA Medicare Advantage	www.medicare.chpw.org	Community Health Plan of WA MA Plan 2 (HMO)	01	01		1			H5826	010	0	2022	Eastern and Western Washington State		2	29944	2			2						www.medicare.chpw.org	www.medicare.chpw.org	www.medicare.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	5	1	2	1			0	08/03/2021	2022.01	08/03/2021 07:03:57 PM Pacific Daylight Time	08/04/2021 01:23:17 PM Pacific Daylight Time	07/29/2021 02:02:15 PM Pacific Daylight Time			08/05/2021 03:17:45 PM Pacific Daylight Time	COMMUNITY HEALTH PLAN OF WASHINGTON	Community Health Plan of WA Medicare Advantage	www.medicare.chpw.org	Community Health Plan of WA Dual Plan (HMO D-SNP)	01	01		1			H5826	014	0	2022	Eastern and Western Washington State		2	47142	2			1	3		2		1	www.medicare.chpw.org	www.medicare.chpw.org	www.medicare.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	5	1					0	07/16/2021	2022.01	07/16/2021 03:45:14 PM Pacific Daylight Time	08/04/2021 01:24:48 PM Pacific Daylight Time	07/29/2021 02:03:01 PM Pacific Daylight Time			08/05/2021 03:17:45 PM Pacific Daylight Time	COMMUNITY HEALTH PLAN OF WASHINGTON	Community Health Plan of WA Medicare Advantage	www.medicare.chpw.org	Community Health Plan of WA MA Plan 1 (HMO)	01	01		1			H5826	016	0	2022	Eastern and Western Washington State		2	6116	2			2						www.medicare.chpw.org	www.medicare.chpw.org	www.medicare.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			
H5828	001	0	1	01	01	H5828_001_0	5	1	2	1	1		0	07/19/2021	2022.01	07/19/2021 02:47:07 PM Eastern Daylight Time	08/03/2021 06:03:59 PM Eastern Daylight Time	08/03/2021 06:03:59 PM Eastern Daylight Time			08/04/2021 02:00:52 PM Eastern Daylight Time	AMERIGROUP TENNESSEE, INC.	AMERIGROUP Community Care	https://shop.anthem.com/medicare	Amerivantage Full Dual Coordination (HMO D-SNP)	01	01		1			H5828	001	0	2022	Tennessee		2		2			1	3		1		1	https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	https://shop.anthem.com/medicare	(833)713-1074		(833)713-1074		(855)679-0560		(855)679-0560		(833)498-1587		(833)498-1587		(855)485-0975		(855)485-0975		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5828	002	0	1	01	01	H5828_002_0	7	1	2	1	1		0	08/02/2021	2022.01	08/02/2021 12:36:40 PM Eastern Daylight Time	08/03/2021 06:03:59 PM Eastern Daylight Time	08/03/2021 06:03:59 PM Eastern Daylight Time			08/04/2021 02:00:52 PM Eastern Daylight Time	AMERIGROUP TENNESSEE, INC.	AMERIGROUP Community Care	https://shop.anthem.com/medicare	Amerivantage Dual Premier (HMO D-SNP)	01	01		1			H5828	002	0	2022	Tennessee		2		2			1	3		1		1	https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	https://shop.anthem.com/medicare	(833)713-1074		(833)713-1074		(855)679-0560		(855)679-0560		(833)498-1587		(833)498-1587		(855)485-0975		(855)485-0975		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5828	005	0	1	02	01	H5828_005_0	9	1			2		0	08/02/2021	2022.01	08/02/2021 12:40:04 PM Eastern Daylight Time	08/03/2021 06:03:59 PM Eastern Daylight Time	08/03/2021 06:03:59 PM Eastern Daylight Time			08/04/2021 02:00:52 PM Eastern Daylight Time	AMERIGROUP TENNESSEE, INC.	AMERIGROUP Community Care	https://shop.anthem.com/medicare	Amerivantage Classic Plus (HMO-POS)	01	02		1			H5828	005	0	2022	Select Counties in Tennessee		2		2			2						https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	https://shop.anthem.com/medicare	(833)713-1073		(833)713-1073		(855)679-0561		(855)679-0561		(833)498-1587		(833)498-1587		(855)485-0976		(855)485-0976		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5828	006	0	1	02	01	H5828_006_0	7	1			2		0	08/02/2021	2022.01	08/02/2021 12:40:20 PM Eastern Daylight Time	08/03/2021 06:03:59 PM Eastern Daylight Time	08/03/2021 06:03:59 PM Eastern Daylight Time			08/04/2021 02:00:52 PM Eastern Daylight Time	AMERIGROUP TENNESSEE, INC.	AMERIGROUP Community Care	https://shop.anthem.com/medicare	Amerivantage Classic Plus (HMO-POS)	01	02		1			H5828	006	0	2022	Select Counties in Tennessee		2		2			2						https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	https://shop.anthem.com/medicare	(833)713-1073		(833)713-1073		(855)679-0561		(855)679-0561		(833)498-1587		(833)498-1587		(855)485-0976		(855)485-0976		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5828	008	0	1	01	01	H5828_008_0	7	1			2		0	07/19/2021	2022.01	07/19/2021 02:48:29 PM Eastern Daylight Time	08/03/2021 06:03:59 PM Eastern Daylight Time	08/03/2021 06:03:59 PM Eastern Daylight Time			08/04/2021 02:00:52 PM Eastern Daylight Time	AMERIGROUP TENNESSEE, INC.	AMERIGROUP Community Care	https://shop.anthem.com/medicare	Amerivantage Balance Plus (HMO)	01	01		1			H5828	008	0	2022	Tennessee		2		2			2						https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	https://shop.anthem.com/medicare	(833)713-1073		(833)713-1073		(855)679-0562		(855)679-0562		(833)498-1587		(833)498-1587		(855)485-0977		(855)485-0977		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5828	009	0	1	01	01	H5828_009_0	7	1		1	2		0	07/19/2021	2022.01	07/19/2021 02:55:36 PM Eastern Daylight Time	08/03/2021 06:03:59 PM Eastern Daylight Time	08/03/2021 06:03:59 PM Eastern Daylight Time			08/04/2021 02:00:52 PM Eastern Daylight Time	AMERIGROUP TENNESSEE, INC.	AMERIGROUP Community Care	https://shop.anthem.com/medicare	Amerivantage Comfort (HMO I-SNP)	01	01		1			H5828	009	0	2022	Select counties in TN		2		2			1	1	3				https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	https://shop.anthem.com/medicare	(833)713-1074		(833)713-1074		(855)679-0560		(855)679-0560		(833)498-1587		(833)498-1587		(855)485-0975		(855)485-0975		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5843	001	0	1	01	01	H5843_001_0	12	1			1		1	08/03/2021	2022.01	08/03/2021 11:40:08 AM US Mountain Standard Time	08/03/2021 03:40:26 PM US Mountain Standard Time	08/03/2021 03:00:10 PM US Mountain Standard Time			08/04/2021 07:16:13 AM US Mountain Standard Time	BANNER HEALTH PLAN, INC.	Banner Medicare Advantage Prime	www.BannerMA.com	Banner Medicare Advantage Prime (HMO)	01	01		1			H5843	001	0	2022	Maricopa, Pinal Counties		2	44588	2			2						www.BannerMA.com	www.BannerMA.com	www.BannerMA.com	(844)549-1857		(602)462-0831		(844)549-1858		(602)462-0831		(844)549-1857		(602)462-0831		(844)549-1858		(602)462-0831		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5843	002	0	1	01	01	H5843_002_0	12	1			1		1	07/31/2021	2022.01	07/31/2021 12:55:27 PM US Mountain Standard Time	08/03/2021 03:40:50 PM US Mountain Standard Time	08/03/2021 03:00:32 PM US Mountain Standard Time			08/04/2021 07:16:13 AM US Mountain Standard Time	BANNER HEALTH PLAN, INC.	Banner Medicare Advantage Prime	www.BannerMA.com	Banner Medicare Advantage Prime (HMO)	01	01		1			H5843	002	0	2022	Pima County		2	16086	2			2						www.BannerMA.com	www.BannerMA.com	www.BannerMA.com	(844)549-1857		(602)462-0831		(844)549-1858		(602)462-0831		(844)549-1857		(602)462-0831		(844)549-1858		(602)462-0831		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5843	004	0	1	01	01	H5843_004_0	12	1			1		1	07/31/2021	2022.01	07/31/2021 12:55:18 PM US Mountain Standard Time	08/03/2021 03:41:18 PM US Mountain Standard Time	08/03/2021 03:00:52 PM US Mountain Standard Time			08/04/2021 07:16:13 AM US Mountain Standard Time	BANNER HEALTH PLAN, INC.	Banner Medicare Advantage Prime	www.BannerMA.com	Banner Medicare Advantage Prime (HMO)	01	01		1			H5843	004	0	2022	Santa Cruz County		2	2648	2			2						www.BannerMA.com	www.BannerMA.com	www.BannerMA.com	(844)549-1857		(602)462-0831		(844)549-1858		(602)462-0831		(844)549-1857		(602)462-0831		(844)549-1858		(602)462-0831		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5843	005	0	1	01	01	H5843_005_0	12	1			1		1	07/31/2021	2022.01	07/31/2021 12:55:54 PM US Mountain Standard Time	08/03/2021 03:41:42 PM US Mountain Standard Time	08/03/2021 03:01:10 PM US Mountain Standard Time			08/04/2021 07:16:13 AM US Mountain Standard Time	BANNER HEALTH PLAN, INC.	Banner Medicare Advantage Prime	www.BannerMA.com	Banner Medicare Advantage Prime (HMO)	01	01		1			H5843	005	0	2022	Yuma County		2	722	2			2						www.BannerMA.com	www.BannerMA.com	www.BannerMA.com	(844)549-1857		(602)462-0831		(844)549-1858		(602)462-0831		(844)549-1857		(602)462-0831		(844)549-1858		(602)462-0831		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5852	001	0	1	01	01	H5852_001_0	4	1		1			0	08/05/2021	2022.01	08/05/2021 03:45:16 PM Pacific Daylight Time	08/05/2021 03:48:46 PM Pacific Daylight Time	08/05/2021 03:51:15 PM Pacific Daylight Time			08/05/2021 03:52:56 PM Pacific Daylight Time	AIDS HEALTHCARE FOUNDATION	AHF	www.php-ca.org	PHP (HMO C-SNP)	01	01		1			H5852	001	0	2022	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	6	1					0	06/15/2021	2022.01	06/15/2021 02:25:27 PM Eastern Daylight Time	08/03/2021 06:04:05 PM Eastern Daylight Time	08/03/2021 06:04:05 PM Eastern Daylight Time			08/04/2021 02:27:41 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	2022	Hartford County		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com/medicare	(866)673-4157		(866)673-4157		(855)679-0563		(855)679-0563		(833)343-4758		(833)343-4758		(855)485-0978		(855)485-0978		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5854	008	0	1	01	01	H5854_008_0	6	1	2	1			0	05/30/2021	2022.01	05/30/2021 06:23:43 PM Eastern Daylight Time	08/03/2021 06:04:05 PM Eastern Daylight Time	08/03/2021 06:04:05 PM Eastern Daylight Time			08/04/2021 02:27:41 PM Eastern Daylight Time	ANTHEM HEALTH PLANS, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/shop	Anthem MediBlue Dual Advantage (HMO D-SNP)	01	01		1			H5854	008	0	2022	State of Connecticut		2		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		(855)679-0564		(855)679-0564		(833)343-4757		(833)343-4757		(855)499-1085		(855)499-1085		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5854	009	0	1	01	01	H5854_009_0	6	1					0	05/31/2021	2022.01	05/31/2021 02:15:09 PM Eastern Daylight Time	08/03/2021 06:04:05 PM Eastern Daylight Time	08/03/2021 06:04:05 PM Eastern Daylight Time			08/04/2021 02:27:41 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	2022	Select Counties in Connecticut		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com/medicare	(866)673-4157		(866)673-4157		(855)679-0563		(855)679-0563		(833)343-4758		(833)343-4758		(855)485-0978		(855)485-0978		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5854	010	0	1	01	01	H5854_010_0	7	1					1	05/31/2021	2022.01	05/31/2021 02:23:16 PM Eastern Daylight Time	08/03/2021 06:04:05 PM Eastern Daylight Time	08/03/2021 06:04:05 PM Eastern Daylight Time			08/04/2021 02:27:41 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	2022	Select Counties in Connecticut		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com/medicare	(866)673-4157		(866)673-4157		(855)679-0563		(855)679-0563		(833)343-4758		(833)343-4758		(855)485-0978		(855)485-0978		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5854	011	0	1	01	01	H5854_011_0	6	1					0	05/31/2021	2022.01	05/31/2021 02:37:58 PM Eastern Daylight Time	08/03/2021 06:04:05 PM Eastern Daylight Time	08/03/2021 06:04:05 PM Eastern Daylight Time			08/04/2021 02:27:41 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	2022	State of Connecticut		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com/medicare	(844)469-6744		(844)469-6744		(855)679-0563		(855)679-0563		(833)343-4755		(833)343-4755		(855)485-0978		(855)485-0978		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5854	012	0	1	02	01	H5854_012_0	12	1		1	2		0	07/18/2021	2022.01	07/18/2021 04:26:52 PM Pacific Daylight Time		08/03/2021 03:04:04 PM Pacific Daylight Time		08/03/2021 03:04:04 PM Pacific Daylight Time	08/04/2021 12:07:42 PM Pacific Daylight Time	ANTHEM HEALTH PLANS, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/shop	Anthem MediBlue ESRD Care (HMO-POS C-SNP)	01	02		1			H5854	012	0	2022	Select Counties in Connecticut		2		2			1	4			00000000100000000000		https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com/medicare	(844)469-6821		(844)469-6821		(855)679-0565		(855)679-0565		(833)343-4756		(833)343-4756		(855)499-1086		(855)499-1086		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5854	013	0	1	01	01	H5854_013_0	6	1	2	1	1		0	07/18/2021	2022.01	07/18/2021 12:49:29 PM Eastern Daylight Time	08/03/2021 06:04:05 PM Eastern Daylight Time	08/03/2021 06:04:05 PM Eastern Daylight Time			08/04/2021 02:27:41 PM Eastern Daylight Time	ANTHEM HEALTH PLANS, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/shop	Anthem MediBlue Dual Advantage Select (HMO D-SNP)	01	01		1			H5854	013	0	2022	State of Connecticut		2		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		(855)679-0564		(855)679-0564		(833)343-4757		(833)343-4757		(855)499-1085		(855)499-1085		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5854	014	0	1	01	01	H5854_014_0	8	1		1	2		0	06/04/2021	2022.01	06/04/2021 08:00:29 AM Pacific Daylight Time	08/03/2021 03:04:04 PM Pacific Daylight Time	08/03/2021 03:04:04 PM Pacific Daylight Time			08/04/2021 12:07:42 PM Pacific Daylight Time	ANTHEM HEALTH PLANS, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/shop	Anthem MediBlue Care To You (HMO I-SNP)	01	01		1			H5854	014	0	2022	Select Counties in CT		2		2			1	1	3				https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com/medicare	(844)209-5421		(844)209-5421		(855)679-0566		(855)679-0566		(833)343-4758		(833)343-4758		(855)499-1087		(855)499-1087		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5854	015	0	1	01	01	H5854_015_0	6	1					0	07/15/2021	2022.01	07/15/2021 10:42:10 AM Eastern Daylight Time	08/03/2021 06:04:05 PM Eastern Daylight Time	08/03/2021 06:04:05 PM Eastern Daylight Time			08/04/2021 02:27:41 PM Eastern Daylight Time	ANTHEM HEALTH PLANS, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/shop	Anthem MediBlue Prime (HMO)	01	01		1			H5854	015	0	2022	New Haven		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com/medicare	(866)673-4157		(866)673-4157		(855)679-0563		(855)679-0563		(833)343-4758		(833)343-4758		(855)485-0978		(855)485-0978		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5854	801	0	1	01	01	H5854_801_0	1	1						06/02/2021	2022.01	06/02/2021 03:57:03 PM Pacific Daylight Time					06/04/2021 10:37:10 AM 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	2022	Connecticut - Select Counties		1	600	2			2						www.anthem.com/ct/medicare	www.anthem.com/ct/medicare	www.anthem.com/ct/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)360-3665		(833)360-3665		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1					1				
H5854	803	0	1	01	01	H5854_803_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 03:57:16 PM Pacific Daylight Time					06/04/2021 10:37:10 AM 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	2022	Connecticut - Select Counties		1	600	2			2						www.anthem.com/ct/medicare	www.anthem.com/ct/medicare	www.anthem.com/ct/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1					1				
H5854	806	0	2	01	01	H5854_806_0	1	1						06/02/2021	2022.01	06/02/2021 03:57:25 PM Pacific Daylight Time					06/04/2021 10:37:10 AM 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	2022	Conneticut - Select Counties		1	600	2			2						www.anthem.com/ct/medicare	www.anthem.com/ct/medicare	www.anthem.com/ct/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)360-3665		(833)360-3665		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1					1				
H5854	807	0	2	01	01	H5854_807_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 03:57:33 PM Pacific Daylight Time					06/04/2021 10:37:10 AM 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	2022	Select Conneticut Counties		1	600	2			2						www.anthem.com/ct/medicare	www.anthem.com/ct/medicare	www.anthem.com/ct/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1					1				
H5854	809	0	1	01	01	H5854_809_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 03:57:45 PM Pacific Daylight Time					06/04/2021 10:37:10 AM 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	2022	Select Conneticut Counties		1	600	2			2						www.anthem.com/ct/medicare	www.anthem.com/ct/medicare	www.anthem.com/ct/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1					1				
H5854	811	0	2	01	01	H5854_811_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 03:58:01 PM Pacific Daylight Time					06/04/2021 10:37:10 AM 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	2022	Select CT counties		1	600	2			2						www.anthem.com/ct/medicare	www.anthem.com/ct/medicare	www.anthem.com/ct/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1					1				
H5859	001	0	1	02	01	H5859_001_0	6	1	2	1	1		0	08/02/2021	2022.01	08/02/2021 10:41:04 AM Pacific Daylight Time	08/03/2021 11:14:54 PM Pacific Daylight Time	08/03/2021 11:25:04 PM Pacific Daylight Time			08/05/2021 07:36:53 AM Pacific Daylight Time	HEALTH PLAN OF CAREOREGON, INC.	CareOregon Advantage	www.careoregonadvantage.org	CareOregon Advantage Plus (HMO-POS D-SNP)	01	02		1			H5859	001	0	2022	Portland Metro Area, Jackson, Tillamook, Columbia		2	165689	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		(711)-		(800)735-2900		(711)-		(800)735-2900		(711)-		(800)735-2900		(711)-		2					2					2	2			
H5883	001	1	1	02	01	H5883_001_1	5	1				0	0	07/01/2021	2022.01	07/01/2021 01:23:52 PM Eastern Daylight Time	07/07/2021 04:23:38 PM Eastern Daylight Time				07/08/2021 05:26:57 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	2022	Michigan	Region 1	2	3114	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(800)450-3680		(800)450-3680		(855)425-7720		(855)425-7720										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H5883	001	2	1	02	01	H5883_001_2	6	1				0	0	07/01/2021	2022.01	07/01/2021 01:25:09 PM Eastern Daylight Time	07/07/2021 04:23:50 PM Eastern Daylight Time				07/08/2021 05:26:57 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	2022	Michigan	Region 2	2	1194	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(800)450-3680		(800)450-3680		(855)425-7720		(855)425-7720										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H5883	001	3	1	02	01	H5883_001_3	5	1				0	0	07/01/2021	2022.01	07/01/2021 01:26:15 PM Eastern Daylight Time	07/07/2021 04:24:01 PM Eastern Daylight Time				07/08/2021 05:26:57 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	2022	Michigan	Region 3	2	792	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(800)450-3680		(800)450-3680		(855)425-7720		(855)425-7720										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H5883	001	4	1	02	01	H5883_001_4	6	1				0	0	07/01/2021	2022.01	07/01/2021 01:27:13 PM Eastern Daylight Time	07/07/2021 04:24:12 PM Eastern Daylight Time				07/08/2021 05:26:57 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	2022	Michigan	Region 4	2	2221	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(800)450-3680		(800)450-3680		(855)425-7720		(855)425-7720										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H5883	001	5	1	02	01	H5883_001_5	5	1				0	0	07/01/2021	2022.01	07/01/2021 01:28:09 PM Eastern Daylight Time	07/07/2021 04:24:24 PM Eastern Daylight Time				07/08/2021 05:26:57 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	2022	Michigan	Region 5	2	2768	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(800)450-3680		(800)450-3680		(855)425-7720		(855)425-7720										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H5883	002	1	1	02	01	H5883_002_1	8	1			2		1	08/03/2021	2022.01	08/03/2021 02:16:04 PM Eastern Daylight Time	08/04/2021 04:24:19 PM Eastern Daylight Time	08/04/2021 04:22:45 PM Eastern Daylight Time			08/05/2021 05:49:21 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	2022	Michigan	Region 1	2	37455	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(800)450-3680		(800)450-3680		(855)425-7720		(855)425-7720		(800)450-3680		(800)450-3680		(855)425-7720		(855)425-7720		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5883	002	2	1	02	01	H5883_002_2	8	1			2		1	08/03/2021	2022.01	08/03/2021 02:22:07 PM Eastern Daylight Time	08/04/2021 04:22:28 PM Eastern Daylight Time	08/04/2021 04:22:06 PM Eastern Daylight Time			08/05/2021 05:49:21 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	2022	Michigan	Region 2	2	21609	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(800)450-3680		(800)450-3680		(855)425-7720		(855)425-7720		(800)450-3680		(800)450-3680		(855)425-7720		(855)425-7720		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5883	002	3	1	02	01	H5883_002_3	8	1			2		1	08/03/2021	2022.01	08/03/2021 02:16:45 PM Eastern Daylight Time	08/04/2021 04:21:42 PM Eastern Daylight Time	08/04/2021 04:21:21 PM Eastern Daylight Time			08/05/2021 05:49:21 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	2022	Michigan	Region 3	2	12531	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(800)450-3680		(800)450-3680		(855)425-7720		(855)425-7720		(800)450-3680		(800)450-3680		(855)425-7720		(855)425-7720		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5883	002	4	1	02	01	H5883_002_4	8	1			2		1	08/03/2021	2022.01	08/03/2021 02:17:01 PM Eastern Daylight Time	08/04/2021 04:21:05 PM Eastern Daylight Time	08/04/2021 04:20:43 PM Eastern Daylight Time			08/05/2021 05:49:21 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	2022	Michigan	Region 4	2	33525	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(800)450-3680		(800)450-3680		(855)425-7720		(855)425-7720		(800)450-3680		(800)450-3680		(855)425-7720		(855)425-7720		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5883	002	7	1	02	01	H5883_002_7	8	1			2		1	08/03/2021	2022.01	08/03/2021 02:17:19 PM Eastern Daylight Time	08/04/2021 04:20:27 PM Eastern Daylight Time	08/04/2021 04:20:05 PM Eastern Daylight Time			08/05/2021 05:49:21 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	2022	Michigan	Region 5	2	59827	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(800)450-3680		(800)450-3680		(855)425-7720		(855)425-7720		(800)450-3680		(800)450-3680		(855)425-7720		(855)425-7720		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5883	003	1	1	02	01	H5883_003_1	8	1			1		1	07/01/2021	2022.01	07/01/2021 01:35:55 PM Eastern Daylight Time	08/04/2021 04:19:55 PM Eastern Daylight Time	08/04/2021 04:19:45 PM Eastern Daylight Time			08/05/2021 05:49:21 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	2022	Michigan	Region 1	2	2906	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(800)450-3680		(800)450-3680		(855)425-7720		(855)425-7720		(800)450-3680		(800)450-3680		(855)425-7720		(855)425-7720		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5883	003	2	1	02	01	H5883_003_2	8	1			1		1	07/01/2021	2022.01	07/01/2021 01:37:00 PM Eastern Daylight Time	08/04/2021 04:19:38 PM Eastern Daylight Time	08/04/2021 04:19:30 PM Eastern Daylight Time			08/05/2021 05:49:21 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	2022	Michigan	Region 2	2	1591	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(800)450-3680		(800)450-3680		(855)425-7720		(855)425-7720		(800)450-3680		(800)450-3680		(855)425-7720		(855)425-7720		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5883	003	3	1	02	01	H5883_003_3	8	1			1		1	07/01/2021	2022.01	07/01/2021 01:37:55 PM Eastern Daylight Time	08/04/2021 04:34:38 PM Eastern Daylight Time	08/04/2021 04:34:30 PM Eastern Daylight Time			08/05/2021 05:49:21 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	2022	Michigan	Region 3	2	541	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(800)450-3680		(800)450-3680		(855)425-7720		(855)425-7720		(800)450-3680		(800)450-3680		(855)425-7720		(855)425-7720		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5883	003	4	1	02	01	H5883_003_4	8	1			1		1	07/01/2021	2022.01	07/01/2021 01:38:46 PM Eastern Daylight Time	08/04/2021 04:34:18 PM Eastern Daylight Time	08/04/2021 04:34:09 PM Eastern Daylight Time			08/05/2021 05:49:21 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	2022	Michigan	Region 4	2	2896	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(800)450-3680		(800)450-3680		(855)425-7720		(855)425-7720		(800)450-3680		(800)450-3680		(855)425-7720		(855)425-7720		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5883	003	5	1	02	01	H5883_003_5	8	1			1		1	07/01/2021	2022.01	07/01/2021 01:39:37 PM Eastern Daylight Time	08/04/2021 04:34:02 PM Eastern Daylight Time	08/04/2021 04:33:50 PM Eastern Daylight Time			08/05/2021 05:49:21 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	2022	Michigan	Region 5	2	8698	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(800)450-3680		(800)450-3680		(855)425-7720		(855)425-7720		(800)450-3680		(800)450-3680		(855)425-7720		(855)425-7720		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5883	007	0	1	01	01	H5883_007_0	8	1					1	07/01/2021	2022.01	07/01/2021 11:35:18 AM Eastern Daylight Time	08/04/2021 04:33:44 PM Eastern Daylight Time	08/04/2021 04:33:35 PM Eastern Daylight Time			08/05/2021 05:49:21 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	2022	Kalamazoo, Metro Detroit Area and Bay Region		2	31197	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(800)450-3680		(800)450-3680		(855)425-7720		(855)425-7720		(800)450-3680		(800)450-3680		(855)425-7720		(855)425-7720		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5883	012	1	1	02	01	H5883_012_1	8	1			2		0	07/01/2021	2022.01	07/01/2021 01:43:00 PM Eastern Daylight Time	08/04/2021 04:33:28 PM Eastern Daylight Time	08/04/2021 04:33:15 PM Eastern Daylight Time			08/05/2021 05:49:21 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage HMO-POS Community Value (HMO-POS)	01	02		1			H5883	012	1	2022	Metro Detroit Area, Genesee, Livingston, St. Clair	Region 1	2	2111	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(800)450-3680		(800)450-3680		(855)425-7720		(855)425-7720		(800)450-3680		(800)450-3680		(855)425-7720		(855)425-7720		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5883	012	2	1	02	01	H5883_012_2	8	1			2		0	07/01/2021	2022.01	07/01/2021 01:43:58 PM Eastern Daylight Time	08/04/2021 04:33:08 PM Eastern Daylight Time	08/04/2021 04:32:58 PM Eastern Daylight Time			08/05/2021 05:49:21 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage HMO-POS Community Value (HMO-POS)	01	02		1			H5883	012	2	2022	Metro Detroit Area, Genesee, Livingston, St. Clair	Region 2	2	6459	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(800)450-3680		(800)450-3680		(855)425-7720		(855)425-7720		(800)450-3680		(800)450-3680		(855)425-7720		(855)425-7720		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5883	014	1	1	02	01	H5883_014_1	8	1					1	07/01/2021	2022.01	07/01/2021 01:48:14 PM Eastern Daylight Time	08/04/2021 04:32:43 PM Eastern Daylight Time	08/04/2021 04:32:33 PM Eastern Daylight Time			08/05/2021 05:49:21 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage HMO-POS Prime Value (HMO-POS)	01	02		1			H5883	014	1	2022	Michigan	Region 1	2	127354	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(800)450-3680		(800)450-3680		(855)425-7720		(855)425-7720		(800)450-3680		(800)450-3680		(855)425-7720		(855)425-7720		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5883	014	2	1	02	01	H5883_014_2	8	1					1	07/01/2021	2022.01	07/01/2021 01:49:12 PM Eastern Daylight Time	08/04/2021 04:32:26 PM Eastern Daylight Time	08/04/2021 04:32:15 PM Eastern Daylight Time			08/05/2021 05:49:21 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage HMO-POS Prime Value (HMO-POS)	01	02		1			H5883	014	2	2022	Michigan	Region 2	2	65636	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(800)450-3680		(800)450-3680		(855)425-7720		(855)425-7720		(800)450-3680		(800)450-3680		(855)425-7720		(855)425-7720		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5883	014	3	1	02	01	H5883_014_3	8	1					1	07/01/2021	2022.01	07/01/2021 01:50:10 PM Eastern Daylight Time	08/04/2021 04:32:06 PM Eastern Daylight Time	08/04/2021 04:31:42 PM Eastern Daylight Time			08/05/2021 05:49:21 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage HMO-POS Prime Value (HMO-POS)	01	02		1			H5883	014	3	2022	Michigan	Region 3	2	56143	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(800)450-3680		(800)450-3680		(855)425-7720		(855)425-7720		(800)450-3680		(800)450-3680		(855)425-7720		(855)425-7720		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5883	014	4	1	02	01	H5883_014_4	8	1					1	07/01/2021	2022.01	07/01/2021 01:51:02 PM Eastern Daylight Time	08/04/2021 04:31:35 PM Eastern Daylight Time	08/04/2021 04:31:26 PM Eastern Daylight Time			08/05/2021 05:49:21 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage HMO-POS Prime Value (HMO-POS)	01	02		1			H5883	014	4	2022	Michigan	Region 4	2	92500	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(800)450-3680		(800)450-3680		(855)425-7720		(855)425-7720		(800)450-3680		(800)450-3680		(855)425-7720		(855)425-7720		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5883	014	5	1	02	01	H5883_014_5	8	1					1	07/01/2021	2022.01	07/01/2021 01:51:59 PM Eastern Daylight Time	08/04/2021 04:31:16 PM Eastern Daylight Time	08/04/2021 04:31:07 PM Eastern Daylight Time			08/05/2021 05:49:21 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage HMO-POS Prime Value (HMO-POS)	01	02		1			H5883	014	5	2022	Michigan	Region 5	2	160468	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(800)450-3680		(800)450-3680		(855)425-7720		(855)425-7720		(800)450-3680		(800)450-3680		(855)425-7720		(855)425-7720		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5883	801	0	1	02	01	H5883_801_0	4	1				0	0	05/04/2021	2022.01	05/04/2021 06:00:57 PM Eastern Daylight Time					06/07/2021 02:11:29 AM 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	2022	Employer Group		1	300688	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(800)450-3680		(800)450-3680		(800)970-6684		(800)970-6684										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;15;	2		1	1	1a;1b;2;5;6;7b;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;9a1;9b;9c;9d;10a;15;	2		1				
H5883	805	0	1	02	01	H5883_805_0	4	1						05/04/2021	2022.01	05/04/2021 06:00:39 PM Eastern Daylight Time					06/07/2021 02:11:29 AM 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	2022	Employer Group		1	99178	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(800)450-3680		(800)450-3680		(800)970-6684		(800)970-6684		(800)450-3680		(800)450-3680		(800)970-6684		(800)970-6684		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;15;	2		1	1	1a;1b;2;5;6;7b;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;9a1;9b;9c;9d;10a;15;	2		1				
H5900	001	0	1	04	01	H5900_001_0	8	1					0	07/06/2021	2022.01	07/06/2021 03:01:23 PM Eastern Daylight Time	07/30/2021 03:16:05 PM Eastern Daylight Time	07/30/2021 03:15:39 PM Eastern Daylight Time			07/30/2021 03:40:17 PM Eastern Daylight Time	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Wellmark Advantage Health Plan	www.Wellmark.com	Blue Medicare Advantage PPO (PPO)	01	04		1			H5900	001	0	2022	Iowa		2	40140	2			2						www.Wellmark.com/Finder-Medicare	www.Wellmark.com/Finder-Medicare	www.Wellmark.com/Finder-Medicare	(855)716-2544		(855)716-2544		(800)213-3771		(800)213-3771		(888)832-6168		(888)832-6168		(800)213-3771		(800)213-3771		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5900	002	0	1	04	01	H5900_002_0	7	1					0	07/06/2021	2022.01	07/06/2021 03:08:58 PM Eastern Daylight Time	07/30/2021 03:16:05 PM Eastern Daylight Time	07/30/2021 03:15:39 PM Eastern Daylight Time			07/30/2021 03:40:17 PM Eastern Daylight Time	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Wellmark Advantage Health Plan	www.Wellmark.com	Blue Medicare Advantage Enhanced PPO (PPO)	01	04		1			H5900	002	0	2022	Iowa		2	14035	2			2						www.Wellmark.com/Finder-Medicare	www.Wellmark.com/Finder-Medicare	www.Wellmark.com/Finder-Medicare	(855)716-2544		(855)716-2544		(800)213-3771		(800)213-3771		(888)832-6168		(888)832-6168		(800)213-3771		(800)213-3771		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5900	003	0	1	04	01	H5900_003_0	6	1					0	07/06/2021	2022.01	07/06/2021 03:03:26 PM Eastern Daylight Time	07/30/2021 03:16:05 PM Eastern Daylight Time	07/30/2021 03:15:40 PM Eastern Daylight Time			07/30/2021 03:40:17 PM Eastern Daylight Time	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Wellmark Advantage Health Plan	www.Wellmark.com	Blue Medicare Advantage PPO (PPO)	01	04		1			H5900	003	0	2022	South Dakota		2	3959	2			2						www.Wellmark.com/Finder-Medicare	www.Wellmark.com/Finder-Medicare	www.Wellmark.com/Finder-Medicare	(855)716-2544		(855)716-2544		(800)213-3771		(800)213-3771		(888)832-6168		(888)832-6168		(800)213-3771		(800)213-3771		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5900	004	0	1	04	01	H5900_004_0	6	1					0	07/06/2021	2022.01	07/06/2021 03:03:56 PM Eastern Daylight Time	07/30/2021 03:16:05 PM Eastern Daylight Time	07/30/2021 03:15:40 PM Eastern Daylight Time			07/30/2021 03:40:17 PM Eastern Daylight Time	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Wellmark Advantage Health Plan	www.Wellmark.com	Blue Medicare Advantage Enhanced PPO (PPO)	01	04		1			H5900	004	0	2022	South Dakota		2	12522	2			2						www.Wellmark.com/Finder-Medicare	www.Wellmark.com/Finder-Medicare	www.Wellmark.com/Finder-Medicare	(855)716-2544		(855)716-2544		(800)213-3771		(800)213-3771		(888)832-6168		(888)832-6168		(800)213-3771		(800)213-3771		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5900	801	0	1	04	01	H5900_801_0	5	1						04/29/2021	2022.01	04/29/2021 12:55:16 PM Eastern Daylight Time					06/07/2021 02:26:36 PM Eastern Daylight Time	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Wellmark Advantage Health Plan	www.Wellmark.com	Blue Medicare Advantage Group PPO (PPO)	01	04		1			H5900	801	0	2022	States of Iowa and South Dakota		1	0	2			2						www.Wellmark.com/Finder-Medicare	www.Wellmark.com/Finder-Medicare	www.Wellmark.com/Finder-Medicare	(855)716-2544		(855)716-2544		(800)213-3771		(800)213-3771		(888)832-6168		(888)832-6168		(800)213-3771		(800)213-3771		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;2;9a1;11a;15;	2		1									
H5900	802	0	1	04	01	H5900_802_0	5	1				0	0	05/20/2021	2022.01	05/20/2021 10:46:47 AM Eastern Daylight Time					06/07/2021 02:26:36 PM Eastern Daylight Time	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Wellmark Advantage Health Plan	www.Wellmark.com	Blue Medicare Advantage Group PPO (PPO)	01	04		1			H5900	802	0	2022	States of Iowa and South Dakota		1	0	2			2						WellmarkAdvantage.com/Pharmacies	WellmarkAdvantage.com/Formularies	www.Wellmark.com/Finder-Medicare	(855)716-2544		(855)716-2544		(800)213-3771		(800)213-3771										(711)-		(711)-		(711)-		(711)-										1	1	1a;2;9a1;11a;15;	2		1									
H5902	001	0	1	20	08	H5902_001_0	2	1						04/28/2021	2022.01	04/28/2021 04:02:38 PM Eastern Daylight Time		07/27/2021 02:08:32 PM Eastern Daylight Time			07/27/2021 02:39:58 PM Eastern Daylight Time	SENIOR LIFE ALTOONA, INC.	Senior LIFE Altoona, Inc.	www.seniorlifepa.com	Senior LIFE Altoona Dual Eligible (PACE)	08	20		1			H5902	001	0	2022	Blair, Indiana, and Cambria Counties		2		2			2						http://granerx.com/	NA										(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000										(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000																
H5902	002	0	1	20	08	H5902_002_0	2	1						04/28/2021	2022.01	04/28/2021 04:02:47 PM Eastern Daylight Time		07/27/2021 02:08:58 PM Eastern Daylight Time			07/27/2021 02:39:58 PM Eastern Daylight Time	SENIOR LIFE ALTOONA, INC.	Senior LIFE Altoona, Inc.	www.seniorlifepa.com	Senior LIFE Altoona Medicare Only (PACE)	08	20		1			H5902	002	0	2022	Blair, Indiana, and Cambria Counties		2		2			2						http://granerx.com/	NA										(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000										(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			0	08/05/2021	2022.01	08/05/2021 11:26:31 AM Pacific Daylight Time	08/04/2021 05:57:54 PM Pacific Daylight Time	08/04/2021 04:43:18 PM Pacific Daylight Time			08/05/2021 03:02:36 PM Pacific Daylight Time	MOLINA HEALTHCARE OF MICHIGAN, INC.	Molina Healthcare of Michigan	www.molinahealthcare.com/medicare	Molina Medicare Complete Care (HMO D-SNP)	01	01		1			H5926	001	0	2022	Select Counties in Michigan		2		2			1	3		1		1	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			
H5926	005	0	1	01	01	H5926_005_0	5	1	2	1			0	08/05/2021	2022.01	08/05/2021 11:26:54 AM Pacific Daylight Time	08/04/2021 05:59:08 PM Pacific Daylight Time	08/04/2021 04:43:42 PM Pacific Daylight Time			08/05/2021 03:02:36 PM Pacific Daylight Time	MOLINA HEALTHCARE OF MICHIGAN, INC.	Molina Healthcare of Michigan	www.molinahealthcare.com/medicare	Molina Medicare Complete Care Select (HMO D-SNP)	01	01		1			H5926	005	0	2022	Select Counties in Michigan		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			
H5926	006	0	1	01	01	H5926_006_0	5	1					1	08/05/2021	2022.01	08/05/2021 11:27:15 AM Pacific Daylight Time	08/04/2021 05:59:52 PM Pacific Daylight Time	08/04/2021 04:44:08 PM Pacific Daylight Time			08/05/2021 03:02:36 PM Pacific Daylight Time	MOLINA HEALTHCARE OF MICHIGAN, INC.	Molina Healthcare of Michigan	www.molinahealthcare.com/medicare	Molina Medicare Choice Care (HMO)	01	01		1			H5926	006	0	2022	Select Counties in Michigan		2		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	004	0	1	01	01	H5928_004_0	7	1					0	08/05/2021	2022.01	08/05/2021 09:44:54 AM Pacific Daylight Time	08/05/2021 08:10:46 AM Pacific Daylight Time	07/29/2021 07:26:27 PM Pacific Daylight Time			08/05/2021 04:48:55 PM Pacific Daylight Time	California Physicians' Service	Blue Shield of California	blueshieldca.com/medicare	Blue Shield AdvantageOptimum Plan (HMO)	01	01		1			H5928	004	0	2022	Los Angeles and Orange Counties		2		2			2						blueshieldca.com/medpharmacy2022	blueshieldca.com/medformulary2022	blueshieldca.com/find-a-doctor	(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5928	005	0	1	01	01	H5928_005_0	7	1	2	1			0	08/05/2021	2022.01	08/05/2021 09:49:16 AM Pacific Daylight Time	08/05/2021 01:39:31 PM Pacific Daylight Time	07/29/2021 07:26:41 PM Pacific Daylight Time			08/05/2021 04:48:55 PM Pacific Daylight Time	California Physicians' Service	Blue Shield of California	blueshieldca.com/medicare	Blue Shield TotalDual Plan (HMO D-SNP)	01	01		1			H5928	005	0	2022	Counties: LA, OR, SB, SD		2		2			1	3		2		1	blueshieldca.com/medpharmacy2022	blueshieldca.com/medformulary2022	blueshieldca.com/find-a-doctor	(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5928	010	0	1	01	01	H5928_010_0	7	1					0	08/05/2021	2022.01	08/05/2021 09:46:33 AM Pacific Daylight Time	08/05/2021 08:19:38 AM Pacific Daylight Time	07/29/2021 07:26:55 PM Pacific Daylight Time			08/05/2021 04:48:55 PM Pacific Daylight Time	California Physicians' Service	Blue Shield of California	blueshieldca.com/medicare	Blue Shield AdvantageOptimum Plan 1 (HMO)	01	01		1			H5928	010	0	2022	San Diego County		2		2			2						blueshieldca.com/medpharmacy2022	blueshieldca.com/medformulary2022	blueshieldca.com/find-a-doctor	(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5928	037	0	1	01	01	H5928_037_0	7	1					0	08/05/2021	2022.01	08/05/2021 09:50:10 AM Pacific Daylight Time	08/05/2021 08:25:12 AM Pacific Daylight Time	07/29/2021 07:27:09 PM Pacific Daylight Time			08/05/2021 04:48:55 PM Pacific Daylight Time	California Physicians' Service	Blue Shield of California	blueshieldca.com/medicare	Blue Shield Coordinated Choice Plan (HMO)	01	01		1			H5928	037	0	2022	Counties: LA, OR, SD, SB, RV, SC, FR, ME, SJ, ST		2		2			2						blueshieldca.com/medpharmacy2022	blueshieldca.com/medformulary2022	blueshieldca.com/find-a-doctor	(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5928	044	0	1	01	01	H5928_044_0	7	1					0	08/05/2021	2022.01	08/05/2021 09:48:15 AM Pacific Daylight Time	08/05/2021 08:30:37 AM Pacific Daylight Time	07/29/2021 07:27:23 PM Pacific Daylight Time			08/05/2021 04:48:55 PM Pacific Daylight Time	California Physicians' Service	Blue Shield of California	blueshieldca.com/medicare	Blue Shield AdvantageOptimum Plan (HMO)	01	01		1			H5928	044	0	2022	Fresno County		2		2			2						blueshieldca.com/medpharmacy2022	blueshieldca.com/medformulary2022	blueshieldca.com/find-a-doctor	(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5928	050	0	1	01	01	H5928_050_0	7	1					0	08/05/2021	2022.01	08/05/2021 10:06:35 AM Pacific Daylight Time	08/05/2021 08:55:27 AM Pacific Daylight Time	07/29/2021 07:28:34 PM Pacific Daylight Time			08/05/2021 04:50:40 PM Pacific Daylight Time	California Physicians' Service	Blue Shield of California	blueshieldca.com/medicare	Blue Shield AdvantageOptimum Plan (HMO)	01	01		1			H5928	050	0	2022	Merced and Santa Clara Counties		2		2			2						blueshieldca.com/medpharmacy2022	blueshieldca.com/medformulary2022	blueshieldca.com/find-a-doctor	(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5928	051	0	1	01	01	H5928_051_0	7	1					0	08/05/2021	2022.01	08/05/2021 10:07:38 AM Pacific Daylight Time	08/05/2021 08:34:30 AM Pacific Daylight Time	07/29/2021 07:27:37 PM Pacific Daylight Time			08/05/2021 04:50:40 PM Pacific Daylight Time	California Physicians' Service	Blue Shield of California	blueshieldca.com/medicare	Blue Shield AdvantageOptimum Plan (HMO)	01	01		1			H5928	051	0	2022	Stanislaus County		2		2			2						blueshieldca.com/medpharmacy2022	blueshieldca.com/medformulary2022	blueshieldca.com/find-a-doctor	(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5928	052	0	1	01	01	H5928_052_0	7	1					0	08/05/2021	2022.01	08/05/2021 10:12:37 AM Pacific Daylight Time	08/05/2021 08:45:37 AM Pacific Daylight Time	07/29/2021 07:27:52 PM Pacific Daylight Time			08/05/2021 04:50:40 PM Pacific Daylight Time	California Physicians' Service	Blue Shield of California	blueshieldca.com/medicare	Blue Shield AdvantageOptimum Plan (HMO)	01	01		1			H5928	052	0	2022	San Joaquin County		2		2			2						blueshieldca.com/medpharmacy2022	blueshieldca.com/medformulary2022	blueshieldca.com/find-a-doctor	(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5928	053	0	1	01	01	H5928_053_0	7	1					0	08/02/2021	2022.01	08/02/2021 09:54:48 AM Pacific Daylight Time	08/05/2021 08:48:54 AM Pacific Daylight Time	07/29/2021 07:28:06 PM Pacific Daylight Time			08/05/2021 04:50:40 PM Pacific Daylight Time	California Physicians' Service	Blue Shield of California	blueshieldca.com/medicare	Blue Shield AdvantageOptimum Plan 2 (HMO)	01	01		1			H5928	053	0	2022	San Diego County		2		2			2						blueshieldca.com/medpharmacy2022	blueshieldca.com/medformulary2022	blueshieldca.com/find-a-doctor	(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5928	054	0	1	01	01	H5928_054_0	8	1	2	1			0	08/05/2021	2022.01	08/05/2021 09:51:13 AM Pacific Daylight Time	08/05/2021 08:50:52 AM Pacific Daylight Time	07/29/2021 07:28:20 PM Pacific Daylight Time			08/05/2021 04:50:40 PM Pacific Daylight Time	California Physicians' Service	Blue Shield of California	blueshieldca.com/medicare	Blue Shield Inspire (HMO D-SNP)	01	01		1			H5928	054	0	2022	Counties: FR, SJ, STAN, MER		2		2			1	3		2		1	blueshieldca.com/medpharmacy2022	blueshieldca.com/medformulary2022	blueshieldca.com/find-a-doctor	(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5932	001	0	1	01	01	H5932_001_0	8	1	2	1			0	08/04/2021	2022.01	08/04/2021 10:32:53 AM Eastern Daylight Time	08/04/2021 04:33:12 PM Eastern Daylight Time	08/02/2021 09:18:34 AM Eastern Daylight Time			08/05/2021 09:31:35 AM Eastern Daylight Time	GATEWAY HEALTH PLAN, INC.	Gateway Health Medicare Assured	www.gatewayhealthplan.com	Gateway Health Medicare Assured Diamond (HMO D-SNP)	01	01		1			H5932	001	0	2022	SW NW NE Central Pennsylvania Counties		2	475704	2			1	3		1		1	www.gatewayhealthplan.com	www.gatewayhealthplan.com	www.gatewayhealthplan.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	8	1	2	1			0	08/04/2021	2022.01	08/04/2021 10:37:40 AM Eastern Daylight Time	08/04/2021 05:46:16 PM Eastern Daylight Time	08/02/2021 09:18:48 AM Eastern Daylight Time			08/05/2021 09:31:35 AM Eastern Daylight Time	GATEWAY HEALTH PLAN, INC.	Gateway Health Medicare Assured	www.gatewayhealthplan.com	Gateway Health Medicare Assured Ruby (HMO D-SNP)	01	01		1			H5932	009	0	2022	SW NW NE Central Pennsylvania Counties		2	91031	2			1	3		2		2	www.gatewayhealthplan.com	www.gatewayhealthplan.com	www.gatewayhealthplan.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	012	0	1	01	01	H5932_012_0	8	1	2	1			0	08/04/2021	2022.01	08/04/2021 10:34:27 AM Eastern Daylight Time	08/04/2021 04:33:50 PM Eastern Daylight Time	08/02/2021 09:19:24 AM Eastern Daylight Time			08/05/2021 09:31:35 AM Eastern Daylight Time	GATEWAY HEALTH PLAN, INC.	Gateway Health Medicare Assured	www.gatewayhealthplan.com	Gateway Health Medicare Assured Diamond (HMO D-SNP)	01	01		1			H5932	012	0	2022	SE Pennsylvania Counties		2	475704	2			1	3		1		1	www.gatewayhealthplan.com	www.gatewayhealthplan.com	www.gatewayhealthplan.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	013	0	1	01	01	H5932_013_0	8	1	2	1			0	08/04/2021	2022.01	08/04/2021 10:39:36 AM Eastern Daylight Time	08/04/2021 05:46:52 PM Eastern Daylight Time	08/02/2021 09:19:36 AM Eastern Daylight Time			08/05/2021 09:31:35 AM Eastern Daylight Time	GATEWAY HEALTH PLAN, INC.	Gateway Health Medicare Assured	www.gatewayhealthplan.com	Gateway Health Medicare Assured Ruby (HMO D-SNP)	01	01		1			H5932	013	0	2022	SE Pennsylvania Counties		2	91031	2			1	3		2		2	www.gatewayhealthplan.com	www.gatewayhealthplan.com	www.gatewayhealthplan.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						06/03/2021	2022.01	06/03/2021 09:57:42 AM Eastern Daylight Time		06/03/2021 09:44:53 AM Eastern Daylight Time			06/03/2021 10:03:00 AM Eastern Daylight Time	HOPE HOSPICE AND COMMUNITY SERVICES, INC.	Hope PACE	www.hopepace.org	Hope PACE (PACE)	08	20		1			H5934	001	0	2022	Lee, Charlotte and Collier Counties Florida		2		2			2						carekinesis.com	hopehcs.org/pace										(800)835-1673		(239)985-6400		(800)835-1673		(239)985-6400										(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771																
H5934	002	0	1	20	08	H5934_002_0	1	1						06/03/2021	2022.01	06/03/2021 09:57:59 AM Eastern Daylight Time		06/03/2021 09:45:37 AM Eastern Daylight Time			06/03/2021 10:03:00 AM Eastern Daylight Time	HOPE HOSPICE AND COMMUNITY SERVICES, INC.	Hope PACE	www.hopepace.org	Hope PACE (PACE)	08	20		1			H5934	002	0	2022	Lee, Charlotte and Collier Counties Florida		2		2			2						carekinesis.com	hopehcs.org/pace										(800)835-1673		(239)985-6400		(800)835-1673		(239)985-6400										(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771																
H5937	001	0	1	01	01	H5937_001_0	5	1	2	1			0	06/04/2021	2022.01	06/04/2021 10:01:56 AM Central Daylight Time	08/04/2021 08:31:18 AM Central Daylight Time	08/04/2021 02:27:19 PM Central Daylight Time			08/05/2021 01:27:48 PM Central Daylight Time	UCARE MINNESOTA	UCare	https://home.ucare.org	UCare Connect + Medicare (HMO D-SNP)	01	01		1			H5937	001	0	2022	65 Counties		2	12	2			1	3		1		1	https://home.ucare.org	https://home.ucare.org/en-us/search-network/formulary	https://search.ucare.org	(855)260-9707		(612)676-3310		(877)671-1065		(612)676-6652		(855)260-9707		(612)676-3310		(877)671-1065		(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	7	1					1	10/04/2021	2022.01	10/04/2021 01:33:54 PM Eastern Daylight Time	08/04/2021 09:29:01 AM Eastern Daylight Time	08/04/2021 09:29:01 AM Eastern Daylight Time			10/04/2021 04:43:14 PM 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	2022	Leon and surrounding counties		2	108005	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	7	1					1	10/04/2021	2022.01	10/04/2021 01:33:32 PM Eastern Daylight Time	08/04/2021 09:29:02 AM Eastern Daylight Time	08/04/2021 09:29:02 AM Eastern Daylight Time			10/04/2021 04:43:14 PM 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	2022	Leon and surrounding counties		2	35103	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	008	0	1	01	01	H5938_008_0	7	1					1	08/05/2021	2022.01	08/05/2021 09:56:36 AM Eastern Daylight Time	08/04/2021 09:29:02 AM Eastern Daylight Time	08/04/2021 09:29:02 AM Eastern Daylight Time			08/05/2021 09:57:54 AM Eastern Daylight Time	CAPITAL HEALTH PLAN	Capital Health Plan	www.capitalhealth.com/Medicare	Capital Health Plan Silver Advantage (HMO)	01	01		1			H5938	008	0	2022	Leon and surrounding counties		2	8498	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	5	1						06/04/2021	2022.01	06/04/2021 03:19:50 PM Eastern Daylight Time					06/07/2021 08:59:38 AM 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	2022	Leon and surrounding counties		1	112213	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;8b1;8b2;11a;11b;15;16b;	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7d;7g;7i;8a;8b1;8b2;8b3;9a1;9b;9d;12;14d;14e2;16b;	1					1				
H5938	803	0	1	01	01	H5938_803_0	5	1				0	0	06/04/2021	2022.01	06/04/2021 03:22:24 PM Eastern Daylight Time					06/07/2021 08:59:38 AM 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	2022	Leon and surrounding counties		1	13259	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;8b1;8b2;11a;11b;15;16b;	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7d;7g;7i;8a;8b1;8b2;8b3;9a1;9b;9d;14d;14e2;16b;	1					1				
H5938	804	0	1	01	01	H5938_804_0	5	1						06/04/2021	2022.01	06/04/2021 03:22:47 PM Eastern Daylight Time					06/07/2021 08:59:38 AM 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	2022	Leon and surrounding counties		1	20376	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;8b1;8b2;11a;11b;15;16b;	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7d;7g;7i;8a;8b1;8b2;8b3;9a1;9b;9d;14d;14e2;16b;	1					1				
H5938	805	0	1	01	01	H5938_805_0	5	1						06/04/2021	2022.01	06/04/2021 03:23:04 PM Eastern Daylight Time					06/07/2021 08:59:38 AM Eastern Daylight Time	CAPITAL HEALTH PLAN	Capital Health Plan	www.capitalhealth.com/Medicare	805 Emp-only SOF Capital Health Plan Retiree Advan (HMO)	01	01		1			H5938	805	0	2022	Florida Statewide		1	13259	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;8b1;8b2;11a;11b;15;16b;	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7d;7g;7i;8a;8b1;8b2;8b3;9a1;9b;9d;14d;14e2;16b;	1					1				
H5943	001	0	1	02	01	H5943_001_0	5	1		1			0	08/05/2021	2022.01	08/05/2021 10:09:12 AM Pacific Daylight Time		07/29/2021 04:19:32 PM Pacific Daylight Time		08/03/2021 02:05:20 PM Pacific Daylight Time	08/05/2021 05:39:13 PM Pacific Daylight Time	SCAN HEALTH PLAN	VillageHealth	www.villagehealthca.com	VillageHealth (HMO-POS C-SNP)	01	02		1			H5943	001	0	2022	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			0	08/05/2021	2022.01	08/05/2021 10:09:38 AM Pacific Daylight Time		07/29/2021 04:20:00 PM Pacific Daylight Time		08/03/2021 02:04:31 PM Pacific Daylight Time	08/05/2021 05:39:13 PM Pacific Daylight Time	SCAN HEALTH PLAN	VillageHealth	www.villagehealthca.com	VillageHealth (HMO-POS C-SNP)	01	02		1			H5943	002	0	2022	Los Angeles County		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	10	1					1	08/04/2021	2022.01	08/04/2021 06:40:29 AM Pacific Daylight Time	08/02/2021 02:07:06 PM Pacific Daylight Time	08/02/2021 06:05:46 PM Pacific Daylight Time			08/05/2021 04:14:31 PM Pacific Daylight Time	PROMINENCE HEALTHFIRST	Prominence Health Plan	www.prominencemedicare.com	Prominence Plus (HMO)	01	01		1			H5945	001	0	2022	Carson City, Douglas, Lyon, Storey, Churchill		2	92838	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	10	1					1	08/04/2021	2022.01	08/04/2021 06:41:24 AM Pacific Daylight Time	08/02/2021 04:05:36 PM Pacific Daylight Time	08/02/2021 06:07:12 PM Pacific Daylight Time			08/05/2021 04:14:31 PM Pacific Daylight Time	PROMINENCE HEALTHFIRST	Prominence Health Plan	www.prominencemedicare.com	Prominence Plus (HMO)	01	01		1			H5945	002	0	2022	Washoe County		2	116808	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	008	0	1	01	01	H5945_008_0	10	1					1	08/04/2021	2022.01	08/04/2021 06:42:13 AM Pacific Daylight Time	08/02/2021 04:09:33 PM Pacific Daylight Time	08/02/2021 06:08:36 PM Pacific Daylight Time			08/05/2021 04:14:31 PM Pacific Daylight Time	PROMINENCE HEALTHFIRST	Prominence Health Plan	www.prominencemedicare.com	Prominence Plus (HMO)	01	01		1			H5945	008	0	2022	Palm Beach		2	32325	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	009	0	1	01	01	H5945_009_0	9	1	2	1			0	08/04/2021	2022.01	08/04/2021 06:45:00 AM Pacific Daylight Time	08/02/2021 02:52:00 PM Pacific Daylight Time	08/02/2021 06:10:02 PM Pacific Daylight Time			08/05/2021 04:14:31 PM Pacific Daylight Time	PROMINENCE HEALTHFIRST	Prominence Health Plan	www.prominencemedicare.com	Prominence Dual (HMO D-SNP)	01	01		1			H5945	009	0	2022	Palm Beach County		2	3375	2			1	3		1		1	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	3	1				0	0	06/07/2021	2022.01	06/07/2021 05:54:58 PM Pacific Daylight Time					06/07/2021 06:57:58 PM Pacific Daylight Time	PROMINENCE HEALTHFIRST	Prominence Health Plan	www.prominencemedicare.com	Prominence Health Plan (HMO)	01	01		1			H5945	801	0	2022	National		1	200	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	3	1						06/07/2021	2022.01	06/07/2021 05:35:20 PM Pacific Daylight Time					06/07/2021 06:57:58 PM Pacific Daylight Time	PROMINENCE HEALTHFIRST	Prominence Health Plan	www.prominencemedicare.com	Prominence Health Plan (HMO)	01	01		1			H5945	802	0	2022	National		1	200	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	804	0	1	01	01	H5945_804_0	1	1				0	0	06/07/2021	2022.01	06/07/2021 05:35:46 PM Pacific Daylight Time					06/07/2021 06:57:58 PM Pacific Daylight Time	PROMINENCE HEALTHFIRST	Prominence Health Plan	www.prominencemedicare.com	Prominence Health Plan (HMO)	01	01		1			H5945	804	0	2022	Nevada Participating Counties		1	2000	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	805	0	1	01	01	H5945_805_0	1	1						06/07/2021	2022.01	06/07/2021 05:35:57 PM Pacific Daylight Time					06/07/2021 06:57:58 PM Pacific Daylight Time	PROMINENCE HEALTHFIRST	Prominence Health Plan	www.prominencemedicare.com	Prominence Health Plan (HMO)	01	01		1			H5945	805	0	2022	Nevada Participating Counties		1	1500	2			2						www.prominencemedicare.com	www.prominencemedicare.com	www.prominencemedicare.com	(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5822		(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	2	1				0	0	07/16/2021	2022.01	07/16/2021 01:12:42 PM Central Daylight Time	07/12/2021 09:54:37 AM Central Daylight Time				07/16/2021 03:47:30 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	2022	51 County Region	Nine County Region	2	22064	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	2	1				0	0	07/16/2021	2022.01	07/16/2021 01:09:33 PM Central Daylight Time	07/12/2021 09:56:37 AM Central Daylight Time				07/16/2021 03:47:30 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	2022	51 County Region	42 County Region	2	42729	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	4	1				0	0	07/16/2021	2022.01	07/16/2021 02:03:13 PM Central Daylight Time	07/12/2021 10:00:24 AM Central Daylight Time				07/16/2021 03:47:30 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	2022	15 County Region		2	9762	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	4	1					0	08/03/2021	2022.01	08/03/2021 10:35:35 AM Central Daylight Time	08/03/2021 08:20:22 AM Central Daylight Time	07/29/2021 06:47:26 PM Central Daylight Time			08/03/2021 03:34:48 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	2022	15 County Region		2	136829	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	4	1					1	08/03/2021	2022.01	08/03/2021 04:33:57 PM Central Daylight Time	08/03/2021 08:21:25 AM Central Daylight Time	07/29/2021 06:58:52 PM Central Daylight Time			08/03/2021 05:01:00 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	2022	51 County Region	Nine County Region	2	167675	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	2	1	04	01	H5959_010_2	4	1					1	08/03/2021	2022.01	08/03/2021 04:35:20 PM Central Daylight Time	08/03/2021 08:22:53 AM Central Daylight Time	07/29/2021 07:10:00 PM Central Daylight Time			08/03/2021 05:01:00 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	2022	51 County Region	42 County Region	2	65081	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	011	0	1	04	01	H5959_011_0	4	1					1	08/03/2021	2022.01	08/03/2021 04:37:11 PM Central Daylight Time	08/03/2021 08:23:43 AM Central Daylight Time	07/29/2021 07:21:22 PM Central Daylight Time			08/03/2021 05:01:00 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	2022	15 County Region		2	32534	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	012	0	1	04	01	H5959_012_0	3	1					0	08/03/2021	2022.01	08/03/2021 10:41:08 AM Central Daylight Time	08/03/2021 08:24:29 AM Central Daylight Time	07/29/2021 07:32:46 PM Central Daylight Time			08/03/2021 04:11:07 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	2022	15 County Region		2	34248	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	3	1					0	08/03/2021	2022.01	08/03/2021 10:53:44 AM Central Daylight Time	08/03/2021 08:25:17 AM Central Daylight Time	07/29/2021 07:43:56 PM Central Daylight Time			08/03/2021 04:11:07 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	2022	51 County Region	Nine County Region	2	136835	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	3	1					0	08/03/2021	2022.01	08/03/2021 10:57:48 AM Central Daylight Time	08/03/2021 08:26:01 AM Central Daylight Time	07/29/2021 07:55:04 PM Central Daylight Time			08/03/2021 04:11:07 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	2022	51 County Region	42 County Region	2	87376	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	3	1					0	08/03/2021	2022.01	08/03/2021 11:03:22 AM Central Daylight Time	08/03/2021 08:26:43 AM Central Daylight Time	07/29/2021 08:06:20 PM Central Daylight Time			08/03/2021 04:11:07 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	2022	51 County Region	Nine County Region	2	481688	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	3	1					0	08/03/2021	2022.01	08/03/2021 11:11:10 AM Central Daylight Time	08/03/2021 08:27:31 AM Central Daylight Time	07/29/2021 08:17:20 PM Central Daylight Time			08/03/2021 04:11:07 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	2022	51 County Region	42 County Region	2	398494	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	1	1						06/02/2021	2022.01	06/02/2021 09:04:47 AM Central Daylight Time					06/03/2021 02:50:22 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	2022	National		1	420	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	807	0	1	04	01	H5959_807_0	1	1				0	0	05/28/2021	2022.01	05/28/2021 01:37:35 PM Central Daylight Time					06/03/2021 02:50:22 PM 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	2022	National		1	23376	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			
H5965	001	0	1	04	01	H5965_001_0	5	1					0	08/10/2021	2022.01	08/10/2021 05:01:51 PM Eastern Daylight Time	08/04/2021 12:56:48 AM Eastern Daylight Time	07/30/2021 01:18:24 PM Eastern Daylight Time			08/11/2021 03:33:23 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Wellcare	www.wellcare.com/medicare	Wellcare Premium Enhanced Open (PPO)	01	04		1			H5965	001	0	2022	Select counties in WA		2	118	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5965	002	0	1	04	01	H5965_002_0	4	1					0	08/02/2021	2022.01	08/02/2021 03:57:54 PM Eastern Daylight Time	08/04/2021 12:57:15 AM Eastern Daylight Time	07/30/2021 01:18:48 PM Eastern Daylight Time			08/04/2021 11:54:32 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Wellcare	www.wellcare.com/medicare	Wellcare No Premium Open (PPO)	01	04		1			H5965	002	0	2022	Select counties in WA		2	503	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5965	003	0	1	04	01	H5965_003_0	3	1				0	0	07/18/2021	2022.01	07/18/2021 06:16:29 PM Eastern Daylight Time	06/04/2021 12:20:00 PM Eastern Daylight Time				07/19/2021 06:09:31 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Wellcare	www.wellcare.com/medicare	Wellcare Patriot Giveback Open (PPO)	01	04		1			H5965	003	0	2022	Select counties in WA		2	1837	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5965	004	0	1	04	01	H5965_004_0	4	1	2	1			0	07/18/2021	2022.01	07/18/2021 06:17:55 PM Eastern Daylight Time	08/04/2021 12:58:14 AM Eastern Daylight Time	07/30/2021 01:19:10 PM Eastern Daylight Time			08/04/2021 11:54:32 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Wellcare	www.wellcare.com/medicare	Wellcare Dual Access Open (PPO D-SNP)	01	04		1			H5965	004	0	2022	Select counties in WA		2	1500	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5969	002	0	1	01	01	H5969_002_0	4	1	2	1			0	07/01/2021	2022.01	07/01/2021 09:16:43 AM Hawaiian Standard Time	08/02/2021 11:28:34 AM Pacific Daylight Time	07/30/2021 11:37:11 AM Pacific Daylight Time			08/03/2021 03:57:45 PM Pacific Daylight Time	ALOHACARE	AlohaCare	AlohaCare.org	AlohaCare Advantage Plus (HMO D-SNP)	01	01		1			H5969	002	0	2022	State of Hawaii		2	39799	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			1		1	07/22/2021	2022.01	07/22/2021 01:28:05 PM Eastern Daylight Time	08/03/2021 05:43:35 PM Eastern Daylight Time	07/30/2021 11:49:30 AM Eastern Daylight Time			08/04/2021 01:51:34 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana	www.humana.com/medicare	HumanaChoice H5970-001 (PPO)	01	04		1			H5970	001	0	2022	Select Counties in New York		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		1	08/01/2021	2022.01	08/01/2021 12:38:09 PM Eastern Daylight Time	08/03/2021 05:46:32 PM Eastern Daylight Time	07/30/2021 11:49:42 AM Eastern Daylight Time			08/04/2021 02:08:55 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana	www.humana.com/medicare	HumanaChoice H5970-015 (PPO)	01	04		1			H5970	015	0	2022	Select Counties in New York		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			2	0	0	08/03/2021	2022.01	08/03/2021 04:32:48 PM Eastern Daylight Time	07/21/2021 02:52:29 PM Eastern Daylight Time				08/05/2021 02:04:59 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana	www.humana.com/medicare	Humana Honor (PPO)	01	04		1			H5970	016	0	2022	Select Counties in New York		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_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	4	1			1		1	08/01/2021	2022.01	08/01/2021 12:38:30 PM Eastern Daylight Time	08/03/2021 05:46:51 PM Eastern Daylight Time	07/30/2021 11:49:54 AM Eastern Daylight Time			08/04/2021 02:08:55 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana	www.humana.com/medicare	HumanaChoice H5970-018 (PPO)	01	04		1			H5970	018	0	2022	Select Counties in New York		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		0	07/22/2021	2022.01	07/22/2021 02:21:05 PM Eastern Daylight Time	08/03/2021 05:45:14 PM Eastern Daylight Time	07/30/2021 11:50:04 AM Eastern Daylight Time			08/04/2021 02:26:09 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana	www.humana.com/medicare	HumanaChoice H5970-019 (PPO)	01	04		1			H5970	019	0	2022	Select Counties in New York		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1	2	1	1		0	07/22/2021	2022.01	07/22/2021 02:21:12 PM Eastern Daylight Time	08/03/2021 05:48:56 PM Eastern Daylight Time	07/30/2021 11:50:16 AM Eastern Daylight Time			08/04/2021 04:50:04 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana	www.humana.com/medicare	HumanaChoice SNP-DE H5970-020 (PPO D-SNP)	01	04		1			H5970	020	0	2022	Cattaraugus, Chautauqua and Madison counties		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5970	024	1	1	04	01	H5970_024_1	4	1			1		1	08/01/2021	2022.01	08/01/2021 12:39:19 PM Eastern Daylight Time	08/03/2021 05:50:53 PM Eastern Daylight Time	07/30/2021 11:50:28 AM Eastern Daylight Time			08/04/2021 02:08:55 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana	www.humana.com/medicare	HumanaChoice H5970-024 (PPO)	01	04		1			H5970	024	1	2022	New York City and Long Island	Select Counties in New York City	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5970	024	2	1	04	01	H5970_024_2	4	1			1		1	08/01/2021	2022.01	08/01/2021 12:39:48 PM Eastern Daylight Time	08/03/2021 05:51:12 PM Eastern Daylight Time	07/30/2021 11:50:40 AM Eastern Daylight Time			08/04/2021 02:08:55 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana	www.humana.com/medicare	HumanaChoice H5970-024 (PPO)	01	04		1			H5970	024	2	2022	New York City and Long Island	Nassau, Richmond and Suffolk counties	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5970	025	0	1	04	01	H5970_025_0	3	1			2		0	08/02/2021	2022.01	08/02/2021 11:23:06 AM Eastern Daylight Time	08/03/2021 05:53:15 PM Eastern Daylight Time	07/30/2021 11:50:52 AM Eastern Daylight Time			08/04/2021 02:08:55 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana	www.humana.com/medicare	HumanaChoice Partnered H5970-025 (PPO)	01	04		1			H5970	025	0	2022	Select Counties in New York		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)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;7a;7g;8a1;8b3;	
H5970	026	0	1	04	01	H5970_026_0	5	1	2	1	1		0	08/02/2021	2022.01	08/02/2021 11:23:17 AM Eastern Daylight Time	08/03/2021 05:52:29 PM Eastern Daylight Time	07/30/2021 11:51:04 AM Eastern Daylight Time			08/04/2021 02:08:55 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana	www.humana.com/medicare	HumanaChoice SNP-DE H5970-026 (PPO D-SNP)	01	04		1			H5970	026	0	2022	Bronx		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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						05/25/2021	2022.01	05/25/2021 03:07:20 PM Eastern Daylight Time					06/03/2021 01:38:12 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	2022	State of New York		1	113850	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242		(866)396-8810		(866)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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H5970	802	0	1	04	01	H5970_802_0	1	1				0	0	05/25/2021	2022.01	05/25/2021 03:11:55 PM Eastern Daylight Time					06/03/2021 01:38:12 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	2022	State of New York		1	7424	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H5970	805	0	2	04	01	H5970_805_0	1	1						05/25/2021	2022.01	05/25/2021 03:21:18 PM Eastern Daylight Time					06/03/2021 01:38:12 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	2022	State of New York		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242		(866)396-8810		(866)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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H5970	806	0	2	04	01	H5970_806_0	1	1				0	0	05/25/2021	2022.01	05/25/2021 03:31:33 PM Eastern Daylight Time					06/03/2021 01:38:12 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	2022	State of New York		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H5970	816	0	1	04	01	H5970_816_0	1	1						05/26/2021	2022.01	05/26/2021 07:50:01 AM Eastern Daylight Time					06/03/2021 01:38:12 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H5970	816	0	2022	State of New York		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242		(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242		(711)-	711	(711)-	711	(711)-	711	(711)-	711	(711)-	711	(711)-	711	(711)-	711	(711)-	711	1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H5970	817	0	1	04	01	H5970_817_0	1	1				0	0	05/26/2021	2022.01	05/26/2021 07:53:45 AM Eastern Daylight Time					06/03/2021 01:38:12 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H5970	817	0	2022	State of New York		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H5970	818	0	1	04	01	H5970_818_0	1	1						05/26/2021	2022.01	05/26/2021 07:57:45 AM Eastern Daylight Time					06/03/2021 01:38:12 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H5970	818	0	2022	State of New York		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242		(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242		(711)-	711	(711)-	711	(711)-	711	(711)-	711	(711)-	711	(711)-	711	(711)-	711	(711)-	711	1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H5970	819	0	1	04	01	H5970_819_0	1	1				0	0	05/26/2021	2022.01	05/26/2021 08:01:16 AM Eastern Daylight Time					06/03/2021 01:38:12 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H5970	819	0	2022	State of New York		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H5970	820	0	1	04	01	H5970_820_0	1	1						05/26/2021	2022.01	05/26/2021 08:06:31 AM Eastern Daylight Time					06/03/2021 01:38:12 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H5970	820	0	2022	State of New York		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242		(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242		(711)-	711	(711)-	711	(711)-	711	(711)-	711	(711)-	711	(711)-	711	(711)-	711	(711)-	711	1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H5970	821	0	1	04	01	H5970_821_0	1	1				0	0	05/26/2021	2022.01	05/26/2021 08:15:06 AM Eastern Daylight Time					06/03/2021 01:38:12 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H5970	821	0	2022	State of New York		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H5970	822	0	1	04	01	H5970_822_0	1	1						05/26/2021	2022.01	05/26/2021 08:21:09 AM Eastern Daylight Time					06/03/2021 01:38:12 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H5970	822	0	2022	State of New York		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242		(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242		(711)-	711	(711)-	711	(711)-	711	(711)-	711	(711)-	711	(711)-	711	(711)-	711	(711)-	711	1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H5970	823	0	1	04	01	H5970_823_0	1	1				0	0	05/26/2021	2022.01	05/26/2021 08:33:42 AM Eastern Daylight Time					06/03/2021 01:38:12 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H5970	823	0	2022	State of New York		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H5978	001	0	1	20	08	H5978_001_0	2	1						04/28/2021	2022.01	04/28/2021 04:03:01 PM Eastern Daylight Time		07/27/2021 02:09:27 PM Eastern Daylight Time			07/27/2021 02:39:58 PM 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	2022	Northampton, Lehigh & Berks Counties		2		2			2						http://granerx.com/	NA										(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000										(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000																
H5978	002	0	1	20	08	H5978_002_0	2	1						04/28/2021	2022.01	04/28/2021 04:03:12 PM Eastern Daylight Time		07/27/2021 02:10:02 PM Eastern Daylight Time			07/27/2021 02:39:58 PM Eastern Daylight Time	SENIOR LIFE LEHIGH VALLEY, INC.	Senior LIFE Lehigh Valley, Inc.	www.seniorlifepa.com	Senior LIFE Lehigh Valley Medicare Only (PACE)	08	20		1			H5978	002	0	2022	Northampton, Lehigh & Berks Counties		2		2			2						http://granerx.com/	NA										(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000										(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000																
H5989	011	0	1	01	01	H5989_011_0	6	1					1	08/04/2021	2022.01	08/04/2021 03:19:41 PM Eastern Daylight Time	08/05/2021 03:43:26 PM Eastern Daylight Time	08/05/2021 12:52:58 PM Eastern Daylight Time			08/05/2021 08:24:05 PM Eastern Daylight Time	HEALTHFIRST HEALTH PLAN, INC.	Healthfirst Medicare Plan	www.healthfirst.org/medicare	Healthfirst Signature (HMO)	01	01		1			H5989	011	0	2022	New York City and Nassau County		2		2			2						www.hfdocfinder.org	www.healthfirst.org/formularies	www.hfdocfinder.org	(855)771-1081		(855)771-1081		(877)237-1303		(877)237-1303		(855)771-1081		(855)771-1081		(877)237-1303		(877)237-1303		(888)542-3821		(888)542-3821		(888)542-3821		(888)542-3821		(888)542-3821		(888)542-3821		(888)542-3821		(888)542-3821		2					2					2	2			
H5991	001	0	1	01	01	H5991_001_0	6	1	2	1	2		0	08/04/2021	2022.01	08/04/2021 01:19:48 PM Eastern Daylight Time	08/05/2021 06:38:00 PM Eastern Daylight Time	08/05/2021 06:38:00 PM Eastern Daylight Time			08/05/2021 03:09:51 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	emblemhealth.com/medicare	EmblemHealth VIP Dual Select (HMO D-SNP)	01	01		1			H5991	001	0	2022	NYC, Long Island and Hudson Valley		2		2			1	3		1		1	emblemhealth.com/medicare	emblemhealth.com/medicare	https://emblemhealth.com/Find-a-Doctor	(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			
H5991	002	0	1	01	01	H5991_002_0	7	1	2	1	2		0	08/04/2021	2022.01	08/04/2021 01:11:50 PM Eastern Daylight Time	08/05/2021 06:38:00 PM Eastern Daylight Time	08/05/2021 06:38:00 PM Eastern Daylight Time			08/05/2021 03:09:51 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	emblemhealth.com/medicare	EmblemHealth VIP Solutions (HMO D-SNP)	01	01		1			H5991	002	0	2022	NYC, Long Island, Hudson Valley, Capital Distrct		2		2			1	3		2		2	emblemhealth.com/medicare	emblemhealth.com/medicare	emblemhealth.com/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			
H5991	003	0	1	01	01	H5991_003_0	7	1			2		0	06/07/2021	2022.01	06/07/2021 07:36:32 PM Eastern Daylight Time	08/05/2021 06:38:00 PM Eastern Daylight Time	08/05/2021 06:38:00 PM Eastern Daylight Time			08/05/2021 03:09:51 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	emblemhealth.com/medicare	EmblemHealth VIP Passport (HMO)	01	01		1			H5991	003	0	2022	Long Island and Lower Hudson Valley		2		2			2						emblemhealth.com/medicare	emblemhealth.com/medicare	emblemhealth.com/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			
H5991	006	0	1	01	01	H5991_006_0	7	1			2		0	06/07/2021	2022.01	06/07/2021 08:00:32 PM Eastern Daylight Time	08/05/2021 06:38:00 PM Eastern Daylight Time	08/05/2021 06:38:00 PM Eastern Daylight Time			08/05/2021 03:09:51 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	emblemhealth.com/medicare	EmblemHealth VIP Passport NYC (HMO)	01	01		1			H5991	006	0	2022	New York City, Bronx, Queens, Kings, Richmond		2		2			2						emblemhealth.com/medicare	emblemhealth.com/medicare	emblemhealth.com/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			
H5991	008	0	1	01	01	H5991_008_0	8	1	2	1	2		0	08/04/2021	2022.01	08/04/2021 01:20:11 PM Eastern Daylight Time	08/05/2021 06:38:00 PM Eastern Daylight Time	08/05/2021 06:38:00 PM Eastern Daylight Time			08/05/2021 03:09:51 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	emblemhealth.com/medicare	EmblemHealth VIP Assist (HMO D-SNP)	01	01		1			H5991	008	0	2022	New York City, Westchester and Long Island		2		2			1	3		1		1	emblemhealth.com/medicare	emblemhealth.com/medicare	emblemhealth.com/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			
H5991	009	0	1	01	01	H5991_009_0	6	1			2		0	08/04/2021	2022.01	08/04/2021 01:02:26 PM Eastern Daylight Time	08/05/2021 06:38:00 PM Eastern Daylight Time	08/05/2021 06:38:00 PM Eastern Daylight Time			08/05/2021 03:09:51 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	emblemhealth.com/medicare	EmblemHealth VIP Reserve (HMO)	01	01		1			H5991	009	0	2022	Bronx, Kings, New York City, Queens		2		2			2						emblemhealth.com/medicare	emblemhealth.com/medicare	emblemhealth.com/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			
H5991	010	0	1	01	01	H5991_010_0	7	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 01:49:34 PM Eastern Daylight Time	08/05/2021 06:38:00 PM Eastern Daylight Time	08/05/2021 06:38:00 PM Eastern Daylight Time			08/05/2021 03:09:51 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	emblemhealth.com/medicare	EmblemHealth VIP Dual Reserve (HMO D-SNP)	01	01		1			H5991	010	0	2022	Bronx, Kings, New York City, Queens		2		2			1	3		1		1	emblemhealth.com/medicare	emblemhealth.com/medicare	emblemhealth.com/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			
H5992	007	0	1	01	01	H5992_007_0	6	1	2	1			0	08/04/2021	2022.01	08/04/2021 02:24:14 PM Pacific Daylight Time	08/04/2021 09:46:42 AM Pacific Daylight Time	08/02/2021 11:42:40 AM Pacific Daylight Time			08/05/2021 03:02:36 PM Pacific Daylight Time	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Senior Whole Health of New York	www.seniorwholehealthNY.com	Molina Medicare Complete Care (HMO D-SNP)	01	01		1			H5992	007	0	2022	Counties: Ki, Qu, Brx, NY, Wes, and Na		2	1824	2			1	3		1		1	www.seniorwholehealth.com	www.seniorwholehealth.com	www.seniorwholehealthNY.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			
H5992	008	0	1	01	01	H5992_008_0	5	1	2	1			0	08/04/2021	2022.01	08/04/2021 02:24:58 PM Pacific Daylight Time	08/04/2021 09:49:18 AM Pacific Daylight Time	08/02/2021 11:44:32 AM Pacific Daylight Time			08/05/2021 03:02:36 PM Pacific Daylight Time	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Senior Whole Health of New York	www.seniorwholehealthNY.com	Senior Whole Health Medicare Complete Care (HMO D-SNP)	01	01		1			H5992	008	0	2022	Select Counties in New York		2	5616	2			1	3		1		1	www.seniorwholehealth.com	www.seniorwholehealth.com	www.seniorwholehealthNY.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	4	1	2	1			0	08/05/2021	2022.01	08/05/2021 11:24:40 AM Pacific Daylight Time	08/04/2021 11:08:52 AM Pacific Daylight Time	08/04/2021 10:15:31 AM Pacific Daylight Time			08/05/2021 11:35:58 AM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	atriohp.com	ATRIO Special Needs Plan (Willamette) (HMO D-SNP)	01	01		1			H5995	001	0	2022	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6059	001	0	1	20	08	H6059_001_0	1	1						06/04/2021	2022.01	06/04/2021 08:50:59 AM Eastern Daylight Time		05/27/2021 09:20:09 AM Eastern Daylight Time			06/04/2021 08:53:16 AM 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	2022	PACE of The Triad - Dual		2		2			2						https://www.carekinesis.com/	N/A										(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						06/04/2021	2022.01	06/04/2021 08:51:18 AM Eastern Daylight Time		05/27/2021 09:20:09 AM Eastern Daylight Time			06/04/2021 08:53:16 AM 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	2022	PACE of The Triad - Medicare only		2		2			2						https://www.carekinesis.com/	N/A										(336)550-4040		(336)550-4040		(336)550-4040		(336)550-4040										(800)735-2962		(800)735-2962		(800)735-2962		(800)735-2962																
H6062	001	0	1	01	01	H6062_001_0	7	1					0	06/02/2021	2022.01	06/02/2021 04:20:33 PM Central Daylight Time	07/30/2021 06:12:42 PM Central Daylight Time	07/30/2021 01:59:52 PM Central Daylight Time			08/04/2021 02:20:08 PM Central Daylight Time	GLOBALHEALTH OF TEXAS, INC.	GlobalHealth	www.GlobalHealth.com/medicare	Global Classic (HMO)	01	01		1			H6062	001	0	2022	Dallas Metro		2	4210	2			2						www.GlobalHealth.com/pharmacy-directories	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)-		2					2					2	2			
H6062	003	0	1	01	01	H6062_003_0	7	1					0	06/03/2021	2022.01	06/03/2021 03:59:49 PM Central Daylight Time	07/30/2021 06:19:32 PM Central Daylight Time	07/30/2021 02:00:06 PM Central Daylight Time			08/04/2021 02:20:08 PM Central Daylight Time	GLOBALHEALTH OF TEXAS, INC.	GlobalHealth	www.GlobalHealth.com/medicare	Global Classic (HMO)	01	01		1			H6062	003	0	2022	Houston Metro		2	604	2			2						www.GlobalHealth.com/pharmacy-directories	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)-		2					2					2	2			
H6062	005	0	1	01	01	H6062_005_0	7	1		1			1	06/03/2021	2022.01	06/03/2021 06:38:51 AM Central Daylight Time	07/30/2021 06:20:32 PM Central Daylight Time	07/30/2021 02:00:22 PM Central Daylight Time			08/04/2021 02:20:08 PM Central Daylight Time	GLOBALHEALTH OF TEXAS, INC.	GlobalHealth	www.GlobalHealth.com/medicare	Global Special Care (HMO C-SNP)	01	01		1			H6062	005	0	2022	Dallas/Fort Worth		2	659	2			1	4			00000000000000000010		www.GlobalHealth.com/pharmacy-directories	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)-		2					2					2	2			
H6062	006	0	1	01	01	H6062_006_0	8	1		1			1	06/03/2021	2022.01	06/03/2021 06:38:58 AM Central Daylight Time	07/30/2021 06:21:34 PM Central Daylight Time	07/30/2021 02:00:36 PM Central Daylight Time			08/04/2021 02:20:08 PM Central Daylight Time	GLOBALHEALTH OF TEXAS, INC.	GlobalHealth	www.GlobalHealth.com/medicare	Global Special Care Savings (HMO C-SNP)	01	01		1			H6062	006	0	2022	Dallas/Ft  Worth		2	659	2			1	4			00000000000000000010		www.GlobalHealth.com/pharmacy-directories	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)-		2					2					2	2			
H6067	001	1	1	01	01	H6067_001_1	9	1					0	08/04/2021	2022.01	08/04/2021 03:55:03 PM Eastern Daylight Time	08/05/2021 10:43:58 AM Eastern Daylight Time	08/05/2021 10:43:58 AM Eastern Daylight Time			08/05/2021 01:35:54 PM Eastern Daylight Time	CAREFIRST ADVANTAGE, INC.	CareFirst BlueCross BlueShield Medicare Advantage	carefirst.com/medicareadvantage	CareFirst BlueCross BlueShield Advantage Core (HMO)	01	01		1			H6067	001	1	2022	Central Maryland	Counties: AA, BA, BC, CA, FR, HA, HO	2	11726	2			2						carefirst.com/medicareadvantage	carefirst.com/medicareadvantage	https://carefirst.sapphirecareselect.com/?ci=dft-carefirstbcbsmedicareadvantagehmo	(855)290-5744		(855)290-5744		(855)290-5744		(855)290-5744		(888)970-0917		(888)970-0917		(888)970-0917		(888)970-0917		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6067	001	2	1	01	01	H6067_001_2	9	1					0	08/04/2021	2022.01	08/04/2021 03:55:28 PM Eastern Daylight Time	08/05/2021 10:43:58 AM Eastern Daylight Time	08/05/2021 10:43:58 AM Eastern Daylight Time			08/05/2021 01:35:54 PM Eastern Daylight Time	CAREFIRST ADVANTAGE, INC.	CareFirst BlueCross BlueShield Medicare Advantage	carefirst.com/medicareadvantage	CareFirst BlueCross BlueShield Advantage Core (HMO)	01	01		1			H6067	001	2	2022	Central Maryland	Counties: MO, PG	2	9161	2			2						carefirst.com/medicareadvantage	carefirst.com/medicareadvantage	https://carefirst.sapphirecareselect.com/?ci=dft-carefirstbcbsmedicareadvantagehmo	(855)290-5744		(855)290-5744		(855)290-5744		(855)290-5744		(888)970-0917		(888)970-0917		(888)970-0917		(888)970-0917		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6067	002	1	1	01	01	H6067_002_1	8	1					0	08/04/2021	2022.01	08/04/2021 03:55:57 PM Eastern Daylight Time	08/05/2021 10:43:58 AM Eastern Daylight Time	08/05/2021 10:43:58 AM Eastern Daylight Time			08/05/2021 01:35:54 PM Eastern Daylight Time	CAREFIRST ADVANTAGE, INC.	CareFirst BlueCross BlueShield Medicare Advantage	carefirst.com/medicareadvantage	CareFirst BlueCross BlueShield Advantage Enhanced (HMO)	01	01		1			H6067	002	1	2022	Central Maryland	Counties: AA, BA, BC, CA, FR, HA, HO	2	6967	2			2						carefirst.com/medicareadvantage	carefirst.com/medicareadvantage	https://carefirst.sapphirecareselect.com/?ci=dft-carefirstbcbsmedicareadvantagehmo	(855)290-5744		(855)290-5744		(855)290-5744		(855)290-5744		(888)970-0917		(888)970-0917		(888)970-0917		(888)970-0917		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6067	002	2	1	01	01	H6067_002_2	8	1					0	08/04/2021	2022.01	08/04/2021 03:56:43 PM Eastern Daylight Time	08/05/2021 10:43:58 AM Eastern Daylight Time	08/05/2021 10:43:58 AM Eastern Daylight Time			08/05/2021 01:35:54 PM Eastern Daylight Time	CAREFIRST ADVANTAGE, INC.	CareFirst BlueCross BlueShield Medicare Advantage	carefirst.com/medicareadvantage	CareFirst BlueCross BlueShield Advantage Enhanced (HMO)	01	01		1			H6067	002	2	2022	Central Maryland	Counties: MO, PG	2	7111	2			2						carefirst.com/medicareadvantage	carefirst.com/medicareadvantage	https://carefirst.sapphirecareselect.com/?ci=dft-carefirstbcbsmedicareadvantagehmo	(855)290-5744		(855)290-5744		(855)290-5744		(855)290-5744		(888)970-0917		(888)970-0917		(888)970-0917		(888)970-0917		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6067	801	0	1	01	01	H6067_801_0	7	1						05/20/2021	2022.01	05/20/2021 02:37:03 PM Eastern Daylight Time					06/06/2021 01:01:33 PM Eastern Daylight Time	CAREFIRST ADVANTAGE, INC.	CareFirst BlueCross BlueShield Medicare Advantage	carefirst.com/medicare	CareFirst BlueCross BlueShield Group Advantage (HMO)	01	01		1			H6067	801	0	2022	Maryland		1	0	2			2						carefirstadvantage.com	carefirstadvantageformulary.com	www.carefirst.com/medicare	(855)290-5744		(855)290-5744		(855)290-5744		(855)290-5744		(888)970-0917		(888)970-0917		(888)970-0917		(888)970-0917		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;11c;15;16b;	1	7d;7g;	1					1				
H6067	802	0	1	01	01	H6067_802_0	7	1				0	0	04/20/2021	2022.01	04/20/2021 11:21:34 AM Eastern Daylight Time					06/06/2021 01:01:33 PM Eastern Daylight Time	CAREFIRST ADVANTAGE, INC.	CareFirst BlueCross BlueShield Medicare Advantage	carefirst.com/medicare	CareFirst BlueCross BlueShield Group Advantage (HMO)	01	01		1			H6067	802	0	2022	Maryland		1	0	2			2						carefirstadvantage.com	carefirstadvantageformulary.com	www.carefirst.com/medicare	(855)290-5744		(855)290-5744		(855)290-5744		(855)290-5744										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;11c;15;16b;	1	7d;7g;	1					1				
H6067	803	0	1	01	01	H6067_803_0	7	1						05/20/2021	2022.01	05/20/2021 02:37:35 PM Eastern Daylight Time					06/06/2021 01:01:33 PM Eastern Daylight Time	CAREFIRST ADVANTAGE, INC.	CareFirst BlueCross BlueShield Medicare Advantage	carefirst.com/medicare	CareFirst BlueCross BlueShield Group Advantage (HMO)	01	01		1			H6067	803	0	2022	Maryland		1	0	2			2						carefirstadvantage.com	carefirstadvantageformulary.com	www.carefirst.com/medicare	(855)290-5744		(855)290-5744		(855)290-5744		(855)290-5744		(888)970-0917		(888)970-0917		(888)970-0917		(888)970-0917		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;11c;15;16b;	1	7d;7g;	1					1				
H6067	804	0	1	01	01	H6067_804_0	7	1				0	0	04/20/2021	2022.01	04/20/2021 11:21:45 AM Eastern Daylight Time					06/06/2021 01:01:33 PM Eastern Daylight Time	CAREFIRST ADVANTAGE, INC.	CareFirst BlueCross BlueShield Medicare Advantage	carefirst.com/medicare	CareFirst BlueCross BlueShield Group Advantage (HMO)	01	01		1			H6067	804	0	2022	Maryland		1	0	2			2						carefirstadvantage.com	carefirstadvantageformulary.com	www.carefirst.com/medicare	(855)290-5744		(855)290-5744		(855)290-5744		(855)290-5744										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7d;7f;7g;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;11c;15;16b;	1	7d;7g;	1					1				
H6078	801	0	1	04	01	H6078_801_0	1	1						06/02/2021	2022.01	06/02/2021 04:18:28 PM Pacific Daylight Time					06/04/2021 09:19:02 AM Pacific Daylight Time	Group Retiree Health Solutions, Inc.	Region 6 Rx Corp PPO	BlueMedicareAdvantage.com/Medicare	Secure Preferred (PPO)	01	04		1			H6078	801	0	2022	Pennsylvania National		1	104004	2			2						BlueMedicareAdvantage.com/Medicare	BlueMedicareAdvantage.com/Medicare	BlueMedicareAdvantage.com/Medicare	(833)434-1253		(833)434-1253		(833)434-1252		(833)434-1252		(833)370-7469		(833)370-7469		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1									
H6078	802	0	1	04	01	H6078_802_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 04:18:35 PM Pacific Daylight Time					06/04/2021 09:19:02 AM Pacific Daylight Time	Group Retiree Health Solutions, Inc.	Region 6 Rx Corp PPO	BlueMedicareAdvantage.com/Medicare	Secure Preferred (PPO)	01	04		1			H6078	802	0	2022	Pennsylvania National		1	600	2			2						BlueMedicareAdvantage.com/Medicare	BlueMedicareAdvantage.com/Medicare	BlueMedicareAdvantage.com/Medicare	(833)434-1253		(833)434-1253		(833)434-1252		(833)434-1252										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1									
H6078	803	0	1	04	01	H6078_803_0	1	1						06/02/2021	2022.01	06/02/2021 04:18:41 PM Pacific Daylight Time					06/04/2021 09:19:02 AM Pacific Daylight Time	Group Retiree Health Solutions, Inc.	Region 6 Rx Corp PPO	BlueMedicareAdvantage.com/Medicare	Secure Preferred (PPO)	01	04		1			H6078	803	0	2022	Pennsylvania National		1	600	2			2						BlueMedicareAdvantage.com/Medicare	BlueMedicareAdvantage.com/Medicare	BlueMedicareAdvantage.com/Medicare	(833)434-1253		(833)434-1253		(833)434-1252		(833)434-1252		(833)370-7469		(833)370-7469		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1									
H6078	804	0	1	04	01	H6078_804_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 04:18:51 PM Pacific Daylight Time					06/04/2021 09:19:02 AM Pacific Daylight Time	Group Retiree Health Solutions, Inc.	Region 6 Rx Corp PPO	BlueMedicareAdvantage.com/Medicare	Secure Preferred (PPO)	01	04		1			H6078	804	0	2022	Pennsylvania National		1	600	2			2						BlueMedicareAdvantage.com/Medicare	BlueMedicareAdvantage.com/Medicare	BlueMedicareAdvantage.com/Medicare	(833)434-1253		(833)434-1253		(833)434-1252		(833)434-1252										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1									
H6078	805	0	2	04	01	H6078_805_0	1	1						06/02/2021	2022.01	06/02/2021 04:19:00 PM Pacific Daylight Time					06/04/2021 09:19:02 AM Pacific Daylight Time	Group Retiree Health Solutions, Inc.	Region 6 Rx Corp PPO	BlueMedicareAdvantage.com/Medicare	Secure Preferred (PPO)	01	04		2	1		H6078	805	0	2022	Pennsylvania National		1	600	2			2						BlueMedicareAdvantage.com/Medicare	BlueMedicareAdvantage.com/Medicare	BlueMedicareAdvantage.com/Medicare	(833)434-1253		(833)434-1253		(833)434-1252		(833)434-1252		(833)370-7469		(833)370-7469		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1									
H6078	806	0	2	04	01	H6078_806_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 04:19:08 PM Pacific Daylight Time					06/04/2021 09:19:02 AM Pacific Daylight Time	Group Retiree Health Solutions, Inc.	Region 6 Rx Corp PPO	BlueMedicareAdvantage.com/Medicare	Secure Preferred (PPO)	01	04		2	1		H6078	806	0	2022	Pennsylvania National		1	600	2			2						BlueMedicareAdvantage.com/Medicare	BlueMedicareAdvantage.com/Medicare	BlueMedicareAdvantage.com/Medicare	(833)434-1253		(833)434-1253		(833)434-1252		(833)434-1252										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1									
H6079	001	0	1	20	08	H6079_001_0	1	1						05/27/2021	2022.01	05/27/2021 09:18:36 AM Mountain Daylight Time		05/27/2021 08:41:40 AM Mountain Daylight Time			05/27/2021 09:22:18 AM Mountain Daylight Time	TOTAL LONGTERM CARE, INC.	InnovAge California PACE	www.MyInnovAge.com	InnovAge California PACE (PACE)	08	20		1			H6079	001	0	2022	San Bernardino and Riverside counties		2		2			2						www.granerx.com	N/A										(844)704-9613	711	(844)704-9613		(844)704-9613		(844)704-9613										(844)704-9613	711	(844)704-9613	711	(844)704-9613		(844)704-9613																
H6079	002	0	1	20	08	H6079_002_0	1	1						05/27/2021	2022.01	05/27/2021 09:18:47 AM Mountain Daylight Time		05/27/2021 08:41:41 AM Mountain Daylight Time			05/27/2021 09:22:18 AM Mountain Daylight Time	TOTAL LONGTERM CARE, INC.	InnovAge California PACE	www.MyInnovAge.com	InnovAge California PACE (PACE)	08	20		1			H6079	002	0	2022	San Bernardino and Riverside counties		2		2			2						www.granerx.com	N/A										(844)704-9613	711	(844)704-9613		(844)704-9613		(844)704-9613										(844)704-9613	711	(844)704-9613	711	(844)704-9613		(844)704-9613																
H6080	001	0	1	48	05	H6080_001_0	3	1						07/15/2021	2022.01	07/15/2021 10:43:52 AM Eastern Daylight Time					07/15/2021 11:55:50 AM Eastern Daylight Time	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Meridian	https://corp.mhplan.com/	MeridianComplete (Medicare-Medicaid Plan)	05	48		1			H6080	001	0	2022	Greater Chicago		2	85000	2			2						https://corp.mhplan.com/	https://corp.mhplan.com/	https://corp.mhplan.com/	(855)580-1689		(855)580-1689		(844)917-0175		(844)917-0175		(855)580-1689		(855)580-1689		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H6121	003	0	1	01	01	H6121_003_0	5	1					0	08/03/2021	2022.01	08/03/2021 03:30:50 PM Central Daylight Time	08/05/2021 03:37:49 PM Central Daylight Time	08/05/2021 03:37:52 PM Central Daylight Time			08/05/2021 05:14:03 PM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY OF ILLINOIS	Bright Health	brighthealthcare.com/medicare	Bright Advantage Classic Choice Plan (HMO)	01	01		1			H6121	003	0	2022	Chicago Area		2	173	2			2						brighthealthcare.com/madoctors	brighthealthcare.com/drug-search/ma	brighthealthcare.com/madoctors	(844)926-4521		(844)926-4521		(844)679-2028		(844)679-2028		(844)926-4521		(844)926-4521		(844)679-2028		(844)679-2028		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6121	008	0	1	01	01	H6121_008_0	5	1					0	08/03/2021	2022.01	08/03/2021 03:31:06 PM Central Daylight Time	08/05/2021 03:37:49 PM Central Daylight Time	08/05/2021 03:37:52 PM Central Daylight Time			08/05/2021 05:14:03 PM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY OF ILLINOIS	Bright Health	brighthealthcare.com/medicare	Bright Advantage Classic Care Plan (HMO)	01	01		1			H6121	008	0	2022	Chicago Area		2	2294	2			2						brighthealthcare.com/madoctors	brighthealthcare.com/drug-search/ma	brighthealthcare.com/madoctors	(844)926-4521		(844)926-4521		(844)679-2028		(844)679-2028		(844)926-4521		(844)926-4521		(844)679-2028		(844)679-2028		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6154	001	0	1	02	01	H6154_001_0	5	1					1	08/04/2021	2022.01	08/04/2021 09:19:26 AM Central Daylight Time	08/05/2021 08:33:04 AM Central Daylight Time	08/05/2021 08:33:43 AM Central Daylight Time			08/05/2021 10:37:46 AM Central Daylight Time	MEDICA HEALTH PLANS	Medica	medica.com	Medica Advantage Solution H6154-001 (HMO-POS)	01	02		1			H6154	001	0	2022	Minneapolis/St. Paul Metro Area		2		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	8	1					1	08/09/2021	2022.01	08/09/2021 11:55:37 AM Central Daylight Time	08/05/2021 08:33:04 AM Central Daylight Time	08/05/2021 08:33:43 AM Central Daylight Time			08/09/2021 11:59:24 AM Central Daylight Time	MEDICA HEALTH PLANS	Medica	medica.com	Medica Advantage Solution H6154-002 (HMO-POS)	01	02		1			H6154	002	0	2022	Select Counties in MN		2		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	003	0	1	01	01	H6154_003_0	7	1		1			1	07/20/2021	2022.01	07/20/2021 04:37:47 PM Central Daylight Time	08/05/2021 12:29:36 PM Central Daylight Time	08/05/2021 12:28:47 PM Central Daylight Time			08/05/2021 01:20:46 PM Central Daylight Time	MEDICA HEALTH PLANS	Medica	medica.com	Medica Advantage Solution PartnerCare Premier (HMO I-SNP)	01	01		1			H6154	003	0	2022	Select counties in MN		2	637	2			1	1	3				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			
H6154	004	0	1	01	01	H6154_004_0	6	1		1			1	08/04/2021	2022.01	08/04/2021 01:38:02 PM Central Daylight Time	08/05/2021 12:29:36 PM Central Daylight Time	08/05/2021 12:28:47 PM Central Daylight Time			08/05/2021 01:20:46 PM Central Daylight Time	MEDICA HEALTH PLANS	Medica	medica.com	Medica Advantage Solution PartnerCare Focus (HMO I-SNP)	01	01		1			H6154	004	0	2022	Select counties in MN		2	955	2			1	1	3				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			
H6158	001	0	1	01	01	H6158_001_0	5	1					1	08/04/2021	2022.01	08/04/2021 04:57:59 PM Central Daylight Time	08/04/2021 05:13:22 PM Central Daylight Time	08/04/2021 05:18:31 PM Central Daylight Time			08/04/2021 05:33:00 PM Central Daylight Time	USABLE HMO, INC.	Arkansas Blue Medicare	www.arkansasbluecross.com/medicare	BlueMedicare Premier (HMO)	01	01		1			H6158	001	0	2022	Select Counties in Northwest, West, and Central AR		2	63780	2			2						www.arkansasbluecross.com/medicare	www.arkansasbluecross.com/medicare	www.arkansasbluecross.com	(844)463-1088		(844)463-1088		(888)605-0322		(888)605-0322		(844)463-1088		(844)463-1088		(888)605-0322		(888)605-0322		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6158	002	0	1	01	01	H6158_002_0	5	1					1	08/04/2021	2022.01	08/04/2021 04:58:55 PM Central Daylight Time	08/04/2021 05:13:27 PM Central Daylight Time	08/04/2021 05:18:35 PM Central Daylight Time			08/04/2021 05:33:00 PM Central Daylight Time	USABLE HMO, INC.	Arkansas Blue Medicare	www.arkansasbluecross.com/medicare	BlueMedicare Premier (HMO)	01	01		1			H6158	002	0	2022	Select Counties in West, Central, and North AR		2	25854	2			2						www.arkansasbluecross.com/medicare	www.arkansasbluecross.com/medicare	www.arkansasbluecross.com	(844)463-1088		(844)463-1088		(888)605-0322		(888)605-0322		(844)463-1088		(844)463-1088		(888)605-0322		(888)605-0322		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6188	001	0	1	20	08	H6188_001_0	1	1						06/02/2021	2022.01	06/02/2021 02:41:01 PM Eastern Daylight Time		06/01/2021 06:57:30 PM Eastern Daylight Time			06/02/2021 02:49:43 PM 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	2022	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						06/02/2021	2022.01	06/02/2021 02:41:18 PM Eastern Daylight Time		06/01/2021 06:58:34 PM Eastern Daylight Time			06/02/2021 02:49:43 PM 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	2022	Armstrong County		2		2			2						www.lutheranseniorlife.org	www.lutheranseniorlife.org												(724)545-8000				(724)545-8000												(711)-				(711)-																
H6193	001	0	1	01	01	H6193_001_0	5	1					0	08/02/2021	2022.01	08/02/2021 09:39:04 AM Eastern Daylight Time	08/04/2021 12:58:43 AM Eastern Daylight Time	07/30/2021 01:19:34 PM Eastern Daylight Time			08/04/2021 11:21:47 PM Eastern Daylight Time	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO)	01	01		1			H6193	001	0	2022	Select counties in MA		2	2202	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6202	001	0	1	04	01	H6202_001_0	7	1					0	07/07/2021	2022.01	07/07/2021 09:56:21 AM Eastern Daylight Time	07/30/2021 03:16:05 PM Eastern Daylight Time	07/30/2021 03:15:40 PM Eastern Daylight Time			07/30/2021 03:40:17 PM Eastern Daylight Time	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	NextBlue of North Dakota	www.nextblueND.com	NextBlue Classic PPO (PPO)	01	04		1			H6202	001	0	2022	Central-East North Dakota		2	10306	2			2						www.nextblueND.com/pharmacies	www.nextblueND.com/formularies	www.nextblueND.com/findadoctor	(844)753-8038		(844)753-8038		(844)753-5678		(844)753-5678		(877)728-0011		(877)728-0011		(844)753-5678		(844)753-5678		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6202	002	0	1	04	01	H6202_002_0	7	1					0	07/06/2021	2022.01	07/06/2021 03:06:57 PM Eastern Daylight Time	07/30/2021 03:16:06 PM Eastern Daylight Time	07/30/2021 03:15:40 PM Eastern Daylight Time			07/30/2021 03:40:17 PM Eastern Daylight Time	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	NextBlue of North Dakota	www.nextblueND.com	NextBlue Premium PPO (PPO)	01	04		1			H6202	002	0	2022	Central-East Region		2	32620	2			2						www.nextblueND.com/pharmacies	www.nextblueND.com/formularies	www.nextblueND.com/findadoctor	(844)753-8038		(844)753-8038		(844)753-5678		(844)753-5678		(877)728-0011		(877)728-0011		(844)753-5678		(844)753-5678		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6202	801	0	1	04	01	H6202_801_0	5	1						04/19/2021	2022.01	04/19/2021 08:54:12 AM Eastern Daylight Time					06/07/2021 02:26:36 PM Eastern Daylight Time	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	NextBlue of North Dakota	www.nextblueND.com	NextBlue of North Dakota Group PPO (PPO)	01	04		1			H6202	801	0	2022	State of North Dakota		1	0	2			2						www.nextblueND.com/pharmacies	www.nextblueND.com/formularies	www.nextblueND.com/findadoctor	(800)570-1144		(800)570-1144		(844)753-5678		(844)753-5678		(877)728-0011		(877)728-0011		(844)753-5678		(844)753-5678		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;2;9a1;11a;15;	2		1									
H6202	802	0	1	04	01	H6202_802_0	5	1						04/18/2021	2022.01	04/18/2021 12:53:19 PM Eastern Daylight Time					06/07/2021 02:26:36 PM Eastern Daylight Time	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	NextBlue of North Dakota	www.nextblueND.com	NextBlue of North Dakota Group PPO (PPO)	01	04		1			H6202	802	0	2022	State of North Dakota		1	0	2			2						www.nextblueND.com/pharmacies	www.nextblueND.com/formularies	www.nextblueND.com/findadoctor	(800)570-1144		(800)570-1144		(844)753-5678		(844)753-5678		(877)728-0011		(877)728-0011		(844)753-5678		(844)753-5678		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;2;9a1;11a;15;	2		1									
H6202	803	0	1	04	01	H6202_803_0	6	1						06/18/2021	2022.01	06/18/2021 09:55:54 AM Eastern Daylight Time					06/18/2021 09:56:19 AM Eastern Daylight Time	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	NextBlue of North Dakota	www.nextblueND.com	NextBlue of North Dakota Group PPO (PPO)	01	04		1			H6202	803	0	2022	State of North Dakota		1	480	2			2						www.nextblueND.com/pharmacies	www.nextblueND.com/formularies	www.nextblueND.com/findadoctor	(800)570-1144		(800)570-1144		(844)753-5678		(844)753-5678		(877)728-0011		(877)728-0011		(844)753-5678		(844)753-5678		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;2;9a1;11a;15;	2		1									
H6202	804	0	1	04	01	H6202_804_0	5	1				0	0	04/18/2021	2022.01	04/18/2021 12:53:59 PM Eastern Daylight Time					06/07/2021 02:26:36 PM Eastern Daylight Time	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	NextBlue of North Dakota	www.nextblueND.com	NextBlue of North Dakota Group PPO (PPO)	01	04		1			H6202	804	0	2022	State of North Dakota		1	0	2			2						www.NextBlueND.com/pharmacies	www.NextBlueND.com/formularies	www.nextblueND.com/findadoctor	(800)570-1144		(800)570-1144		(844)753-5678		(844)753-5678										(711)-		(711)-		(711)-		(711)-										1	1	1a;2;9a1;11a;15;	2		1									
H6229	005	0	1	48	05	H6229_005_0	3	1						07/01/2021	2022.01	07/01/2021 04:37:06 PM Eastern Daylight Time					07/01/2021 08:30:52 PM Eastern Daylight Time	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN, INC.	Anthem Blue Cross Cal MediConnect	duals.anthem.com	Anthem Blue Cross Cal MediConnect (Medicare-Medicaid Plan)	05	48		1			H6229	005	0	2022	Los Angeles County (Partial)		2	23509	2			2						duals.anthem.com	duals.anthem.com	duals.anthem.com	(888)350-3447		(888)350-3447		(888)350-3447		(888)350-3447		(833)214-3606		(833)214-3606		(888)350-3447		(888)350-3447		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H6229	006	0	1	48	05	H6229_006_0	3	1						07/01/2021	2022.01	07/01/2021 04:38:51 PM Eastern Daylight Time					07/01/2021 08:30:52 PM Eastern Daylight Time	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN, INC.	Anthem Blue Cross Cal MediConnect	duals.anthem.com	Anthem Blue Cross Cal MediConnect (Medicare-Medicaid Plan)	05	48		1			H6229	006	0	2022	Santa Clara County		2	19880	2			2						duals.anthem.com	duals.anthem.com	duals.anthem.com	(855)817-5785		(855)817-5785		(855)817-5785		(855)817-5785		(833)370-7466		(833)370-7466		(855)817-5785		(855)817-5785		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H6231	001	0	1	20	08	H6231_001_0	1	1						05/31/2021	2022.01	05/31/2021 07:46:38 AM Central Daylight Time		05/28/2021 12:02:41 PM Central Daylight Time			05/31/2021 07:48:51 AM Central Daylight Time	FRANCISCAN PACE, INC.	PACE Baton Rouge	www.ololrmc.com	Franciscan PACE, Inc. (PACE)	08	20		1			H6231	001	0	2022	PACE Baton Rouge		2		2			2						www.carekinesis.com	www.ololrmc.org										(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	1	1						05/31/2021	2022.01	05/31/2021 07:47:01 AM Central Daylight Time		05/28/2021 12:02:41 PM Central Daylight Time			05/31/2021 07:48:51 AM Central Daylight Time	FRANCISCAN PACE, INC.	PACE Baton Rouge	www.fmolhs.org	Franciscan PACE, Inc. (PACE)	08	20		1			H6231	002	0	2022	PACE Baton Rouge		2		2			2						www.carekinesis.com	www.ololrmc.org										(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	006	0	1	01	01	H6237_006_0	4	1				0	0	07/07/2021	2022.01	07/07/2021 12:05:46 PM Pacific Daylight Time	07/01/2021 02:31:28 PM Pacific Daylight Time				07/07/2021 03:24:11 PM Pacific Daylight Time	REGENCE BLUECROSS BLUESHIELD OF OREGON	Regence BlueCross BlueShield of Oregon	www.regence.com/medicare	Regence Valiance (HMO)	01	01		1			H6237	006	0	2022	Select Counties in Oregon/Clark County, WA		2	2960	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										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H6237	007	1	1	01	01	H6237_007_1	7	1					1	08/03/2021	2022.01	08/03/2021 01:35:42 PM Pacific Daylight Time	08/04/2021 01:01:25 PM Pacific Daylight Time	08/06/2021 10:36:53 AM Pacific Daylight Time			08/09/2021 09:46:09 AM Pacific Daylight Time	REGENCE BLUECROSS BLUESHIELD OF OREGON	Regence BlueCross BlueShield of Oregon	www.regence.com/medicare	Regence BlueAdvantage HMO (HMO)	01	01		1			H6237	007	1	2022	Select Counties in Oregon/Clark County, WA	Metro	2	57116	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	007	2	1	01	01	H6237_007_2	8	1					1	08/03/2021	2022.01	08/03/2021 01:36:06 PM Pacific Daylight Time	08/05/2021 07:04:48 AM Pacific Daylight Time	08/06/2021 10:39:34 AM Pacific Daylight Time			08/09/2021 09:46:09 AM Pacific Daylight Time	REGENCE BLUECROSS BLUESHIELD OF OREGON	Regence BlueCross BlueShield of Oregon	www.regence.com/medicare	Regence BlueAdvantage HMO (HMO)	01	01		1			H6237	007	2	2022	Select Counties in Oregon/Clark County, WA	Lane	2	16138	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	007	3	1	01	01	H6237_007_3	8	1					1	08/03/2021	2022.01	08/03/2021 01:36:21 PM Pacific Daylight Time	08/05/2021 07:05:31 AM Pacific Daylight Time	08/06/2021 10:41:10 AM Pacific Daylight Time			08/09/2021 09:46:09 AM Pacific Daylight Time	REGENCE BLUECROSS BLUESHIELD OF OREGON	Regence BlueCross BlueShield of Oregon	www.regence.com/medicare	Regence BlueAdvantage HMO (HMO)	01	01		1			H6237	007	3	2022	Select Counties in Oregon/Clark County, WA	Deschutes	2	7731	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	008	1	1	01	01	H6237_008_1	7	1					1	07/07/2021	2022.01	07/07/2021 12:18:25 PM Pacific Daylight Time	08/04/2021 01:04:37 PM Pacific Daylight Time	08/06/2021 10:42:55 AM Pacific Daylight Time			08/09/2021 09:46:09 AM Pacific 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	008	1	2022	Select Counties in Oregon/Clark County, WA	Metro	2	32089	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	008	2	1	01	01	H6237_008_2	8	1					1	07/07/2021	2022.01	07/07/2021 12:21:17 PM Pacific Daylight Time	08/05/2021 07:06:15 AM Pacific Daylight Time	08/06/2021 10:45:21 AM Pacific Daylight Time			08/09/2021 09:46:09 AM Pacific 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	008	2	2022	Select Counties in Oregon/Clark County, WA	Lane	2	820	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	008	3	1	01	01	H6237_008_3	7	1					1	07/07/2021	2022.01	07/07/2021 12:23:57 PM Pacific Daylight Time	08/05/2021 07:06:56 AM Pacific Daylight Time	08/06/2021 10:49:41 AM Pacific Daylight Time			08/09/2021 09:46:09 AM Pacific 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	008	3	2022	Select Counties in Oregon/Clark County, WA	Deschutes	2	2234	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			
H6306	005	0	1	01	01	H6306_005_0	7	1					0	08/04/2021	2022.01	08/04/2021 03:18:02 PM Central Daylight Time	08/03/2021 12:20:47 AM Central Daylight Time	07/30/2021 12:22:06 PM Central Daylight Time			08/04/2021 11:16:11 PM Central Daylight Time	FIRSTCAROLINACARE INSURANCE COMPANY	FirstMedicare Direct	www.firstmedicare.com	FirstMedicare Direct smartHMO (HMO)	01	01		1			H6306	005	0	2022	Wake County		2	9019	2			2						www.firstmedicare.com	www.firstmedicare.com	www.firstmedicare.com	(844)499-5630		(844)499-5630		(877)749-3356		(877)749-3356		(844)499-5630		(844)499-5630		(877)749-3356		(877)749-3356		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6306	011	1	1	02	01	H6306_011_1	8	1					1	07/15/2021	2022.01	07/15/2021 03:20:02 PM Central Daylight Time	08/03/2021 12:11:44 AM Central Daylight Time	07/30/2021 02:14:50 PM Central Daylight Time			08/04/2021 11:16:11 PM Central Daylight Time	FIRSTCAROLINACARE INSURANCE COMPANY	FirstMedicare Direct	www.firstmedicare.com	FirstMedicare Direct POS Plus (HMO-POS)	01	02		1			H6306	011	1	2022	North Carolina	Sandhills	2	49090	2			2						www.firstmedicare.com	www.firstmedicare.com	www.firstmedicare.com	(877)210-9167		(877)210-9167		(888)382-9781		(888)382-9781		(877)210-9167		(877)210-9167		(888)382-9781		(888)382-9781		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6306	011	3	1	02	01	H6306_011_3	8	1					1	07/15/2021	2022.01	07/15/2021 03:20:32 PM Central Daylight Time	08/03/2021 12:13:32 AM Central Daylight Time	07/30/2021 02:15:19 PM Central Daylight Time			08/04/2021 11:16:11 PM Central Daylight Time	FIRSTCAROLINACARE INSURANCE COMPANY	FirstMedicare Direct	www.firstmedicare.com	FirstMedicare Direct POS Plus (HMO-POS)	01	02		1			H6306	011	3	2022	North Carolina	Western North Carolina	2	1024	2			2						www.firstmedicare.com	www.firstmedicare.com	www.firstmedicare.com	(877)210-9167		(877)210-9167		(888)382-9781		(888)382-9781		(877)210-9167		(877)210-9167		(888)382-9781		(888)382-9781		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6306	012	1	1	02	01	H6306_012_1	8	1					1	07/15/2021	2022.01	07/15/2021 03:20:53 PM Central Daylight Time	08/03/2021 12:15:22 AM Central Daylight Time	07/30/2021 02:15:47 PM Central Daylight Time			08/04/2021 11:16:11 PM Central Daylight Time	FIRSTCAROLINACARE INSURANCE COMPANY	FirstMedicare Direct	www.firstmedicare.com	FirstMedicare Direct POS Standard (HMO-POS)	01	02		1			H6306	012	1	2022	North Carolina	Sandhills	2	6922	2			2						www.firstmedicare.com	www.firstmedicare.com	www.firstmedicare.com	(877)210-9167		(877)210-9167		(888)382-9781		(888)382-9781		(877)210-9167		(877)210-9167		(888)382-9781		(888)382-9781		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6306	012	5	1	02	01	H6306_012_5	8	1					1	07/15/2021	2022.01	07/15/2021 03:21:14 PM Central Daylight Time	08/03/2021 12:17:11 AM Central Daylight Time	07/30/2021 02:16:15 PM Central Daylight Time			08/04/2021 11:16:11 PM Central Daylight Time	FIRSTCAROLINACARE INSURANCE COMPANY	FirstMedicare Direct	www.firstmedicare.com	FirstMedicare Direct POS Standard (HMO-POS)	01	02		1			H6306	012	5	2022	North Carolina	Western North Carolina	2	708	2			2						www.firstmedicare.com	www.firstmedicare.com	www.firstmedicare.com	(877)210-9167		(877)210-9167		(888)382-9781		(888)382-9781		(877)210-9167		(877)210-9167		(888)382-9781		(888)382-9781		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6306	013	0	1	02	01	H6306_013_0	6	1					0	07/15/2021	2022.01	07/15/2021 03:21:34 PM Central Daylight Time	08/04/2021 12:31:30 PM Central Daylight Time	07/30/2021 09:56:56 AM Central Daylight Time			08/04/2021 11:16:11 PM Central Daylight Time	FIRSTCAROLINACARE INSURANCE COMPANY	FirstMedicare Direct	www.firstmedicare.com	New Hanover Health Advantage Select (HMO-POS)	01	02		1			H6306	013	0	2022	New Hanover, Pender, and Brunswick counties		2	3310	2			2						www.firstmedicare.com	www.firstmedicare.com	www.firstmedicare.com	(855)291-9336		(855)291-9336		(888)384-4842		(888)384-4842		(855)291-9336		(855)291-9336		(888)384-4842		(888)384-4842		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6306	014	0	1	02	01	H6306_014_0	6	1					0	07/15/2021	2022.01	07/15/2021 03:21:53 PM Central Daylight Time	08/04/2021 12:24:58 PM Central Daylight Time	07/30/2021 10:01:42 AM Central Daylight Time			08/04/2021 11:16:11 PM Central Daylight Time	FIRSTCAROLINACARE INSURANCE COMPANY	FirstMedicare Direct	www.firstmedicare.com	New Hanover Health Advantage Platinum (HMO-POS)	01	02		1			H6306	014	0	2022	New Hanover, Pender, and Brunswick counties		2	452	2			2						www.firstmedicare.com	www.firstmedicare.com	www.firstmedicare.com	(855)291-9336		(855)291-9336		(888)384-4842		(888)384-4842		(855)291-9336		(855)291-9336		(888)384-4842		(888)384-4842		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6306	015	0	1	02	01	H6306_015_0	5	1				0	0	07/15/2021	2022.01	07/15/2021 03:22:08 PM Central Daylight Time	06/05/2021 08:54:54 PM Central Daylight Time				07/15/2021 03:32:35 PM Central Daylight Time	FIRSTCAROLINACARE INSURANCE COMPANY	FirstMedicare Direct	www.firstmedicare.com	FirstMedicare Direct POS Choice (HMO-POS)	01	02		1			H6306	015	0	2022	Sandhills		2	352	2			2						www.firstmedicare.com	www.firstmedicare.com	www.firstmedicare.com	(877)210-9167		(877)210-9167		(888)382-9781		(888)382-9781										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H6316	001	0	1	01	01	H6316_001_0	7	1			2		0	08/02/2021	2022.01	08/02/2021 02:28:55 PM Eastern Daylight Time	08/03/2021 06:04:00 PM Eastern Daylight Time	08/03/2021 06:04:00 PM Eastern Daylight Time			08/04/2021 02:28:17 PM Eastern Daylight Time	MISSOURI CARE, INCORPORATED	Healthy Blue	https://shop.healthybluemo.com/medicare	Healthy Blue Essential (HMO)	01	01		1			H6316	001	0	2022	Select Counties in Missouri		2		2			2						https://shop.healthybluemo.com/medicare	https://shop.healthybluemo.com/medicare	https://shop.healthybluemo.com/medicare	(833)557-0951		(833)557-0951		(855)679-0568		(855)679-0568		(833)409-1210		(833)409-1210		(855)499-1089		(855)499-1089		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6316	002	0	1	01	01	H6316_002_0	8	1	2	1	1		0	07/28/2021	2022.01	07/28/2021 03:20:52 PM Eastern Daylight Time	08/03/2021 06:04:00 PM Eastern Daylight Time	08/03/2021 06:04:00 PM Eastern Daylight Time			08/04/2021 02:28:17 PM Eastern Daylight Time	MISSOURI CARE, INCORPORATED	Healthy Blue	https://shop.healthybluemo.com/medicare	Healthy Blue Dual (HMO D-SNP)	01	01		1			H6316	002	0	2022	Select Counties in Missouri		2		2			1	3		1		1	https://shop.healthybluemo.com/medicare	https://shop.healthybluemo.com/medicare	https://shop.healthybluemo.com/medicare	(833)557-0952		(833)557-0952		(855)768-1039		(855)768-1039		(833)409-1210		(833)409-1210		(855)499-1090		(855)499-1090		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6322	001	0	1	01	01	H6322_001_0	8	1					1	08/03/2021	2022.01	08/03/2021 08:18:29 PM Eastern Daylight Time	08/03/2021 04:58:30 PM Eastern Daylight Time	08/03/2021 03:51:08 PM Eastern Daylight Time			08/05/2021 05:22:47 PM Eastern Daylight Time	MCLAREN HEALTH PLAN, INC.	McLaren Medicare	www.mclarenhealthplan.org	McLaren Medicare Inspire (HMO)	01	01		1			H6322	001	0	2022	Lower Peninsula of Michigan		2		2			2						www.mclarenhealthplan.org	www.mclarenhealthplan.org	www.mclarenhealthplan.org	(833)358-2140		(317)822-7401		(833)358-2140		(317)822-7401		(844)336-2678		(317)822-7401		(844)336-2678		(317)822-7401		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6322	002	0	1	01	01	H6322_002_0	9	1					1	07/08/2021	2022.01	07/08/2021 02:48:20 PM Eastern Daylight Time	08/03/2021 05:02:16 PM Eastern Daylight Time	08/03/2021 03:53:12 PM Eastern Daylight Time			08/05/2021 05:22:47 PM Eastern Daylight Time	MCLAREN HEALTH PLAN, INC.	McLaren Medicare	www.mclarenhealthplan.org	McLaren Medicare Inspire Plus (HMO)	01	01		1			H6322	002	0	2022	Lower Peninsula of Michigan		2		2			2						www.mclarenhealthplan.org	www.mclarenhealthplan.org	www.mclarenhealthplan.org	(833)358-2140		(317)822-7401		(833)358-2140		(317)822-7401		(844)336-2678		(317)822-7401		(844)336-2678		(317)822-7401		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6322	003	1	1	02	01	H6322_003_1	8	1					1	07/08/2021	2022.01	07/08/2021 02:50:17 PM Eastern Daylight Time	08/03/2021 05:04:44 PM Eastern Daylight Time	08/03/2021 03:56:52 PM Eastern Daylight Time			08/05/2021 05:22:47 PM Eastern Daylight Time	MCLAREN HEALTH PLAN, INC.	McLaren Medicare	www.mclarenhealthplan.org	McLaren Medicare Inspire Flex (HMO-POS)	01	02		1			H6322	003	1	2022	Lower Peninsula of Michigan	Region 1 - Select Lower MI Counties	2		2			2						www.mclarenhealthplan.org	www.mclarenhealthplan.org	www.mclarenhealthplan.org	(833)358-2140		(317)822-7401		(833)358-2140		(317)822-7401		(844)336-2678		(317)822-7401		(844)336-2678		(317)822-7401		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6322	003	2	1	02	01	H6322_003_2	9	1					1	07/08/2021	2022.01	07/08/2021 02:53:56 PM Eastern Daylight Time	08/03/2021 05:07:50 PM Eastern Daylight Time	08/03/2021 03:59:42 PM Eastern Daylight Time			08/05/2021 05:22:47 PM Eastern Daylight Time	MCLAREN HEALTH PLAN, INC.	McLaren Medicare	www.mclarenhealthplan.org	McLaren Medicare Inspire Flex (HMO-POS)	01	02		1			H6322	003	2	2022	Lower Peninsula of Michigan	Region 2 - Select Lower MI Counties	2		2			2						www.mclarenhealthplan.org	www.mclarenhealthplan.org	www.mclarenhealthplan.org	(833)358-2140		(317)822-7401		(833)358-2140		(317)822-7401		(844)336-2678		(317)822-7401		(844)336-2678		(317)822-7401		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6322	004	0	1	01	01	H6322_004_0	9	1	2	1			0	08/05/2021	2022.01	08/05/2021 05:17:07 PM Eastern Daylight Time	08/03/2021 05:11:10 PM Eastern Daylight Time	08/03/2021 04:06:08 PM Eastern Daylight Time			08/05/2021 05:22:47 PM Eastern Daylight Time	MCLAREN HEALTH PLAN, INC.	McLaren Medicare	www.mclarenhealthplan.org	McLaren Medicare Inspire Duals (HMO D-SNP)	01	01		1			H6322	004	0	2022	Lower Peninsula of Michigan DSNP		2		2			1	3		1		1	www.mclarenhealthplan.org	www.mclarenhealthplan.org	www.mclarenhealthplan.org	(833)358-2140		(317)822-7401		(833)358-2140		(317)822-7401		(844)336-2678		(317)822-7401		(844)336-2678		(317)822-7401		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6322	801	0	1	01	01	H6322_801_0	4	1						06/03/2021	2022.01	06/03/2021 03:36:50 PM Eastern Daylight Time					06/07/2021 06:12:22 AM Eastern Daylight Time	MCLAREN HEALTH PLAN, INC.	McLaren Medicare	www.mclarenhealthplan.org	McLaren Medicare EGWP CY (HMO)	01	01		1			H6322	801	0	2022	Michigan EGWP Area		1	2812	2			2						www.mclarenhealthplan.org	www.mclarenhealthplan.org	www.mclarenhealthplan.org	(833)358-2140		(317)822-7401		(833)358-2140		(317)822-7401		(844)336-2678		(317)822-7401		(844)336-2678		(317)822-7401		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6322	803	0	1	01	01	H6322_803_0	4	1				0	0	06/01/2021	2022.01	06/01/2021 02:14:33 PM Eastern Daylight Time					06/07/2021 06:12:22 AM Eastern Daylight Time	MCLAREN HEALTH PLAN, INC.	McLaren Medicare	www.mclarenhealthplan.org	McLaren Medicare EGWP MA-Only (HMO)	01	01		1			H6322	803	0	2022	Michigan EGWP Area		1	938	2			2						www.mclarenhealthplan.org	www.mclarenhealthplan.org	www.mclarenhealthplan.org	(833)358-2140		(317)822-7401		(833)358-2140		(317)822-7401										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H6328	001	0	1	04	01	H6328_001_0	5	1					1	07/15/2021	2022.01	07/15/2021 03:36:15 PM Eastern Daylight Time	07/30/2021 03:15:25 PM Eastern Daylight Time	07/30/2021 12:10:17 PM Eastern Daylight Time			08/04/2021 11:16:07 AM 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	2022	Dallas/Fort Worth Metro Area		2	9822	2			2						www.cnchealthplan.com	www.cnchealthplan.com	www.cnchealthplan.com	(877)374-7993		(877)374-7993		(877)665-2622		(877)665-2622		(877)374-7993		(877)374-7993		(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					1	07/15/2021	2022.01	07/15/2021 03:36:27 PM Eastern Daylight Time	07/30/2021 12:07:49 PM Eastern Daylight Time	07/30/2021 12:10:43 PM Eastern Daylight Time			08/04/2021 11:16:07 AM 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	2022	Dallas/Fort Worth Metro Area		2	22100	2			2						www.cnchealthplan.com	www.cnchealthplan.com	www.cnchealthplan.com	(877)374-7993		(877)374-7993		(877)665-2622		(877)665-2622		(877)374-7993		(877)374-7993		(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					1	07/15/2021	2022.01	07/15/2021 03:36:51 PM Eastern Daylight Time	07/30/2021 12:08:29 PM Eastern Daylight Time	07/30/2021 12:11:20 PM Eastern Daylight Time			08/04/2021 11:16:07 AM 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	2022	Dallas/Fort Worth Metro Area		2	92031	2			2						www.cnchealthplan.com	www.cnchealthplan.com	www.cnchealthplan.com	(877)374-7993		(877)374-7993		(877)665-2622		(877)665-2622		(877)374-7993		(877)374-7993		(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	5	1				0	0	07/16/2021	2022.01	07/16/2021 02:20:22 PM Eastern Daylight Time	07/06/2021 11:49:05 AM Eastern Daylight Time				07/16/2021 02:22:10 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	2022	Dallas/Fort Worth Metro Area		2	3364	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	2	1						06/06/2021	2022.01	06/06/2021 08:22:38 AM Eastern Daylight Time					06/07/2021 03:16:13 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	2022	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		(877)374-7993		(877)374-7993		(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	2	1						06/06/2021	2022.01	06/06/2021 08:24:10 AM Eastern Daylight Time					06/07/2021 03:16:13 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	2022	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		(877)374-7993		(877)374-7993		(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	2	1				0	0	06/06/2021	2022.01	06/06/2021 08:24:58 AM Eastern Daylight Time					06/07/2021 03:16:13 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	2022	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	2	1				0	0	06/06/2021	2022.01	06/06/2021 08:25:31 AM Eastern Daylight Time					06/07/2021 03:16:13 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	2022	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						06/02/2021	2022.01	06/02/2021 12:31:02 PM Central Daylight Time		06/02/2021 01:30:14 PM Central Daylight Time			06/02/2021 01:31:37 PM Central Daylight Time	COMPLETE HEALTH WITH PACE	Complete Health with PACE	www.completehealthwithpace.com	Complete Health with PACE (PACE)	08	20		1			H6342	001	0	2022	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						06/02/2021	2022.01	06/02/2021 12:31:10 PM Central Daylight Time		06/02/2021 01:30:14 PM Central Daylight Time			06/02/2021 01:31:37 PM Central Daylight Time	COMPLETE HEALTH WITH PACE	Complete Health with PACE	www.completehealthwithpace.com	Complete Health with PACE (PACE)	08	20		1			H6342	002	0	2022	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	7	1		1			0	08/04/2021	2022.01	08/04/2021 08:32:53 AM Central Daylight Time	08/04/2021 11:55:13 AM Central Daylight Time	08/02/2021 12:26:42 PM Central Daylight Time			08/05/2021 11:18:13 AM Central Daylight Time	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	PruittHealth Premier	www.pruitthealthpremier.com	PruittHealth Premier (HMO I-SNP)	01	01		1			H6345	001	0	2022	NC (Partial)		2	3468	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	7	1		1			0	08/04/2021	2022.01	08/04/2021 08:33:18 AM Central Daylight Time	08/04/2021 11:57:40 AM Central Daylight Time	08/02/2021 12:25:29 PM Central Daylight Time			08/05/2021 11:18:13 AM Central Daylight Time	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	PruittHealth Premier	www.pruitthealthpremier.com	PruittHealth Premier (HMO I-SNP)	01	01		1			H6345	002	0	2022	South Carolina (partial)		2	5904	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	002	0	1	04	01	H6348_002_0	3	1					0	08/03/2021	2022.01	08/03/2021 10:42:36 AM Eastern Daylight Time	08/04/2021 08:39:59 AM Eastern Daylight Time	07/30/2021 01:20:32 PM Eastern Daylight Time			08/04/2021 10:34:28 PM Eastern Daylight Time	COORDINATED CARE CORPORATION	Wellcare by Allwell	www.wellcare.com/allwellIN	Wellcare No Premium Open (PPO)	01	04		1			H6348	002	0	2022	Select counties in IN		2	5192	2			2						www.wellcare.com/allwellIN	www.wellcare.com/allwellIN	www.wellcare.com/allwellIN	(855)766-1541		(855)766-1541		(866)277-6583		(866)277-6583		(855)766-1541		(855)766-1541		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6348	005	0	1	04	01	H6348_005_0	2	1				0	0	07/19/2021	2022.01	07/19/2021 09:07:57 AM Eastern Daylight Time	06/04/2021 08:08:36 PM Eastern Daylight Time				07/19/2021 06:29:48 PM Eastern Daylight Time	COORDINATED CARE CORPORATION	Wellcare by Allwell	www.wellcare.com/allwellIN	Wellcare Patriot Giveback Open (PPO)	01	04		1			H6348	005	0	2022	Select counites in IN		2	2414	2			2						www.wellcare.com/allwellIN	www.wellcare.com/allwellIN	www.wellcare.com/allwellIN	(855)766-1541		(855)766-1541		(866)277-6583		(866)277-6583										(711)-		(711)-		(711)-		(711)-										2					2						2			
H6348	801	0	1	04	01	H6348_801_0	2	1						05/04/2021	2022.01	05/04/2021 08:43:41 AM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	COORDINATED CARE CORPORATION	Wellcare by Allwell	allwell.mhsindiana.com	Allwell Group (PPO)	01	04		1			H6348	801	0	2022	Indiana		1	100	2			2						allwell.mhsindiana.com/findadoctor	allwell.mhsindiana.com/formulary	allwell.mhsindiana.com/findadoctor	(855)766-1541		(855)766-1541		(844)942-0039		(844)942-0039		(855)766-1541		(855)766-1541		(844)942-0039		(844)942-0039		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H6348	802	0	1	04	01	H6348_802_0	2	1				0	0	05/04/2021	2022.01	05/04/2021 08:43:57 AM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	COORDINATED CARE CORPORATION	Wellcare by Allwell	allwell.mhsindiana.com	Allwell Group (PPO)	01	04		1			H6348	802	0	2022	Indiana		1	100	2			2						allwell.mhsindiana.com/findadoctor	allwell.mhsindiana.com/formulary	allwell.mhsindiana.com/findadoctor	(855)766-1541		(855)766-1541		(844)942-0039		(844)942-0039										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H6348	803	0	1	04	01	H6348_803_0	2	1						05/04/2021	2022.01	05/04/2021 08:44:14 AM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	COORDINATED CARE CORPORATION	Wellcare by Allwell	allwell.mhsindiana.com	Allwell Group (PPO)	01	04		1			H6348	803	0	2022	Indiana		1	100	2			2						allwell.mhsindiana.com/findadoctor	allwell.mhsindiana.com/formulary	allwell.mhsindiana.com/findadoctor	(855)766-1541		(855)766-1541		(844)942-0039		(844)942-0039		(855)766-1541		(855)766-1541		(844)942-0039		(844)942-0039		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H6351	001	0	1	01	01	H6351_001_0	6	1		1			0	08/04/2021	2022.01	08/04/2021 08:41:32 AM Central Daylight Time	08/04/2021 12:05:17 PM Central Daylight Time	08/03/2021 01:37:06 PM Central Daylight Time			08/05/2021 11:18:13 AM Central Daylight Time	LIBERTY ADVANTAGE, LLC	Liberty Advantage	http://www.libertyadvantageplan.com	Liberty Advantage Nursing Home Plan (HMO I-SNP)	01	01		1			H6351	001	0	2022	North Carolina (partial)		2		2			1	1	3				http://www.navitus.com/	http://www.libertyadvantageplan.com	http://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	10	1		1			0	08/04/2021	2022.01	08/04/2021 08:42:20 AM Central Daylight Time	08/04/2021 12:08:47 PM Central Daylight Time	08/02/2021 11:31:19 AM Central Daylight Time			08/05/2021 11:18:13 AM Central Daylight Time	LIBERTY ADVANTAGE, LLC	Liberty Advantage	www.libertyadvantageplan.com	Liberty Medicare Healthy at Home (HMO I-SNP)	01	01		1			H6351	003	0	2022	North Carolina (partial)		2		2			1	1	3				www.navitus.com	www.libertyadvantageplan.com	http://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	004	0	1	01	01	H6351_004_0	9	1		1			0	08/04/2021	2022.01	08/04/2021 08:42:46 AM Central Daylight Time	08/04/2021 12:12:19 PM Central Daylight Time	08/02/2021 11:28:53 AM Central Daylight Time			08/05/2021 11:18:13 AM Central Daylight Time	LIBERTY ADVANTAGE, LLC	Liberty Advantage	http://www.libertyadvantageplan.com	Liberty Medicare Heart and Diabetes Plan (HMO C-SNP)	01	01		1			H6351	004	0	2022	North Carolina (partial)		2		2			1	4			00000000000000000010		http://www.libertyadvantageplan.com	http://www.libertyadvantageplan.com	http://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	005	0	1	01	01	H6351_005_0	9	1	2	1			0	08/04/2021	2022.01	08/04/2021 08:43:17 AM Central Daylight Time	08/04/2021 12:15:47 PM Central Daylight Time	08/02/2021 11:26:23 AM Central Daylight Time			08/05/2021 11:18:13 AM Central Daylight Time	LIBERTY ADVANTAGE, LLC	Liberty Advantage	http://www.libertyadvantageplan.com	Liberty Medicare Dual Plan (HMO D-SNP)	01	01		1			H6351	005	0	2022	North Carolina (partial)		2		2			1	3		2		2	http://www.libertyadvantageplan.com	http://www.libertyadvantageplan.com	http://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						06/01/2021	2022.01	06/01/2021 03:58:21 PM Eastern Daylight Time		06/01/2021 03:52:39 PM Eastern Daylight Time			06/01/2021 04:01:25 PM Eastern Daylight Time	LUTHERAN SENIOR HEALTHCARE, INC.	Lutheran Senior LIFE	www.lifelsmnj.org	Lutheran Senior Healthcare (PACE)	08	20		1			H6371	001	0	2022	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						06/01/2021	2022.01	06/01/2021 03:59:11 PM Eastern Daylight Time		06/01/2021 03:52:58 PM Eastern Daylight Time			06/01/2021 04:01:25 PM Eastern Daylight Time	LUTHERAN SENIOR HEALTHCARE, INC.	Lutheran Senior LIFE	www.lifelsmnj.org	Lutheran Senior Healthcare (PACE)	08	20		1			H6371	002	0	2022	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																
H6379	001	0	1	01	01	H6379_001_0	5	1					1	08/05/2021	2022.01	08/05/2021 08:37:37 AM Central Daylight Time	08/05/2021 02:09:22 PM Central Daylight Time	08/05/2021 02:07:38 PM Central Daylight Time			08/05/2021 06:05:28 PM Central Daylight Time	CLEAR SPRING HEALTH (CO), INC.	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Essential (HMO)	01	01		1			H6379	001	0	2022	Metro Denver,Boulder,Ft.Collins,CO Springs, Pueblo		2		2			2						www.clearspringhealthcare.com	www.clearspringhealthcare.com	www.clearspringhealthcare.com	(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6396	001	0	1	01	01	H6396_001_0	4	1					0	08/04/2021	2022.01	08/04/2021 03:07:40 PM Eastern Daylight Time	08/03/2021 01:20:06 PM Eastern Daylight Time	07/30/2021 03:25:28 PM Eastern Daylight Time			08/05/2021 04:11:48 PM Eastern Daylight Time	CARESOURCE OHIO, INC.	CareSource	www.caresource.com/oh/plans/medicare/	CareSource Advantage (HMO)	01	01		1			H6396	001	0	2022	Region 3		2		2			2						www.caresource.com	www.caresource.com/oh/plans/medicare/benefits-services/pharmacy/drug-formulary/	www.caresource.com/providers	(844)607-2827		(844)607-2827		(844)607-2830		(844)607-2830		(844)607-2827		(844)607-2827		(844)607-2830		(844)607-2830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6396	004	0	1	01	01	H6396_004_0	5	1					0	08/03/2021	2022.01	08/03/2021 12:11:32 PM Eastern Daylight Time	08/03/2021 01:23:04 PM Eastern Daylight Time	07/30/2021 03:26:20 PM Eastern Daylight Time			08/05/2021 04:11:48 PM Eastern Daylight Time	CARESOURCE OHIO, INC.	CareSource	www.caresource.com/oh/plans/medicare/	CareSource Advantage Zero Premium (HMO)	01	01		1			H6396	004	0	2022	Region 3		2		2			2						www.caresource.com	www.caresource.com/oh/plans/medicare/benefits-services/pharmacy/drug-formulary/	www.caresource.com/providers	(844)607-2827		(844)607-2827		(844)607-2830		(844)607-2830		(844)607-2827		(844)607-2827		(844)607-2830		(844)607-2830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6396	005	0	1	01	01	H6396_005_0	5	1	2	1			0	08/03/2021	2022.01	08/03/2021 11:52:24 AM Eastern Daylight Time	08/03/2021 01:25:54 PM Eastern Daylight Time	07/30/2021 03:27:04 PM Eastern Daylight Time			08/05/2021 04:11:48 PM Eastern Daylight Time	CARESOURCE OHIO, INC.	CareSource	www.caresource.com/oh/plans/dsnp/	CareSource Dual Advantage (HMO D-SNP)	01	01		1			H6396	005	0	2022	Region 3		2		2			1	3		1		1	www.caresource.com	www.caresource.com/oh/plans/dsnp/pharmacy/drug-formulary/	www.caresource.com/providers	(833)230-2020		(833)230-2020		(844)607-2830		(844)607-2830		(833)230-2020		(833)230-2020		(844)607-2830		(844)607-2830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6396	011	0	1	01	01	H6396_011_0	4	1					0	08/03/2021	2022.01	08/03/2021 12:08:12 PM Eastern Daylight Time	08/03/2021 01:27:46 PM Eastern Daylight Time	07/30/2021 03:28:20 PM Eastern Daylight Time			08/05/2021 04:11:48 PM Eastern Daylight Time	CARESOURCE OHIO, INC.	CareSource	www.caresource.com/oh/plans/medicare/	CareSource Advantage (HMO)	01	01		1			H6396	011	0	2022	Region 2		2		2			2						www.caresource.com	www.caresource.com/oh/plans/medicare/benefits-services/pharmacy/drug-formulary/	www.caresource.com/providers	(844)607-2827		(844)607-2827		(844)607-2830		(844)607-2830		(844)607-2827		(844)607-2827		(844)607-2830		(844)607-2830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6396	012	0	1	01	01	H6396_012_0	5	1					0	08/03/2021	2022.01	08/03/2021 11:59:03 AM Eastern Daylight Time	08/03/2021 01:29:56 PM Eastern Daylight Time	07/30/2021 03:29:04 PM Eastern Daylight Time			08/05/2021 04:11:48 PM Eastern Daylight Time	CARESOURCE OHIO, INC.	CareSource	www.caresource.com/oh/plans/medicare/	CareSource Advantage (HMO)	01	01		1			H6396	012	0	2022	Region 4		2		2			2						www.caresource.com	www.caresource.com/oh/plans/medicare/benefits-services/pharmacy/drug-formulary/	www.caresource.com/providers	(844)607-2827		(844)607-2827		(844)607-2830		(844)607-2830		(844)607-2827		(844)607-2827		(844)607-2830		(844)607-2830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6396	013	0	1	01	01	H6396_013_0	5	1					0	08/03/2021	2022.01	08/03/2021 12:02:24 PM Eastern Daylight Time	08/03/2021 01:31:48 PM Eastern Daylight Time	07/30/2021 03:29:58 PM Eastern Daylight Time			08/05/2021 04:11:48 PM Eastern Daylight Time	CARESOURCE OHIO, INC.	CareSource	www.caresource.com/oh/plans/medicare/	CareSource Advantage Zero Premium (HMO)	01	01		1			H6396	013	0	2022	Region 2		2		2			2						www.caresource.com	www.caresource.com/oh/plans/medicare/benefits-services/pharmacy/drug-formulary/	www.caresource.com/providers	(844)607-2827		(844)607-2827		(844)607-2830		(844)607-2830		(844)607-2827		(844)607-2827		(844)607-2830		(844)607-2830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6396	014	0	1	01	01	H6396_014_0	5	1	2	1			0	08/03/2021	2022.01	08/03/2021 12:24:21 PM Eastern Daylight Time	08/03/2021 01:33:42 PM Eastern Daylight Time	07/30/2021 03:30:56 PM Eastern Daylight Time			08/05/2021 04:11:48 PM Eastern Daylight Time	CARESOURCE OHIO, INC.	CareSource	www.caresource.com/oh/plans/dsnp/	CareSource Dual Advantage (HMO D-SNP)	01	01		1			H6396	014	0	2022	Region 2		2		2			1	3		1		1	www.caresource.com	www.caresource.com/oh/plans/dsnp/pharmacy/drug-formulary/	www.caresource.com/providers	(833)230-2020		(833)230-2020		(844)607-2830		(844)607-2830		(833)230-2020		(833)230-2020		(844)607-2830		(844)607-2830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6396	015	0	1	01	01	H6396_015_0	5	1	2	1			0	08/03/2021	2022.01	08/03/2021 11:54:07 AM Eastern Daylight Time	08/03/2021 01:35:50 PM Eastern Daylight Time	07/30/2021 03:31:44 PM Eastern Daylight Time			08/05/2021 04:11:48 PM Eastern Daylight Time	CARESOURCE OHIO, INC.	CareSource	www.caresource.com/oh/plans/dsnp/	CareSource Dual Advantage (HMO D-SNP)	01	01		1			H6396	015	0	2022	Region 4		2		2			1	3		1		1	www.caresource.com	www.caresource.com/oh/plans/dsnp/pharmacy/drug-formulary/	www.caresource.com/providers	(833)230-2020		(833)230-2020		(844)607-2830		(844)607-2830		(833)230-2020		(833)230-2020		(844)607-2830		(844)607-2830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6399	001	0	1	01	01	H6399_001_0	3	1	2	1			0	06/01/2021	2022.01	06/01/2021 05:15:42 PM Eastern Daylight Time	08/03/2021 10:41:45 AM Eastern Daylight Time	08/02/2021 09:56:55 AM Eastern Daylight Time			08/04/2021 04:49:45 PM Eastern Daylight Time	AETNA BETTER HEALTH INC. (NJ)	Aetna Better Health of New Jersey	www.aetnabetterhealth.com/new-jersey-hmosnp	Aetna Assure Premier Plus (HMO D-SNP)	01	01		1			H6399	001	0	2022	New Jersey Counties: All		2		2			1	3		1		1	www.aetnabetterhealth.com/new-jersey-hmosnp/find-provider	www.aetnabetterhealth.com/new-jersey-hmosnp/drug-formulary	www.aetnabetterhealth.com/new-jersey-hmosnp/find-provider	(844)362-0934		(844)362-0934		(833)874-8529		(833)874-8529		(844)362-0934		(844)362-0934		(833)874-8529		(833)874-8529		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6425	001	0	1	20	08	H6425_001_0	1	1						06/02/2021	2022.01	06/02/2021 12:13:31 PM Central Daylight Time		06/02/2021 12:14:43 PM Central Daylight Time			06/02/2021 12:17:21 PM Central Daylight Time	WASHINGTON REGIONAL MEDICORP	PACE of the Ozarks	www.wregional.com	Washington Regional Medicorp PACE of the Ozarks (PACE)	08	20		1			H6425	001	0	2022	Northwest Arkansas		2		2			2						www.carekinesis.com	N/A												(479)463-6600				(479)463-6600												(711)-				(711)-																
H6425	002	0	1	20	08	H6425_002_0	1	1						06/02/2021	2022.01	06/02/2021 12:13:40 PM Central Daylight Time		06/02/2021 12:14:43 PM Central Daylight Time			06/02/2021 12:17:21 PM Central Daylight Time	WASHINGTON REGIONAL MEDICORP	PACE of the Ozarks	www.wregional.com	Washington Regional Medicorp PACE of the Ozarks (PACE)	08	20		1			H6425	002	0	2022	Northwest Arkansas		2		2			2						www.carekinesis.com	N/A												(479)463-6600				(479)463-6600												(711)-				(711)-																
H6446	001	0	1	01	01	H6446_001_0	4	1					0	08/03/2021	2022.01	08/03/2021 02:25:07 PM Central Daylight Time	08/04/2021 12:59:44 AM Eastern Daylight Time	07/30/2021 01:20:56 PM Eastern Daylight Time			08/04/2021 10:40:50 PM Eastern Daylight Time	SILVERSUMMIT HEALTHPLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellNV	Wellcare No Premium P3 (HMO)	01	01		1			H6446	001	0	2022	Select counties in NV		2	12150	2			2						www.wellcare.com/allwellNV	www.wellcare.com/allwellNV	www.wellcare.com/allwellNV	(833)854-4766		(833)854-4766		(866)277-6583		(866)277-6583		(833)854-4766		(833)854-4766		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6446	003	0	1	01	01	H6446_003_0	4	1					0	08/03/2021	2022.01	08/03/2021 02:26:21 PM Central Daylight Time	08/04/2021 05:40:34 PM Eastern Daylight Time	07/30/2021 01:21:22 PM Eastern Daylight Time			08/04/2021 10:40:50 PM Eastern Daylight Time	SILVERSUMMIT HEALTHPLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellNV	Wellcare Giveback P3 (HMO)	01	01		1			H6446	003	0	2022	Select counties in NV		2	3828	2			2						www.wellcare.com/allwellNV	www.wellcare.com/allwellNV	www.wellcare.com/allwellNV	(833)854-4766		(833)854-4766		(866)277-6583		(866)277-6583		(833)854-4766		(833)854-4766		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6446	004	0	1	01	01	H6446_004_0	4	1					0	08/03/2021	2022.01	08/03/2021 02:27:23 PM Central Daylight Time	08/04/2021 01:00:44 AM Eastern Daylight Time	07/30/2021 01:22:26 PM Eastern Daylight Time			08/04/2021 10:40:50 PM Eastern Daylight Time	SILVERSUMMIT HEALTHPLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellNV	Wellcare Giveback USHS (HMO)	01	01		1			H6446	004	0	2022	Select counties in NV		2	3164	2			2						www.wellcare.com/allwellNV	www.wellcare.com/allwellNV	www.wellcare.com/allwellNV	(833)854-4766		(833)854-4766		(866)277-6583		(866)277-6583		(833)854-4766		(833)854-4766		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6446	005	0	1	01	01	H6446_005_0	4	1					0	08/03/2021	2022.01	08/03/2021 02:28:35 PM Central Daylight Time	08/04/2021 01:01:12 AM Eastern Daylight Time	07/30/2021 01:22:52 PM Eastern Daylight Time			08/04/2021 10:40:50 PM Eastern Daylight Time	SILVERSUMMIT HEALTHPLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellNV	Wellcare Giveback (HMO)	01	01		1			H6446	005	0	2022	Select counties in NV		2	2219	2			2						www.wellcare.com/allwellNV	www.wellcare.com/allwellNV	www.wellcare.com/allwellNV	(833)854-4766		(833)854-4766		(866)277-6583		(866)277-6583		(833)854-4766		(833)854-4766		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6446	009	0	1	01	01	H6446_009_0	4	1					0	08/03/2021	2022.01	08/03/2021 02:30:51 PM Central Daylight Time	08/04/2021 01:01:40 AM Eastern Daylight Time	07/30/2021 01:23:14 PM Eastern Daylight Time			08/04/2021 10:40:50 PM Eastern Daylight Time	SILVERSUMMIT HEALTHPLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellNV	Wellcare No Premium USHS (HMO)	01	01		1			H6446	009	0	2022	Select counties in NV		2	6053	2			2						www.wellcare.com/allwellNV	www.wellcare.com/allwellNV	www.wellcare.com/allwellNV	(833)854-4766		(833)854-4766		(866)277-6583		(866)277-6583		(833)854-4766		(833)854-4766		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6446	010	0	1	01	01	H6446_010_0	4	1					0	08/03/2021	2022.01	08/03/2021 02:32:52 PM Central Daylight Time	08/04/2021 01:02:10 AM Eastern Daylight Time	07/30/2021 01:25:26 PM Eastern Daylight Time			08/04/2021 10:40:50 PM Eastern Daylight Time	SILVERSUMMIT HEALTHPLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellNV	Wellcare No Premium (HMO)	01	01		1			H6446	010	0	2022	Select counties in NV		2	3783	2			2						www.wellcare.com/allwellNV	www.wellcare.com/allwellNV	www.wellcare.com/allwellNV	(833)854-4766		(833)854-4766		(866)277-6583		(866)277-6583		(833)854-4766		(833)854-4766		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6446	011	0	1	01	01	H6446_011_0	4	1					0	06/04/2021	2022.01	06/04/2021 01:30:09 PM Eastern Daylight Time	08/04/2021 03:40:56 PM Eastern Daylight Time	07/30/2021 01:26:02 PM Eastern Daylight Time			08/04/2021 10:40:50 PM Eastern Daylight Time	SILVERSUMMIT HEALTHPLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellNV	Wellcare Assist P3 (HMO)	01	01		1			H6446	011	0	2022	Select counties in NV		2	279	2			2						www.wellcare.com/allwellNV	www.wellcare.com/allwellNV	www.wellcare.com/allwellNV	(833)854-4766		(833)854-4766		(866)277-6583		(866)277-6583		(833)854-4766		(833)854-4766		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6446	012	0	1	01	01	H6446_012_0	4	1					0	06/04/2021	2022.01	06/04/2021 01:30:53 PM Eastern Daylight Time	08/04/2021 03:41:22 PM Eastern Daylight Time	07/30/2021 01:26:24 PM Eastern Daylight Time			08/04/2021 10:40:50 PM Eastern Daylight Time	SILVERSUMMIT HEALTHPLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellNV	Wellcare Assist USHS (HMO)	01	01		1			H6446	012	0	2022	Select counties in NV		2	129	2			2						www.wellcare.com/allwellNV	www.wellcare.com/allwellNV	www.wellcare.com/allwellNV	(833)854-4766		(833)854-4766		(866)277-6583		(866)277-6583		(833)854-4766		(833)854-4766		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6446	013	0	1	01	01	H6446_013_0	4	1					0	06/04/2021	2022.01	06/04/2021 01:31:31 PM Eastern Daylight Time	08/04/2021 01:03:38 AM Eastern Daylight Time	07/30/2021 01:26:42 PM Eastern Daylight Time			08/04/2021 10:40:50 PM Eastern Daylight Time	SILVERSUMMIT HEALTHPLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellNV	Wellcare Assist (HMO)	01	01		1			H6446	013	0	2022	Select counties in NV		2	807	2			2						www.wellcare.com/allwellNV	www.wellcare.com/allwellNV	www.wellcare.com/allwellNV	(833)854-4766		(833)854-4766		(866)277-6583		(866)277-6583		(833)854-4766		(833)854-4766		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6446	014	0	1	01	01	H6446_014_0	4	1	2	1			0	08/03/2021	2022.01	08/03/2021 02:48:00 PM Central Daylight Time	08/04/2021 03:41:48 PM Eastern Daylight Time	07/30/2021 01:27:02 PM Eastern Daylight Time			08/04/2021 10:40:50 PM Eastern Daylight Time	SILVERSUMMIT HEALTHPLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellNV	Wellcare Dual Access P3 (HMO D-SNP)	01	01		1			H6446	014	0	2022	Select counties in NV		2	5299	2			1	3		1		1	www.wellcare.com/allwellNV	www.wellcare.com/allwellNV	www.wellcare.com/allwellNV	(833)717-0806		(833)717-0806		(866)277-6583		(866)277-6583		(833)717-0806		(833)717-0806		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6446	015	0	1	01	01	H6446_015_0	4	1	2	1			0	08/04/2021	2022.01	08/04/2021 09:10:17 AM Central Daylight Time	08/04/2021 03:42:14 PM Eastern Daylight Time	07/30/2021 01:27:22 PM Eastern Daylight Time			08/04/2021 10:40:50 PM Eastern Daylight Time	SILVERSUMMIT HEALTHPLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellNV	Wellcare Dual Access USHS (HMO D-SNP)	01	01		1			H6446	015	0	2022	Select counties in NV		2	3418	2			1	3		1		1	www.wellcare.com/allwellNV	www.wellcare.com/allwellNV	www.wellcare.com/allwellNV	(833)717-0806		(833)717-0806		(866)277-6583		(866)277-6583		(833)717-0806		(833)717-0806		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6446	016	0	1	01	01	H6446_016_0	4	1	2	1			0	08/03/2021	2022.01	08/03/2021 02:50:05 PM Central Daylight Time	08/04/2021 01:05:08 AM Eastern Daylight Time	07/30/2021 01:27:46 PM Eastern Daylight Time			08/04/2021 10:40:50 PM Eastern Daylight Time	SILVERSUMMIT HEALTHPLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellNV	Wellcare Dual Access (HMO D-SNP)	01	01		1			H6446	016	0	2022	Select counties in NV		2	3528	2			1	3		1		1	www.wellcare.com/allwellNV	www.wellcare.com/allwellNV	www.wellcare.com/allwellNV	(833)717-0806		(833)717-0806		(866)277-6583		(866)277-6583		(833)717-0806		(833)717-0806		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6446	017	0	1	01	01	H6446_017_0	4	1		1			1	08/03/2021	2022.01	08/03/2021 02:34:57 PM Central Daylight Time	08/04/2021 01:05:38 AM Eastern Daylight Time	07/30/2021 01:28:08 PM Eastern Daylight Time			08/04/2021 10:40:50 PM Eastern Daylight Time	SILVERSUMMIT HEALTHPLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellNV	Wellcare Specialty No Premium P3 (HMO C-SNP)	01	01		1			H6446	017	0	2022	Select counties in NV		2	633	2			1	4			00000000000000000010		www.wellcare.com/allwellNV	www.wellcare.com/allwellNV	www.wellcare.com/allwellNV	(833)854-4766		(833)854-4766		(866)277-6583		(866)277-6583		(833)854-4766		(833)854-4766		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6446	018	0	1	01	01	H6446_018_0	4	1		1			1	08/03/2021	2022.01	08/03/2021 02:37:18 PM Central Daylight Time	08/04/2021 01:06:06 AM Eastern Daylight Time	07/30/2021 01:29:02 PM Eastern Daylight Time			08/04/2021 10:40:50 PM Eastern Daylight Time	SILVERSUMMIT HEALTHPLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellNV	Wellcare Specialty No Premium USHS (HMO C-SNP)	01	01		1			H6446	018	0	2022	Select counties in NV		2	747	2			1	4			00000000000000000010		www.wellcare.com/allwellNV	www.wellcare.com/allwellNV	www.wellcare.com/allwellNV	(833)854-4766		(833)854-4766		(866)277-6583		(866)277-6583		(833)854-4766		(833)854-4766		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6453	005	0	1	01	01	H6453_005_0	9	1					0	08/03/2021	2022.01	08/03/2021 10:44:44 AM Central Daylight Time	08/03/2021 07:25:08 AM Central Daylight Time	07/30/2021 09:39:48 AM Central Daylight Time			08/05/2021 10:28:13 AM Central Daylight Time	HMO LOUISIANA, INC.	Blue Cross and Blue Shield of Louisiana HMO	www.bcbsla.com/blueadvantage	Blue Advantage (HMO)	01	01		1			H6453	005	0	2022	Northwest Parishes		2	7266	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	9	1					0	08/03/2021	2022.01	08/03/2021 10:45:43 AM Central Daylight Time	08/03/2021 07:25:48 AM Central Daylight Time	07/30/2021 09:40:08 AM Central Daylight Time			08/05/2021 10:28:13 AM Central Daylight Time	HMO LOUISIANA, INC.	Blue Cross and Blue Shield of Louisiana HMO	www.bcbsla.com/blueadvantage	Blue Advantage (HMO)	01	01		1			H6453	006	0	2022	Northeast Parishes		2	10571	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	007	1	1	01	01	H6453_007_1	9	1					0	08/03/2021	2022.01	08/03/2021 10:46:58 AM Central Daylight Time	08/03/2021 07:26:32 AM Central Daylight Time	07/30/2021 09:57:30 AM Central Daylight Time			08/05/2021 10:28:13 AM Central Daylight Time	HMO LOUISIANA, INC.	Blue Cross and Blue Shield of Louisiana HMO	www.bcbsla.com/blueadvantage	Blue Advantage (HMO)	01	01		1			H6453	007	1	2022	Baton Rouge	Ascension, East Baton Rouge	2	24508	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	007	2	1	01	01	H6453_007_2	10	1					0	08/03/2021	2022.01	08/03/2021 10:47:46 AM Central Daylight Time	08/03/2021 07:27:26 AM Central Daylight Time	07/30/2021 09:57:52 AM Central Daylight Time			08/05/2021 10:28:13 AM Central Daylight Time	HMO LOUISIANA, INC.	Blue Cross and Blue Shield of Louisiana HMO	www.bcbsla.com/blueadvantage	Blue Advantage (HMO)	01	01		1			H6453	007	2	2022	Baton Rouge	West Baton Rouge Parishes, Select Parishes	2	12067	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	008	1	1	01	01	H6453_008_1	10	1					0	08/03/2021	2022.01	08/03/2021 11:02:48 AM Central Daylight Time	08/03/2021 07:28:08 AM Central Daylight Time	07/30/2021 09:58:12 AM Central Daylight Time			08/05/2021 10:28:13 AM Central Daylight Time	HMO LOUISIANA, INC.	Blue Cross and Blue Shield of Louisiana HMO	www.bcbsla.com/blueadvantage	Blue Advantage (HMO)	01	01		1			H6453	008	1	2022	Greater New Orleans	Terrebonne, Lafourche, Greater New Orleans	2	35696	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	008	2	1	01	01	H6453_008_2	10	1					0	08/03/2021	2022.01	08/03/2021 11:06:10 AM Central Daylight Time	08/03/2021 07:28:42 AM Central Daylight Time	07/30/2021 09:58:32 AM Central Daylight Time			08/05/2021 10:28:13 AM Central Daylight Time	HMO LOUISIANA, INC.	Blue Cross and Blue Shield of Louisiana HMO	www.bcbsla.com/blueadvantage	Blue Advantage (HMO)	01	01		1			H6453	008	2	2022	Greater New Orleans	Assumption, Plaquemines, Select Parishes	2	13390	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	009	1	1	01	01	H6453_009_1	10	1					0	08/03/2021	2022.01	08/03/2021 11:09:42 AM Central Daylight Time	08/03/2021 07:29:22 AM Central Daylight Time	07/30/2021 09:58:52 AM Central Daylight Time			08/05/2021 10:28:13 AM Central Daylight Time	HMO LOUISIANA, INC.	Blue Cross and Blue Shield of Louisiana HMO	www.bcbsla.com/blueadvantage	Blue Advantage (HMO)	01	01		1			H6453	009	1	2022	North Shore	St. Tammany, Tangipahoa	2	63320	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	009	2	1	01	01	H6453_009_2	10	1					0	08/03/2021	2022.01	08/03/2021 11:17:30 AM Central Daylight Time	08/03/2021 07:30:02 AM Central Daylight Time	07/30/2021 09:59:12 AM Central Daylight Time			08/05/2021 10:28:13 AM Central Daylight Time	HMO LOUISIANA, INC.	Blue Cross and Blue Shield of Louisiana HMO	www.bcbsla.com/blueadvantage	Blue Advantage (HMO)	01	01		1			H6453	009	2	2022	North Shore	Washington	2	6004	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	010	1	1	01	01	H6453_010_1	11	1					0	08/03/2021	2022.01	08/03/2021 11:20:29 AM Central Daylight Time	08/03/2021 07:30:46 AM Central Daylight Time	07/30/2021 09:59:32 AM Central Daylight Time			08/05/2021 10:28:13 AM Central Daylight Time	HMO LOUISIANA, INC.	Blue Cross and Blue Shield of Louisiana HMO	www.bcbsla.com/blueadvantage	Blue Advantage (HMO)	01	01		1			H6453	010	1	2022	Acadiana	Rapides, Calcasieu, Greater Lafayette Parishes	2	44073	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	010	2	1	01	01	H6453_010_2	10	1					0	08/03/2021	2022.01	08/03/2021 11:22:21 AM Central Daylight Time	08/03/2021 07:42:18 AM Central Daylight Time	07/30/2021 09:59:54 AM Central Daylight Time			08/05/2021 10:28:13 AM Central Daylight Time	HMO LOUISIANA, INC.	Blue Cross and Blue Shield of Louisiana HMO	www.bcbsla.com/blueadvantage	Blue Advantage (HMO)	01	01		1			H6453	010	2	2022	Acadiana	Avoyelles, Grant, St. Mary, Southwest Parishes	2	10149	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	1	1						06/06/2021	2022.01	06/06/2021 02:32:49 PM Central Daylight Time					06/06/2021 03:38:26 PM Central Daylight Time	HMO LOUISIANA, INC.	Blue Cross and Blue Shield of Louisiana HMO	www.bcbsla.com/blueadvantage	Blue Advantage (HMO)	01	01		1			H6453	801	0	2022	State of Louisiana		1	1	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;3-4;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;15;	2		1					2				
H6453	802	0	1	01	01	H6453_802_0	1	1						06/06/2021	2022.01	06/06/2021 02:38:15 PM Central Daylight Time					06/06/2021 03:38:26 PM Central Daylight Time	HMO LOUISIANA, INC.	Blue Cross and Blue Shield of Louisiana HMO	www.bcbsla.com/blueadvantage	Blue Advantage (HMO)	01	01		1			H6453	802	0	2022	State of Louisiana		1	1	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;3-4;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;15;	2		1					2				
H6453	803	0	1	01	01	H6453_803_0	1	1				0	0	06/06/2021	2022.01	06/06/2021 02:41:42 PM Central Daylight Time					06/06/2021 03:38:26 PM Central Daylight Time	HMO LOUISIANA, INC.	Blue Cross and Blue Shield of Louisiana HMO	www.bcbsla.com/blueadvantage	Blue Advantage (HMO)	01	01		1			H6453	803	0	2022	State of Louisiana		1	1	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;3-4;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;15;	2		1					2				
H6502	002	0	1	04	01	H6502_002_0	12	1					1	07/30/2021	2022.01	07/30/2021 11:41:08 AM Central Daylight Time	08/04/2021 07:48:00 AM Central Daylight Time	08/04/2021 07:48:00 AM Central Daylight Time			08/04/2021 08:02:24 AM Central Daylight Time	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Blue Medicare Advantage	www.MedicareBlueKC.com	Blue Medicare Advantage Essential (PPO)	01	04		1			H6502	002	0	2022	Kansas City Area		2		2			2						www.MedicareBlueKC.com	www.MedicareBlueKC.com	www.MedicareBlueKC.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	003	0	1	04	01	H6502_003_0	5	1				0	0	07/14/2021	2022.01	07/14/2021 10:17:46 AM Central Daylight Time	06/07/2021 05:57:25 AM Central Daylight Time				07/14/2021 10:28:18 AM Central Daylight Time	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Blue Medicare Advantage	www.MedicareBlueKC.com	Blue Medicare Advantage Flex (no Part D) (PPO)	01	04		1			H6502	003	0	2022	Kansas City Area		2		2			2						www.MedicareBlueKC.com	www.MedicareBlueKC.com	www.MedicareBlueKC.com	(866)508-7140		(866)508-7140		(855)208-8246		(816)395-3152										(711)-		(711)-		(711)-		(711)-										2					2						2			
H6502	004	0	1	04	01	H6502_004_0	8	1					1	07/30/2021	2022.01	07/30/2021 11:42:12 AM Central Daylight Time	08/04/2021 07:48:00 AM Central Daylight Time	08/04/2021 07:48:00 AM Central Daylight Time			08/04/2021 08:02:24 AM Central Daylight Time	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Blue Medicare Advantage	www.MedicareBlueKC.com	Simply Blue (PPO)	01	04		1			H6502	004	0	2022	Kansas City Area		2		2			2						www.MedicareBlueKC.com	www.MedicareBlueKC.com	www.MedicareBlueKC.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	005	0	1	04	01	H6502_005_0	8	1					1	07/30/2021	2022.01	07/30/2021 11:43:44 AM Central Daylight Time	08/04/2021 07:48:01 AM Central Daylight Time	08/04/2021 07:48:01 AM Central Daylight Time			08/04/2021 08:02:24 AM Central Daylight Time	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Blue Medicare Advantage	www.MedicareBlueKC.com	Simply Blue Advantage (PPO)	01	04		1			H6502	005	0	2022	Kansas City Area		2		2			2						www.MedicareBlueKC.com	www.MedicareBlueKC.com	www.MedicareBlueKC.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				0	0	06/05/2021	2022.01	06/05/2021 07:50:04 AM Central Daylight Time					06/05/2021 08:07:03 AM Central Daylight Time	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Blue Medicare Advantage	www.MedicareBlueKC.com	Blue Medicare Advantage Employer Group MA-CY (PPO)	01	04		1			H6502	801	0	2022	Kansas City Area		1	0	2			2						www.MedicareBlueKC.com	www.MedicareBlueKC.com	www.MedicareBlueKC.com	(866)508-7140		(866)508-7140		(855)208-8246		(816)395-3152										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	2		1									
H6502	802	0	1	04	01	H6502_802_0	1	1						06/05/2021	2022.01	06/05/2021 07:50:24 AM Central Daylight Time					06/05/2021 08:07:03 AM Central Daylight Time	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Blue Medicare Advantage	www.MedicareBlueKC.com	Blue Medicare Advantage Employer Group MAPD - CY (PPO)	01	04		1			H6502	802	0	2022	Kansas City Area		1	6680	2			2						www.MedicareBlueKC.com	www.MedicareBlueKC.com	www.MedicareBlueKC.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;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	2		1									
H6502	803	0	1	04	01	H6502_803_0	1	1						06/05/2021	2022.01	06/05/2021 07:53:03 AM Central Daylight Time					06/05/2021 08:07:03 AM Central Daylight Time	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Blue Medicare Advantage	www.MedicareBlueKC.com	Blue Medicare Advantage Employer Group MAPD - BY (PPO)	01	04		1			H6502	803	0	2022	Kansas City Area		1	0	2			2						www.MedicareBlueKC.com	www.MedicareBlueKC.com	www.MedicareBlueKC.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;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	2		1									
H6526	001	0	1	01	01	H6526_001_0	3	1					1	08/04/2021	2022.01	08/04/2021 11:49:49 AM Central Daylight Time	08/03/2021 12:30:21 PM Central Daylight Time	07/29/2021 09:11:12 PM Central Daylight Time			08/04/2021 08:05:11 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW MEXICO, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO)	01	01		1			H6526	001	0	2022	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	3	1					1	08/04/2021	2022.01	08/04/2021 11:50:47 AM Central Daylight Time	08/03/2021 12:30:53 PM Central Daylight Time	07/29/2021 09:11:28 PM Central Daylight Time			08/04/2021 08:05:11 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW MEXICO, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO)	01	01		1			H6526	002	0	2022	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			2		1	08/04/2021	2022.01	08/04/2021 10:06:59 AM Central Daylight Time	08/03/2021 01:36:09 PM Central Daylight Time	07/29/2021 09:11:43 PM Central Daylight Time			08/04/2021 02:05:05 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Medicare Advantage Choice Plan 1 (PPO)	01	04		1			H6528	006	0	2022	Select Counties in Georiga		2		2			2						www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.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			
H6528	031	0	1	04	01	H6528_031_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 10:05:08 AM Central Daylight Time	08/03/2021 01:36:44 PM Central Daylight Time	07/29/2021 09:11:58 PM Central Daylight Time			08/04/2021 02:05:05 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H6528	031	0	2022	NW AR		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			
H6528	033	0	1	04	01	H6528_033_0	5	1			1		1	08/04/2021	2022.01	08/04/2021 10:03:42 AM Central Daylight Time	08/03/2021 01:37:20 PM Central Daylight Time	07/29/2021 09:12:13 PM Central Daylight Time			08/04/2021 02:05:05 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H6528	033	0	2022	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			
H6528	035	0	1	04	01	H6528_035_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 11:51:51 AM Central Daylight Time	08/03/2021 01:37:57 PM Central Daylight Time	07/29/2021 09:12:29 PM Central Daylight Time			08/04/2021 08:05:11 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H6528	035	0	2022	Select Counties in Wyoming		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			
H6529	001	1	1	01	01	H6529_001_1	6	1					1	08/05/2021	2022.01	08/05/2021 12:51:01 PM Central Daylight Time	08/05/2021 11:48:24 AM Central Daylight Time	08/04/2021 11:52:23 AM Central Daylight Time			08/05/2021 03:25:40 PM Central Daylight Time	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	MyTruAdvantage	www.mytruadvantage.com	MyTruAdvantage Select (HMO)	01	01		1			H6529	001	1	2022	Select Counties in Indiana	Segment 1	2		2			2						www.mytruadvantage.com	www.mytruadvantage.com	www.mytruadvantage.com	(844)425-4280		(812)348-4576		(833)213-6731		(812)314-2505		(844)283-2788		(844)283-2788		(833)213-6731		(812)314-2505		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6529	001	2	1	01	01	H6529_001_2	6	1					1	08/05/2021	2022.01	08/05/2021 12:53:03 PM Central Daylight Time	08/05/2021 11:50:29 AM Central Daylight Time	08/04/2021 11:53:52 AM Central Daylight Time			08/05/2021 03:25:40 PM Central Daylight Time	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	MyTruAdvantage	www.mytruadvantage.com	MyTruAdvantage Select (HMO)	01	01		1			H6529	001	2	2022	Select Counties in Indiana	Segment 2	2		2			2						www.mytruadvantage.com	www.mytruadvantage.com	www.mytruadvantage.com	(844)425-4280		(812)348-4576		(833)213-6731		(812)314-2505		(844)283-2788		(844)283-2788		(833)213-6731		(812)314-2505		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6550	003	0	1	01	01	H6550_003_0	3	1					0	07/30/2021	2022.01	07/30/2021 02:13:21 PM Eastern Daylight Time	08/04/2021 08:41:51 AM Eastern Daylight Time	07/30/2021 01:29:34 PM Eastern Daylight Time			08/04/2021 09:45:33 PM Eastern Daylight Time	SUNFLOWER STATE HEALTH PLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellKS	Wellcare No Premium (HMO)	01	01		1			H6550	003	0	2022	Select counties in KS		2	6503	2			2						www.wellcare.com/allwellKS	www.wellcare.com/allwellKS	www.wellcare.com/allwellKS	(855)565-9519		(855)565-9519		(866)277-6583		(866)277-6583		(855)565-9519		(855)565-9519		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6550	004	0	1	01	01	H6550_004_0	3	1	2	1			0	07/30/2021	2022.01	07/30/2021 02:18:31 PM Eastern Daylight Time	08/04/2021 08:34:00 AM Eastern Daylight Time	07/30/2021 01:29:54 PM Eastern Daylight Time			08/04/2021 09:45:33 PM Eastern Daylight Time	SUNFLOWER STATE HEALTH PLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellKS	Wellcare Dual Access (HMO D-SNP)	01	01		1			H6550	004	0	2022	Select counties in KS		2	24121	2			1	3		1		1	www.wellcare.com/allwellKS	www.wellcare.com/allwellKS	www.wellcare.com/allwellKS	(833)402-6707		(833)402-6707		(866)277-6583		(866)277-6583		(833)402-6707		(833)402-6707		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6550	006	0	1	01	01	H6550_006_0	3	1					0	06/04/2021	2022.01	06/04/2021 01:39:04 PM Eastern Daylight Time	08/04/2021 08:37:24 AM Eastern Daylight Time	07/30/2021 01:30:16 PM Eastern Daylight Time			08/04/2021 09:45:33 PM Eastern Daylight Time	SUNFLOWER STATE HEALTH PLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellKS	Wellcare Assist (HMO)	01	01		1			H6550	006	0	2022	Select counties in KS		2	608	2			2						www.wellcare.com/allwellKS	www.wellcare.com/allwellKS	www.wellcare.com/allwellKS	(855)565-9519		(855)565-9519		(866)277-6583		(866)277-6583		(855)565-9519		(855)565-9519		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6550	007	0	1	01	01	H6550_007_0	3	1					0	07/30/2021	2022.01	07/30/2021 02:58:25 PM Eastern Daylight Time	08/04/2021 08:31:36 AM Eastern Daylight Time	07/30/2021 01:30:36 PM Eastern Daylight Time			08/04/2021 09:45:33 PM Eastern Daylight Time	SUNFLOWER STATE HEALTH PLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellKS	Wellcare Giveback (HMO)	01	01		1			H6550	007	0	2022	Select counties in KS		2	3424	2			2						www.wellcare.com/allwellKS	www.wellcare.com/allwellKS	www.wellcare.com/allwellKS	(855)565-9519		(855)565-9519		(866)277-6583		(866)277-6583		(855)565-9519		(855)565-9519		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6550	009	0	1	01	01	H6550_009_0	3	1	2	1			0	07/30/2021	2022.01	07/30/2021 02:20:43 PM Eastern Daylight Time	08/04/2021 08:34:50 AM Eastern Daylight Time	07/30/2021 01:31:10 PM Eastern Daylight Time			08/04/2021 09:45:33 PM Eastern Daylight Time	SUNFLOWER STATE HEALTH PLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellKS	Wellcare Dual Liberty (HMO D-SNP)	01	01		1			H6550	009	0	2022	Select counties in KS		2	1841	2			1	3		1		1	www.wellcare.com/allwellKS	www.wellcare.com/allwellKS	www.wellcare.com/allwellKS	(833)402-6707		(833)402-6707		(866)277-6583		(866)277-6583		(833)402-6707		(833)402-6707		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6550	801	0	1	01	01	H6550_801_0	2	1						05/03/2021	2022.01	05/03/2021 02:11:01 PM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	SUNFLOWER STATE HEALTH PLAN, INC.	Wellcare by Allwell	allwell.sunflowerhealthplan.com	Allwell Group (HMO)	01	01		1			H6550	801	0	2022	Kansas		1	100	2			2						allwell.sunflowerhealthplan.com/findadoctor	allwell.sunflowerhealthplan.com/formulary	allwell.sunflowerhealthplan.com/findadoctor	(855)565-9519		(855)565-9519		(844)942-0039		(844)942-0039		(855)565-9519		(855)565-9519		(844)942-0039		(844)942-0039		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H6550	802	0	1	01	01	H6550_802_0	2	1				0	0	05/03/2021	2022.01	05/03/2021 02:11:07 PM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	SUNFLOWER STATE HEALTH PLAN, INC.	Wellcare by Allwell	allwell.sunflowerhealthplan.com	Allwell Group (HMO)	01	01		1			H6550	802	0	2022	Kansas		1	100	2			2						allwell.sunflowerhealthplan.com/findadoctor	allwell.sunflowerhealthplan.com/formulary	allwell.sunflowerhealthplan.com/findadoctor	(855)565-9519		(855)565-9519		(844)942-0039		(844)942-0039										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H6550	803	0	1	01	01	H6550_803_0	2	1						05/03/2021	2022.01	05/03/2021 02:11:14 PM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	SUNFLOWER STATE HEALTH PLAN, INC.	Wellcare by Allwell	allwell.sunflowerhealthplan.com	Allwell Group (HMO)	01	01		1			H6550	803	0	2022	Kansas		1	100	2			2						allwell.sunflowerhealthplan.com/findadoctor	allwell.sunflowerhealthplan.com/formulary	allwell.sunflowerhealthplan.com/findadoctor	(855)565-9519		(855)565-9519		(844)942-0039		(844)942-0039		(855)565-9519		(855)565-9519		(844)942-0039		(844)942-0039		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H6551	001	0	1	20	08	H6551_001_0	1	1						05/14/2021	2022.01	05/14/2021 12:45:06 PM Eastern Daylight Time		06/02/2021 01:17:39 PM Eastern Daylight Time			06/02/2021 01:18:22 PM Eastern Daylight Time	LIFE ST. MARY	LIFE St. Mary	trinityhealthpace.org	LIFE St. Mary (PACE)	08	20		1			H6551	001	0	2022	Partial Bucks County and Partial Montgomery County		2		2			2						stmaryhealthcare.org	stmaryhealthcare.org										(267)991-7600		(267)991-7600		(267)991-7600		(267)991-7600										(267)991-7600		(267)991-7600		(267)991-7600		(267)991-7600																
H6551	002	0	1	20	08	H6551_002_0	1	1						05/14/2021	2022.01	05/14/2021 12:45:20 PM Eastern Daylight Time		06/02/2021 01:17:39 PM Eastern Daylight Time			06/02/2021 01:18:22 PM Eastern Daylight Time	LIFE ST. MARY	LIFE St. Mary	trinityhealthpace.org	LIFE St. Mary (PACE)	08	20		1			H6551	002	0	2022	Partial Bucks County and Partial Montgomery County		2		2			2						stmaryhealthcare.org	stmaryhealthcare.org										(267)991-7600		(267)991-7600		(267)991-7600		(267)991-7600										(267)991-7600		(267)991-7600		(267)991-7600		(267)991-7600																
H6594	001	0	1	04	01	H6594_001_0	5	1					0	08/03/2021	2022.01	08/03/2021 02:07:37 PM Eastern Daylight Time	08/04/2021 01:07:49 AM Eastern Daylight Time	07/30/2021 01:31:28 PM Eastern Daylight Time			08/04/2021 11:21:47 PM Eastern Daylight Time	WELLCARE HEALTH PLANS OF VERMONT, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium Open (PPO)	01	04		1			H6594	001	0	2022	Select counties in VT		2	9331	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6594	002	0	1	04	01	H6594_002_0	6	1					0	08/03/2021	2022.01	08/03/2021 09:55:05 AM Eastern Daylight Time	08/04/2021 01:08:18 AM Eastern Daylight Time	07/30/2021 01:31:48 PM Eastern Daylight Time			08/04/2021 11:21:47 PM Eastern Daylight Time	WELLCARE HEALTH PLANS OF VERMONT, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Giveback Open (PPO)	01	04		1			H6594	002	0	2022	Select counties in VT		2	5438	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6594	003	0	1	04	01	H6594_003_0	7	1					0	07/15/2021	2022.01	07/15/2021 11:44:56 AM Eastern Daylight Time	08/04/2021 01:08:46 AM Eastern Daylight Time	07/30/2021 01:32:08 PM Eastern Daylight Time			08/04/2021 11:21:47 PM Eastern Daylight Time	WELLCARE HEALTH PLANS OF VERMONT, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Plus Open (PPO)	01	04		1			H6594	003	0	2022	Select counties in VT		2	5174	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6594	004	0	1	04	01	H6594_004_0	6	1					0	07/15/2021	2022.01	07/15/2021 11:43:18 AM Eastern Daylight Time	08/04/2021 01:09:14 AM Eastern Daylight Time	07/30/2021 01:32:34 PM Eastern Daylight Time			08/04/2021 11:21:47 PM Eastern Daylight Time	WELLCARE HEALTH PLANS OF VERMONT, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Assist Open (PPO)	01	04		1			H6594	004	0	2022	Select counties in VT		2	1435	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6595	002	1	1	01	01	H6595_002_1	4	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 10:52:44 AM Central Daylight Time	08/03/2021 01:13:30 PM Central Daylight Time	07/29/2021 09:12:45 PM Central Daylight Time			08/04/2021 04:48:24 PM Central Daylight Time	UNITEDHEALTHCARE OF KENTUCKY, LTD.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO D-SNP)	01	01		1			H6595	002	1	2022	Select Counties in Kentucky	Select Counties in Kentucky	2		2			1	3		1		1	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(844)855-9774		(844)855-9774		(888)834-3721		(888)834-3721		(844)855-9774		(844)855-9774		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6595	002	2	1	01	01	H6595_002_2	4	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 11:00:37 AM Central Daylight Time	08/03/2021 01:14:05 PM Central Daylight Time	07/29/2021 09:13:02 PM Central Daylight Time			08/04/2021 04:48:24 PM Central Daylight Time	UNITEDHEALTHCARE OF KENTUCKY, LTD.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO D-SNP)	01	01		1			H6595	002	2	2022	Select Counties in Kentucky	Select Counties in Kentucky	2		2			1	3		1		1	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(844)855-9774		(844)855-9774		(888)834-3721		(888)834-3721		(844)855-9774		(844)855-9774		(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						05/30/2021	2022.01	05/30/2021 04:51:17 PM Eastern Daylight Time		06/02/2021 02:14:00 PM Eastern Daylight Time			06/02/2021 03:09:19 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	2022	Erie County		2	1930	2			2						Not applicable	fallonweinberg.org	fallonweinberg.org									(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						05/30/2021	2022.01	05/30/2021 04:56:44 PM Eastern Daylight Time		06/02/2021 02:14:04 PM Eastern Daylight Time			06/02/2021 03:09:19 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	2022	Erie County		2	50	2			2						Not applicable	fallonweinberg.org	fallonweinberg.org									(855)665-1113		(716)810-1895		(855)665-1113		(716)810-1895										(711)-		(711)-		(711)-		(711)-																
H6605	001	0	1	04	01	H6605_001_0	4	1					0	08/03/2021	2022.01	08/03/2021 02:21:42 PM Central Daylight Time	08/04/2021 01:09:42 AM Eastern Daylight Time	07/30/2021 01:32:54 PM Eastern Daylight Time			08/04/2021 10:40:50 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Wellcare by Ohana	www.wellcare.com/ohana	Wellcare 'Ohana No Premium Open (PPO)	01	04		1			H6605	001	0	2022	Select counties in HI		2	2558	2			2						www.wellcare.com/ohana	www.wellcare.com/ohana	www.wellcare.com/ohana	(877)457-7621		(877)457-7621		(844)917-0175		(844)917-0175		(877)457-7621		(877)457-7621		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6605	002	0	1	04	01	H6605_002_0	3	1				0	0	06/01/2021	2022.01	06/01/2021 08:06:07 PM Eastern Daylight Time	06/04/2021 03:06:47 PM Eastern Daylight Time				07/19/2021 06:53:05 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Wellcare by Ohana	www.wellcare.com/ohana	Wellcare 'OhanaPatriot Giveback Open (PPO)	01	04		1			H6605	002	0	2022	Select counties in HI		2	1889	2			2						www.wellcare.com/ohana	www.wellcare.com/ohana	www.wellcare.com/ohana	(877)457-7621		(877)457-7621		(844)917-0175		(844)917-0175										(711)-		(711)-		(711)-		(711)-										2					2						2			
H6605	003	0	1	04	01	H6605_003_0	4	1					0	06/04/2021	2022.01	06/04/2021 01:34:28 PM Eastern Daylight Time	08/04/2021 01:10:38 AM Eastern Daylight Time	07/30/2021 01:33:14 PM Eastern Daylight Time			08/04/2021 10:40:50 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Wellcare by Ohana	www.wellcare.com/ohana	Wellcare 'Ohana Assist Open (PPO)	01	04		1			H6605	003	0	2022	Select counties in HI		2	2895	2			2						www.wellcare.com/ohana	www.wellcare.com/ohana	www.wellcare.com/ohana	(877)457-7621		(877)457-7621		(844)917-0175		(844)917-0175		(877)457-7621		(877)457-7621		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6622	001	0	1	01	01	H6622_001_0	5	1			1		1	08/04/2021	2022.01	08/04/2021 10:15:21 AM Eastern Daylight Time	08/03/2021 07:46:30 PM Eastern Daylight Time	07/30/2021 11:51:16 AM Eastern Daylight Time			08/04/2021 06:08:57 PM 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	2022	Green Bay area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		1	08/04/2021	2022.01	08/04/2021 10:14:30 AM Eastern Daylight Time	08/03/2021 08:05:58 PM Eastern Daylight Time	07/30/2021 11:51:28 AM Eastern Daylight Time			08/04/2021 06:08:57 PM 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	2022	Milwaukee area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	08/01/2021	2022.01	08/01/2021 01:09:29 PM Eastern Daylight Time	08/03/2021 09:44:25 PM Eastern Daylight Time	07/30/2021 11:51:40 AM Eastern Daylight Time			08/04/2021 02:22:33 PM 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	2022	Richmond Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	08/02/2021	2022.01	08/02/2021 12:35:19 PM Eastern Daylight Time	08/03/2021 09:44:46 PM Eastern Daylight Time	07/30/2021 11:51:52 AM Eastern Daylight Time			08/04/2021 02:22:33 PM 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	2022	Tidewater Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		1	08/04/2021	2022.01	08/04/2021 02:19:52 PM Eastern Daylight Time	08/03/2021 06:40:50 PM Eastern Daylight Time	07/30/2021 11:52:02 AM Eastern Daylight Time			08/04/2021 02:33:41 PM 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	2022	Select Counties in Montana		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	7	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 02:19:59 PM Eastern Daylight Time	08/03/2021 06:44:10 PM Eastern Daylight Time	07/30/2021 11:52:14 AM Eastern Daylight Time			08/04/2021 02:33:41 PM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H6622-008 (HMO D-SNP)	01	01		1			H6622	008	0	2022	Select Counties in Montana		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		1	08/01/2021	2022.01	08/01/2021 01:12:15 PM Eastern Daylight Time	08/03/2021 09:45:42 PM Eastern Daylight Time	07/30/2021 11:52:26 AM Eastern Daylight Time			08/04/2021 02:22:33 PM 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	2022	Kent, New Castle and Sussex Counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		1	07/15/2021	2022.01	07/15/2021 04:32:23 PM Eastern Daylight Time	08/03/2021 05:56:21 PM Eastern Daylight Time	07/30/2021 11:52:38 AM Eastern Daylight Time			08/04/2021 01:32:44 PM 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	2022	Cleveland Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		1	07/31/2021	2022.01	07/31/2021 02:56:41 PM Eastern Daylight Time	08/03/2021 06:00:52 PM Eastern Daylight Time	07/30/2021 11:52:50 AM Eastern Daylight Time			08/04/2021 02:37:33 PM 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	2022	Columbus Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		1	07/31/2021	2022.01	07/31/2021 02:56:48 PM Eastern Daylight Time	08/03/2021 06:02:15 PM Eastern Daylight Time	07/30/2021 11:53:00 AM Eastern Daylight Time			08/04/2021 02:37:33 PM 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	2022	Canton-Akron Metro Areas		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	1		0	07/08/2021	2022.01	07/08/2021 04:21:08 PM Eastern Daylight Time	08/03/2021 06:03:36 PM Eastern Daylight Time	07/30/2021 11:53:12 AM Eastern Daylight Time			08/04/2021 02:37:33 PM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H6622-015 (HMO D-SNP)	01	01		1			H6622	015	0	2022	Select counties in Ohio		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1		1	1		1	07/15/2021	2022.01	07/15/2021 05:55:57 PM Eastern Daylight Time	08/03/2021 06:07:33 PM Eastern Daylight Time	07/30/2021 11:53:24 AM Eastern Daylight Time			08/04/2021 02:37:33 PM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus - Diabetes and Heart (HMO C-SNP)	01	01		1			H6622	017	0	2022	Ohio & N KY		2		2			1	4			00000000000000000010		https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1	2	1	1		0	07/08/2021	2022.01	07/08/2021 04:22:20 PM Eastern Daylight Time	08/03/2021 06:09:58 PM Eastern Daylight Time	07/30/2021 11:53:36 AM Eastern Daylight Time			08/04/2021 02:37:33 PM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H6622-018 (HMO D-SNP)	01	01		1			H6622	018	0	2022	Northern Kentucky Area		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		1	07/15/2021	2022.01	07/15/2021 05:56:59 PM Eastern Daylight Time	08/03/2021 06:38:20 PM Eastern Daylight Time	07/30/2021 11:53:48 AM Eastern Daylight Time			08/04/2021 02:37:33 PM 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	2022	Ohio & N KY		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		1	07/31/2021	2022.01	07/31/2021 02:57:09 PM Eastern Daylight Time	08/03/2021 06:16:15 PM Eastern Daylight Time	07/30/2021 11:54:00 AM Eastern Daylight Time			08/04/2021 02:37:33 PM 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	2022	Select KY counties in Cincinnati Metro Area	Select KY counties in Cincinnati Metro Area	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		1	07/31/2021	2022.01	07/31/2021 02:57:22 PM Eastern Daylight Time	08/03/2021 06:17:33 PM Eastern Daylight Time	07/30/2021 11:54:12 AM Eastern Daylight Time			08/04/2021 02:37:33 PM 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	2022	Select KY counties in Cincinnati Metro Area	Cincinnati/Dayton	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		1	07/31/2021	2022.01	07/31/2021 02:50:42 PM Eastern Daylight Time	08/03/2021 05:49:40 PM Eastern Daylight Time	07/30/2021 11:54:24 AM Eastern Daylight Time			08/04/2021 01:32:44 PM 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	2022	Cleveland/Toledo		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	6	1			1		1	08/03/2021	2022.01	08/03/2021 09:48:42 AM Eastern Daylight Time	08/03/2021 06:00:34 PM Eastern Daylight Time	07/30/2021 11:54:34 AM Eastern Daylight Time			08/04/2021 01:32:44 PM 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	2022	Select counties in Ohio		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	02	01	H6622_025_0	5	1			1		1	08/02/2021	2022.01	08/02/2021 03:06:18 PM Eastern Daylight Time	08/03/2021 09:47:14 PM Eastern Daylight Time	07/30/2021 11:54:46 AM Eastern Daylight Time			08/04/2021 02:22:44 PM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-025 (HMO-POS)	01	02		1			H6622	025	0	2022	Western North Carolina Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	02	01	H6622_026_0	4	1			1		1	08/03/2021	2022.01	08/03/2021 10:36:44 AM Eastern Daylight Time	08/03/2021 09:46:04 PM Eastern Daylight Time	07/30/2021 11:54:58 AM Eastern Daylight Time			08/04/2021 02:22:44 PM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-026 (HMO-POS)	01	02		1			H6622	026	0	2022	Western North Carolina Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	1		0	08/02/2021	2022.01	08/02/2021 03:07:03 PM Eastern Daylight Time	08/03/2021 10:04:38 PM Eastern Daylight Time	07/30/2021 11:55:10 AM Eastern Daylight Time			08/04/2021 02:22:44 PM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H6622-027 (HMO D-SNP)	01	01		1			H6622	027	0	2022	Western North Carolina Area		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		1	07/31/2021	2022.01	07/31/2021 03:23:33 PM Eastern Daylight Time	08/03/2021 07:11:07 PM Eastern Daylight Time	07/30/2021 11:55:22 AM Eastern Daylight Time			08/04/2021 02:46:24 PM 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	2022	Clark and Nye (partial) counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1		1	1		1	07/31/2021	2022.01	07/31/2021 03:19:16 PM Eastern Daylight Time	08/03/2021 07:10:20 PM Eastern Daylight Time	07/30/2021 11:55:34 AM Eastern Daylight Time			08/04/2021 02:40:54 PM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus - Diabetes and Heart (HMO C-SNP)	01	01		1			H6622	029	0	2022	Clark and Nye (partial) counties		2		2			1	4			00000000000000000010		https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	1		1	07/31/2021	2022.01	07/31/2021 03:19:24 PM Eastern Daylight Time	08/03/2021 07:10:44 PM Eastern Daylight Time	07/30/2021 11:55:46 AM Eastern Daylight Time			08/04/2021 02:40:54 PM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus Lung (HMO C-SNP)	01	01		1			H6622	030	0	2022	Clark and Nye (partial) counties		2		2			1	4			00000000000100000000		https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	08/01/2021	2022.01	08/01/2021 12:53:12 PM Eastern Daylight Time	08/03/2021 05:52:50 PM Eastern Daylight Time	07/30/2021 11:56:00 AM Eastern Daylight Time			08/04/2021 02:54:56 PM 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	2022	Select Counties in Oklahoma		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	6	1			1		1	08/01/2021	2022.01	08/01/2021 12:54:34 PM Eastern Daylight Time	08/03/2021 06:31:33 PM Eastern Daylight Time	07/30/2021 11:56:12 AM Eastern Daylight Time			08/04/2021 02:54:56 PM 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	2022	Select Counties in Oklahoma		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		1	08/02/2021	2022.01	08/02/2021 03:26:56 PM Eastern Daylight Time	08/03/2021 07:52:40 PM Eastern Daylight Time	07/30/2021 11:56:22 AM Eastern Daylight Time			08/04/2021 06:08:57 PM 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	2022	Milwaukee area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	7	1			1		1	08/05/2021	2022.01	08/05/2021 01:47:51 PM Eastern Daylight Time	08/03/2021 05:31:43 PM Eastern Daylight Time	07/30/2021 11:56:34 AM Eastern Daylight Time			08/05/2021 03:39:25 PM 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	2022	Central-Western Pennsylvania area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	7	1			1		1	08/05/2021	2022.01	08/05/2021 01:48:35 PM Eastern Daylight Time	08/03/2021 05:32:02 PM Eastern Daylight Time	07/30/2021 11:56:46 AM Eastern Daylight Time			08/05/2021 03:39:25 PM 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	2022	Northeast Pennsylvania Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	6	1			1		1	08/02/2021	2022.01	08/02/2021 12:35:26 PM Eastern Daylight Time	08/03/2021 05:32:23 PM Eastern Daylight Time	07/30/2021 11:56:58 AM Eastern Daylight Time			08/04/2021 02:16:11 PM 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	2022	Greater Philadelphia Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		1	08/02/2021	2022.01	08/02/2021 06:57:48 PM Eastern Daylight Time	08/03/2021 06:36:35 PM Eastern Daylight Time	07/30/2021 11:57:10 AM Eastern Daylight Time			08/04/2021 02:59:21 PM 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	2022	Select Counties in Mississippi		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	1		0	07/08/2021	2022.01	07/08/2021 04:59:56 PM Eastern Daylight Time	08/03/2021 06:35:16 PM Eastern Daylight Time	07/30/2021 11:57:22 AM Eastern Daylight Time			08/04/2021 03:07:30 PM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H6622-048 (HMO D-SNP)	01	01		1			H6622	048	0	2022	Select Counties in Mississippi		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1			1		0	07/22/2021	2022.01	07/22/2021 04:06:41 PM Eastern Daylight Time	08/03/2021 05:57:32 PM Eastern Daylight Time	07/30/2021 11:57:34 AM Eastern Daylight Time			08/04/2021 02:54:56 PM 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	2022	Select Counties in Oklahoma		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	1		0	08/02/2021	2022.01	08/02/2021 12:37:03 PM Eastern Daylight Time	08/03/2021 10:07:09 PM Eastern Daylight Time	07/30/2021 11:57:46 AM Eastern Daylight Time			08/04/2021 02:22:33 PM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H6622-051 (HMO D-SNP)	01	01		1			H6622	051	0	2022	Kent, New Castle and Sussex Counties		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	6	1			1		1	08/05/2021	2022.01	08/05/2021 01:41:34 PM Eastern Daylight Time	08/03/2021 05:46:52 PM Eastern Daylight Time	07/30/2021 11:57:58 AM Eastern Daylight Time			08/05/2021 03:49:12 PM 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	2022	Guthrie and Susquehanna Valley HMO		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	6	1			1		1	08/05/2021	2022.01	08/05/2021 01:42:03 PM Eastern Daylight Time	08/03/2021 05:46:04 PM Eastern Daylight Time	07/30/2021 11:58:10 AM Eastern Daylight Time			08/05/2021 03:49:12 PM 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	2022	Greater Pittsburgh Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		1	07/31/2021	2022.01	07/31/2021 02:57:32 PM Eastern Daylight Time	08/03/2021 06:10:43 PM Eastern Daylight Time	07/30/2021 11:58:22 AM Eastern Daylight Time			08/04/2021 02:37:33 PM 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	2022	Select counties in Ohio		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	6	1			1		1	08/02/2021	2022.01	08/02/2021 10:46:08 AM Eastern Daylight Time	08/03/2021 07:38:24 PM Eastern Daylight Time	07/30/2021 11:58:34 AM Eastern Daylight Time			08/04/2021 02:40:54 PM 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	2022	Clark and Nye (partial) counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		1	08/02/2021	2022.01	08/02/2021 03:08:38 PM Eastern Daylight Time	08/03/2021 10:10:56 PM Eastern Daylight Time	07/30/2021 11:58:46 AM Eastern Daylight Time			08/04/2021 02:22:44 PM 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	2022	Charlotte Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	059	0	1	01	01	H6622_059_0	5	1			1		1	08/02/2021	2022.01	08/02/2021 06:58:48 PM Eastern Daylight Time	08/03/2021 06:46:45 PM Eastern Daylight Time	07/30/2021 11:58:56 AM Eastern Daylight Time			08/04/2021 03:07:30 PM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-059 (HMO)	01	01		1			H6622	059	0	2022	Select Counties in Mississippi		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	060	0	1	01	01	H6622_060_0	6	1			1		1	08/02/2021	2022.01	08/02/2021 03:09:02 PM Eastern Daylight Time	08/03/2021 10:18:02 PM Eastern Daylight Time	07/30/2021 11:59:08 AM Eastern Daylight Time			08/04/2021 02:22:44 PM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-060 (HMO)	01	01		1			H6622	060	0	2022	Triangle Perimeter		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	061	0	1	01	01	H6622_061_0	6	1			1		1	08/05/2021	2022.01	08/05/2021 11:10:37 AM Eastern Daylight Time	08/03/2021 10:12:36 PM Eastern Daylight Time	07/30/2021 11:59:20 AM Eastern Daylight Time			08/05/2021 03:15:44 PM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-061 (HMO)	01	01		1			H6622	061	0	2022	Wilmington		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	062	0	1	02	01	H6622_062_0	5	1			1		1	07/22/2021	2022.01	07/22/2021 01:19:39 PM Eastern Daylight Time	08/03/2021 08:28:24 PM Eastern Daylight Time	07/30/2021 11:59:32 AM Eastern Daylight Time			08/04/2021 05:50:55 PM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-062 (HMO-POS)	01	02		1			H6622	062	0	2022	Select Counties in Minnesota		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	063	0	1	01	01	H6622_063_0	4	1			1		1	08/01/2021	2022.01	08/01/2021 12:24:39 PM Eastern Daylight Time	08/03/2021 05:49:15 PM Eastern Daylight Time	07/30/2021 11:59:42 AM Eastern Daylight Time			08/04/2021 01:51:34 PM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-063 (HMO)	01	01		1			H6622	063	0	2022	Select Counties in New Jersey		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	064	0	1	01	01	H6622_064_0	9	1			1		0	07/23/2021	2022.01	07/23/2021 02:37:06 PM Eastern Daylight Time	08/03/2021 07:40:42 PM Eastern Daylight Time	07/30/2021 11:59:54 AM Eastern Daylight Time			08/04/2021 02:54:24 PM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Value Plus H6622-064 (HMO)	01	01		1			H6622	064	0	2022	Clark and Nye (partial) counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	066	0	1	01	01	H6622_066_0	6	1			1		1	08/05/2021	2022.01	08/05/2021 01:45:58 PM Eastern Daylight Time	08/03/2021 05:50:12 PM Eastern Daylight Time	07/30/2021 12:00:06 PM Eastern Daylight Time			08/05/2021 03:32:00 PM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-066 (HMO)	01	01		1			H6622	066	0	2022	Southern New Jersey		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	069	0	1	01	01	H6622_069_0	5	1			1		1	07/15/2021	2022.01	07/15/2021 05:59:36 PM Eastern Daylight Time	08/03/2021 06:17:37 PM Eastern Daylight Time	07/30/2021 12:00:18 PM Eastern Daylight Time			08/04/2021 02:37:33 PM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-069 (HMO)	01	01		1			H6622	069	0	2022	Columbus Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	070	0	1	01	01	H6622_070_0	5	1			1		1	07/15/2021	2022.01	07/15/2021 06:00:16 PM Eastern Daylight Time	08/03/2021 06:18:47 PM Eastern Daylight Time	07/30/2021 12:00:30 PM Eastern Daylight Time			08/04/2021 02:37:33 PM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-070 (HMO)	01	01		1			H6622	070	0	2022	Canton-Akron Metro Areas		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	071	0	1	01	01	H6622_071_0	6	1		1	1		1	08/01/2021	2022.01	08/01/2021 12:56:06 PM Eastern Daylight Time	08/03/2021 06:10:22 PM Eastern Daylight Time	07/30/2021 12:00:42 PM Eastern Daylight Time			08/04/2021 02:54:56 PM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus - Diabetes and Heart (HMO C-SNP)	01	01		1			H6622	071	0	2022	Select Counties in Oklahoma		2		2			1	4			00000000000000000010		https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	073	0	1	02	01	H6622_073_0	4	1			1		1	08/03/2021	2022.01	08/03/2021 02:19:28 PM Eastern Daylight Time	08/03/2021 08:31:47 PM Eastern Daylight Time	07/30/2021 12:00:54 PM Eastern Daylight Time			08/04/2021 05:50:55 PM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-073 (HMO-POS)	01	02		1			H6622	073	0	2022	Select Counties in Minnesota		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	074	1	1	01	01	H6622_074_1	4	1			1		1	08/02/2021	2022.01	08/02/2021 12:39:12 PM Eastern Daylight Time	08/03/2021 10:20:52 PM Eastern Daylight Time	07/30/2021 12:01:06 PM Eastern Daylight Time			08/04/2021 02:22:33 PM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-074 (HMO)	01	01		1			H6622	074	1	2022	Virginia	Virginia	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	074	2	1	01	01	H6622_074_2	4	1			1		1	07/22/2021	2022.01	07/22/2021 04:18:22 PM Eastern Daylight Time	08/03/2021 10:21:13 PM Eastern Daylight Time	07/30/2021 12:01:18 PM Eastern Daylight Time			08/04/2021 02:22:33 PM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-074 (HMO)	01	01		1			H6622	074	2	2022	Virginia	Richmond Tidewater	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	075	0	1	01	01	H6622_075_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 11:53:16 AM Eastern Daylight Time	08/03/2021 07:44:45 PM Eastern Daylight Time	07/30/2021 12:01:30 PM Eastern Daylight Time			08/04/2021 02:46:24 PM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-075 (HMO)	01	01		1			H6622	075	0	2022	Carson City and Washoe counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	076	0	1	01	01	H6622_076_0	6	1		1	2		0	08/04/2021	2022.01	08/04/2021 10:25:33 AM Eastern Daylight Time	08/03/2021 08:50:11 PM Eastern Daylight Time	07/30/2021 12:01:42 PM Eastern Daylight Time			08/04/2021 06:29:06 PM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Together in Health I-SNP (HMO I-SNP)	01	01		1			H6622	076	0	2022	Select Counties in Wisconsin		2		2			1	1	1				https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	077	0	1	01	01	H6622_077_0	6	1		1	2		0	08/04/2021	2022.01	08/04/2021 10:26:28 AM Eastern Daylight Time	08/03/2021 08:52:46 PM Eastern Daylight Time	07/30/2021 12:01:54 PM Eastern Daylight Time			08/04/2021 06:29:06 PM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Together in Health IE-SNP (HMO I-SNP)	01	01		1			H6622	077	0	2022	Select Counties in Wisconsin		2		2			1	1	2				https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	078	1	1	01	01	H6622_078_1	8	1	2	1	1		0	07/20/2021	2022.01	07/20/2021 01:34:56 PM Eastern Daylight Time	08/03/2021 05:51:01 PM Eastern Daylight Time	07/30/2021 12:02:04 PM Eastern Daylight Time			08/04/2021 04:54:56 PM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H6622-078 (HMO D-SNP)	01	01		1			H6622	078	1	2022	Pennsylvania	Select counties in Pennsylvania	2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	078	2	1	01	01	H6622_078_2	7	1	2	1	1		0	07/20/2021	2022.01	07/20/2021 01:35:25 PM Eastern Daylight Time	08/03/2021 06:02:52 PM Eastern Daylight Time	07/30/2021 12:02:18 PM Eastern Daylight Time			08/04/2021 02:10:07 PM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H6622-078 (HMO D-SNP)	01	01		1			H6622	078	2	2022	Pennsylvania	Greater Philadelphia	2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	079	0	1	01	01	H6622_079_0	4	1	2	1	1		0	08/02/2021	2022.01	08/02/2021 10:46:21 AM Eastern Daylight Time	08/03/2021 07:45:09 PM Eastern Daylight Time	07/30/2021 12:02:28 PM Eastern Daylight Time			08/04/2021 02:40:54 PM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H6622-079 (HMO D-SNP)	01	01		1			H6622	079	0	2022	Select Counties in Nevada		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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						05/25/2021	2022.01	05/25/2021 03:57:42 PM Eastern Daylight Time					06/04/2021 08:33:40 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H6622	801	0	2022	Select counties in Multi States		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242		(866)396-8810		(866)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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H6622	802	0	1	01	01	H6622_802_0	1	1				0	0	05/25/2021	2022.01	05/25/2021 04:00:23 PM Eastern Daylight Time					06/04/2021 08:33:40 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H6622	802	0	2022	Select counties in Multi States		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H6622	804	0	1	01	01	H6622_804_0	1	1						05/27/2021	2022.01	05/27/2021 04:16:12 PM Eastern Daylight Time					06/04/2021 08:33:40 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H6622	804	0	2022	Select counties in Multi States		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242		(866)396-8810		(866)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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					2				
H6622	805	0	1	01	01	H6622_805_0	1	1				0	0	05/27/2021	2022.01	05/27/2021 04:19:26 PM Eastern Daylight Time					06/04/2021 08:33:40 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H6622	805	0	2022	Select counties in Multi States		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					2				
H6652	001	0	1	01	01	H6652_001_0	2	1		1			0	08/03/2021	2022.01	08/03/2021 03:02:05 PM Central Daylight Time	08/05/2021 08:08:03 AM Central Daylight Time	08/05/2021 08:08:22 AM Central Daylight Time			08/05/2021 08:42:27 AM Central Daylight Time	AMERICAN HEALTH PLAN OF FL, INC.	American Health Advantage of Florida	fl.amhealthplans.com	American Health Advantage of Florida (HMO I-SNP)	01	01		1			H6652	001	0	2022	Central/East Florida		2		2			1	1	3				fl.amhealthplans.com	fl.amhealthplans.com	fl.amhealthplans.com	(855)521-0626		(855)521-0626		(855)521-0626		(855)521-0626		(855)521-0626		(855)521-0626		(855)521-0626		(855)521-0626		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6672	001	0	1	01	01	H6672_001_0	5	1	2	1			0	08/05/2021	2022.01	08/05/2021 08:38:43 AM Central Daylight Time	08/05/2021 02:09:23 PM Central Daylight Time	08/05/2021 02:07:43 PM Central Daylight Time			08/05/2021 06:05:28 PM Central Daylight Time	EON HEALTH, INC. (GA)	Clear Spring Health	www.eonhealthplan.com	Clear Spring Health Deluxe Plan (HMO D-SNP)	01	01		1			H6672	001	0	2022	Select Georgia Counties		2		2			1	3		1		1	https://www.eonhp.com/	https://www.eonhp.com/	www.eonhealthplan.com	(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6672	003	0	1	01	01	H6672_003_0	5	1		1			1	08/05/2021	2022.01	08/05/2021 08:43:41 AM Central Daylight Time	08/05/2021 02:09:24 PM Central Daylight Time	08/05/2021 02:07:47 PM Central Daylight Time			08/05/2021 06:05:28 PM Central Daylight Time	EON HEALTH, INC. (GA)	Clear Spring Health	www.eonhealthplan.com	Clear Spring Health Silver Plan (HMO C-SNP)	01	01		1			H6672	003	0	2022	Select Georgia Counties		2		2			1	4			00000000000000000010		https://www.eonhp.com/	https://www.eonhp.com/	www.eonhealthplan.com	(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6672	004	0	1	01	01	H6672_004_0	9	1					1	08/09/2021	2022.01	08/09/2021 03:09:37 PM Central Daylight Time	08/05/2021 02:09:25 PM Central Daylight Time	08/05/2021 02:08:00 PM Central Daylight Time			08/11/2021 10:02:18 AM Central Daylight Time	EON HEALTH, INC. (GA)	Clear Spring Health	www.eonhealthplan.com	Clear Spring Health Select (HMO)	01	01		1			H6672	004	0	2022	Select Georgia Counties		2		2			2						https://www.eonhp.com/	https://www.eonhp.com/	www.eonhealthplan.com	(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6672	005	0	1	01	01	H6672_005_0	5	1					1	08/05/2021	2022.01	08/05/2021 08:45:43 AM Central Daylight Time	08/05/2021 02:09:26 PM Central Daylight Time	08/05/2021 02:08:04 PM Central Daylight Time			08/05/2021 06:05:28 PM Central Daylight Time	EON HEALTH, INC. (GA)	Clear Spring Health	www.eonhealthplan.com	Clear Spring Health Select Plus (HMO)	01	01		1			H6672	005	0	2022	Select Georgia Counties		2		2			2						https://www.eonhp.com/	https://www.eonhp.com/	www.eonhealthplan.com	(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6678	001	0	1	01	01	H6678_001_0	4	1					0	08/02/2021	2022.01	08/02/2021 10:13:33 AM Central Daylight Time	08/04/2021 12:11:05 AM Central Daylight Time	07/30/2021 12:33:36 PM Central Daylight Time			08/04/2021 10:17:29 PM Central Daylight Time	CENTENE VENTURE INSURANCE COMPANY TEXAS	Ascension Complete	ascensioncomplete.com	Ascension Complete Seton Reward (HMO)	01	01		1			H6678	001	0	2022	Austin Area Counties		2	3264	2			2						ascensioncomplete.com/findadoctor	ascensioncomplete.com/formulary	ascensioncomplete.com/findadoctor	(833)705-1358		(833)705-1358		(866)277-6541		(866)277-6541		(833)705-1358		(833)705-1358		(866)277-6541		(866)277-6541		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6678	002	0	1	01	01	H6678_002_0	4	1					0	08/02/2021	2022.01	08/02/2021 10:14:01 AM Central Daylight Time	08/04/2021 12:11:32 AM Central Daylight Time	07/30/2021 12:33:56 PM Central Daylight Time			08/04/2021 10:17:29 PM Central Daylight Time	CENTENE VENTURE INSURANCE COMPANY TEXAS	Ascension Complete	ascensioncomplete.com	Ascension Complete Seton Secure (HMO)	01	01		1			H6678	002	0	2022	Austin Area Counties		2	365	2			2						ascensioncomplete.com/findadoctor	ascensioncomplete.com/formulary	ascensioncomplete.com/findadoctor	(833)705-1358		(833)705-1358		(866)277-6541		(866)277-6541		(833)705-1358		(833)705-1358		(866)277-6541		(866)277-6541		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6678	003	0	1	01	01	H6678_003_0	4	1					0	08/02/2021	2022.01	08/02/2021 10:14:31 AM Central Daylight Time	08/04/2021 12:11:59 AM Central Daylight Time	07/30/2021 12:34:40 PM Central Daylight Time			08/04/2021 10:17:29 PM Central Daylight Time	CENTENE VENTURE INSURANCE COMPANY TEXAS	Ascension Complete	ascensioncomplete.com	Ascension Complete Providence Reward (HMO)	01	01		1			H6678	003	0	2022	Waco Area Counties		2	1142	2			2						ascensioncomplete.com/findadoctor	ascensioncomplete.com/formulary	ascensioncomplete.com/findadoctor	(833)705-1358		(833)705-1358		(866)277-6541		(866)277-6541		(833)705-1358		(833)705-1358		(866)277-6541		(866)277-6541		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6678	004	0	1	01	01	H6678_004_0	4	1					0	08/02/2021	2022.01	08/02/2021 10:15:01 AM Central Daylight Time	08/04/2021 12:12:29 AM Central Daylight Time	07/30/2021 12:35:24 PM Central Daylight Time			08/04/2021 10:17:29 PM Central Daylight Time	CENTENE VENTURE INSURANCE COMPANY TEXAS	Ascension Complete	ascensioncomplete.com	Ascension Complete Providence Secure (HMO)	01	01		1			H6678	004	0	2022	Waco Area Counties		2	128	2			2						ascensioncomplete.com/findadoctor	ascensioncomplete.com/formulary	ascensioncomplete.com/findadoctor	(833)705-1358		(833)705-1358		(866)277-6541		(866)277-6541		(833)705-1358		(833)705-1358		(866)277-6541		(866)277-6541		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6706	001	0	1	01	01	H6706_001_0	3	1					1	08/04/2021	2022.01	08/04/2021 11:52:53 AM Central Daylight Time	08/03/2021 12:21:52 PM Central Daylight Time	07/29/2021 09:13:17 PM Central Daylight Time			08/04/2021 08:05:11 PM Central Daylight Time	UNITEDHEALTHCARE OF COLORADO, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO)	01	01		1			H6706	001	0	2022	Boulder 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			
H6713	001	0	1	04	01	H6713_001_0	4	1					0	08/01/2021	2022.01	08/01/2021 10:43:31 AM Eastern Daylight Time	08/04/2021 01:13:00 AM Eastern Daylight Time	07/30/2021 01:35:58 PM Eastern Daylight Time			08/04/2021 11:43:06 PM Eastern Daylight Time	WELLCARE OF ILLINOIS, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium Open (PPO)	01	04		1			H6713	001	0	2022	Select counties in IL		2	33348	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6713	002	0	1	04	01	H6713_002_0	4	1					0	08/01/2021	2022.01	08/01/2021 10:55:34 AM Eastern Daylight Time	08/04/2021 01:13:30 AM Eastern Daylight Time	07/30/2021 01:36:20 PM Eastern Daylight Time			08/04/2021 11:43:06 PM Eastern Daylight Time	WELLCARE OF ILLINOIS, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Giveback Open (PPO)	01	04		1			H6713	002	0	2022	Select counties in IL		2	39375	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6723	001	1	1	01	01	H6723_001_1	9	1					0	08/03/2021	2022.01	08/03/2021 03:04:08 PM Eastern Daylight Time	08/02/2021 08:58:46 PM Eastern Daylight Time	08/02/2021 07:56:12 PM Eastern Daylight Time			08/05/2021 11:37:29 AM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/planfinder	MedMutual Advantage Classic (HMO)	01	01		1			H6723	001	1	2022	Ohio Regions	Northeast Ohio	2		2			2						medmutual.com/maplaninfo	medmutual.com/maplaninfo	providersearch.medmutual.com	(800)982-3117		(800)982-3117		(877)368-0081		(877)368-0081		(800)982-3117		(800)982-3117		(877)368-0081		(877)368-0081		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6723	001	2	1	01	01	H6723_001_2	9	1					0	08/03/2021	2022.01	08/03/2021 03:04:27 PM Eastern Daylight Time	08/02/2021 08:57:54 PM Eastern Daylight Time	08/02/2021 07:53:08 PM Eastern Daylight Time			08/05/2021 11:37:29 AM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/planfinder	MedMutual Advantage Classic (HMO)	01	01		1			H6723	001	2	2022	Ohio Regions	Select Ohio Counties	2		2			2						medmutual.com/maplaninfo	medmutual.com/maplaninfo	providersearch.medmutual.com	(800)982-3117		(800)982-3117		(877)368-0081		(877)368-0081		(800)982-3117		(800)982-3117		(877)368-0081		(877)368-0081		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6723	001	3	1	01	01	H6723_001_3	9	1					0	08/03/2021	2022.01	08/03/2021 03:05:11 PM Eastern Daylight Time	08/02/2021 08:56:16 PM Eastern Daylight Time	08/02/2021 07:53:56 PM Eastern Daylight Time			08/05/2021 11:37:29 AM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/planfinder	MedMutual Advantage Classic (HMO)	01	01		1			H6723	001	3	2022	Ohio Regions	Central Ohio, Cincinnati/Dayton and Toledo	2		2			2						medmutual.com/maplaninfo	medmutual.com/maplaninfo	providersearch.medmutual.com	(800)982-3117		(800)982-3117		(877)368-0081		(877)368-0081		(800)982-3117		(800)982-3117		(877)368-0081		(877)368-0081		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6723	002	1	1	01	01	H6723_002_1	9	1					0	07/16/2021	2022.01	07/16/2021 01:06:20 PM Eastern Daylight Time	08/02/2021 08:54:22 PM Eastern Daylight Time	08/02/2021 07:50:58 PM Eastern Daylight Time			08/05/2021 11:37:29 AM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/planfinder	MedMutual Advantage Choice (HMO)	01	01		1			H6723	002	1	2022	Ohio Regions	Northeast Ohio	2		2			2						medmutual.com/maplaninfo	medmutual.com/maplaninfo	providersearch.medmutual.com	(800)982-3117		(800)982-3117		(877)368-0081		(877)368-0081		(800)982-3117		(800)982-3117		(877)368-0081		(877)368-0081		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6723	002	2	1	01	01	H6723_002_2	9	1					0	07/16/2021	2022.01	07/16/2021 12:45:04 PM Eastern Daylight Time	08/02/2021 08:53:08 PM Eastern Daylight Time	08/02/2021 07:47:14 PM Eastern Daylight Time			08/05/2021 11:37:29 AM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/planfinder	MedMutual Advantage Choice (HMO)	01	01		1			H6723	002	2	2022	Ohio Regions	Select Ohio Counties	2		2			2						medmutual.com/maplaninfo	medmutual.com/maplaninfo	providersearch.medmutual.com	(800)982-3117		(800)982-3117		(877)368-0081		(877)368-0081		(800)982-3117		(800)982-3117		(877)368-0081		(877)368-0081		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6723	002	3	1	01	01	H6723_002_3	9	1					0	07/16/2021	2022.01	07/16/2021 12:47:01 PM Eastern Daylight Time	08/02/2021 08:52:08 PM Eastern Daylight Time	08/02/2021 07:48:58 PM Eastern Daylight Time			08/05/2021 11:37:29 AM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/planfinder	MedMutual Advantage Choice (HMO)	01	01		1			H6723	002	3	2022	Ohio Regions	Central Ohio, Cincinnati/Dayton and Toledo	2		2			2						medmutual.com/maplaninfo	medmutual.com/maplaninfo	providersearch.medmutual.com	(800)982-3117		(800)982-3117		(877)368-0081		(877)368-0081		(800)982-3117		(800)982-3117		(877)368-0081		(877)368-0081		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6723	003	1	1	01	01	H6723_003_1	11	1					0	07/16/2021	2022.01	07/16/2021 12:50:05 PM Eastern Daylight Time	08/02/2021 08:49:14 PM Eastern Daylight Time	08/02/2021 07:46:48 PM Eastern Daylight Time			08/05/2021 11:37:29 AM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/planfinder	MedMutual Advantage Plus (HMO)	01	01		1			H6723	003	1	2022	Ohio Regions	Northeast Ohio	2		2			2						medmutual.com/maplaninfo	medmutual.com/maplaninfo	providersearch.medmutual.com	(800)982-3117		(800)982-3117		(877)368-0081		(877)368-0081		(800)982-3117		(800)982-3117		(877)368-0081		(877)368-0081		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6723	003	2	1	01	01	H6723_003_2	9	1					0	07/16/2021	2022.01	07/16/2021 12:51:43 PM Eastern Daylight Time	08/02/2021 08:45:06 PM Eastern Daylight Time	08/02/2021 07:46:12 PM Eastern Daylight Time			08/05/2021 11:37:29 AM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/planfinder	MedMutual Advantage Plus (HMO)	01	01		1			H6723	003	2	2022	Ohio Regions	Select Ohio Counties	2		2			2						medmutual.com/maplaninfo	medmutual.com/maplaninfo	providersearch.medmutual.com	(800)982-3117		(800)982-3117		(877)368-0081		(877)368-0081		(800)982-3117		(800)982-3117		(877)368-0081		(877)368-0081		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6723	003	3	1	01	01	H6723_003_3	9	1					0	07/16/2021	2022.01	07/16/2021 12:53:03 PM Eastern Daylight Time	08/02/2021 08:48:04 PM Eastern Daylight Time	08/02/2021 07:44:42 PM Eastern Daylight Time			08/05/2021 11:37:29 AM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/planfinder	MedMutual Advantage Plus (HMO)	01	01		1			H6723	003	3	2022	Ohio Regions	Central Ohio, Cincinnati/Dayton and Toledo	2		2			2						medmutual.com/maplaninfo	medmutual.com/maplaninfo	providersearch.medmutual.com	(800)982-3117		(800)982-3117		(877)368-0081		(877)368-0081		(800)982-3117		(800)982-3117		(877)368-0081		(877)368-0081		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6723	005	1	1	01	01	H6723_005_1	9	1					0	08/03/2021	2022.01	08/03/2021 02:17:29 PM Eastern Daylight Time	08/02/2021 08:45:48 PM Eastern Daylight Time	08/02/2021 07:44:02 PM Eastern Daylight Time			08/05/2021 11:37:29 AM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/planfinder	MedMutual Advantage Secure (HMO)	01	01		1			H6723	005	1	2022	Ohio Regions	Northeast Ohio	2		2			2						medmutual.com/maplaninfo	medmutual.com/maplaninfo	providersearch.medmutual.com	(800)982-3117		(800)982-3117		(877)368-0081		(877)368-0081		(800)982-3117		(800)982-3117		(877)368-0081		(877)368-0081		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6723	005	2	1	01	01	H6723_005_2	9	1					0	07/16/2021	2022.01	07/16/2021 12:56:14 PM Eastern Daylight Time	08/02/2021 09:02:14 PM Eastern Daylight Time	08/02/2021 07:40:56 PM Eastern Daylight Time			08/05/2021 11:37:29 AM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/planfinder	MedMutual Advantage Secure (HMO)	01	01		1			H6723	005	2	2022	Ohio Regions	Central Ohio, Cincinnati/Dayton and Toledo	2		2			2						medmutual.com/maplaninfo	medmutual.com/maplaninfo	providersearch.medmutual.com	(800)982-3117		(800)982-3117		(877)368-0081		(877)368-0081		(800)982-3117		(800)982-3117		(877)368-0081		(877)368-0081		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6723	006	1	1	01	01	H6723_006_1	9	1					0	08/03/2021	2022.01	08/03/2021 03:05:43 PM Eastern Daylight Time	08/02/2021 08:59:22 PM Eastern Daylight Time	08/02/2021 07:37:06 PM Eastern Daylight Time			08/05/2021 11:37:29 AM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/planfinder	MedMutual Advantage Signature (HMO)	01	01		1			H6723	006	1	2022	Ohio Regions	Northeast Ohio	2		2			2						medmutual.com/maplaninfo	medmutual.com/maplaninfo	providersearch.medmutual.com	(800)982-3117		(800)982-3117		(877)368-0081		(877)368-0081		(800)982-3117		(800)982-3117		(877)368-0081		(877)368-0081		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6723	006	2	1	01	01	H6723_006_2	9	1					0	08/03/2021	2022.01	08/03/2021 03:06:03 PM Eastern Daylight Time	08/02/2021 09:01:30 PM Eastern Daylight Time	08/02/2021 07:36:26 PM Eastern Daylight Time			08/05/2021 11:37:29 AM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/planfinder	MedMutual Advantage Signature (HMO)	01	01		1			H6723	006	2	2022	Ohio Regions	Central Ohio, Cincinnati/Dayton and Toledo	2		2			2						medmutual.com/maplaninfo	medmutual.com/maplaninfo	providersearch.medmutual.com	(800)982-3117		(800)982-3117		(877)368-0081		(877)368-0081		(800)982-3117		(800)982-3117		(877)368-0081		(877)368-0081		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6723	006	3	1	01	01	H6723_006_3	9	1					0	08/03/2021	2022.01	08/03/2021 03:06:28 PM Eastern Daylight Time	08/02/2021 09:00:42 PM Eastern Daylight Time	08/02/2021 07:32:24 PM Eastern Daylight Time			08/05/2021 11:37:29 AM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/planfinder	MedMutual Advantage Signature (HMO)	01	01		1			H6723	006	3	2022	Ohio Regions	Cuyahoga, Lake, Medina, Portage, Stark, Summit	2		2			2						medmutual.com/maplaninfo	medmutual.com/maplaninfo	providersearch.medmutual.com	(800)982-3117		(800)982-3117		(877)368-0081		(877)368-0081		(800)982-3117		(800)982-3117		(877)368-0081		(877)368-0081		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6723	801	0	1	01	01	H6723_801_0	3	1						06/01/2021	2022.01	06/01/2021 05:41:50 PM Eastern Daylight Time					07/19/2021 06:27:36 PM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/magroup	MedMutual Advantage EGWP (Calendar Year) (HMO)	01	01		1			H6723	801	0	2022	Ohio Regions		1	6000	2			2						medmutual.com/magroup	medmutual.com/magroup	providersearch.medmutual.com	(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;15;	2		1					2				
H6723	802	0	1	01	01	H6723_802_0	3	1						05/18/2021	2022.01	05/18/2021 02:08:38 PM Eastern Daylight Time					07/19/2021 06:27:36 PM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/magroup	MedMutual Advantage EGWP (Non-Calendar Year) (HMO)	01	01		1			H6723	802	0	2022	Ohio Regions		1	100	2			2						medmutual.com/magroup	medmutual.com/magroup	providersearch.medmutual.com	(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;3-2;6;8a;8b1;8b2;9a1;9b;10a;11a;11b;15;	2		1					2				
H6723	803	0	1	01	01	H6723_803_0	3	1				0	0	05/18/2021	2022.01	05/18/2021 02:08:46 PM Eastern Daylight Time					07/19/2021 06:27:36 PM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/magroup	MedMutual Advantage EGWP (MA-Only) (HMO)	01	01		1			H6723	803	0	2022	Ohio Regions		1	100	2			2						medmutual.com/magroup	medmutual.com/magroup	providersearch.medmutual.com	(800)801-4823		(800)801-4823		(866)406-8777		(866)406-8777										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;6;8a;8b1;8b2;9a1;9b;10a;11a;11b;15;	2		1					2				
H6743	001	0	1	04	01	H6743_001_0	5	1					0	08/03/2021	2022.01	08/03/2021 04:15:57 PM Pacific Daylight Time	08/04/2021 10:11:08 AM Pacific Daylight Time	08/04/2021 10:15:51 AM Pacific Daylight Time			08/05/2021 11:35:58 AM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	atriohp.com	ATRIO Choice Rx (PPO)	01	04		1			H6743	001	0	2022	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6743	007	0	1	04	01	H6743_007_0	5	1					0	08/04/2021	2022.01	08/04/2021 11:50:28 AM Pacific Daylight Time	08/04/2021 10:11:25 AM Pacific Daylight Time	08/04/2021 10:16:10 AM Pacific Daylight Time			08/05/2021 11:35:58 AM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	atriohp.com	ATRIO Choice Rx (PPO)	01	04		1			H6743	007	0	2022	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6743	018	1	1	04	01	H6743_018_1	5	1					0	08/03/2021	2022.01	08/03/2021 04:17:57 PM Pacific Daylight Time	08/04/2021 10:11:42 AM Pacific Daylight Time	08/04/2021 10:16:29 AM Pacific Daylight Time			08/05/2021 11:35:58 AM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	atriohp.com	ATRIO Choice Rx (PPO)	01	04		1			H6743	018	1	2022	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6743	018	3	1	04	01	H6743_018_3	5	1					0	08/03/2021	2022.01	08/03/2021 04:19:12 PM Pacific Daylight Time	08/04/2021 10:12:00 AM Pacific Daylight Time	08/04/2021 10:16:49 AM Pacific Daylight Time			08/05/2021 11:35:58 AM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	atriohp.com	ATRIO Choice Rx (PPO)	01	04		1			H6743	018	3	2022	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6743	019	2	1	04	01	H6743_019_2	3	1				0	0	07/12/2021	2022.01	07/12/2021 08:29:40 AM Pacific Daylight Time	07/16/2021 11:23:30 AM Pacific Daylight Time				07/21/2021 01:01:43 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	atriohp.com	ATRIO Select (PPO)	01	04		1			H6743	019	2	2022	Douglas and Klamath counties	Douglas County	2	2864	2			2						atriohp.com	atriohp.com	atriohp.com	(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620										(711)-		(711)-		(711)-		(711)-										2					2						2			
H6743	019	4	1	04	01	H6743_019_4	3	1				0	0	07/12/2021	2022.01	07/12/2021 08:36:04 AM Pacific Daylight Time	07/16/2021 11:23:48 AM Pacific Daylight Time				07/21/2021 01:01:43 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	atriohp.com	ATRIO Select (PPO)	01	04		1			H6743	019	4	2022	Douglas and Klamath counties	Klamath County	2	2864	2			2						atriohp.com	atriohp.com	atriohp.com	(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620										(711)-		(711)-		(711)-		(711)-										2					2						2			
H6743	020	1	1	04	01	H6743_020_1	5	1					0	08/03/2021	2022.01	08/03/2021 01:52:06 PM Pacific Daylight Time	08/04/2021 10:12:17 AM Pacific Daylight Time	08/04/2021 10:17:08 AM Pacific Daylight Time			08/05/2021 11:35:58 AM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	atriohp.com	ATRIO Select Rx (PPO)	01	04		1			H6743	020	1	2022	Douglas, Jackson, Josephine, and Klamath counties	Jackson County	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6743	020	2	1	04	01	H6743_020_2	5	1					0	08/03/2021	2022.01	08/03/2021 01:52:41 PM Pacific Daylight Time	08/04/2021 10:12:34 AM Pacific Daylight Time	08/04/2021 10:17:28 AM Pacific Daylight Time			08/05/2021 11:35:58 AM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	atriohp.com	ATRIO Select Rx (PPO)	01	04		1			H6743	020	2	2022	Douglas, Jackson, Josephine, and Klamath counties	Douglas County	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6743	020	3	1	04	01	H6743_020_3	5	1					0	08/03/2021	2022.01	08/03/2021 01:53:25 PM Pacific Daylight Time	08/04/2021 10:12:52 AM Pacific Daylight Time	08/04/2021 10:17:47 AM Pacific Daylight Time			08/05/2021 11:35:58 AM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	atriohp.com	ATRIO Select Rx (PPO)	01	04		1			H6743	020	3	2022	Douglas, Jackson, Josephine, and Klamath counties	Josephine County	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6743	020	4	1	04	01	H6743_020_4	5	1					0	08/03/2021	2022.01	08/03/2021 01:54:03 PM Pacific Daylight Time	08/04/2021 10:13:10 AM Pacific Daylight Time	08/04/2021 10:18:06 AM Pacific Daylight Time			08/05/2021 11:35:58 AM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	atriohp.com	ATRIO Select Rx (PPO)	01	04		1			H6743	020	4	2022	Douglas, Jackson, Josephine, and Klamath counties	Klamath County	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6743	021	2	1	04	01	H6743_021_2	5	1					0	08/03/2021	2022.01	08/03/2021 01:54:49 PM Pacific Daylight Time	08/04/2021 10:13:28 AM Pacific Daylight Time	08/04/2021 10:18:24 AM Pacific Daylight Time			08/05/2021 11:35:58 AM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	atriohp.com	ATRIO Prime Rx (PPO)	01	04		1			H6743	021	2	2022	Douglas and Klamath counties	Douglas County	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6743	021	4	1	04	01	H6743_021_4	5	1					0	08/03/2021	2022.01	08/03/2021 01:55:25 PM Pacific Daylight Time	08/04/2021 10:13:46 AM Pacific Daylight Time	08/04/2021 10:18:42 AM Pacific Daylight Time			08/05/2021 11:35:58 AM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	atriohp.com	ATRIO Prime Rx (PPO)	01	04		1			H6743	021	4	2022	Douglas and Klamath counties	Klamath County	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6743	022	1	1	04	01	H6743_022_1	3	1				0	0	07/15/2021	2022.01	07/15/2021 04:06:17 PM Pacific Daylight Time	07/16/2021 11:25:50 AM Pacific Daylight Time				07/21/2021 01:01:43 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	atriohp.com	ATRIO Choice (PPO)	01	04		1			H6743	022	1	2022	Douglas, Jackson, and Klamath 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										(711)-		(711)-		(711)-		(711)-										2					2						2			
H6743	022	2	1	04	01	H6743_022_2	3	1				0	0	07/12/2021	2022.01	07/12/2021 10:07:22 AM Pacific Daylight Time	07/16/2021 11:26:08 AM Pacific Daylight Time				07/21/2021 01:01:43 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	atriohp.com	ATRIO Choice (PPO)	01	04		1			H6743	022	2	2022	Douglas, Jackson, and Klamath counties	Douglas County	2	5768	2			2						atriohp.com	atriohp.com	atriohp.com	(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620										(711)-		(711)-		(711)-		(711)-										2					2						2			
H6743	022	4	1	04	01	H6743_022_4	4	1				0	0	07/12/2021	2022.01	07/12/2021 09:35:39 AM Pacific Daylight Time	07/16/2021 11:26:28 AM Pacific Daylight Time				07/21/2021 01:01:43 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	atriohp.com	ATRIO Choice (PPO)	01	04		1			H6743	022	4	2022	Douglas, Jackson, and Klamath counties	Klamath County	2	5768	2			2						atriohp.com	atriohp.com	atriohp.com	(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620										(711)-		(711)-		(711)-		(711)-										2					2						2			
H6750	005	0	1	01	01	H6750_005_0	8	1					1	08/05/2021	2022.01	08/05/2021 03:16:15 PM Eastern Daylight Time	08/04/2021 12:19:56 PM Eastern Daylight Time	07/30/2021 12:06:14 PM Eastern Daylight Time			08/05/2021 04:18:27 PM Eastern Daylight Time	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Harvard Pilgrim Health Care of New England, Inc.	www.hpforlife.org	Harvard Pilgrim Stride Basic Rx (HMO)	01	01		1			H6750	005	0	2022	Most of New Hampshire		2	42588	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	012	1	1	01	01	H6750_012_1	7	1					1	07/15/2021	2022.01	07/15/2021 03:55:57 PM Eastern Daylight Time	08/04/2021 09:14:22 AM Eastern Daylight Time	07/30/2021 12:07:22 PM Eastern Daylight Time			08/05/2021 04:18:27 PM Eastern Daylight Time	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Harvard Pilgrim Health Care of New England, Inc.	www.hpforlife.org	Harvard Pilgrim Stride Value Rx Plus (HMO)	01	01		1			H6750	012	1	2022	New Hampshire	Strafford County NH	2	1188	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	012	2	1	01	01	H6750_012_2	7	1					1	07/15/2021	2022.01	07/15/2021 03:56:42 PM Eastern Daylight Time	08/04/2021 09:16:06 AM Eastern Daylight Time	07/30/2021 12:08:32 PM Eastern Daylight Time			08/05/2021 04:18:27 PM Eastern Daylight Time	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Harvard Pilgrim Health Care of New England, Inc.	www.hpforlife.org	Harvard Pilgrim Stride Value Rx Plus (HMO)	01	01		1			H6750	012	2	2022	New Hampshire	Most New Hampshire Counties	2	1188	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	013	0	1	01	01	H6750_013_0	7	1					1	08/03/2021	2022.01	08/03/2021 11:20:42 AM Eastern Daylight Time	08/04/2021 09:17:52 AM Eastern Daylight Time	07/30/2021 12:09:32 PM Eastern Daylight Time			08/05/2021 04:18:27 PM Eastern Daylight Time	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Harvard Pilgrim Health Care of New England, Inc.	www.hpforlife.org	Harvard Pilgrim Stride Value Rx (HMO)	01	01		1			H6750	013	0	2022	Most of New Hampshire		2	57264	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	014	0	1	02	01	H6750_014_0	7	1					1	07/15/2021	2022.01	07/15/2021 03:58:34 PM Eastern Daylight Time	08/04/2021 09:19:22 AM Eastern Daylight Time	07/30/2021 12:10:26 PM Eastern Daylight Time			08/05/2021 04:18:27 PM Eastern Daylight Time	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Harvard Pilgrim Health Care of New England, Inc.	www.hpforlife.org	Harvard Pilgrim Stride Choice Rx (HMO-POS)	01	02		1			H6750	014	0	2022	Most of New Hampshire		2	21588	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	807	0	1	01	01	H6750_807_0	1	1						06/08/2021	2022.01	06/08/2021 01:34:46 AM Eastern Daylight Time					06/08/2021 02:01:22 AM Eastern Daylight Time	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Harvard Pilgrim Health Care of New England, Inc.	www.hpforlife.org	Harvard Pilgrim Stride Rx (HMO)	01	01		1			H6750	807	0	2022	New Hampshire		1	12	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	808	0	1	01	01	H6750_808_0	1	1						06/08/2021	2022.01	06/08/2021 01:54:03 AM Eastern Daylight Time					06/08/2021 02:01:22 AM Eastern Daylight Time	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Harvard Pilgrim Health Care of New England, Inc.	www.hpforlife.org	Harvard Pilgrim Stride Rx (HMO)	01	01		1			H6750	808	0	2022	New Hampshire		1	12	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	809	0	1	01	01	H6750_809_0	1	1				0	0	06/08/2021	2022.01	06/08/2021 01:54:45 AM Eastern Daylight Time					06/08/2021 02:01:22 AM Eastern Daylight Time	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Harvard Pilgrim Health Care of New England, Inc.	www.hpforlife.org	Harvard Pilgrim Stride (HMO)	01	01		1			H6750	809	0	2022	New Hampshire		1	12	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										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H6750	810	0	1	01	01	H6750_810_0	1	1				0	0	06/08/2021	2022.01	06/08/2021 01:55:21 AM Eastern Daylight Time					06/08/2021 02:01:22 AM Eastern Daylight Time	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Harvard Pilgrim Health Care of New England, Inc.	www.hpforlife.org	Harvard Pilgrim Stride (HMO)	01	01		1			H6750	810	0	2022	New Hampshire		1	12	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										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H6750	811	0	1	02	01	H6750_811_0	1	1						06/08/2021	2022.01	06/08/2021 01:53:17 AM Eastern Daylight Time					06/08/2021 02:01:22 AM Eastern Daylight Time	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Harvard Pilgrim Health Care of New England, Inc.	www.hpforlife.org	Harvard Pilgrim Stride Rx (HMO-POS)	01	02		1			H6750	811	0	2022	New Hampshire		1	12	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	812	0	1	02	01	H6750_812_0	1	1						06/08/2021	2022.01	06/08/2021 01:56:40 AM Eastern Daylight Time					06/08/2021 02:01:22 AM Eastern Daylight Time	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Harvard Pilgrim Health Care of New England, Inc.	www.hpforlife.org	Harvard Pilgrim Stride Rx (HMO-POS)	01	02		1			H6750	812	0	2022	New Hampshire		1	12	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	813	0	1	02	01	H6750_813_0	1	1				0	0	06/08/2021	2022.01	06/08/2021 01:57:14 AM Eastern Daylight Time					06/08/2021 02:01:22 AM Eastern Daylight Time	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Harvard Pilgrim Health Care of New England, Inc.	www.hpforlife.org	Harvard Pilgrim Stride (HMO-POS)	01	02		1			H6750	813	0	2022	New Hampshire		1	12	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										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H6750	814	0	1	02	01	H6750_814_0	1	1				0	0	06/08/2021	2022.01	06/08/2021 01:57:47 AM Eastern Daylight Time					06/08/2021 02:01:22 AM Eastern Daylight Time	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Harvard Pilgrim Health Care of New England, Inc.	www.hpforlife.org	Harvard Pilgrim Stride (HMO-POS)	01	02		1			H6750	814	0	2022	New Hampshire		1	12	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										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H6776	001	0	1	01	01	H6776_001_0	9	1		1			0	07/14/2021	2022.01	07/14/2021 09:59:10 AM Eastern Daylight Time	07/29/2021 06:58:36 PM Eastern Daylight Time	07/29/2021 07:00:55 PM Eastern Daylight Time			08/04/2021 10:39:27 AM Eastern Daylight Time	ELDERSERVE HEALTH, INC.	RiverSpring Health Plans	riverspringstar.org	RiverSpring Star (HMO I-SNP)	01	01		1			H6776	001	0	2022	Counties: Brx, Ki, Na, NY, Qu, Ri, Wes		2	2040	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					2					2	2			
H6776	002	0	1	01	01	H6776_002_0	7	1	2	1			0	07/14/2021	2022.01	07/14/2021 10:02:43 AM Eastern Daylight Time	07/29/2021 06:55:56 PM Eastern Daylight Time	07/29/2021 07:03:32 PM Eastern Daylight Time			08/04/2021 10:39:27 AM Eastern Daylight Time	ELDERSERVE HEALTH, INC.	RiverSpring Health Plans	riverspringMAP.org	RiverSpring MAP (HMO D-SNP)	01	01		1			H6776	002	0	2022	Counties: Brx, Ki, Na, NY, Qu, Ri, Wes		2	2592	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					2					2	2			
H6787	001	0	1	20	08	H6787_001_0	1	1						05/27/2021	2022.01	05/27/2021 10:58:29 AM Eastern Daylight Time		05/27/2021 10:48:49 AM Eastern Daylight Time			05/27/2021 11:00:44 AM 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	2022	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						05/27/2021	2022.01	05/27/2021 10:59:00 AM Eastern Daylight Time		05/27/2021 10:48:58 AM Eastern Daylight Time			05/27/2021 11:00:44 AM 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	2022	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	037	0	1	01	01	H6815_037_0	4	1					0	08/02/2021	2022.01	08/02/2021 02:44:32 PM Eastern Daylight Time	08/04/2021 01:14:00 AM Eastern Daylight Time	07/30/2021 01:36:52 PM Eastern Daylight Time			08/04/2021 11:54:32 PM Eastern Daylight Time	HEALTH NET HEALTH PLAN OF OREGON	Wellcare by Health Net	www.wellcare.com/healthnetOR	Wellcare Assist (HMO)	01	01		1			H6815	037	0	2022	Select counties in OR		2	25168	2			2						www.wellcare.com/healthnetOR	www.wellcare.com/healthnetOR	www.wellcare.com/healthnetOR	(844)582-5177		(844)582-5177		(866)277-6583		(866)277-6583		(844)582-5177		(844)582-5177		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6815	038	0	1	01	01	H6815_038_0	4	1					0	08/02/2021	2022.01	08/02/2021 02:43:15 PM Eastern Daylight Time	08/04/2021 01:14:28 AM Eastern Daylight Time	07/30/2021 01:37:10 PM Eastern Daylight Time			08/04/2021 11:54:32 PM Eastern Daylight Time	HEALTH NET HEALTH PLAN OF OREGON	Wellcare by Health Net	www.wellcare.com/healthnetOR	Wellcare No Premium (HMO)	01	01		1			H6815	038	0	2022	Select counties in OR		2	223362	2			2						www.wellcare.com/healthnetOR	www.wellcare.com/healthnetOR	www.wellcare.com/healthnetOR	(844)582-5177		(844)582-5177		(866)277-6583		(866)277-6583		(844)582-5177		(844)582-5177		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6815	801	0	1	01	01	H6815_801_0	2	1						05/03/2021	2022.01	05/03/2021 02:11:25 PM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	HEALTH NET HEALTH PLAN OF OREGON	Wellcare by Health Net	or.healthnetadvantage.com	Health Net Seniority Plus Employer (HMO)	01	01		1			H6815	801	0	2022	Oregon and California		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)275-4737		(800)275-4737		(844)942-0039		(844)942-0039		(800)275-4737		(800)275-4737		(844)942-0039		(844)942-0039		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H6815	802	0	1	01	01	H6815_802_0	2	1				0	0	05/03/2021	2022.01	05/03/2021 02:11:33 PM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	HEALTH NET HEALTH PLAN OF OREGON	Wellcare by Health Net	or.healthnetadvantage.com	Health Net Seniority Plus Employer (HMO)	01	01		1			H6815	802	0	2022	Oregon and California		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)275-4737		(800)275-4737		(844)942-0039		(844)942-0039										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H6815	803	0	1	01	01	H6815_803_0	2	1						05/03/2021	2022.01	05/03/2021 02:11:39 PM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	HEALTH NET HEALTH PLAN OF OREGON	Wellcare by Health Net	or.healthnetadvantage.com	Health Net Seniority Plus Employer (HMO)	01	01		1			H6815	803	0	2022	Oregon and California		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)275-4737		(800)275-4737		(844)942-0039		(844)942-0039		(800)275-4737		(800)275-4737		(844)942-0039		(844)942-0039		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H6830	001	0	1	04	01	H6830_001_0	4	1					0	08/02/2021	2022.01	08/02/2021 10:16:15 AM Central Daylight Time	08/04/2021 12:15:00 AM Central Daylight Time	07/30/2021 12:37:30 PM Central Daylight Time			08/04/2021 10:17:29 PM Central Daylight Time	CENTENE VENTURE COMPANY KANSAS	Ascension Complete	www.ascensioncomplete.com	Ascension Complete Via Christi Access Plus (PPO)	01	04		1			H6830	001	0	2022	Butler, Harvey and Sedgwick Counties		2	1877	2			2						www.ascensioncomplete.com/findadoctor	www.ascensioncomplete.com/formulary	www.ascensioncomplete.com/findadoctor	(833)816-6623		(833)816-6623		(877)831-9439		(877)831-9439		(833)816-6623		(833)816-6623		(877)831-9439		(877)831-9439		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6830	002	0	1	04	01	H6830_002_0	4	1					0	08/02/2021	2022.01	08/02/2021 10:17:27 AM Central Daylight Time	08/04/2021 12:15:27 AM Central Daylight Time	07/30/2021 12:38:06 PM Central Daylight Time			08/04/2021 10:17:29 PM Central Daylight Time	CENTENE VENTURE COMPANY KANSAS	Ascension Complete	ascensioncomplete.com	Ascension Complete Via Christi Access (PPO)	01	04		1			H6830	002	0	2022	Butler, Harvey and Sedgwick Counties		2	674	2			2						ascensioncomplete.com/findadoctor	ascensioncomplete.com/formulary	ascensioncomplete.com/findadoctor	(833)816-6623		(833)816-6623		(877)831-9439		(877)831-9439		(833)816-6623		(833)816-6623		(877)831-9439		(877)831-9439		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6832	001	0	1	01	01	H6832_001_0	5	1		1			0	08/04/2021	2022.01	08/04/2021 02:55:10 PM Eastern Daylight Time	08/05/2021 01:16:56 PM Eastern Daylight Time	08/02/2021 03:16:47 PM Eastern Daylight Time			08/05/2021 04:38:50 PM Eastern Daylight Time	ALIGN SENIOR CARE MI, LLC	Align Senior Care	www.alignseniorcare.com	Align Thrive (HMO I-SNP)	01	01		1			H6832	001	0	2022	Michigan (partial)		2	4574	2			1	1	3				www.PLACEHOLDER.com	www.PLACEHOLDER.com	www.alignseniorcare.com	(844)205-7244		(844)205-7244		(844)205-7244		(844)205-7244		(844)205-7244		(844)205-7244		(844)205-7244		(844)205-7244		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6832	002	0	1	01	01	H6832_002_0	5	1		1			0	08/05/2021	2022.01	08/05/2021 04:21:55 PM Eastern Daylight Time	08/05/2021 01:17:31 PM Eastern Daylight Time	08/02/2021 03:17:16 PM Eastern Daylight Time			08/05/2021 04:38:50 PM Eastern Daylight Time	ALIGN SENIOR CARE MI, LLC	Align Senior Care	www.alignseniorcare.com	Align Connect (HMO C-SNP)	01	01		1			H6832	002	0	2022	Michigan (partial)		2	1369	2			1	4			00000100000000000000		www.PLACEHOLDER.com	www.PLACEHOLDER.com	www.alignseniorcare.com	(844)205-7244		(844)205-7244		(844)205-7244		(844)205-7244		(844)205-7244		(844)205-7244		(844)205-7244		(844)205-7244		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6846	001	0	1	20	08	H6846_001_0	1	1						06/07/2021	2022.01	06/07/2021 01:39:51 PM Eastern Daylight Time		06/07/2021 01:49:17 PM Eastern Daylight Time			06/07/2021 01:52:37 PM Eastern Daylight Time	CAREPARTNERS REHABILITATION HOSPITAL, LLLP	CarePartners PACE	https://missionhealth.org/services-treatments	CarePartners PACE (PACE)	08	20		1			H6846	001	0	2022	Buncombe and Henderson Counties		2		2			2						http://www.missionpardeehealthcampus.org/services/	www.Missionhealth.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						06/07/2021	2022.01	06/07/2021 01:40:23 PM Eastern Daylight Time		06/07/2021 01:49:17 PM Eastern Daylight Time			06/07/2021 01:52:37 PM Eastern Daylight Time	CAREPARTNERS REHABILITATION HOSPITAL, LLLP	CarePartners PACE	https://missionhealth.org/services-treatments	CarePartners PACE (PACE)	08	20		1			H6846	002	0	2022	Buncombe and Henderson Counties		2		2			2						http://www.missionpardeehealthcampus.org/services/	www.Missionhealth.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																
H6851	001	0	1	01	01	H6851_001_0	6	1					0	08/04/2021	2022.01	08/04/2021 04:18:53 PM Eastern Daylight Time	08/04/2021 03:44:31 PM Eastern Daylight Time	08/04/2021 03:44:31 PM Eastern Daylight Time			08/04/2021 06:21:29 PM Eastern Daylight Time	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	BMC HealthNet Plan	www.wellsense.org	Well Sense Medicare Advantage (HMO)	01	01		1			H6851	001	0	2022	All Counties		2		2			2						www.wellsense.org/members/pharmacy	www.wellsense.org/members/pharmacy	www.wellsense.org	(877)957-1300		(617)478-3596		(877)957-1300		(617)478-3596		(877)957-1300		(617)478-3596		(877)957-1300		(617)478-3596		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6870	001	0	1	48	05	H6870_001_0	3	1						07/01/2021	2022.01	07/01/2021 12:37:06 PM Eastern Daylight Time					07/01/2021 03:25:33 PM Eastern 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	2022	Bexar, Dallas and Hidalgo Counties		2	93000	2			2						mmp.superiorhealthplan.com/findadoctor	mmp.superiorhealthplan.com/formulary	mmp.superiorhealthplan.com/findadoctor	(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)-																
H6874	001	0	1	04	01	H6874_001_0	10	1					1	08/05/2021	2022.01	08/05/2021 06:06:04 PM Central Daylight Time	08/05/2021 04:28:12 PM Central Daylight Time	07/29/2021 07:58:05 PM Central Daylight Time			08/05/2021 07:14:41 PM Central Daylight Time	ASPIRUS HEALTH PLAN, INC.	Aspirus Health Plan	www.aspirushealthplan.com	Essential Rx (PPO)	01	04		1			H6874	001	0	2022	Central WI: 18 counties		2		2			2						www.aspirushealthplan.com	www.aspirushealthplan.com	www.aspirushealthplan.com	(855)931-4850		(715)631-7411		(855)931-4859		(715)631-7441		(855)931-4850		(715)631-7411		(855)931-4859		(715)631-7441		(855)931-4852		(715)631-7413		(855)931-4852		(715)631-7413		(855)931-4852		(715)631-7413		(855)931-4852		(715)631-7413		2					2						2			
H6874	002	0	1	04	01	H6874_002_0	8	1					1	07/20/2021	2022.01	07/20/2021 12:28:20 PM Central Daylight Time	08/04/2021 10:22:35 AM Central Daylight Time	07/29/2021 08:04:36 PM Central Daylight Time			08/05/2021 01:27:48 PM Central Daylight Time	ASPIRUS HEALTH PLAN, INC.	Aspirus Health Plan	www.aspirushealthplan.com	Elite Rx (PPO)	01	04		1			H6874	002	0	2022	Central WI: 18 counties		2		2			2						www.aspirushealthplan.com	www.aspirushealthplan.com	www.ucare.org	(855)931-4850		(715)631-7411		(855)931-4859		(715)631-7441		(855)931-4850		(715)631-7411		(855)931-4859		(715)631-7441		(855)931-4852		(715)631-7413		(855)931-4852		(715)631-7413		(855)931-4852		(715)631-7413		(855)931-4852		(715)631-7413		2					2						2			
H6874	003	0	1	04	01	H6874_003_0	4	1				0	0	07/20/2021	2022.01	07/20/2021 12:30:05 PM Central Daylight Time	07/13/2021 02:19:51 PM Central Daylight Time				07/20/2021 12:59:53 PM Central Daylight Time	ASPIRUS HEALTH PLAN, INC.	Aspirus Health Plan	www.aspirushealthplan.com/medicare	Elite (PPO)	01	04		1			H6874	003	0	2022	Central WI: 18 counties		2		2			2						www.aspirushealthplan.com	www.aspirushealthplan.com	www.ucare.org	(855)931-4850		(715)631-7411		(855)931-4859		(715)631-7441										(855)931-4852		(715)631-7413		(855)931-4852		(715)631-7413										2					2						2			
H6887	001	0	1	20	08	H6887_001_0	1	1						06/04/2021	2022.01	06/04/2021 12:14:55 PM Eastern Daylight Time		06/04/2021 08:47:21 AM Eastern Daylight Time			06/04/2021 12:18:20 PM 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	2022	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)362-4511										(855)295-5433		(856)632-4516		(855)295-5433		(856)632-4511																
H6887	002	0	1	20	08	H6887_002_0	1	1						06/04/2021	2022.01	06/04/2021 12:15:34 PM Eastern Daylight Time		06/04/2021 08:47:23 AM Eastern Daylight Time			06/04/2021 12:18:20 PM 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	2022	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)362-4511										(855)295-5433		(856)362-4516		(855)295-5433		(856)362-4511																
H6891	001	0	1	01	01	H6891_001_0	2	1		1			0	08/03/2021	2022.01	08/03/2021 03:02:44 PM Central Daylight Time	08/05/2021 08:08:03 AM Central Daylight Time	08/05/2021 08:08:22 AM Central Daylight Time			08/05/2021 08:44:00 AM Central Daylight Time	AMERICAN HEALTH PLAN OF TX, INC.	American Health Advantage of Texas	tx.amhealthplans.com	American Health Advantage of Texas (HMO I-SNP)	01	01		1			H6891	001	0	2022	Northeast Texas and Lubbock County		2		2			1	1	3				tx.amhealthplans.com	tx.amhealthplans.com	tx.amhealthplans.com	(855)521-0628		(855)521-0628		(855)521-0628		(855)521-0628		(855)521-0628		(855)521-0628		(855)521-0628		(855)521-0628		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6898	001	0	1	04	01	H6898_001_0	7	1					0	07/06/2021	2022.01	07/06/2021 03:07:26 PM Eastern Daylight Time	07/30/2021 03:16:06 PM Eastern Daylight Time	07/30/2021 03:15:40 PM Eastern Daylight Time			07/30/2021 03:40:17 PM Eastern Daylight Time	VERMONT BLUE ADVANTAGE, INC.	Vermont Blue Advantage	www.vermontblueadvantage.com	Vermont Blue Advantage Freedom PPO (PPO)	01	04		1			H6898	001	0	2022	State of Vermont		2	20723	2			2						www.vermontblueadvantage.com/pharmacies	www.vermontblueadvantage.com/formularies	www.vermontblueadvantage.com/findadoctor	(844)839-5125		(844)839-5125		(844)510-2583		(844)510-2583		(877)710-3796		(877)710-3796		(844)510-2583		(844)510-2583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6898	002	0	1	04	01	H6898_002_0	7	1					0	07/06/2021	2022.01	07/06/2021 03:08:40 PM Eastern Daylight Time	07/30/2021 03:16:06 PM Eastern Daylight Time	07/30/2021 03:15:40 PM Eastern Daylight Time			07/30/2021 03:40:17 PM Eastern Daylight Time	VERMONT BLUE ADVANTAGE, INC.	Vermont Blue Advantage	www.vermontblueadvantage.com	Vermont Blue Advantage Freedom Plus PPO (PPO)	01	04		1			H6898	002	0	2022	State of Vermont		2	21461	2			2						www.vermontblueadvantage.com/pharmacies	www.vermontblueadvantage.com/formularies	www.vermontblueadvantage.com/findadoctor	(844)839-5125		(844)839-5125		(844)510-2583		(844)510-2583		(877)710-3796		(877)710-3796		(844)510-2583		(844)510-2583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6898	801	0	1	04	01	H6898_801_0	5	1						04/18/2021	2022.01	04/18/2021 01:22:56 PM Eastern Daylight Time					06/07/2021 02:26:36 PM Eastern Daylight Time	VERMONT BLUE ADVANTAGE, INC.	Vermont Blue Advantage	www.vermontblueadvantage.com	Vermont Blue Advantage Group PPO (PPO)	01	04		1			H6898	801	0	2022	State of Vermont		1	0	2			2						www.vermontblueadvantage.com/pharmacies	www.vermontblueadvantage.com/formularies	www.vermontblueadvantage.com/findadoctor	(800)572-0280		(800)572-0280		(844)510-2583		(844)510-2583		(877)710-3796		(877)710-3796		(844)510-2583		(844)510-2583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;2;9a1;11a;15;	2		1									
H6898	802	0	1	04	01	H6898_802_0	5	1						04/19/2021	2022.01	04/19/2021 08:38:54 AM Eastern Daylight Time					06/07/2021 02:26:36 PM Eastern Daylight Time	VERMONT BLUE ADVANTAGE, INC.	Vermont Blue Advantage	www.vermontblueadvantage.com	Vermont Blue Advantage Group PPO (PPO)	01	04		1			H6898	802	0	2022	State of Vermont		1	0	2			2						www.vermontblueadvantage.com/pharmacies	www.vermontblueadvantage.com/formularies	www.vermontblueadvantage.com/findadoctor	(800)572-0280		(800)572-0280		(844)510-2583		(844)510-2583		(877)710-3796		(877)710-3796		(844)510-2583		(844)510-2583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;2;9a1;11a;15;	2		1									
H6898	803	0	1	04	01	H6898_803_0	6	1						06/18/2021	2022.01	06/18/2021 09:55:30 AM Eastern Daylight Time					06/18/2021 09:56:19 AM Eastern Daylight Time	VERMONT BLUE ADVANTAGE, INC.	Vermont Blue Advantage	www.vermontblueadvantage.com	Vermont Blue Advantage Group PPO (PPO)	01	04		1			H6898	803	0	2022	State of Vermont		1	113784	2			2						www.vermontblueadvantage.com/pharmacies	www.vermontblueadvantage.com/formularies	www.vermontblueadvantage.com/findadoctor	(800)572-0280		(800)572-0280		(844)510-2583		(844)510-2583		(877)710-3796		(877)710-3796		(844)510-2583		(844)510-2583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;2;9a1;11a;15;	2		1									
H6898	804	0	1	04	01	H6898_804_0	5	1				0	0	04/19/2021	2022.01	04/19/2021 08:40:24 AM Eastern Daylight Time					06/07/2021 02:26:36 PM Eastern Daylight Time	VERMONT BLUE ADVANTAGE, INC.	Vermont Blue Advantage	www.vermontblueadvantage.com	Vermont Blue Advantage Group PPO (PPO)	01	04		1			H6898	804	0	2022	State of Vermont		1	0	2			2						www.VermontBlueAdvantage.com/pharmacies	www.VermontBlueAdvantage.com/formularies	www.vermontblueadvantage.com/findadoctor	(800)572-0280		(800)572-0280		(844)510-2583		(844)510-2583										(711)-		(711)-		(711)-		(711)-										1	1	1a;2;9a1;11a;15;	2		1									
H6910	001	0	1	01	01	H6910_001_0	5	1					1	08/04/2021	2022.01	08/04/2021 07:44:45 AM Eastern Daylight Time	08/05/2021 07:06:01 AM Eastern Daylight Time	08/05/2021 07:06:02 AM Eastern Daylight Time			08/05/2021 07:34:42 AM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	MediGold	www.MediGold.com	MediGold Essential Care (HMO)	01	01		1			H6910	001	0	2022	Select Counties in Idaho		2		2			2						www.MediGold.com	www.MediGold.com	www.MediGold.com	(800)240-3851		(800)240-3851		(800)964-4525		(800)964-4525		(800)240-3851		(800)240-3851		(800)964-4525		(800)964-4525		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6910	002	0	1	01	01	H6910_002_0	5	1					1	08/04/2021	2022.01	08/04/2021 07:48:44 AM Eastern Daylight Time	08/05/2021 07:06:03 AM Eastern Daylight Time	08/05/2021 07:06:03 AM Eastern Daylight Time			08/05/2021 07:34:42 AM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	MediGold	www.MediGold.com	MediGold True Advantage (HMO)	01	01		1			H6910	002	0	2022	Select Counties in Idaho		2		2			2						www.MediGold.com	www.MediGold.com	www.MediGold.com	(800)240-3851		(800)240-3851		(800)964-4525		(800)964-4525		(800)240-3851		(800)240-3851		(800)964-4525		(800)964-4525		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6910	003	0	1	01	01	H6910_003_0	5	1					1	08/04/2021	2022.01	08/04/2021 07:51:42 AM Eastern Daylight Time	08/05/2021 07:06:04 AM Eastern Daylight Time	08/05/2021 07:06:05 AM Eastern Daylight Time			08/05/2021 07:34:42 AM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	MediGold	www.MediGold.com	MediGold Classic Preferred (HMO)	01	01		1			H6910	003	0	2022	Select Counties in Idaho		2		2			2						www.MediGold.com	www.MediGold.com	www.MediGold.com	(800)240-3851		(800)240-3851		(800)964-4525		(800)964-4525		(800)240-3851		(800)240-3851		(800)964-4525		(800)964-4525		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6910	004	0	1	01	01	H6910_004_0	4	1				0	0	07/17/2021	2022.01	07/17/2021 08:27:37 AM Eastern Daylight Time	07/19/2021 06:59:25 AM Eastern Daylight Time				07/19/2021 07:48:08 AM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	MediGold	www.MediGold.com	MediGold Medical Only (HMO)	01	01		1			H6910	004	0	2022	Select Counties in Idaho		2		2			2						www.MediGold.com	www.MediGold.com	www.MediGold.com	(800)240-3851		(800)240-3851		(800)964-4525		(800)964-4525										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H6936	003	0	1	01	01	H6936_003_0	10	1					0	06/25/2021	2022.01	06/25/2021 03:52:23 PM US Mountain Standard Time	08/04/2021 10:19:23 AM US Mountain Standard Time	08/03/2021 03:33:02 PM US Mountain Standard Time			08/04/2021 05:55:53 PM US Mountain Standard Time	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Blue Cross Blue Shield of Arizona	azbluemedicare.com	BluePathway Plan 2 (HMO)	01	01		1			H6936	003	0	2022	Maricopa County		2		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			
H6936	004	0	1	01	01	H6936_004_0	10	1					0	06/25/2021	2022.01	06/25/2021 03:53:14 PM US Mountain Standard Time	08/04/2021 10:19:39 AM US Mountain Standard Time	08/03/2021 03:33:17 PM US Mountain Standard Time			08/04/2021 05:55:53 PM US Mountain Standard Time	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Blue Cross Blue Shield of Arizona	azbluemedicare.com	BluePathway Plan 3 (HMO)	01	01		1			H6936	004	0	2022	Maricopa County		2		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			
H6936	005	0	1	01	01	H6936_005_0	10	1					0	06/25/2021	2022.01	06/25/2021 03:54:21 PM US Mountain Standard Time	08/04/2021 12:01:10 PM US Mountain Standard Time	08/03/2021 03:33:33 PM US Mountain Standard Time			08/04/2021 05:55:53 PM US Mountain Standard Time	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Blue Cross Blue Shield of Arizona	azbluemedicare.com	BluePathway Plan 2 (HMO)	01	01		1			H6936	005	0	2022	Pima County		2		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			
H6936	006	0	1	01	01	H6936_006_0	9	1					0	06/25/2021	2022.01	06/25/2021 03:57:43 PM US Mountain Standard Time	08/04/2021 01:22:45 PM US Mountain Standard Time	08/03/2021 03:33:50 PM US Mountain Standard Time			08/04/2021 05:55:53 PM US Mountain Standard Time	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Blue Cross Blue Shield of Arizona	azbluemedicare.com	BluePathway Plan 1 (HMO)	01	01		1			H6936	006	0	2022	Maricopa County		2		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			
H6941	001	0	1	20	08	H6941_001_0	1	1						06/01/2021	2022.01	06/01/2021 10:13:24 AM Central Daylight Time		06/01/2021 09:16:08 AM Central Daylight Time			06/01/2021 10:16:12 AM Central Daylight Time	LIFE PACE	LIFE PACE, INC.	www.lifepace.org	LIFE PACE Dual Eligible 001 (PACE)	08	20		1			H6941	001	0	2022	Tulsa County and portions of Creek County		2		2			2						www.carekinesis.com	www.lifepace.org												(918)949-9969				(918)949-9969												(918)949-9969				(918)949-9969																
H6941	002	0	1	20	08	H6941_002_0	1	1						06/01/2021	2022.01	06/01/2021 10:14:38 AM Central Daylight Time		06/01/2021 09:24:59 AM Central Daylight Time			06/01/2021 10:16:12 AM Central Daylight Time	LIFE PACE	LIFE PACE, INC.	www.lifepace.org	LIFE PACE Medicare Only 002 (PACE)	08	20		1			H6941	002	0	2022	Tulsa County and portions of Creek County		2		2			2						www.carekinesis.com	www.lifepace.org												(918)949-9969				(918)949-9969												(918)949-9969				(918)949-9969																
H6959	001	0	1	01	01	H6959_001_0	7	1		1			0	08/04/2021	2022.01	08/04/2021 08:40:34 AM Central Daylight Time	08/04/2021 12:19:50 PM Central Daylight Time	08/02/2021 12:13:43 PM Central Daylight Time			08/05/2021 11:18:13 AM Central Daylight Time	ISNP VENTURES, LLC	KeyCare Advantage	www.keycareadvantage.com	KeyCare Advantage (HMO I-SNP)	01	01		1			H6959	001	0	2022	Maryland (partial)		2		2			1	1	1				www.keycareadvantage.com	www.keycareadvantage.com	www.keycareadvantage.com	(844)206-1205		(844)206-1205		(844)206-1205		(844)206-1205		(844)206-1205		(844)206-1205		(844)206-1205		(844)206-1205		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6975	002	0	1	01	01	H6975_002_0	5	1	2	1			0	07/18/2021	2022.01	07/18/2021 11:17:06 AM Eastern Daylight Time	08/04/2021 01:15:56 AM Eastern Daylight Time	07/30/2021 01:38:24 PM Eastern Daylight Time			08/04/2021 09:45:33 PM Eastern Daylight Time	WELLCARE OF ALABAMA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Liberty (HMO D-SNP)	01	01		1			H6975	002	0	2022	Select counties in AL		2	2729	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6975	003	0	1	01	01	H6975_003_0	5	1					0	07/18/2021	2022.01	07/18/2021 11:26:04 AM Eastern Daylight Time	08/04/2021 01:16:25 AM Eastern Daylight Time	07/30/2021 01:39:00 PM Eastern Daylight Time			08/04/2021 09:45:33 PM Eastern Daylight Time	WELLCARE OF ALABAMA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Assist (HMO)	01	01		1			H6975	003	0	2022	Select counties in AL		2	1487	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6975	004	0	1	01	01	H6975_004_0	5	1	2	1			0	07/18/2021	2022.01	07/18/2021 11:32:18 AM Eastern Daylight Time	08/04/2021 01:16:54 AM Eastern Daylight Time	07/30/2021 01:39:20 PM Eastern Daylight Time			08/04/2021 09:45:33 PM Eastern Daylight Time	WELLCARE OF ALABAMA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Access (HMO D-SNP)	01	01		1			H6975	004	0	2022	Select counties in AL		2	1783	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6975	005	0	1	01	01	H6975_005_0	5	1					0	07/30/2021	2022.01	07/30/2021 01:47:09 PM Eastern Daylight Time	08/04/2021 01:17:22 AM Eastern Daylight Time	07/30/2021 01:39:38 PM Eastern Daylight Time			08/04/2021 09:45:33 PM Eastern Daylight Time	WELLCARE OF ALABAMA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO)	01	01		1			H6975	005	0	2022	Select counties in AL		2	5382	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6975	006	0	1	01	01	H6975_006_0	4	1				0	0	07/18/2021	2022.01	07/18/2021 12:02:04 PM Eastern Daylight Time	06/04/2021 02:30:55 PM Eastern Daylight Time				07/19/2021 05:11:22 PM Eastern Daylight Time	WELLCARE OF ALABAMA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Patriot No Premium (HMO)	01	01		1			H6975	006	0	2022	Select counties in AL		2	511	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H6988	001	0	1	01	01	H6988_001_0	13	1					0	08/05/2021	2022.01	08/05/2021 11:39:22 AM Eastern Daylight Time	08/03/2021 04:20:00 PM Eastern Daylight Time	07/30/2021 11:44:22 AM Eastern Daylight Time			08/05/2021 12:12:30 PM 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	2022	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	12	1	2	1			0	08/05/2021	2022.01	08/05/2021 12:07:29 PM Eastern Daylight Time	08/05/2021 11:58:06 AM Eastern Daylight Time	07/30/2021 11:54:44 AM Eastern Daylight Time			08/05/2021 12:12:30 PM Eastern Daylight Time	CENTERS PLAN FOR HEALTHY LIVING, LLC	Centers Plan for Healthy Living	www.centersplan.com	Centers Plan for Dual Coverage Care (HMO D-SNP)	01	01		1			H6988	002	0	2022	NYC Metro Area, NASS, ROCK 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	14	1		1			0	08/09/2021	2022.01	08/09/2021 12:52:28 PM Eastern Daylight Time	08/06/2021 04:06:32 PM Eastern Daylight Time	07/30/2021 11:58:36 AM Eastern Daylight Time			08/09/2021 12:58:21 PM Eastern Daylight Time	CENTERS PLAN FOR HEALTHY LIVING, LLC	Centers Plan for Healthy Living	www.centersplan.com	Centers Plan for Nursing Home Care (HMO I-SNP)	01	01		1			H6988	003	0	2022	NYC Metro, ER, NA, SU, RO, WE, NI, 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	13	1	2	1			0	08/06/2021	2022.01	08/06/2021 02:17:19 PM Eastern Daylight Time	08/03/2021 04:23:36 PM Eastern Daylight Time	07/30/2021 12:04:00 PM Eastern Daylight Time			08/09/2021 12:58:21 PM Eastern Daylight Time	CENTERS PLAN FOR HEALTHY LIVING, LLC	Centers Plan for Healthy Living	www.centersplan.com	Centers Plan for Medicaid Advantage Plus (HMO D-SNP)	01	01		1			H6988	004	0	2022	NYC Metro Area, NASS, ROCK, WEST Counties		2		2			1	3		1		1	www.centersplan.com	www.centersplan.com	www.centersplan.com	(833)274-5627		(833)274-5627		(833)274-5627		(833)274-5627		(888)807-5717		(888)807-5717		(833)274-5627		(833)274-5627		(800)421-1220		(711)-		(800)421-1220		(711)-		(800)421-1220		(711)-		(800)421-1220		(711)-		2					2					2	2			
H7003	001	0	1	20	08	H7003_001_0	1	1						06/04/2021	2022.01	06/04/2021 05:01:36 PM Central Daylight Time		06/01/2021 10:30:11 AM Central Daylight Time			06/04/2021 05:02:48 PM Central Daylight Time	PACE NEBRASKA	Immanuel Pathways Omaha	Immanuel.com	PACE Nebraska (PACE)	08	20		1			H7003	001	0	2022	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						06/04/2021	2022.01	06/04/2021 05:01:50 PM Central Daylight Time		06/01/2021 10:30:11 AM Central Daylight Time			06/04/2021 05:02:48 PM Central Daylight Time	PACE NEBRASKA	Immanuel Pathways Omaha	immanuelpathways.org	PACE Nebraska (PACE)	08	20		1			H7003	002	0	2022	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	5	1					0	08/03/2021	2022.01	08/03/2021 02:28:32 PM Pacific Daylight Time	08/04/2021 11:09:26 AM Pacific Daylight Time	08/04/2021 10:19:02 AM Pacific Daylight Time			08/05/2021 11:35:58 AM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	atriohp.com	ATRIO Prime Rx (PPO)	01	04		1			H7006	001	0	2022	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7006	003	0	1	04	01	H7006_003_0	5	1					0	08/03/2021	2022.01	08/03/2021 02:29:10 PM Pacific Daylight Time	08/04/2021 10:14:20 AM Pacific Daylight Time	08/04/2021 10:19:20 AM Pacific Daylight Time			08/05/2021 11:35:58 AM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	atriohp.com	ATRIO Select Rx (PPO)	01	04		1			H7006	003	0	2022	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7006	007	0	1	04	01	H7006_007_0	4	1					0	08/03/2021	2022.01	08/03/2021 02:29:40 PM Pacific Daylight Time	08/04/2021 10:14:39 AM Pacific Daylight Time	08/04/2021 10:19:39 AM Pacific Daylight Time			08/05/2021 11:35:58 AM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	atriohp.com	ATRIO Choice Rx (PPO)	01	04		1			H7006	007	0	2022	Marion and Polk counties, Oregon		2		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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7006	008	0	1	04	01	H7006_008_0	4	1					0	08/03/2021	2022.01	08/03/2021 02:31:48 PM Pacific Daylight Time	08/04/2021 10:14:57 AM Pacific Daylight Time	08/04/2021 10:19:56 AM Pacific Daylight Time			08/05/2021 11:35:58 AM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	atriohp.com	ATRIO Choice Rx (PPO)	01	04		1			H7006	008	0	2022	Louisiana		2		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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7006	009	0	1	04	01	H7006_009_0	4	1					0	08/03/2021	2022.01	08/03/2021 02:32:20 PM Pacific Daylight Time	08/04/2021 10:15:14 AM Pacific Daylight Time	08/04/2021 10:20:15 AM Pacific Daylight Time			08/05/2021 11:35:58 AM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	atriohp.com	ATRIO Select Rx (PPO)	01	04		1			H7006	009	0	2022	Louisiana		2		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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7006	010	0	1	04	01	H7006_010_0	4	1					0	08/03/2021	2022.01	08/03/2021 02:33:03 PM Pacific Daylight Time	08/04/2021 10:15:33 AM Pacific Daylight Time	08/04/2021 10:20:34 AM Pacific Daylight Time			08/05/2021 11:35:58 AM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	atriohp.com	Saint Mary's ATRIO Choice Rx (PPO)	01	04		1			H7006	010	0	2022	Nevada		2		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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7006	011	0	1	04	01	H7006_011_0	4	1					0	08/03/2021	2022.01	08/03/2021 02:33:37 PM Pacific Daylight Time	08/04/2021 10:15:50 AM Pacific Daylight Time	08/04/2021 10:20:52 AM Pacific Daylight Time			08/05/2021 11:35:58 AM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	atriohp.com	Saint Mary's ATRIO Select Rx (PPO)	01	04		1			H7006	011	0	2022	Nevada		2		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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7006	012	0	1	04	01	H7006_012_0	4	1					0	08/03/2021	2022.01	08/03/2021 02:34:36 PM Pacific Daylight Time	08/04/2021 10:16:08 AM Pacific Daylight Time	08/04/2021 10:21:09 AM Pacific Daylight Time			08/05/2021 11:35:58 AM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	atriohp.com	ATRIO Choice Rx (PPO)	01	04		1			H7006	012	0	2022	Tennessee		2		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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7006	013	0	1	04	01	H7006_013_0	4	1					0	08/03/2021	2022.01	08/03/2021 02:35:10 PM Pacific Daylight Time	08/04/2021 10:16:25 AM Pacific Daylight Time	08/04/2021 10:21:28 AM Pacific Daylight Time			08/05/2021 11:35:58 AM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	atriohp.com	ATRIO Select Rx (PPO)	01	04		1			H7006	013	0	2022	Tennessee		2		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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7020	004	0	1	01	01	H7020_004_0	4	1					0	08/02/2021	2022.01	08/02/2021 03:17:59 PM Central Daylight Time	08/02/2021 05:53:31 PM Central Daylight Time	07/30/2021 12:01:53 PM Central Daylight Time			08/04/2021 10:59:49 AM Central Daylight Time	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H7020	004	0	2022	South Carolina		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)980-3049		(855)980-3049		(800)668-3813		(800)668-3813		(855)980-3049		(855)980-3049		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7020	005	0	1	01	01	H7020_005_0	3	1				0	0	07/08/2021	2022.01	07/08/2021 03:55:49 PM Central Daylight Time	05/28/2021 09:44:16 AM Central Daylight Time				07/19/2021 04:08:28 PM Central Daylight Time	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Cigna	www.cignamedicare.com	Cigna Fundamental Medicare (HMO)	01	01		1			H7020	005	0	2022	South Carolina		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)980-3049		(855)980-3049										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H7020	006	0	1	01	01	H7020_006_0	4	1					0	08/02/2021	2022.01	08/02/2021 04:31:48 PM Central Daylight Time	08/03/2021 02:01:57 PM Central Daylight Time	07/30/2021 12:02:16 PM Central Daylight Time			08/04/2021 10:59:49 AM Central Daylight Time	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Plus Medicare (HMO)	01	01		1			H7020	006	0	2022	South Carolina		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)980-3049		(855)980-3049		(800)668-3813		(800)668-3813		(855)980-3049		(855)980-3049		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7020	008	0	1	01	01	H7020_008_0	4	1					0	08/03/2021	2022.01	08/03/2021 07:08:56 AM Central Daylight Time	08/03/2021 02:06:20 PM Central Daylight Time	07/30/2021 12:02:40 PM Central Daylight Time			08/04/2021 10:59:49 AM Central Daylight Time	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H7020	008	0	2022	South Carolina		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)980-3049		(855)980-3049		(800)668-3813		(800)668-3813		(855)980-3049		(855)980-3049		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7020	801	0	1	01	01	H7020_801_0	2	1						05/10/2021	2022.01	05/10/2021 10:46:47 AM Central Daylight Time					06/02/2021 05:19:32 PM Central Daylight Time	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Cigna	www.cignahealthspring.com	Cigna Preferred Medicare (HMO)	01	01		1			H7020	801	0	2022	Statewide SC		1	600	2			2						www.cigna.com/medicare	www.cignahealthspring.com	www.cignamedicare.com	(888)281-7867		(888)281-7867		(888)281-7867		(888)281-7867		(888)281-7867		(888)281-7867		(888)281-7867		(888)281-7867		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H7063	001	0	1	04	01	H7063_001_0	7	1					0	08/05/2021	2022.01	08/05/2021 11:06:52 AM Central Daylight Time	08/04/2021 03:37:03 PM Central Daylight Time	08/03/2021 11:50:13 AM Central Daylight Time			08/05/2021 11:26:44 AM Central Daylight Time	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Blue Cross and Blue Shield of Kansas	www.bcbsks.com/medicare	Blue Medicare Advantage (PPO)	01	04		1			H7063	001	0	2022	NE Region		2	12019	2			2						www.MyPrime.com	www.bcbsks.com/medicare	www.bcbsks.com/medicare	(800)222-7645		(800)222-7645		(800)354-9387		(800)354-9387		(866)230-7265		(866)230-7265		(800)354-9387		(800)354-9387		(711)-		(711)-		(800)766-3777		(800)766-3777		(711)-		(711)-		(800)766-3777		(800)766-3777		2					2						2			
H7063	002	0	1	04	01	H7063_002_0	8	1					1	08/05/2021	2022.01	08/05/2021 11:08:15 AM Central Daylight Time	08/04/2021 03:42:13 PM Central Daylight Time	08/03/2021 11:54:23 AM Central Daylight Time			08/05/2021 11:26:44 AM Central Daylight Time	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Blue Cross and Blue Shield of Kansas	www.bcbsks.com/medicare	Blue Medicare Advantage Comprehensive (PPO)	01	04		1			H7063	002	0	2022	NE Region		2	4583	2			2						www.MyPrime.com	www.bcbsks.com/medicare	www.bcbsks.com/medicare	(800)222-7645		(800)222-7645		(800)354-9387		(800)354-9387		(866)230-7265		(866)230-7265		(800)354-9387		(800)354-9387		(711)-		(711)-		(800)766-3777		(800)766-3777		(711)-		(711)-		(800)766-3777		(800)766-3777		2					2						2			
H7063	006	0	1	04	01	H7063_006_0	7	1					0	08/05/2021	2022.01	08/05/2021 11:10:42 AM Central Daylight Time	08/04/2021 03:48:00 PM Central Daylight Time	08/03/2021 11:59:58 AM Central Daylight Time			08/05/2021 11:26:44 AM Central Daylight Time	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Blue Cross and Blue Shield of Kansas	www.bcbsks.com/medicare	Blue Medicare Advantage (PPO)	01	04		1			H7063	006	0	2022	SC Region		2	14313	2			2						www.MyPrime.com	www.bcbsks.com/medicare	www.bcbsks.com/medicare	(800)222-7645		(800)222-7645		(800)354-9387		(800)354-9387		(866)230-7265		(866)230-7265		(800)354-9387		(800)354-9387		(711)-		(711)-		(800)766-3777		(800)766-3777		(711)-		(711)-		(800)766-3777		(800)766-3777		2					2						2			
H7063	007	0	1	04	01	H7063_007_0	8	1					1	08/05/2021	2022.01	08/05/2021 11:12:04 AM Central Daylight Time	08/04/2021 03:51:16 PM Central Daylight Time	08/03/2021 12:04:45 PM Central Daylight Time			08/05/2021 11:26:44 AM Central Daylight Time	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Blue Cross and Blue Shield of Kansas	www.bcbsks.com/medicare	Blue Medicare Advantage Comprehensive (PPO)	01	04		1			H7063	007	0	2022	SC Region		2	7973	2			2						www.MyPrime.com	www.bcbsks.com/medicare	www.bcbsks.com/medicare	(800)222-7645		(800)222-7645		(800)354-9387		(800)354-9387		(866)230-7265		(866)230-7265		(800)354-9387		(800)354-9387		(711)-		(711)-		(800)766-3777		(800)766-3777		(711)-		(711)-		(800)766-3777		(800)766-3777		2					2						2			
H7063	012	0	1	04	01	H7063_012_0	6	1					0	08/05/2021	2022.01	08/05/2021 11:15:13 AM Central Daylight Time	08/04/2021 03:55:59 PM Central Daylight Time	08/03/2021 12:07:27 PM Central Daylight Time			08/05/2021 11:26:44 AM Central Daylight Time	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Blue Cross and Blue Shield of Kansas	www.bcbsks.com/medicare	Blue Medicare Advantage Choice (PPO)	01	04		1			H7063	012	0	2022	NE and SC Region		2	1657	2			2						www.MyPrime.com	www.bcbsks.com/medicare	www.bcbsks.com/medicare	(800)222-7645		(800)222-7645		(800)354-9387		(800)354-9387		(866)230-7265		(866)230-7265		(800)354-9387		(800)354-9387		(711)-		(711)-		(800)766-3777		(800)766-3777		(711)-		(711)-		(800)766-3777		(800)766-3777		2					2						2			
H7063	801	0	1	04	01	H7063_801_0	3	1						05/28/2021	2022.01	05/28/2021 10:42:14 AM Central Daylight Time					06/07/2021 09:25:30 PM Central Daylight Time	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Blue Cross and Blue Shield of Kansas	www.bcbsks.com/medicare	MAPD Group Plan Calendar Year (PPO)	01	04		1			H7063	801	0	2022	Nationwide		1	0	2			2						www.MyPrime.com	www.bcbsks.com/medicare	www.bcbsks.com/medicare	(800)222-7645		(800)222-7645		(800)354-9387		(800)354-9387		(866)230-7265		(866)230-7265		(800)354-9387		(800)354-9387		(711)-		(711)-		(800)766-3777		(800)766-3777		(711)-		(711)-		(800)766-3777		(800)766-3777		1	1	1a;1b;2;7e;7h;11c;	2		1									
H7063	802	0	1	04	01	H7063_802_0	3	1						05/28/2021	2022.01	05/28/2021 10:41:59 AM Central Daylight Time					06/07/2021 09:25:30 PM Central Daylight Time	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Blue Cross and Blue Shield of Kansas	www.bcbsks.com/medicare	MAPD Group Plan Calendar Year (PPO)	01	04		1			H7063	802	0	2022	Nationwide		1	0	2			2						www.MyPrime.com	www.bcbsks.com/medicare	www.bcbsks.com/medicare	(800)222-7645		(800)222-7645		(800)354-9387		(800)354-9387		(866)230-7265		(866)230-7265		(800)354-9387		(800)354-9387		(711)-		(711)-		(800)766-3777		(800)766-3777		(711)-		(711)-		(800)766-3777		(800)766-3777		1	1	1a;1b;2;7e;7h;11c;	2		1									
H7074	001	0	1	04	01	H7074_001_0	7	1					0	08/04/2021	2022.01	08/04/2021 12:34:25 PM Pacific Daylight Time	08/02/2021 09:24:20 PM Pacific Daylight Time	07/30/2021 11:08:42 AM Pacific Daylight Time			08/04/2021 12:36:10 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Alignment Health Plan	www.alignmenthealthplan.com	AVA (PPO)	01	04		1			H7074	001	0	2022	Mountains and Piedmont Regions		2	4287	2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(866)634-2247		(888)979-2247		(888)979-2247		(844)227-7616		(844)227-7616		(888)979-2247		(888)979-2247		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7074	801	0	1	04	01	H7074_801_0	3	1						07/13/2021	2022.01	07/13/2021 09:45:30 AM Pacific Daylight Time					07/13/2021 12:24:55 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan Retiree Options (PPO)	01	04		1			H7074	801	0	2022	Mountains and Piedmont Regions		1	6000	2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(866)634-2247	5550	(888)979-2247	1	(888)979-2247	6	(844)227-7616		(844)227-7616		(888)979-2247	1	(888)979-2247	6	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7074	802	0	1	04	01	H7074_802_0	3	1						07/13/2021	2022.01	07/13/2021 09:48:08 AM Pacific Daylight Time					07/13/2021 12:24:55 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan Retiree Options (PPO)	01	04		1			H7074	802	0	2022	Mountains and Piedmont Regions		1	6000	2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(866)634-2247	5550	(888)979-2247	1	(888)979-2247	6	(844)227-7616		(844)227-7616		(888)979-2247	1	(888)979-2247	6	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7074	803	0	1	04	01	H7074_803_0	3	1				0	0	07/13/2021	2022.01	07/13/2021 09:48:57 AM Pacific Daylight Time					07/13/2021 12:24:55 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan Retiree Options (PPO)	01	04		1			H7074	803	0	2022	Mountains and Piedmont Regions		1	6000	2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(866)634-2247	5550	(888)979-2247	1	(888)979-2247	6									(711)-		(711)-		(711)-		(711)-										2					2						2			
H7074	804	0	1	04	01	H7074_804_0	3	1				0	0	07/13/2021	2022.01	07/13/2021 10:54:34 AM Pacific Daylight Time					07/13/2021 12:24:55 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan Retiree Options (PPO)	01	04		1			H7074	804	0	2022	Mountains and Piedmont Regions		1	6000	2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(866)634-2247	5550	(888)979-2247	1	(888)979-2247	6									(711)-		(711)-		(711)-		(711)-										2					2						2			
H7076	015	0	1	01	01	H7076_015_0	5	1	2	1			0	08/03/2021	2022.01	08/03/2021 11:47:12 AM Eastern Daylight Time	08/03/2021 01:37:40 PM Eastern Daylight Time	07/30/2021 03:32:30 PM Eastern Daylight Time			08/05/2021 04:16:47 PM Eastern Daylight Time	CARESOURCE INDIANA, INC.	CareSource	www.caresource.com/in/plans/dsnp/	CareSource Dual Advantage (HMO D-SNP)	01	01		1			H7076	015	0	2022	Region 1		2		2			1	3		1		1	www.caresource.com	www.caresource.com/in/plans/dsnp/pharmacy/drug-formulary/	www.caresource.com/providers	(833)230-2020		(833)230-2020		(844)607-2830		(844)607-2830		(833)230-2020		(833)230-2020		(844)607-2830		(844)607-2830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7076	016	0	1	01	01	H7076_016_0	5	1	2	1			0	08/03/2021	2022.01	08/03/2021 11:47:48 AM Eastern Daylight Time	08/03/2021 01:39:40 PM Eastern Daylight Time	07/30/2021 03:33:30 PM Eastern Daylight Time			08/05/2021 04:16:47 PM Eastern Daylight Time	CARESOURCE INDIANA, INC.	CareSource	www.caresource.com/in/plans/dsnp/	CareSource Dual Advantage (HMO D-SNP)	01	01		1			H7076	016	0	2022	Region 2		2		2			1	3		1		1	www.caresource.com	www.caresource.com/in/plans/dsnp/pharmacy/drug-formulary/	www.caresource.com/providers	(833)230-2020		(833)230-2020		(844)607-2830		(844)607-2830		(833)230-2020		(833)230-2020		(844)607-2830		(844)607-2830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7093	001	0	1	04	01	H7093_001_0	8	1				0	0	07/19/2021	2022.01	07/19/2021 02:24:25 PM Eastern Daylight Time	07/16/2021 06:58:52 PM Eastern Daylight Time				07/19/2021 04:21:07 PM Eastern Daylight Time	COMMUNITY INSURANCE COMPANY	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Service (PPO)	01	04		1			H7093	001	0	2022	Indiana		2		2			2						https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	https://shop.anthem.com/medicare	(855)558-1438		(855)558-1438		(855)593-0907		(855)593-0907										(711)-		(711)-		(711)-		(711)-										2					2						2			
H7093	002	0	1	04	01	H7093_002_0	7	1					0	08/02/2021	2022.01	08/02/2021 02:29:32 PM Eastern Daylight Time	08/03/2021 06:04:00 PM Eastern Daylight Time	08/03/2021 06:04:00 PM Eastern Daylight Time			08/04/2021 02:28:17 PM Eastern Daylight Time	COMMUNITY INSURANCE COMPANY	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Access (PPO)	01	04		1			H7093	002	0	2022	Indiana		2		2			2						https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	https://shop.anthem.com/medicare	(855)558-1438		(855)558-1438		(855)593-0907		(855)593-0907		(833)293-5471		(833)293-5471		(855)948-5578		(855)948-5578		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7114	001	0	1	20	08	H7114_001_0	1	1						06/07/2021	2022.01	06/07/2021 03:04:19 PM Central Daylight Time		06/07/2021 02:59:50 PM Central Daylight Time			06/07/2021 03:06:12 PM Central Daylight Time	VALIR PACE FOUNDATION	Valir PACE Foundation	www.valirpace.org	Dual (PACE)	08	20		1			H7114	001	0	2022	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	1	1						06/07/2021	2022.01	06/07/2021 03:04:53 PM Central Daylight Time		06/07/2021 02:59:50 PM Central Daylight Time			06/07/2021 03:06:12 PM Central Daylight Time	VALIR PACE FOUNDATION	Valir PACE Foundation	www.valirpace.org	Medicare Only (PACE)	08	20		1			H7114	002	0	2022	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	6	1					0	08/03/2021	2022.01	08/03/2021 01:16:35 PM Central Daylight Time	08/03/2021 12:12:51 PM Central Daylight Time	07/29/2021 04:05:21 PM Central Daylight Time			08/04/2021 03:32:03 PM 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	2022	TX -Harris,Montgomery,Fort Bend,Liberty,Galveston		2		2			2						healthplan.memorialhermann.org/medicare	healthplan.memorialhermann.org/medicare	healthplan.memorialhermann.org/medicare	(855)645-8448		(855)645-8448		(866)434-1282		(866)434-1282		(855)645-8448		(855)645-8448		(866)434-1282		(866)434-1282		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7115	003	0	1	01	01	H7115_003_0	8	1					0	08/03/2021	2022.01	08/03/2021 01:16:56 PM Central Daylight Time	08/03/2021 12:15:20 PM Central Daylight Time	07/29/2021 04:06:25 PM Central Daylight Time			08/04/2021 03:32:03 PM Central Daylight Time	MEMORIAL HERMANN HEALTH PLAN	Memorial Hermann Health Plan	healthplan.memorialhermann.org/medicare	Memorial Hermann Advantage Plus (HMO)	01	01		1			H7115	003	0	2022	TX -Harris,Montgomery,Fort Bend,Liberty,Galveston		2		2			2						healthplan.memorialhermann.org/medicare	healthplan.memorialhermann.org/medicare	healthplan.memorialhermann.org/medicare	(855)645-8448		(855)645-8448		(866)434-1282		(866)434-1282		(855)645-8448		(855)645-8448		(866)434-1282		(866)434-1282		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7115	004	0	1	01	01	H7115_004_0	7	1					0	08/03/2021	2022.01	08/03/2021 01:17:15 PM Central Daylight Time	08/03/2021 12:17:29 PM Central Daylight Time	07/29/2021 04:07:28 PM Central Daylight Time			08/04/2021 03:32:03 PM Central Daylight Time	MEMORIAL HERMANN HEALTH PLAN	Memorial Hermann Health Plan	healthplan.memorialhermann.org/medicare	Memorial Hermann Advantage Jefferson (HMO)	01	01		1			H7115	004	0	2022	Jefferson County, TX		2		2			2						healthplan.memorialhermann.org/medicare	healthplan.memorialhermann.org/medicare	healthplan.memorialhermann.org/medicare	(855)645-8448		(855)645-8448		(866)434-1282		(866)434-1282		(855)645-8448		(855)645-8448		(866)434-1282		(866)434-1282		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7115	005	0	1	01	01	H7115_005_0	6	1	2	1			0	07/08/2021	2022.01	07/08/2021 09:47:30 AM Central Daylight Time	08/03/2021 12:19:37 PM Central Daylight Time	07/29/2021 04:08:30 PM Central Daylight Time			08/04/2021 03:32:03 PM Central Daylight Time	MEMORIAL HERMANN HEALTH PLAN	Memorial Hermann Health Plan	healthplan.memorialhermann.org/medicare	Memorial Hermann Dual Advantage (HMO D-SNP)	01	01		1			H7115	005	0	2022	Fort Bend, Harris, Montgomery Counties, TX		2		2			1	3		1		1	healthplan.memorialhermann.org/medicare	healthplan.memorialhermann.org/medicare	healthplan.memorialhermann.org/medicare	(855)645-8448		(855)645-8448		(866)434-1282		(866)434-1282		(855)645-8448		(855)645-8448		(866)434-1282		(866)434-1282		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7115	805	0	1	01	01	H7115_805_0	1	1						05/13/2021	2022.01	05/13/2021 09:22:45 AM Central Daylight Time					05/31/2021 10:20:44 AM 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	2022	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						05/13/2021	2022.01	05/13/2021 09:21:26 AM Central Daylight Time					05/31/2021 10:20:44 AM 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	2022	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				0	0	05/13/2021	2022.01	05/13/2021 09:20:14 AM Central Daylight Time					05/31/2021 10:20:44 AM 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	2022	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			
H7123	001	0	1	01	01	H7123_001_0	8	1	2	1			0	08/04/2021	2022.01	08/04/2021 03:04:50 PM Eastern Daylight Time	08/05/2021 08:15:24 AM Eastern Daylight Time	08/05/2021 12:27:33 PM Eastern Daylight Time			08/05/2021 01:57:30 PM Eastern Daylight Time	UPMC HEALTH COVERAGE, INC.	UPMC for Life Complete Care	https://www.upmchealthplan.com/snp/	UPMC for Life Complete Care (HMO D-SNP)	01	01		1			H7123	001	0	2022	Southeastern Pennsylvania		2	10017	2			1	3		1		1	https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/	https://findcare.upmchealthplan.com/browse?caretype=Medical	(833)526-6264		(833)526-6264		(866)405-8762		(866)405-8762		(833)526-6264		(833)526-6264		(866)405-8762		(866)405-8762		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7149	001	0	1	02	01	H7149_001_0	2	1			2		0	08/02/2021	2022.01	08/02/2021 03:16:42 PM Central Daylight Time	08/03/2021 01:24:49 PM Central Daylight Time	08/02/2021 08:56:59 AM Central Daylight Time			08/04/2021 01:00:17 PM Central Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (HMO-POS)	01	02		1			H7149	001	0	2022	Partial State of Nebraska		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7149	004	0	1	02	01	H7149_004_0	2	1			2		0	08/02/2021	2022.01	08/02/2021 03:17:12 PM Central Daylight Time	08/03/2021 01:25:55 PM Central Daylight Time	08/02/2021 08:57:03 AM Central Daylight Time			08/04/2021 01:00:17 PM Central Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime (HMO-POS)	01	02		1			H7149	004	0	2022	Douglas and Sarpy Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7149	006	0	1	01	01	H7149_006_0	4	1	2	1	1		0	07/08/2021	2022.01	07/08/2021 11:34:08 AM Eastern Daylight Time	08/04/2021 09:24:46 AM Central Daylight Time	08/02/2021 08:57:07 AM Central Daylight Time			08/04/2021 01:00:17 PM Central Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Assure Premier (HMO D-SNP)	01	01		1			H7149	006	0	2022	Partial State of Nebraska		2		2			1	3		1		1	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7149	007	0	1	02	01	H7149_007_0	1	1			2	0	0	06/02/2021	2022.01	06/02/2021 11:25:50 AM Eastern Daylight Time	06/01/2021 04:09:57 PM Central Daylight Time				06/03/2021 11:42:21 AM Central Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Eagle (HMO-POS)	01	02		1			H7149	007	0	2022	Partial State of Nebraska		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031										(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031										2					2					2	2			
H7149	801	0	1	01	01	H7149_801_0	1	1				0	0	05/28/2021	2022.01	05/28/2021 01:13:39 PM Eastern Daylight Time					06/03/2021 01:53:09 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (HMO)	01	01		1			H7149	801	0	2022	Nebraska		1	120	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H7149	802	0	1	01	01	H7149_802_0	1	1						05/28/2021	2022.01	05/28/2021 01:13:58 PM Eastern Daylight Time					06/03/2021 01:53:09 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan w/Rx (HMO)	01	01		1			H7149	802	0	2022	Nebraska		1	120	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H7151	001	0	1	01	01	H7151_001_0	12	1					1	07/16/2021	2022.01	07/16/2021 12:19:34 AM US Eastern Daylight Time	08/04/2021 03:35:48 PM Eastern Daylight Time	07/30/2021 10:22:46 AM Eastern Daylight Time			08/05/2021 09:29:00 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Devoted Health	www.Devoted.com	Devoted Health Core (HMO)	01	01		1			H7151	001	0	2022	Cook, DuPage, Kane, Kendall, Lake, McHenry, Will		2		2			2						www.Devoted.com	www.Devoted.com	www.Devoted.com	(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7151	002	0	1	01	01	H7151_002_0	14	1					0	07/20/2021	2022.01	07/20/2021 01:54:08 PM US Eastern Daylight Time	08/04/2021 03:36:16 PM Eastern Daylight Time	07/30/2021 10:23:06 AM Eastern Daylight Time			08/05/2021 09:29:00 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Devoted Health	www.Devoted.com	Devoted Health Prime (HMO)	01	01		1			H7151	002	0	2022	Cook, DuPage, Kane, Kendall, Lake, McHenry, Will		2		2			2						www.Devoted.com	www.Devoted.com	www.Devoted.com	(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7151	003	0	1	01	01	H7151_003_0	11	1					1	07/15/2021	2022.01	07/15/2021 09:02:44 PM US Eastern Daylight Time	08/04/2021 03:36:44 PM Eastern Daylight Time	07/30/2021 10:23:25 AM Eastern Daylight Time			08/05/2021 09:29:00 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Devoted Health	www.Devoted.com	Devoted Health Essentials (HMO)	01	01		1			H7151	003	0	2022	Cook, DuPage, Kane, Kendall, Lake, McHenry, Will		2		2			2						www.Devoted.com	www.Devoted.com	www.Devoted.com	(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7163	002	0	1	02	01	H7163_002_0	12	1					1	08/01/2021	2022.01	08/01/2021 07:48:18 PM Central Daylight Time	07/30/2021 05:25:36 PM Central Daylight Time	07/29/2021 08:27:26 PM Central Daylight Time			08/04/2021 10:51:39 AM Central Daylight Time	VANTAGE HEALTH PLAN OF MISSISSIPPI, INC.	Vantage Health Plan	www.VantageMedicare.com	Vantage BASIC (HMO-POS)	01	02		1			H7163	002	0	2022	Central and South Mississippi		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			
H7163	003	0	1	02	01	H7163_003_0	11	1	2	1			0	06/03/2021	2022.01	06/03/2021 12:10:31 PM Central Daylight Time	07/30/2021 05:27:16 PM Central Daylight Time	07/29/2021 08:27:56 PM Central Daylight Time			08/04/2021 04:19:41 PM Central Daylight Time	VANTAGE HEALTH PLAN OF MISSISSIPPI, INC.	Vantage Health Plan	www.VantageMedicare.com	Vantage DUAL PLUS (HMO-POS D-SNP)	01	02		1			H7163	003	0	2022	Central and South Mississippi		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			
H7163	004	0	1	02	01	H7163_004_0	12	1					1	07/15/2021	2022.01	07/15/2021 10:19:05 AM Central Daylight Time	07/30/2021 05:28:04 PM Central Daylight Time	07/29/2021 08:29:28 PM Central Daylight Time			08/04/2021 04:19:41 PM Central Daylight Time	VANTAGE HEALTH PLAN OF MISSISSIPPI, INC.	Vantage Health Plan	www.VantageMedicare.com	Vantage STANDARD (HMO-POS)	01	02		1			H7163	004	0	2022	Central and South Mississippi		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			
H7163	801	0	1	02	01	H7163_801_0	7	1						04/12/2021	2022.01	04/12/2021 04:57:08 PM Central Daylight Time					06/06/2021 07:04:41 PM Central Daylight Time	VANTAGE HEALTH PLAN OF MISSISSIPPI, INC.	Vantage Health Plan	www.VantageMedicare.com	Vantage - MAPD Employer Calendar (HMO-POS)	01	02		1			H7163	801	0	2022	Mississippi		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			
H7165	001	0	1	01	01	H7165_001_0	4	1					1	08/05/2021	2022.01	08/05/2021 10:54:01 AM Eastern Daylight Time	08/05/2021 11:30:14 AM Eastern Daylight Time	08/05/2021 12:03:17 PM Eastern Daylight Time			08/05/2021 05:33:20 PM Eastern Daylight Time	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Blue Cross Blue Shield of South Carolina	www.scbluesmedadvantage.com/marx22	BlueCross Secure (HMO)	01	01		1			H7165	001	0	2022	Greenville County		2	1200	2			2						www.scbluesmedadvantage.com/marx22	www.scbluesmedadvantage.com/marx22	www.scbluesmedadvantage.com/marx22	(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	4	1					1	08/05/2021	2022.01	08/05/2021 10:54:30 AM Eastern Daylight Time	08/05/2021 11:30:51 AM Eastern Daylight Time	08/05/2021 12:04:23 PM Eastern Daylight Time			08/05/2021 05:33:20 PM Eastern Daylight Time	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Blue Cross Blue Shield of South Carolina	www.scbluesmedadvantage.com/marx22	BlueCross Secure (HMO)	01	01		1			H7165	002	0	2022	Richland County		2	1500	2			2						www.scbluesmedadvantage.com/marx22	www.scbluesmedadvantage.com/marx22	www.scbluesmedadvantage.com/marx22	(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	805	0	1	01	01	H7165_805_0	2	1						05/27/2021	2022.01	05/27/2021 11:50:34 AM Eastern Daylight Time					06/07/2021 01:55:56 PM Eastern Daylight Time	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Blue Cross Blue Shield of South Carolina	www.scbluesmedadvantage.com	BlueCross MAPD Calendar Year (HMO)	01	01		1			H7165	805	0	2022	Nationwide		1	100	2			2						www.scbluesmedadvantage.com	www.scbluesmedadvantage.com	www.scbluesmedadvantage.com	(855)204-2744		(855)204-2744		(855)204-2744		(855)204-2744		(855)204-2744		(855)204-2744		(855)204-2744		(855)204-2744		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1				
H7165	806	0	1	01	01	H7165_806_0	2	1						05/27/2021	2022.01	05/27/2021 11:52:09 AM Eastern Daylight Time					06/07/2021 01:55:56 PM Eastern Daylight Time	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Blue Cross Blue Shield of South Carolina	www.scbluesmedadvantage.com/marx22	BlueCross MAPD Non-Calendar Year (HMO)	01	01		1			H7165	806	0	2022	Nationwide		1	100	2			2						www.scbluesmedadvantage.com/marx22	www.scbluesmedadvantage.com/marx22	www.scbluesmedadvantage.com/marx22	(855)204-2744		(855)204-2744		(855)204-2744		(855)204-2744		(855)204-2744		(855)204-2744		(855)204-2744		(855)204-2744		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1				
H7169	001	0	1	04	01	H7169_001_0	4	1					0	08/03/2021	2022.01	08/03/2021 11:45:53 AM Eastern Daylight Time	08/04/2021 01:18:21 AM Eastern Daylight Time	07/30/2021 01:39:56 PM Eastern Daylight Time			08/04/2021 09:45:33 PM Eastern Daylight Time	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Wellcare	www.wellcare.com/allwellOH	Wellcare No Premium Open (PPO)	01	04		1			H7169	001	0	2022	Select counties in OH		2	16893	2			2						www.wellcare.com/allwellOH	www.wellcare.com/allwellOH	www.wellcare.com/allwellOH	(855)766-1851		(855)766-1851		(844)917-0175		(844)917-0175		(855)766-1851		(855)766-1851		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7172	001	0	1	48	05	H7172_001_0	3	1						07/13/2021	2022.01	07/13/2021 09:53:28 AM Central Daylight Time					07/13/2021 10:00:15 AM 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	2022	Ohio		2	332778	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	4	1	2	1			0	07/19/2021	2022.01	07/19/2021 12:55:12 PM Eastern Daylight Time	08/04/2021 01:18:49 AM Eastern Daylight Time	07/30/2021 01:40:16 PM Eastern Daylight Time			08/04/2021 09:57:30 PM Eastern Daylight Time	PEACH STATE HEALTH PLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellGA	Wellcare Dual Access Medicare (HMO D-SNP)	01	01		1			H7173	001	0	2022	Select counties in GA		2	3986	2			1	3		1		1	www.wellcare.com/allwellGA	www.wellcare.com/allwellGA	www.wellcare.com/allwellGA	(877)725-7748		(877)725-7748		(866)277-6583		(866)277-6583		(877)725-7748		(877)725-7748		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7173	002	0	1	01	01	H7173_002_0	4	1					0	08/02/2021	2022.01	08/02/2021 12:05:18 PM Eastern Daylight Time	08/04/2021 01:19:17 AM Eastern Daylight Time	07/30/2021 01:40:36 PM Eastern Daylight Time			08/04/2021 09:57:30 PM Eastern Daylight Time	PEACH STATE HEALTH PLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellGA	Wellcare No Premium Medicare (HMO)	01	01		1			H7173	002	0	2022	Select counties in GA		2	7798	2			2						www.wellcare.com/allwellGA	www.wellcare.com/allwellGA	www.wellcare.com/allwellGA	(844)890-2326		(844)890-2326		(866)277-6583		(866)277-6583		(844)890-2326		(844)890-2326		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7173	007	0	1	01	01	H7173_007_0	5	1					0	08/03/2021	2022.01	08/03/2021 12:18:13 PM Eastern Daylight Time	08/04/2021 06:05:20 PM Eastern Daylight Time	07/30/2021 01:40:56 PM Eastern Daylight Time			08/04/2021 09:57:30 PM Eastern Daylight Time	PEACH STATE HEALTH PLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellGA	Wellcare Giveback Medicare (HMO)	01	01		1			H7173	007	0	2022	Select counties in GA		2	1820	2			2						www.wellcare.com/allwellGA	www.wellcare.com/allwellGA	www.wellcare.com/allwellGA	(844)890-2326		(844)890-2326		(866)277-6583		(866)277-6583		(844)890-2326		(844)890-2326		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7173	801	0	1	01	01	H7173_801_0	2	1						05/03/2021	2022.01	05/03/2021 02:11:49 PM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	PEACH STATE HEALTH PLAN, INC.	Wellcare by Allwell	allwell.pshpgeorgia.com	Allwell Group (HMO)	01	01		1			H7173	801	0	2022	Statewide		1	100	2			2						allwell.pshpgeorgia.com/findadoctor	allwell.pshpgeorgia.com/formulary	allwell.pshpgeorgia.com/findadoctor	(844)890-2326		(844)890-2326		(844)942-0039		(844)942-0039		(844)890-2326		(844)890-2326		(844)942-0039		(844)942-0039		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H7173	802	0	1	01	01	H7173_802_0	2	1				0	0	05/03/2021	2022.01	05/03/2021 02:11:55 PM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	PEACH STATE HEALTH PLAN, INC.	Wellcare by Allwell	allwell.pshpgeorgia.com	Allwell Group (HMO)	01	01		1			H7173	802	0	2022	Statewide		1	100	2			2						allwell.pshpgeorgia.com/findadoctor	allwell.pshpgeorgia.com/formulary	allwell.pshpgeorgia.com/findadoctor	(844)890-2326		(844)890-2326		(844)942-0039		(844)942-0039										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H7173	803	0	1	01	01	H7173_803_0	2	1						05/03/2021	2022.01	05/03/2021 02:12:07 PM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	PEACH STATE HEALTH PLAN, INC.	Wellcare by Allwell	allwell.pshpgeorgia.com	Allwell Group (HMO)	01	01		1			H7173	803	0	2022	Statewide		1	100	2			2						allwell.pshpgeorgia.com/findadoctor	allwell.pshpgeorgia.com/formulary	allwell.pshpgeorgia.com/findadoctor	(844)890-2326		(844)890-2326		(844)942-0039		(844)942-0039		(844)890-2326		(844)890-2326		(844)942-0039		(844)942-0039		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H7175	001	0	1	04	01	H7175_001_0	5	1					0	08/03/2021	2022.01	08/03/2021 01:00:26 PM Eastern Daylight Time	08/04/2021 01:20:15 AM Eastern Daylight Time	07/30/2021 01:41:16 PM Eastern Daylight Time			08/04/2021 10:12:55 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium Open (PPO)	01	04		1			H7175	001	0	2022	Select counties in NC		2	34078	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7175	002	0	1	04	01	H7175_002_0	6	1	2	1			0	08/03/2021	2022.01	08/03/2021 01:29:33 PM Eastern Daylight Time	08/04/2021 01:20:45 AM Eastern Daylight Time	07/30/2021 01:41:34 PM Eastern Daylight Time			08/04/2021 10:12:55 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Liberty Open (PPO D-SNP)	01	04		1			H7175	002	0	2022	Select counties in NC		2	14768	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7175	003	0	1	04	01	H7175_003_0	6	1					0	06/07/2021	2022.01	06/07/2021 01:07:14 PM Eastern Daylight Time	08/04/2021 01:21:14 AM Eastern Daylight Time	07/30/2021 01:41:54 PM Eastern Daylight Time			08/04/2021 10:12:55 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Assist Open (PPO)	01	04		1			H7175	003	0	2022	Select counties in NC		2	4936	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7175	004	0	1	04	01	H7175_004_0	6	1					0	08/03/2021	2022.01	08/03/2021 01:06:39 PM Eastern Daylight Time	08/04/2021 01:21:42 AM Eastern Daylight Time	07/30/2021 01:42:14 PM Eastern Daylight Time			08/04/2021 10:12:55 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Giveback Open (PPO)	01	04		1			H7175	004	0	2022	Select counties in NC		2	41930	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7175	005	0	1	04	01	H7175_005_0	5	1				0	0	06/06/2021	2022.01	06/06/2021 05:42:26 PM Eastern Daylight Time	06/04/2021 01:49:50 PM Eastern Daylight Time				07/19/2021 07:06:39 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Patriot No Premium Open (PPO)	01	04		1			H7175	005	0	2022	Select counties in NC		2	2280	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175										(711)-		(711)-		(711)-		(711)-										2					2						2			
H7175	006	0	1	04	01	H7175_006_0	6	1					0	08/03/2021	2022.01	08/03/2021 01:13:28 PM Eastern Daylight Time	08/04/2021 01:22:40 AM Eastern Daylight Time	07/30/2021 01:42:34 PM Eastern Daylight Time			08/04/2021 10:12:55 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Premium Enhanced Open (PPO)	01	04		1			H7175	006	0	2022	Select counties in NC		2	2184	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7175	007	0	1	04	01	H7175_007_0	6	1					0	08/03/2021	2022.01	08/03/2021 01:17:56 PM Eastern Daylight Time	08/04/2021 01:23:09 AM Eastern Daylight Time	07/30/2021 01:42:54 PM Eastern Daylight Time			08/04/2021 10:12:55 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Premium Ultra Open (PPO)	01	04		1			H7175	007	0	2022	Select counties in NC		2	2186	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7195	001	0	1	20	08	H7195_001_0	1	1						05/28/2021	2022.01	05/28/2021 11:11:05 AM Central Daylight Time		05/28/2021 09:48:24 AM Central Daylight Time			05/28/2021 11:12:51 AM 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	2022	Burleigh, Cass, 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						05/28/2021	2022.01	05/28/2021 11:11:28 AM Central Daylight Time		05/28/2021 09:48:24 AM Central Daylight Time			05/28/2021 11:12:51 AM 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	2022	Burleigh, Cass, 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	4	1				0	0	07/08/2021	2022.01	07/08/2021 03:56:19 PM Eastern Daylight Time	07/15/2021 02:39:56 PM Eastern Daylight Time				07/15/2021 02:44:19 PM Eastern Daylight Time	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Indiana University Health Plans	www.iuhealthplans.org	IU Health Plans Medicare Select - Medical Only (HMO)	01	01		1			H7220	002	0	2022	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										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H7220	004	0	1	02	01	H7220_004_0	7	1					1	08/04/2021	2022.01	08/04/2021 03:06:22 PM Eastern Daylight Time	08/05/2021 01:15:45 PM Eastern Daylight Time	08/05/2021 01:15:45 PM Eastern Daylight Time			08/05/2021 03:41:40 PM Eastern Daylight Time	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Indiana University Health Plans	www.iuhealthplans.org	IU Health Plans Medicare Choice (HMO-POS)	01	02		1			H7220	004	0	2022	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7220	009	1	1	01	01	H7220_009_1	6	1					1	08/04/2021	2022.01	08/04/2021 03:06:45 PM Eastern Daylight Time	08/05/2021 01:15:45 PM Eastern Daylight Time	08/05/2021 01:15:45 PM Eastern Daylight Time			08/05/2021 03:41:40 PM Eastern Daylight Time	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Indiana University Health Plans	www.iuhealthplans.org	IU Health Plans Medicare Select Plus (HMO)	01	01		1			H7220	009	1	2022	Indianapolis Metro Area and Surrounding Counties	State of Indiana - 33 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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	7a;	
H7220	009	2	1	01	01	H7220_009_2	6	1					1	08/04/2021	2022.01	08/04/2021 03:07:42 PM Eastern Daylight Time	08/05/2021 01:15:45 PM Eastern Daylight Time	08/05/2021 01:15:45 PM Eastern Daylight Time			08/05/2021 03:41:40 PM Eastern Daylight Time	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Indiana University Health Plans	www.iuhealthplans.org	IU Health Plans Medicare Select Plus (HMO)	01	01		1			H7220	009	2	2022	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	7a;	
H7220	009	3	1	01	01	H7220_009_3	6	1					1	08/04/2021	2022.01	08/04/2021 03:08:24 PM Eastern Daylight Time	08/05/2021 01:15:45 PM Eastern Daylight Time	08/05/2021 01:15:45 PM Eastern Daylight Time			08/05/2021 03:41:40 PM Eastern Daylight Time	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Indiana University Health Plans	www.iuhealthplans.org	IU Health Plans Medicare Select Plus (HMO)	01	01		1			H7220	009	3	2022	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7220	010	0	1	01	01	H7220_010_0	7	1					1	08/04/2021	2022.01	08/04/2021 03:08:54 PM Eastern Daylight Time	08/05/2021 01:15:45 PM Eastern Daylight Time	08/05/2021 01:15:45 PM Eastern Daylight Time			08/05/2021 03:41:40 PM Eastern Daylight Time	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Indiana University Health Plans	www.iuhealthplans.org	IU Health Plans Medicare $0 Preferred (HMO)	01	01		1			H7220	010	0	2022	State of Indiana - 6 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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7220	011	0	1	02	01	H7220_011_0	8	1					1	07/08/2021	2022.01	07/08/2021 03:59:16 PM Eastern Daylight Time	08/05/2021 01:15:45 PM Eastern Daylight Time	08/05/2021 01:15:45 PM Eastern Daylight Time			08/05/2021 03:41:40 PM Eastern Daylight Time	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Indiana University Health Plans	www.iuhealthplans.org	IU Health Plans Medicare Flex Network (HMO-POS)	01	02		1			H7220	011	0	2022	State of Indiana - 12 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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7245	001	0	1	01	01	H7245_001_0	8	1					1	08/05/2021	2022.01	08/05/2021 10:22:26 AM Pacific Daylight Time	08/05/2021 09:07:22 AM Pacific Daylight Time	08/04/2021 10:16:42 AM Pacific Daylight Time			08/05/2021 12:37:11 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	2022	Various Counties in Eastern and Western WA		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	7	1					1	08/04/2021	2022.01	08/04/2021 07:41:54 AM Pacific Daylight Time	08/05/2021 09:10:06 AM Pacific Daylight Time	08/04/2021 10:16:58 AM Pacific Daylight Time			08/05/2021 12:37:11 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	2022	Various Counties in Western WA		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	7	1					1	08/04/2021	2022.01	08/04/2021 07:41:25 AM Pacific Daylight Time	08/05/2021 09:11:22 AM Pacific Daylight Time	08/04/2021 10:17:14 AM Pacific Daylight Time			08/05/2021 12:37:11 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	2022	Various Counties in Western WA		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	7	1					1	08/05/2021	2022.01	08/05/2021 07:45:46 AM Pacific Daylight Time	08/05/2021 09:12:04 AM Pacific Daylight Time	08/04/2021 10:17:28 AM Pacific Daylight Time			08/05/2021 12:37:11 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	2022	Various Counties in Eastern WA		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						06/02/2021	2022.01	06/02/2021 10:34:41 AM Mountain Daylight Time		06/02/2021 10:23:18 AM Mountain Daylight Time			06/02/2021 10:36:47 AM Mountain Daylight Time	TRU COMMUNITY CARE	TRU PACE	www.pace.trucare.org	TRU Community Care (PACE)	08	20		1			H7262	001	0	2022	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						06/02/2021	2022.01	06/02/2021 10:35:06 AM Mountain Daylight Time		06/02/2021 10:24:01 AM Mountain Daylight Time			06/02/2021 10:36:47 AM Mountain Daylight Time	TRU COMMUNITY CARE	TRU PACE	www.pace.trucare.org	TRU Community Care (PACE)	08	20		1			H7262	002	0	2022	Boulder and Southwest Weld Counties		2		2			2						TBD	www.trucare.org												(303)665-0115				(303)665-0115												(800)659-2656				(800)659-2656																
H7273	001	0	1	04	01	H7273_001_0	12	1			1		1	08/03/2021	2022.01	08/03/2021 11:37:43 AM US Mountain Standard Time	08/03/2021 03:42:06 PM US Mountain Standard Time	08/03/2021 03:01:28 PM US Mountain Standard Time			08/04/2021 07:16:13 AM US Mountain Standard Time	BANNER HEALTH INSURANCE GROUP	Banner Medicare Advantage Plus	www.BannerMA.com	Banner Medicare Advantage Plus (PPO)	01	04		1			H7273	001	0	2022	Maricopa, Pinal Counties		2	11251	2			2						www.BannerMA.com	www.BannerMA.com	www.BannerMA.com	(844)549-1859		(602)462-0830		(844)556-7685		(602)462-0830		(844)549-1859		(602)462-0830		(844)556-7685		(602)462-0830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7273	002	0	1	04	01	H7273_002_0	12	1			1		1	08/03/2021	2022.01	08/03/2021 11:38:08 AM US Mountain Standard Time	08/03/2021 03:42:32 PM US Mountain Standard Time	08/03/2021 03:01:46 PM US Mountain Standard Time			08/04/2021 07:16:13 AM US Mountain Standard Time	BANNER HEALTH INSURANCE GROUP	Banner Medicare Advantage Plus	https://www.bannerhealth.com/services/insurance	Banner Medicare Advantage Plus (PPO)	01	04		1			H7273	002	0	2022	Pima County		2	3238	2			2						www.BannerMA.com	www.BannerMA.com	https://www.bannerhealth.com/physician-directory	(844)549-1859		(602)462-0830		(844)556-7685		(602)462-0830		(844)549-1859		(602)462-0830		(844)556-7685		(602)462-0830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7273	004	0	1	04	01	H7273_004_0	12	1			1		1	08/03/2021	2022.01	08/03/2021 11:38:25 AM US Mountain Standard Time	08/03/2021 03:42:56 PM US Mountain Standard Time	08/03/2021 03:02:04 PM US Mountain Standard Time			08/04/2021 07:16:13 AM US Mountain Standard Time	BANNER HEALTH INSURANCE GROUP	Banner Medicare Advantage Plus	www.BannerMA.com	Banner Medicare Advantage Plus (PPO)	01	04		1			H7273	004	0	2022	Santa Cruz County		2	526	2			2						www.BannerMA.com	www.BannerMA.com	www.BannerMA.com	(844)549-1859		(602)462-0830		(844)556-7685		(602)462-0830		(844)549-1859		(602)462-0830		(844)556-7685		(602)462-0830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7273	005	0	1	04	01	H7273_005_0	12	1			1		1	08/03/2021	2022.01	08/03/2021 11:38:44 AM US Mountain Standard Time	08/03/2021 03:43:22 PM US Mountain Standard Time	08/03/2021 03:02:24 PM US Mountain Standard Time			08/04/2021 07:16:13 AM US Mountain Standard Time	BANNER HEALTH INSURANCE GROUP	Banner Medicare Advantage Plus	www.BannerMA.com	Banner Medicare Advantage Plus (PPO)	01	04		1			H7273	005	0	2022	Yuma County		2	142	2			2						www.BannerMA.com	www.BannerMA.com	www.BannerMA.com	(844)549-1859		(602)462-0830		(844)556-7685		(602)462-0830		(844)549-1859		(602)462-0830		(844)556-7685		(602)462-0830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7284	001	0	1	04	01	H7284_001_0	4	1			1		1	07/08/2021	2022.01	07/08/2021 06:09:13 PM Eastern Daylight Time	08/03/2021 05:41:32 PM Eastern Daylight Time	07/30/2021 12:02:40 PM Eastern Daylight Time			08/04/2021 01:39:20 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	2022	Lake, Marion, Seminole and Sumter counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7284	003	0	1	04	01	H7284_003_0	6	1	2	1	1		0	08/02/2021	2022.01	08/02/2021 11:59:42 AM Eastern Daylight Time	08/03/2021 05:42:46 PM Eastern Daylight Time	07/30/2021 12:02:52 PM Eastern Daylight Time			08/04/2021 02:07:37 PM Eastern Daylight Time	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Humana	www.humana.com/medicare	HumanaChoice SNP-DE H7284-003 (PPO D-SNP)	01	04		1			H7284	003	0	2022	North Florida Rural Counties		2		2			1	3		2		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7284	006	0	1	04	01	H7284_006_0	4	1			1		1	07/08/2021	2022.01	07/08/2021 04:09:53 PM Eastern Daylight Time	08/03/2021 05:43:53 PM Eastern Daylight Time	07/30/2021 12:03:04 PM Eastern Daylight Time			08/04/2021 01:25:06 PM Eastern Daylight Time	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Humana	www.humana.com/medicare	HumanaChoice Florida H7284-006 (PPO)	01	04		1			H7284	006	0	2022	Daytona and Jacksonville		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7284	007	0	1	04	01	H7284_007_0	4	1			1		0	07/08/2021	2022.01	07/08/2021 04:45:04 PM Eastern Daylight Time	08/03/2021 05:45:58 PM Eastern Daylight Time	07/30/2021 12:03:16 PM Eastern Daylight Time			08/04/2021 01:34:40 PM Eastern Daylight Time	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Humana	www.humana.com/medicare	HumanaChoice Florida H7284-007 (PPO)	01	04		1			H7284	007	0	2022	Southeast Florida		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7284	008	0	1	04	01	H7284_008_0	5	1			1		0	08/02/2021	2022.01	08/02/2021 10:51:40 AM Eastern Daylight Time	08/03/2021 05:44:53 PM Eastern Daylight Time	07/30/2021 12:03:28 PM Eastern Daylight Time			08/04/2021 01:34:40 PM Eastern Daylight Time	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Humana	www.humana.com/medicare	HumanaChoice Florida H7284-008 (PPO)	01	04		1			H7284	008	0	2022	Broward, Miami-Dade, and Palm Beach counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7284	009	0	1	04	01	H7284_009_0	3	1			2		0	08/01/2021	2022.01	08/01/2021 12:14:25 PM Eastern Daylight Time	08/03/2021 05:47:04 PM Eastern Daylight Time	07/30/2021 12:03:40 PM Eastern Daylight Time			08/04/2021 01:25:06 PM Eastern Daylight Time	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Humana	www.humana.com/medicare	HumanaChoice Florida H7284-009 (PPO)	01	04		1			H7284	009	0	2022	Select Counties in Florida		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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					0	08/02/2021	2022.01	08/02/2021 12:51:42 PM Eastern Daylight Time	08/03/2021 01:27:12 PM Eastern Daylight Time	08/02/2021 09:57:11 AM Eastern Daylight Time			08/04/2021 05:06:45 PM Eastern Daylight Time	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Advantra (PPO)	01	04		1			H7301	002	0	2022	Northern/Northwestern Illinois		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7301	006	0	1	04	01	H7301_006_0	4	1					0	08/02/2021	2022.01	08/02/2021 04:10:26 PM Eastern Daylight Time	08/03/2021 01:28:19 PM Eastern Daylight Time	08/02/2021 09:57:15 AM Eastern Daylight Time			08/04/2021 05:06:45 PM Eastern Daylight Time	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Advantra (PPO)	01	04		1			H7301	006	0	2022	Northern/Northwestern Illinois		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7301	007	0	1	04	01	H7301_007_0	2	1					0	08/02/2021	2022.01	08/02/2021 02:46:34 PM Central Daylight Time	08/03/2021 10:40:13 AM Central Daylight Time	08/02/2021 08:57:20 AM Central Daylight Time			08/04/2021 12:29:03 PM Central Daylight Time	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value (PPO)	01	04		1			H7301	007	0	2022	Illinois		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7301	009	0	1	04	01	H7301_009_0	2	1					0	05/27/2021	2022.01	05/27/2021 05:23:47 PM Eastern Daylight Time	08/03/2021 10:37:40 AM Central Daylight Time	08/02/2021 08:57:24 AM Central Daylight Time			08/04/2021 12:29:03 PM Central Daylight Time	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (PPO)	01	04		1			H7301	009	0	2022	Illinois		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7301	011	0	1	04	01	H7301_011_0	2	1					0	08/02/2021	2022.01	08/02/2021 02:47:04 PM Central Daylight Time	08/03/2021 10:32:36 AM Central Daylight Time	08/02/2021 08:57:28 AM Central Daylight Time			08/04/2021 12:29:03 PM Central Daylight Time	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value (PPO)	01	04		1			H7301	011	0	2022	St Louis Metro		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		2					2						2			
H7301	012	0	1	04	01	H7301_012_0	4	1					0	08/02/2021	2022.01	08/02/2021 02:48:07 PM Central Daylight Time	08/03/2021 10:30:23 AM Central Daylight Time	08/02/2021 08:57:32 AM Central Daylight Time			08/04/2021 12:29:03 PM Central Daylight Time	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value (PPO)	01	04		1			H7301	012	0	2022	Southwest Illinois		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		2					2						2			
H7301	801	0	1	04	01	H7301_801_0	1	1						05/28/2021	2022.01	05/28/2021 01:15:35 PM Eastern Daylight Time					06/03/2021 01:53:09 PM Eastern Daylight Time	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan w/Rx (PPO)	01	04		1			H7301	801	0	2022	Illinois		1	120	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H7301	803	0	1	04	01	H7301_803_0	1	1				0	0	05/28/2021	2022.01	05/28/2021 01:18:14 PM Eastern Daylight Time					06/03/2021 01:53:09 PM Eastern Daylight Time	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (PPO)	01	04		1			H7301	803	0	2022	Illinois		1	120	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H7322	001	0	1	01	01	H7322_001_0	7	1					0	08/05/2021	2022.01	08/05/2021 08:26:51 AM Eastern Daylight Time	08/05/2021 07:04:02 AM Eastern Daylight Time	08/05/2021 07:04:10 AM Eastern Daylight Time			08/05/2021 08:36:05 AM Eastern Daylight Time	OSCAR HEALTH PLAN OF NEW YORK, INC.	Oscar	www.hioscar.com/medicare	Montefiore + Oscar Easy Care (HMO)	01	01		1			H7322	001	0	2022	Bronx County		2	27866	2			2						www.hioscar.com/search	www.hioscar.com/search	www.hioscar.com/search	(855)672-2720		(855)672-2720		(855)672-2710		(855)672-2710		(855)672-2720		(855)672-2720		(855)672-2710		(855)672-2710		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7322	002	0	1	01	01	H7322_002_0	7	1					0	08/05/2021	2022.01	08/05/2021 08:27:00 AM Eastern Daylight Time	08/05/2021 07:04:21 AM Eastern Daylight Time	08/05/2021 07:04:30 AM Eastern Daylight Time			08/05/2021 08:36:05 AM Eastern Daylight Time	OSCAR HEALTH PLAN OF NEW YORK, INC.	Oscar	www.hioscar.com/medicare	Oscar Easy Care (HMO)	01	01		1			H7322	002	0	2022	Orange and Rockland Counties		2	9041	2			2						www.hioscar.com/search	www.hioscar.com/search	www.hioscar.com/search	(855)672-2720		(855)672-2720		(855)672-2710		(855)672-2710		(855)672-2720		(855)672-2720		(855)672-2710		(855)672-2710		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7322	003	0	1	01	01	H7322_003_0	7	1					0	08/05/2021	2022.01	08/05/2021 08:27:10 AM Eastern Daylight Time	08/05/2021 07:10:48 AM Eastern Daylight Time	08/05/2021 07:05:38 AM Eastern Daylight Time			08/05/2021 08:36:05 AM Eastern Daylight Time	OSCAR HEALTH PLAN OF NEW YORK, INC.	Oscar	www.hioscar.com/medicare	Montefiore + Oscar Extra Benefits (HMO)	01	01		1			H7322	003	0	2022	Bronx County		2	3373	2			2						www.hioscar.com/search	www.hioscar.com/search	www.hioscar.com/search	(855)672-2720		(855)672-2720		(855)672-2710		(855)672-2710		(855)672-2720		(855)672-2720		(855)672-2710		(855)672-2710		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7323	001	0	1	04	01	H7323_001_0	4	1					0	07/31/2021	2022.01	07/31/2021 04:01:22 PM Pacific Daylight Time	08/04/2021 01:23:38 AM Eastern Daylight Time	07/30/2021 01:43:14 PM Eastern Daylight Time			08/04/2021 10:52:49 PM Eastern Daylight Time	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Wellcare	www.wellcare.com/medicare	Wellcare Low Premium Open (PPO)	01	04		1			H7323	001	0	2022	Select counties in TX		2	1233	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7323	002	0	1	04	01	H7323_002_0	4	1					0	07/31/2021	2022.01	07/31/2021 04:02:38 PM Pacific Daylight Time	08/04/2021 01:24:09 AM Eastern Daylight Time	07/30/2021 01:43:34 PM Eastern Daylight Time			08/04/2021 10:52:49 PM Eastern Daylight Time	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Wellcare	www.wellcare.com/medicare	Wellcare No Premium Open (PPO)	01	04		1			H7323	002	0	2022	Select counties in TX		2	3730	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7323	003	0	1	04	01	H7323_003_0	4	1					1	07/31/2021	2022.01	07/31/2021 04:12:14 PM Pacific Daylight Time	08/04/2021 01:24:40 AM Eastern Daylight Time	07/30/2021 01:43:52 PM Eastern Daylight Time			08/04/2021 10:52:49 PM Eastern Daylight Time	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Wellcare	www.wellcare.com/medicare	Wellcare No Premium Open (PPO)	01	04		1			H7323	003	0	2022	Select counties in TX		2	11067	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7323	004	0	1	04	01	H7323_004_0	4	1					0	07/31/2021	2022.01	07/31/2021 04:04:02 PM Pacific Daylight Time	08/04/2021 01:25:10 AM Eastern Daylight Time	07/30/2021 01:44:12 PM Eastern Daylight Time			08/04/2021 10:52:49 PM Eastern Daylight Time	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Wellcare	www.wellcare.com/medicare	Wellcare No Premium Open (PPO)	01	04		1			H7323	004	0	2022	Select counties in TX		2	2986	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7323	005	0	1	04	01	H7323_005_0	4	1	2	1			0	07/16/2021	2022.01	07/16/2021 02:37:06 PM Pacific Daylight Time	08/04/2021 01:25:40 AM Eastern Daylight Time	07/30/2021 01:44:32 PM Eastern Daylight Time			08/04/2021 10:52:49 PM Eastern Daylight Time	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Wellcare	www.wellcare.com/medicare	Wellcare Dual Access Open (PPO D-SNP)	01	04		1			H7323	005	0	2022	Select counties in TX		2	10384	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7323	006	0	1	04	01	H7323_006_0	4	1					0	07/31/2021	2022.01	07/31/2021 04:06:53 PM Pacific Daylight Time	08/04/2021 01:26:08 AM Eastern Daylight Time	07/30/2021 01:44:52 PM Eastern Daylight Time			08/04/2021 10:52:49 PM Eastern Daylight Time	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Wellcare	www.wellcare.com/medicare	Wellcare No Premium Rx Plus Open (PPO)	01	04		1			H7323	006	0	2022	Select counties in TX		2	4840	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7323	007	0	1	04	01	H7323_007_0	4	1					0	07/31/2021	2022.01	07/31/2021 04:09:38 PM Pacific Daylight Time	08/04/2021 01:26:35 AM Eastern Daylight Time	07/30/2021 01:45:14 PM Eastern Daylight Time			08/04/2021 10:52:49 PM Eastern Daylight Time	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Wellcare	www.wellcare.com/medicare	Wellcare No Premium Open (PPO)	01	04		1			H7323	007	0	2022	Select counties in TX		2	4561	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7326	001	0	1	04	01	H7326_001_0	5	1					0	08/10/2021	2022.01	08/10/2021 07:39:11 PM Eastern Daylight Time	08/04/2021 01:27:04 AM Eastern Daylight Time	07/30/2021 01:45:34 PM Eastern Daylight Time			08/11/2021 02:50:06 PM Eastern Daylight Time	WELLCARE OF SOUTH CAROLINA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium Open (PPO)	01	04		1			H7326	001	0	2022	All counties in SC		2	68818	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7326	002	0	1	04	01	H7326_002_0	5	1					0	08/10/2021	2022.01	08/10/2021 07:41:05 PM Eastern Daylight Time	08/04/2021 01:27:33 AM Eastern Daylight Time	07/30/2021 01:45:56 PM Eastern Daylight Time			08/11/2021 02:50:06 PM Eastern Daylight Time	WELLCARE OF SOUTH CAROLINA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Low Premium Open (PPO)	01	04		1			H7326	002	0	2022	All counties in SC		2	6380	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7326	003	0	1	04	01	H7326_003_0	5	1					0	08/11/2021	2022.01	08/11/2021 11:51:56 AM Eastern Daylight Time	08/04/2021 01:27:59 AM Eastern Daylight Time	07/30/2021 01:46:16 PM Eastern Daylight Time			08/11/2021 02:50:06 PM Eastern Daylight Time	WELLCARE OF SOUTH CAROLINA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Giveback Open (PPO)	01	04		1			H7326	003	0	2022	All counties in SC		2	212927	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(866)892-8340		(866)892-8340		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7330	001	0	1	01	01	H7330_001_0	8	1					1	08/10/2021	2022.01	08/10/2021 09:22:15 AM Central Daylight Time	08/05/2021 12:16:39 PM Central Daylight Time	08/05/2021 12:16:39 PM Central Daylight Time			08/10/2021 09:33:48 AM Central Daylight Time	ZING HEALTH, INC.	Zing Health	myzinghealth.com	Zing Choice IL (HMO)	01	01		1			H7330	001	0	2022	Cook, DeKalb, DuPage, Kankakee & Lake Counties		2		2			2						myzinghealth.com	myzinghealth.com	myzinghealth.com	(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7330	002	0	1	02	01	H7330_002_0	8	1					1	08/10/2021	2022.01	08/10/2021 09:22:03 AM Central Daylight Time	08/05/2021 12:16:39 PM Central Daylight Time	08/05/2021 12:16:39 PM Central Daylight Time			08/10/2021 09:33:48 AM Central Daylight Time	ZING HEALTH, INC.	Zing Health	myzinghealth.com	Zing Open Access IL (HMO-POS)	01	02		1			H7330	002	0	2022	Cook, DeKalb, DuPage, Kankakee & Lake Counties		2		2			2						myzinghealth.com	myzinghealth.com	myzinghealth.com	(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7330	003	0	1	01	01	H7330_003_0	8	1		1			1	08/10/2021	2022.01	08/10/2021 09:22:45 AM Central Daylight Time	08/05/2021 12:16:39 PM Central Daylight Time	08/05/2021 12:16:40 PM Central Daylight Time			08/10/2021 09:33:48 AM Central Daylight Time	ZING HEALTH, INC.	Zing Health	myzinghealth.com	Zing Essential Wellness IL (HMO C-SNP)	01	01		1			H7330	003	0	2022	DeKalb, DuPage, Kankakee & Lake Counties		2		2			1	4			00000000000000000010		myzinghealth.com	myzinghealth.com	myzinghealth.com	(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7330	004	0	1	02	01	H7330_004_0	9	1					1	08/17/2021	2022.01	08/17/2021 11:19:59 AM Central Daylight Time	08/05/2021 12:16:40 PM Central Daylight Time	08/05/2021 12:16:40 PM Central Daylight Time			08/17/2021 11:28:42 AM Central Daylight Time	ZING HEALTH, INC.	Zing Health	myzinghealth.com	Zing Signature Care (HMO-POS)	01	02		1			H7330	004	0	2022	Cook County		2		2			2						myzinghealth.com	myzinghealth.com	myzinghealth.com	(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7330	801	0	1	01	01	H7330_801_0	6	1						07/14/2021	2022.01	07/14/2021 01:04:59 PM Central Daylight Time					07/14/2021 01:13:17 PM Central Daylight Time	ZING HEALTH, INC.	Zing Health	myzinghealth.com	Zing EGWP CY (HMO)	01	01		1			H7330	801	0	2022	Cook, DeKalb, DuPage, Kankakee & Lake Counties		1	12000	2			2						myzinghealth.com	myzinghealth.com	myzinghealth.com	(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7330	802	0	1	01	01	H7330_802_0	6	1						07/14/2021	2022.01	07/14/2021 01:05:18 PM Central Daylight Time					07/14/2021 01:13:17 PM Central Daylight Time	ZING HEALTH, INC.	Zing Health	myzinghealth.com	Zing EGWP NCY (HMO)	01	01		1			H7330	802	0	2022	Cook, DeKalb, DuPage, Kankakee & Lake Counties		1	12000	2			2						myzinghealth.com	myzinghealth.com	myzinghealth.com	(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7330	803	0	1	01	01	H7330_803_0	6	1				0	0	07/14/2021	2022.01	07/14/2021 01:05:40 PM Central Daylight Time					07/14/2021 01:13:17 PM Central Daylight Time	ZING HEALTH, INC.	Zing Health	myzinghealth.com	Zing EGWP MA Only CY (HMO)	01	01		1			H7330	803	0	2022	Cook, DeKalb, DuPage, Kankakee & Lake Counties		1	12000	2			2						myzinghealth.com	myzinghealth.com	myzinghealth.com	(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H7330	804	0	1	01	01	H7330_804_0	6	1				0	0	07/14/2021	2022.01	07/14/2021 01:06:03 PM Central Daylight Time					07/14/2021 01:13:17 PM Central Daylight Time	ZING HEALTH, INC.	Zing Health	myzinghealth.com	Zing EGWP MA Only NCY (HMO)	01	01		1			H7330	804	0	2022	Cook, DeKalb, DuPage, Kankakee & Lake Counties		1	12000	2			2						myzinghealth.com	myzinghealth.com	myzinghealth.com	(866)946-4458		(866)946-4458		(866)946-4458		(866)946-4458										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H7360	001	0	1	04	01	H7360_001_0	4	1					0	08/02/2021	2022.01	08/02/2021 09:25:58 PM Eastern Daylight Time	08/04/2021 01:28:27 AM Eastern Daylight Time	07/30/2021 01:46:36 PM Eastern Daylight Time			08/04/2021 11:49:10 PM Eastern Daylight Time	HEALTH NET OF CALIFORNIA, INC.	Health Net	www.wellcare.com/healthnetCA	Wellcare No Premium Open (PPO)	01	04		1			H7360	001	0	2022	Select counties in CA		2	2086	2			2						www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	www.wellcare.com/healthnetCA	(800)275-4737		(800)275-4737		(866)277-6583		(866)277-6583		(800)275-4737		(800)275-4737		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7379	801	0	1	04	01	H7379_801_0	4	1						05/26/2021	2022.01	05/26/2021 01:57:03 PM Eastern Daylight Time					06/06/2021 01:01:33 PM Eastern Daylight Time	CAREFIRST ADVANTAGE PPO, INC.	CareFirst BlueCross BlueShield Medicare Advantage	www.carefirst.com/medicare	CareFirst BlueCross BlueShield Group Advantage (PPO)	01	04		1			H7379	801	0	2022	United States of America		1	36000	2			2						www.carefirst.com/medicare	www.carefirst.com/medicare	www.carefirst.com/medicare	(855)290-5744		(855)290-5744		(855)290-5744		(855)290-5744		(888)970-0917		(888)970-0917		(888)970-0917		(888)970-0917		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;11c;15;16b;	2		1									
H7379	802	0	1	04	01	H7379_802_0	4	1				0	0	05/26/2021	2022.01	05/26/2021 01:58:50 PM Eastern Daylight Time					06/06/2021 01:01:33 PM Eastern Daylight Time	CAREFIRST ADVANTAGE PPO, INC.	CareFirst BlueCross BlueShield Medicare Advantage	www.carefirst.com/medicare	CareFirst BlueCross BlueShield Group Advantage (PPO)	01	04		1			H7379	802	0	2022	50 United States, DC, and Puerto Rico		1	30000	2			2						www.carefirst.com/medicare	www.carefirst.com/medicare	www.carefirst.com/medicare	(855)290-5744		(855)290-5744		(855)290-5744		(855)290-5744										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;11c;15;16b;	2		1									
H7379	803	0	1	04	01	H7379_803_0	4	1						05/04/2021	2022.01	05/04/2021 08:08:26 AM Eastern Daylight Time					06/06/2021 01:01:33 PM Eastern Daylight Time	CAREFIRST ADVANTAGE PPO, INC.	CareFirst BlueCross BlueShield Medicare Advantage	www.carefirst.com/medicare	CareFirst BlueCross BlueShield Group Advantage (PPO)	01	04		1			H7379	803	0	2022	50 United States, DC, and Puerto Rico		1	10000	2			2						www.carefirst.com/medicare	www.carefirst.com/medicare	www.carefirst.com/medicare	(855)290-5744		(855)290-5744		(855)290-5744		(855)290-5744		(888)970-0917		(888)970-0917		(888)970-0917		(888)970-0917		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;11c;15;16b;	2		1									
H7379	804	0	1	04	01	H7379_804_0	4	1				0	0	05/04/2021	2022.01	05/04/2021 08:08:33 AM Eastern Daylight Time					06/06/2021 01:01:33 PM Eastern Daylight Time	CAREFIRST ADVANTAGE PPO, INC.	CareFirst BlueCross BlueShield Medicare Advantage	www.carefirst.com/medicare	CareFirst BlueCross BlueShield Group Advantage (PPO)	01	04		1			H7379	804	0	2022	50 United States, DC, and Puerto Rico		1	1000	2			2						www.carefirst.com/medicare	www.carefirst.com/medicare	www.carefirst.com/medicare	(855)290-5744		(855)290-5744		(855)290-5744		(855)290-5744										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;11c;15;16b;	2		1									
H7389	001	0	1	01	01	H7389_001_0	5	1					0	08/02/2021	2022.01	08/02/2021 05:39:51 PM Central Daylight Time	08/02/2021 04:01:46 PM Central Daylight Time	07/30/2021 12:03:03 PM Central Daylight Time			08/04/2021 10:59:49 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H7389	001	0	2022	Salt Lake City Area		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cigna.com	(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101		(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7389	002	0	1	01	01	H7389_002_0	4	1					0	08/03/2021	2022.01	08/03/2021 10:24:43 AM Central Daylight Time	08/02/2021 05:01:29 PM Central Daylight Time	07/30/2021 12:03:27 PM Central Daylight Time			08/04/2021 10:59:49 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H7389	002	0	2022	Portland		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cigna.com	(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101		(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7389	003	0	1	01	01	H7389_003_0	4	1					0	08/02/2021	2022.01	08/02/2021 08:16:31 PM Central Daylight Time	08/03/2021 09:44:27 AM Central Daylight Time	07/30/2021 12:03:51 PM Central Daylight Time			08/04/2021 10:59:49 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H7389	003	0	2022	St. Louis Area		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cigna.com	(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101		(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7389	004	0	1	01	01	H7389_004_0	4	1					0	08/02/2021	2022.01	08/02/2021 08:17:04 PM Central Daylight Time	08/03/2021 09:45:26 AM Central Daylight Time	07/30/2021 12:04:15 PM Central Daylight Time			08/04/2021 10:59:49 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H7389	004	0	2022	Southern IL		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cigna.com	(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101		(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7389	005	0	1	01	01	H7389_005_0	4	1					0	06/04/2021	2022.01	06/04/2021 01:32:54 PM Central Daylight Time	08/03/2021 09:46:49 AM Central Daylight Time	07/30/2021 12:04:38 PM Central Daylight Time			08/04/2021 10:59:49 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Preferred Plus Medicare (HMO)	01	01		1			H7389	005	0	2022	Southern IL		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cigna.com	(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101		(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7399	001	0	1	01	01	H7399_001_0	4	1					0	08/02/2021	2022.01	08/02/2021 10:18:32 AM Central Daylight Time	08/04/2021 12:28:56 AM Central Daylight Time	07/30/2021 12:46:56 PM Central Daylight Time			08/04/2021 10:17:29 PM Central Daylight Time	CENTENE VENTURE COMPANY ILLINOIS	Ascension Complete	ascensioncomplete.com	Ascension Complete AMITA Health Reward (HMO)	01	01		1			H7399	001	0	2022	Cook, DuPage, Kankakee, Kane and Will Counties		2	1389	2			2						ascensioncomplete.com/findadoctor	ascensioncomplete.com/formulary	ascensioncomplete.com/findadoctor	(833)293-5966		(833)293-5966		(877)831-9411		(877)831-9411		(833)293-5966		(833)293-5966		(877)831-9411		(877)831-9411		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7399	002	0	1	01	01	H7399_002_0	4	1					0	08/02/2021	2022.01	08/02/2021 10:19:03 AM Central Daylight Time	08/04/2021 12:29:24 AM Central Daylight Time	07/30/2021 12:47:16 PM Central Daylight Time			08/04/2021 10:17:29 PM Central Daylight Time	CENTENE VENTURE COMPANY ILLINOIS	Ascension Complete	ascensioncomplete.com	Ascension Complete AMITA Health Secure (HMO)	01	01		1			H7399	002	0	2022	Cook, DuPage, Kankakee, Kane and Will Counties		2	12667	2			2						ascensioncomplete.com/findadoctor	ascensioncomplete.com/formulary	ascensioncomplete.com/findadoctor	(833)293-5966		(833)293-5966		(877)831-9411		(877)831-9411		(833)293-5966		(833)293-5966		(877)831-9411		(877)831-9411		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7404	001	0	1	04	01	H7404_001_0	6	1					1	08/04/2021	2022.01	08/04/2021 03:02:28 PM Central Daylight Time	08/03/2021 11:44:32 AM Central Daylight Time	07/29/2021 09:13:32 PM Central Daylight Time			08/05/2021 11:36:15 AM Central Daylight Time	PACIFICARE LIFE ASSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Headwaters (PPO)	01	04		1			H7404	001	0	2022	Select Counties in Twin Cities Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(844)867-3487		(844)867-3487		(800)555-5757		(800)555-5757		(844)867-3487		(844)867-3487		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						1	01	7a;7d;7g;9a1;9a2;9b;	
H7404	002	0	1	04	01	H7404_002_0	3	1					1	08/04/2021	2022.01	08/04/2021 03:03:39 PM Central Daylight Time	08/03/2021 11:45:03 AM Central Daylight Time	07/29/2021 09:13:48 PM Central Daylight Time			08/05/2021 11:36:15 AM Central Daylight Time	PACIFICARE LIFE ASSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Lakeshore (PPO)	01	04		1			H7404	002	0	2022	Select Counties in Twin Cities Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(844)867-3487		(844)867-3487		(800)555-5757		(800)555-5757		(844)867-3487		(844)867-3487		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						1	01	7a;7d;7g;9a1;9a2;9b;	
H7404	004	0	1	04	01	H7404_004_0	4	1					0	08/04/2021	2022.01	08/04/2021 03:04:47 PM Central Daylight Time	08/03/2021 11:45:33 AM Central Daylight Time	07/29/2021 09:14:04 PM Central Daylight Time			08/05/2021 11:36:15 AM Central Daylight Time	PACIFICARE LIFE ASSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP Medicare Advantage Premier (PPO)	01	04		1			H7404	004	0	2022	Select Counties in Minnesota and North Dakota		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(844)876-6177		(844)876-6177		(800)555-5757		(800)555-5757		(844)876-6177		(844)876-6177		(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	3	1					1	08/04/2021	2022.01	08/04/2021 03:06:02 PM Central Daylight Time	08/03/2021 11:46:03 AM Central Daylight Time	07/29/2021 09:14:19 PM Central Daylight Time			08/05/2021 11:36:15 AM Central Daylight Time	PACIFICARE LIFE ASSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Headwaters (PPO)	01	04		1			H7404	005	0	2022	Select Counties in Minnesota and North Dakota		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(844)867-3487		(844)867-3487		(800)555-5757		(800)555-5757		(844)867-3487		(844)867-3487		(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	3	1					1	08/04/2021	2022.01	08/04/2021 03:07:15 PM Central Daylight Time	08/03/2021 11:46:33 AM Central Daylight Time	07/29/2021 09:14:35 PM Central Daylight Time			08/05/2021 11:36:15 AM Central Daylight Time	PACIFICARE LIFE ASSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Lakeshore (PPO)	01	04		1			H7404	006	0	2022	Select Counties in Minnesota and North Dakota		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(844)867-3487		(844)867-3487		(800)555-5757		(800)555-5757		(844)867-3487		(844)867-3487		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7404	011	0	1	04	01	H7404_011_0	3	1					1	08/04/2021	2022.01	08/04/2021 03:08:32 PM Central Daylight Time	08/03/2021 11:47:04 AM Central Daylight Time	07/29/2021 09:14:50 PM Central Daylight Time			08/05/2021 11:36:15 AM Central Daylight Time	PACIFICARE LIFE ASSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Headwaters (PPO)	01	04		1			H7404	011	0	2022	Select Counties in MN		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(844)867-3487		(844)867-3487		(800)555-5757		(800)555-5757		(844)867-3487		(844)867-3487		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7404	012	0	1	04	01	H7404_012_0	3	1					1	08/04/2021	2022.01	08/04/2021 03:09:41 PM Central Daylight Time	08/03/2021 11:47:46 AM Central Daylight Time	07/29/2021 09:15:06 PM Central Daylight Time			08/05/2021 11:36:15 AM Central Daylight Time	PACIFICARE LIFE ASSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Lakeshore (PPO)	01	04		1			H7404	012	0	2022	Select Counties in MN		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(844)867-3487		(844)867-3487		(800)555-5757		(800)555-5757		(844)867-3487		(844)867-3487		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7404	014	0	1	04	01	H7404_014_0	3	1					1	08/04/2021	2022.01	08/04/2021 03:11:40 PM Central Daylight Time	08/03/2021 11:48:16 AM Central Daylight Time	07/29/2021 09:15:22 PM Central Daylight Time			08/05/2021 11:36:15 AM Central Daylight Time	PACIFICARE LIFE ASSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Riverbank (PPO)	01	04		1			H7404	014	0	2022	Select Counties in Twin Cities Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(844)867-3487		(844)867-3487		(800)555-5757		(800)555-5757		(844)867-3487		(844)867-3487		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						1	01	7d;7g;9a1;9a2;9b;	
H7404	015	0	1	04	01	H7404_015_0	2	1				0	0	07/15/2021	2022.01	07/15/2021 02:36:03 PM Central Daylight Time	06/03/2021 03:43:45 PM Central Daylight Time				07/16/2021 10:38:48 AM Central Daylight Time	PACIFICARE LIFE ASSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP Medicare Advantage Patriot (PPO)	01	04		1			H7404	015	0	2022	Select Counties in Minnesota		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(844)867-3487		(844)867-3487		(800)555-5757		(800)555-5757										(711)-		(711)-		(711)-		(711)-										2					2						2			
H7404	018	0	1	04	01	H7404_018_0	3	1					1	08/04/2021	2022.01	08/04/2021 02:16:24 PM Central Daylight Time	08/03/2021 11:48:47 AM Central Daylight Time	07/29/2021 09:15:37 PM Central Daylight Time			08/04/2021 10:05:00 PM Central Daylight Time	PACIFICARE LIFE ASSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H7404	018	0	2022	Clark and Nye counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(844)867-3487		(844)867-3487		(800)555-5757		(800)555-5757		(844)867-3487		(844)867-3487		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7404	019	0	1	04	01	H7404_019_0	2	1				0	0	07/15/2021	2022.01	07/15/2021 03:42:57 PM Central Daylight Time	06/03/2021 03:44:30 PM Central Daylight Time				07/16/2021 01:47:37 PM Central Daylight Time	PACIFICARE LIFE ASSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (PPO)	01	04		1			H7404	019	0	2022	Clark and Nye counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(844)867-3487		(844)867-3487		(800)555-5757		(800)555-5757										(711)-		(711)-		(711)-		(711)-										2					2						2			
H7404	020	0	1	04	01	H7404_020_0	3	1					1	08/04/2021	2022.01	08/04/2021 02:20:45 PM Central Daylight Time	08/03/2021 11:49:18 AM Central Daylight Time	07/29/2021 09:15:52 PM Central Daylight Time			08/04/2021 10:05:00 PM Central Daylight Time	PACIFICARE LIFE ASSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Walgreens Plan 2 (PPO)	01	04		1			H7404	020	0	2022	Clark and Nye counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(844)867-3487		(844)867-3487		(800)555-5757		(800)555-5757		(844)867-3487		(844)867-3487		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7404	021	0	1	04	01	H7404_021_0	3	1					1	08/04/2021	2022.01	08/04/2021 02:28:28 PM Central Daylight Time	08/03/2021 11:49:49 AM Central Daylight Time	07/29/2021 09:16:07 PM Central Daylight Time			08/04/2021 10:05:00 PM Central Daylight Time	PACIFICARE LIFE ASSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H7404	021	0	2022	Select counties in Northern Utah		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(844)867-3487		(844)867-3487		(800)555-5757		(800)555-5757		(844)867-3487		(844)867-3487		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7404	022	0	1	04	01	H7404_022_0	3	1					1	08/04/2021	2022.01	08/04/2021 03:13:57 PM Central Daylight Time	08/03/2021 11:50:19 AM Central Daylight Time	07/29/2021 09:16:23 PM Central Daylight Time			08/05/2021 11:36:15 AM Central Daylight Time	PACIFICARE LIFE ASSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Riverbank (PPO)	01	04		1			H7404	022	0	2022	Select Counties in Minnesota and North Dakota		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(844)867-3487		(844)867-3487		(800)555-5757		(800)555-5757		(844)867-3487		(844)867-3487		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7404	023	0	1	04	01	H7404_023_0	3	1					1	08/04/2021	2022.01	08/04/2021 03:15:08 PM Central Daylight Time	08/03/2021 11:50:50 AM Central Daylight Time	07/29/2021 09:16:38 PM Central Daylight Time			08/05/2021 11:36:15 AM Central Daylight Time	PACIFICARE LIFE ASSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Riverbank (PPO)	01	04		1			H7404	023	0	2022	Select Counties in Minnesota and North Dakota		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(844)867-3487		(844)867-3487		(800)555-5757		(800)555-5757		(844)867-3487		(844)867-3487		(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	2	1						07/27/2021	2022.01	07/27/2021 03:54:56 PM Eastern Daylight Time					07/27/2021 04:01:25 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	2022	Counties: NOR, PLY, BRI, MID, SUF, WOR		2	48092	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	005	0	1	01	01	H7445_005_0	3	1					1	08/04/2021	2022.01	08/04/2021 03:55:49 PM Central Daylight Time	08/03/2021 01:14:37 PM Central Daylight Time	07/29/2021 09:16:53 PM Central Daylight Time			08/05/2021 04:36:52 PM Central Daylight Time	UNITEDHEALTHCARE OF ILLINOIS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO)	01	01		1			H7445	005	0	2022	Kent, New Castle, and Sussex 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			
H7445	006	0	1	01	01	H7445_006_0	2	1				0	0	07/15/2021	2022.01	07/15/2021 12:03:01 PM Central Daylight Time	06/03/2021 03:27:14 PM Central Daylight Time				07/16/2021 02:02:28 PM Central Daylight Time	UNITEDHEALTHCARE OF ILLINOIS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (HMO)	01	01		1			H7445	006	0	2022	Kent, New Castle, and Sussex 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			
H7464	001	0	1	01	01	H7464_001_0	4	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 10:50:06 AM Central Daylight Time	08/03/2021 12:23:16 PM Central Daylight Time	07/29/2021 09:17:08 PM Central Daylight Time			08/04/2021 04:51:30 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO D-SNP)	01	01		1			H7464	001	0	2022	Select Counties in 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	2			
H7464	005	0	1	01	01	H7464_005_0	4	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 10:51:36 AM Central Daylight Time	08/03/2021 12:23:44 PM Central Daylight Time	07/29/2021 09:17:24 PM Central Daylight Time			08/04/2021 04:51:30 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete ONE (HMO D-SNP)	01	01		1			H7464	005	0	2022	Select Counties in 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	2			
H7464	006	0	1	01	01	H7464_006_0	4	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 10:53:19 AM Central Daylight Time	08/03/2021 12:24:11 PM Central Daylight Time	07/29/2021 09:17:39 PM Central Daylight Time			08/04/2021 04:51:30 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Plan 2 (HMO D-SNP)	01	01		1			H7464	006	0	2022	Select Counties in 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	2			
H7464	007	0	1	01	01	H7464_007_0	4	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 10:55:05 AM Central Daylight Time	08/03/2021 12:24:40 PM Central Daylight Time	07/29/2021 09:17:56 PM Central Daylight Time			08/04/2021 04:51:30 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete ONE Plus (HMO D-SNP)	01	01		1			H7464	007	0	2022	Select Counties in 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	2			
H7464	008	1	1	02	01	H7464_008_1	4	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 10:58:37 AM Central Daylight Time	08/03/2021 12:25:08 PM Central Daylight Time	07/29/2021 09:18:12 PM Central Daylight Time			08/04/2021 04:51:30 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Plan 1 (HMO-POS D-SNP)	01	02		1			H7464	008	1	2022	Select counties in Maryland	Greater Maryland	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			
H7464	008	2	1	02	01	H7464_008_2	4	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 11:21:59 AM Central Daylight Time	08/03/2021 12:25:35 PM Central Daylight Time	07/29/2021 09:18:28 PM Central Daylight Time			08/04/2021 04:51:30 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Plan 1 (HMO-POS D-SNP)	01	02		1			H7464	008	2	2022	Select counties in Maryland	Baltimore Metro Area	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			
H7469	001	0	1	20	08	H7469_001_0	2	1						06/03/2021	2022.01	06/03/2021 11:37:15 AM Eastern Daylight Time		06/01/2021 06:40:06 AM Eastern Daylight Time			06/04/2021 02:37:36 PM Eastern Daylight Time	PACE PARTNERS OF NORTHEAST FLORIDA, INC.	PACE Partners of Northeast Florida	thepaceplace.org	PACE Partners of Northeast Florida (PACE)	08	20		1			H7469	001	0	2022	Duval, Clay, Nassau and St. Johns Counties		2		2			2						www.thepaceplace.net	PACE Partners will not have a formulary.												(904)428-0400				(904)428-0400												(800)955-8771				(800)955-8771																
H7469	002	0	1	20	08	H7469_002_0	1	1						06/02/2021	2022.01	06/02/2021 03:22:54 PM Eastern Daylight Time		06/01/2021 06:41:34 AM Eastern Daylight Time			06/04/2021 11:39:54 AM Eastern Daylight Time	PACE PARTNERS OF NORTHEAST FLORIDA, INC.	PACE Partners of Northeast Florida	thepaceplace.org	PACE Partners of Northeast Florida MO (PACE)	08	20		1			H7469	002	0	2022	Medicare Only		2		2			2						www.thepaceplace.net	PACE Partners will not have a formulary.												(904)428-0400				(904)428-0400												(800)955-8771				(800)955-8771																
H7501	001	0	1	20	08	H7501_001_0	1	1						05/28/2021	2022.01	05/28/2021 12:35:37 PM Pacific Daylight Time		05/28/2021 12:37:35 PM Pacific Daylight Time			05/28/2021 12:38:53 PM Pacific Daylight Time	ORANGE COUNTY HEALTH AUTHORITY	CalOptima PACE	www.caloptima.org/PACE	CalOptima PACE (PACE)	08	20		1			H7501	001	0	2022	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	1	1						05/28/2021	2022.01	05/28/2021 12:36:10 PM Pacific Daylight Time		05/28/2021 12:37:40 PM Pacific Daylight Time			05/28/2021 12:38:53 PM Pacific Daylight Time	ORANGE COUNTY HEALTH AUTHORITY	CalOptima PACE	www.caloptima.org/PACE	CalOptima PACE (PACE)	08	20		1			H7501	002	0	2022	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																
H7511	001	0	1	01	01	H7511_001_0	10	1		1			0	07/15/2021	2022.01	07/15/2021 12:20:23 PM Central Daylight Time	08/04/2021 12:22:28 PM Central Daylight Time	08/02/2021 12:02:24 PM Central Daylight Time			08/05/2021 11:18:13 AM Central Daylight Time	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Great Plains Medicare Advantage	www.greatplainsmedicareadvantage.com	Great Plains Medicare Advantage (HMO I-SNP)	01	01		1			H7511	001	0	2022	Nebraska (partial)		2		2			1	1	3				www.greatplainsmedicareadvantage.com	www.greatplainsmedicareadvantage.com	www.greatplainsmedicareadvantage.com	(844)637-4760		(844)637-4760		(844)637-4760		(844)637-4760		(800)498-5428		(520)918-1254		(800)498-5428		(520)918-1254		(711)-		(711)-		(711)-		(711)-		(800)498-5428		(711)-		(800)498-5428		(711)-		2					2					2	2			
H7511	002	0	1	01	01	H7511_002_0	10	1		1			0	07/15/2021	2022.01	07/15/2021 12:20:37 PM Central Daylight Time	08/04/2021 04:25:57 PM Central Daylight Time	08/02/2021 11:54:16 AM Central Daylight Time			08/05/2021 11:18:13 AM Central Daylight Time	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Great Plains Medicare Advantage	www.greatplainsmedicareadvantage.com	Great Plains Medicare Advantage Gold (HMO I-SNP)	01	01		1			H7511	002	0	2022	Nebraska (partial)		2		2			1	1	3				www.greatplainsmedicareadvantage.com	www.greatplainsmedicareadvantage.com	www.greatplainsmedicareadvantage.com	(844)637-4760		(844)637-4760		(844)637-4760		(844)637-4760		(800)498-5428		(520)918-1254		(800)498-5428		(520)918-1254		(711)-		(711)-		(711)-		(711)-		(800)498-5428		(711)-		(800)498-5428		(711)-		2					2					2	2			
H7512	001	0	1	04	01	H7512_001_0	4	1					0	08/02/2021	2022.01	08/02/2021 04:13:15 PM Central Daylight Time	08/04/2021 12:29:53 AM Central Daylight Time	07/30/2021 12:47:36 PM Central Daylight Time			08/04/2021 10:17:29 PM Central Daylight Time	CENTENE VENTURE COMPANY MICHIGAN	Ascension Complete	ascensioncomplete.com	Ascension Complete Michigan Access Plus (PPO)	01	04		1			H7512	001	0	2022	Detroit Area Counties		2	3445	2			2						ascensioncomplete.com/findadoctor	ascensioncomplete.com/formulary	ascensioncomplete.com/findadoctor	(833)431-1356		(833)431-1356		(844)578-1928		(844)578-1928		(833)431-1356		(833)431-1356		(844)578-1928		(844)578-1928		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7512	002	0	1	04	01	H7512_002_0	4	1					0	08/02/2021	2022.01	08/02/2021 10:22:52 AM Central Daylight Time	08/04/2021 12:30:21 AM Central Daylight Time	07/30/2021 12:47:56 PM Central Daylight Time			08/04/2021 10:17:29 PM Central Daylight Time	CENTENE VENTURE COMPANY MICHIGAN	Ascension Complete	ascensioncomplete.com	Ascension Complete Michigan Access (PPO)	01	04		1			H7512	002	0	2022	Detroit Area Counties		2	3445	2			2						ascensioncomplete.com/findadoctor	ascensioncomplete.com/formulary	ascensioncomplete.com/findadoctor	(833)431-1356		(833)431-1356		(844)578-1928		(844)578-1928		(833)431-1356		(833)431-1356		(844)578-1928		(844)578-1928		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7512	003	0	1	04	01	H7512_003_0	4	1					0	08/02/2021	2022.01	08/02/2021 10:24:48 AM Central Daylight Time	08/04/2021 12:30:49 AM Central Daylight Time	07/30/2021 12:48:16 PM Central Daylight Time			08/04/2021 10:17:29 PM Central Daylight Time	CENTENE VENTURE COMPANY MICHIGAN	Ascension Complete	ascensioncomplete.com	Ascension Complete Michigan Access Plus (PPO)	01	04		1			H7512	003	0	2022	Genesee, Iosco,Kalamazoo, Saginaw		2	1203	2			2						ascensioncomplete.com/findadoctor	ascensioncomplete.com/formulary	ascensioncomplete.com/findadoctor	(833)431-1356		(833)431-1356		(844)578-1928		(844)578-1928		(833)431-1356		(833)431-1356		(844)578-1928		(844)578-1928		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7512	004	0	1	04	01	H7512_004_0	4	1					0	08/02/2021	2022.01	08/02/2021 10:26:36 AM Central Daylight Time	08/04/2021 12:31:19 AM Central Daylight Time	07/30/2021 12:48:40 PM Central Daylight Time			08/04/2021 10:17:29 PM Central Daylight Time	CENTENE VENTURE COMPANY MICHIGAN	Ascension Complete	ascensioncomplete.com	Ascension Complete Michigan Access (PPO)	01	04		1			H7512	004	0	2022	Genesee, Iosco,Kalamazoo, Saginaw		2	1203	2			2						ascensioncomplete.com/findadoctor	ascensioncomplete.com/formulary	ascensioncomplete.com/findadoctor	(833)431-1356		(833)431-1356		(844)578-1928		(844)578-1928		(833)431-1356		(833)431-1356		(844)578-1928		(844)578-1928		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7512	801	0	1	04	01	H7512_801_0	2	1						05/04/2021	2022.01	05/04/2021 08:44:43 AM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	CENTENE VENTURE COMPANY MICHIGAN	Ascension Complete	https://www.ascensioncomplete.com	Ascension Complete Group Medicare Advantage (PPO)	01	04		1			H7512	801	0	2022	Detroit Area Counties		1	100	2			2						In development	In development	https://www.ascensioncomplete.com/findadoctor	(855)848-6940		(855)848-6940		(844)942-0039		(844)942-0039		(855)848-6940		(855)848-6940		(844)942-0039		(844)942-0039		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H7512	802	0	1	04	01	H7512_802_0	2	1				0	0	05/04/2021	2022.01	05/04/2021 08:45:01 AM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	CENTENE VENTURE COMPANY MICHIGAN	Ascension Complete	https://www.ascensioncomplete.com	Ascension Complete Group Medicare Advantage (PPO)	01	04		1			H7512	802	0	2022	Detroit Area Counties		1	100	2			2						In development	In development	https://www.ascensioncomplete.com/findadoctor	(855)848-6940		(855)848-6940		(844)942-0039		(844)942-0039										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H7512	803	0	1	04	01	H7512_803_0	2	1						05/04/2021	2022.01	05/04/2021 08:45:17 AM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	CENTENE VENTURE COMPANY MICHIGAN	Ascension Complete	https://www.ascensioncomplete.com	Ascension Complete Group Medicare Advantage (PPO)	01	04		1			H7512	803	0	2022	Detroit Area Counties		1	100	2			2						In development	In development	https://www.ascensioncomplete.com/findadoctor	(855)848-6940		(855)848-6940		(844)942-0039		(844)942-0039		(855)848-6940		(855)848-6940		(844)942-0039		(844)942-0039		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H7518	001	0	1	04	01	H7518_001_0	4	1					0	08/02/2021	2022.01	08/02/2021 04:03:08 PM Eastern Daylight Time	08/04/2021 01:31:48 AM Eastern Daylight Time	07/30/2021 01:49:00 PM Eastern Daylight Time			08/04/2021 11:43:06 PM Eastern Daylight Time	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Wellcare	www.wellcare.com/medicare	Wellcare No Premium Open (PPO)	01	04		1			H7518	001	0	2022	Select counties in MO		2	7776	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7518	002	0	1	04	01	H7518_002_0	4	1				0	0	06/02/2021	2022.01	06/02/2021 02:24:42 PM Pacific Daylight Time	06/06/2021 12:56:35 PM Eastern Daylight Time				07/19/2021 05:24:36 PM Eastern Daylight Time	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Wellcare	www.wellcare.com/medicare	Wellcare Patriot Giveback Open (PPO)	01	04		1			H7518	002	0	2022	Select counties in MO		2	5836	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175										(711)-		(711)-		(711)-		(711)-										2					2						2			
H7518	003	0	1	04	01	H7518_003_0	4	1	2	1			0	07/18/2021	2022.01	07/18/2021 06:35:33 PM Eastern Daylight Time	08/04/2021 01:32:45 AM Eastern Daylight Time	07/30/2021 01:49:20 PM Eastern Daylight Time			08/04/2021 11:43:06 PM Eastern Daylight Time	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Wellcare	www.wellcare.com/medicare	Wellcare Dual Access Open (PPO D-SNP)	01	04		1			H7518	003	0	2022	Select counties in MO		2	1741	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7518	004	0	1	04	01	H7518_004_0	4	1					0	08/02/2021	2022.01	08/02/2021 04:06:35 PM Eastern Daylight Time	08/04/2021 01:33:15 AM Eastern Daylight Time	07/30/2021 01:49:40 PM Eastern Daylight Time			08/04/2021 11:43:06 PM Eastern Daylight Time	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Wellcare	www.wellcare.com/medicare	Wellcare Low Premium Open (PPO)	01	04		1			H7518	004	0	2022	Select Counties in MO		2	2803	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7518	005	0	1	04	01	H7518_005_0	4	1					0	08/02/2021	2022.01	08/02/2021 04:10:23 PM Eastern Daylight Time	08/04/2021 01:33:44 AM Eastern Daylight Time	07/30/2021 01:50:00 PM Eastern Daylight Time			08/04/2021 11:43:06 PM Eastern Daylight Time	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Wellcare	www.wellcare.com/medicare	Wellcare Community Assist (PPO)	01	04		1			H7518	005	0	2022	Select Counties in MO		2	0	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7522	801	0	1	04	01	H7522_801_0	3	1						06/04/2021	2022.01	06/04/2021 06:10:34 PM SA Western Standard Time					06/07/2021 08:11:08 PM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Ms	www.mmmpr.com	MMM Advantage Group A Calendar (PPO)	01	04		1			H7522	801	0	2022	Puerto Rico		1	13813	2			2						www.mmmpr.com	www.mmmpr.com	www.mmmpr.com	(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		1	1	1a;1b;2;5;6;7c;7i;7k;8b1;8b2;9a1;9a2;9b;9c;11a;11b;11c;	2		1									
H7522	802	0	1	04	01	H7522_802_0	3	1						06/04/2021	2022.01	06/04/2021 06:09:41 PM SA Western Standard Time					06/07/2021 08:11:08 PM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Ms	www.mmmpr.com	MMM Advantage Group B Calendar (PPO)	01	04		1			H7522	802	0	2022	Puerto Rico		1	0	2			2						www.mmmpr.com	www.mmmpr.com	www.mmmpr.com	(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		1	1	1a;1b;2;5;6;7c;7i;7k;8b1;8b2;9a1;9a2;9b;9c;11a;11b;11c;	2		1									
H7522	804	0	1	04	01	H7522_804_0	3	1						06/04/2021	2022.01	06/04/2021 06:09:25 PM SA Western Standard Time					06/07/2021 08:11:08 PM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Ms	www.mmmpr.com	MMM Advantage Group C Calendar (PPO)	01	04		1			H7522	804	0	2022	Puerto Rico		1	0	2			2						www.mmmpr.com	www.mmmpr.com	www.mmmpr.com	(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		1	1	1a;1b;2;5;6;7c;7i;7k;8b1;8b2;9a1;9a2;9b;9c;11a;11b;11c;	2		1									
H7522	805	0	1	04	01	H7522_805_0	3	1						06/04/2021	2022.01	06/04/2021 06:08:58 PM SA Western Standard Time					06/07/2021 08:11:08 PM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Ms	www.mmmpr.com	MMM Advantage Group D Calendar (PPO)	01	04		1			H7522	805	0	2022	Puerto Rico		1	0	2			2						www.mmmpr.com	www.mmmpr.com	www.mmmpr.com	(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		1	1	6;7c;7i;7k;8b1;8b2;9a1;9a2;9b;9c;11a;11b;11c;	2		1									
H7522	806	0	1	04	01	H7522_806_0	3	1						06/04/2021	2022.01	06/04/2021 06:09:13 PM SA Western Standard Time					06/07/2021 08:11:08 PM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Ms	www.mmmpr.com	MMM Advantage Group A Non-Calendar (PPO)	01	04		1			H7522	806	0	2022	Puerto Rico		1	0	2			2						www.mmmpr.com	www.mmmpr.com	www.mmmpr.com	(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		1	1	1a;1b;2;5;6;7c;7i;7k;8b1;8b2;9a1;9a2;9b;9c;11a;11b;11c;	2		1									
H7522	807	0	1	04	01	H7522_807_0	3	1						06/04/2021	2022.01	06/04/2021 06:08:39 PM SA Western Standard Time					06/07/2021 08:11:08 PM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Ms	www.mmmpr.com	MMM Advantage Group B Non-Calendar (PPO)	01	04		1			H7522	807	0	2022	Puerto Rico		1	0	2			2						www.mmmpr.com	www.mmmpr.com	www.mmmpr.com	(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		1	1	1a;1b;2;5;6;7c;7i;7k;8b1;8b2;9a1;9a2;9b;9c;11a;11b;11c;	2		1									
H7522	808	0	1	04	01	H7522_808_0	3	1						06/04/2021	2022.01	06/04/2021 06:08:24 PM SA Western Standard Time					06/07/2021 08:11:08 PM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Ms	www.mmmpr.com	MMM Advantage Group C Non-Calendar (PPO)	01	04		1			H7522	808	0	2022	Puerto Rico		1	0	2			2						www.mmmpr.com	www.mmmpr.com	www.mmmpr.com	(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		1	1	1a;1b;2;5;6;7c;7i;7k;8b1;8b2;9a1;9a2;9b;9c;11a;11b;11c;	2		1									
H7522	809	0	1	04	01	H7522_809_0	3	1						06/04/2021	2022.01	06/04/2021 06:03:47 PM SA Western Standard Time					06/07/2021 08:11:08 PM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Ms	www.mmmpr.com	MMM Advantage Group D Non-Calendar (PPO)	01	04		1			H7522	809	0	2022	Puerto Rico		1	0	2			2						www.mmmpr.com	www.mmmpr.com	www.mmmpr.com	(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		1	1	1a;1b;2;5;6;7c;7i;7k;8b1;8b2;9a1;9a2;9b;9c;11a;11b;11c;	2		1									
H7522	810	0	1	04	01	H7522_810_0	3	1						06/04/2021	2022.01	06/04/2021 06:07:50 PM SA Western Standard Time					06/07/2021 08:11:08 PM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Ms	www.mmmpr.com	MMM Advantage Group E Calendar (PPO)	01	04		1			H7522	810	0	2022	Puerto Rico		1	0	2			2						www.mmmpr.com	www.mmmpr.com	www.mmmpr.com	(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		1	1	1a;1b;2;5;6;7c;7i;7k;8b1;8b2;9a1;9a2;9b;9c;11a;11b;11c;	2		1									
H7522	811	0	1	04	01	H7522_811_0	3	1						06/04/2021	2022.01	06/04/2021 06:07:33 PM SA Western Standard Time					06/07/2021 08:11:08 PM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Ms	www.mmmpr.com	MMM Advantage Group E Non-Calendar (PPO)	01	04		1			H7522	811	0	2022	Puerto Rico		1	0	2			2						www.mmmpr.com	www.mmmpr.com	www.mmmpr.com	(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(866)333-5471		(787)620-2396		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		(877)522-0655		1	1	1a;1b;2;5;6;7c;7i;7k;8b1;8b2;9a1;9a2;9b;9c;11a;11b;11c;	2		1									
H7556	001	0	1	04	01	H7556_001_0	4	1					0	08/02/2021	2022.01	08/02/2021 10:29:06 AM Central Daylight Time	08/04/2021 12:34:15 AM Central Daylight Time	07/30/2021 12:50:20 PM Central Daylight Time			08/04/2021 10:17:29 PM Central Daylight Time	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Ascension Complete	ascensioncomplete.com	Ascension Complete St. Vincent's Access Plus (PPO)	01	04		1			H7556	001	0	2022	Birmingham & Surrounding  Counties in Alabama		2	703	2			2						ascensioncomplete.com/findadoctor	ascensioncomplete.com/formulary	ascensioncomplete.com/findadoctor	(833)623-0771		(833)623-0771		(844)578-1926		(844)578-1926		(833)623-0771		(833)623-0771		(844)578-1926		(844)578-1926		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7556	002	0	1	04	01	H7556_002_0	4	1					0	08/02/2021	2022.01	08/02/2021 10:30:48 AM Central Daylight Time	08/04/2021 12:34:47 AM Central Daylight Time	07/30/2021 12:50:40 PM Central Daylight Time			08/04/2021 10:17:29 PM Central Daylight Time	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Ascension Complete	ascensioncomplete.com	Ascension Complete St. Vincent's Access (PPO)	01	04		1			H7556	002	0	2022	Birmingham & Surrounding  Counties in Alabama		2	703	2			2						ascensioncomplete.com/findadoctor	ascensioncomplete.com/formulary	ascensioncomplete.com/findadoctor	(833)623-0771		(833)623-0771		(844)578-1926		(844)578-1926		(833)623-0771		(833)623-0771		(844)578-1926		(844)578-1926		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7556	003	0	1	04	01	H7556_003_0	4	1					0	08/02/2021	2022.01	08/02/2021 10:33:01 AM Central Daylight Time	08/04/2021 12:35:17 AM Central Daylight Time	07/30/2021 12:51:00 PM Central Daylight Time			08/04/2021 10:17:29 PM Central Daylight Time	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Ascension Complete	ascensioncomplete.com	Ascension Complete Providence Access Plus (PPO)	01	04		1			H7556	003	0	2022	Mobile area in Alabama		2	445	2			2						ascensioncomplete.com/findadoctor	ascensioncomplete.com/formulary	ascensioncomplete.com/findadoctor	(833)623-0771		(833)623-0771		(844)578-1926		(844)578-1926		(833)623-0771		(833)623-0771		(844)578-1926		(844)578-1926		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7556	004	0	1	04	01	H7556_004_0	4	1					0	08/02/2021	2022.01	08/02/2021 10:35:22 AM Central Daylight Time	08/04/2021 12:35:46 AM Central Daylight Time	07/30/2021 12:51:18 PM Central Daylight Time			08/04/2021 10:17:29 PM Central Daylight Time	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Ascension Complete	ascensioncomplete.com	Ascension Complete Providence Access (PPO)	01	04		1			H7556	004	0	2022	Mobile area in Alabama		2	445	2			2						ascensioncomplete.com/findadoctor	ascensioncomplete.com/formulary	ascensioncomplete.com/findadoctor	(833)623-0771		(833)623-0771		(844)578-1926		(844)578-1926		(833)623-0771		(833)623-0771		(844)578-1926		(844)578-1926		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7557	001	0	1	01	01	H7557_001_0	7	1		1			0	07/03/2021	2022.01	07/03/2021 01:21:51 AM Eastern Daylight Time	08/02/2021 04:07:55 PM Eastern Daylight Time	08/02/2021 12:51:47 PM Eastern Daylight Time			08/05/2021 06:15:19 PM Eastern Daylight Time	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Longevity Health Plan	www.longevityhealthplan.com	Longevity Health Plan (HMO I-SNP)	01	01		1			H7557	001	0	2022	MI service areas		2		2			1	1	1				www.longevityhealthplan.com	www.longevityhealthplan.com	www.longevityhealthplan.com	(888)312-8825		(888)312-8825		(888)312-8825		(888)312-8825		(888)312-8825		(888)312-8825		(888)312-8825		(888)312-8825		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7559	001	0	1	01	01	H7559_001_0	5	1	2	1			0	08/04/2021	2022.01	08/04/2021 02:30:15 PM Pacific Daylight Time	08/04/2021 09:58:00 AM Pacific Daylight Time	08/02/2021 11:46:24 AM Pacific Daylight Time			08/05/2021 03:02:36 PM Pacific Daylight Time	MAGELLAN COMPLETE CARE OF VIRGINIA, LLC.	Magellan Complete Care	mccofva.com	Molina Medicare Complete Care (HMO D-SNP)	01	01		1			H7559	001	0	2022	Virginia		2	11881	2			1	3		1		1	mccofva.com	mccofva.com	mccofva.com	(800)424-4495		(800)424-4495		(800)424-4497		(800)424-4497		(800)424-4495		(800)424-4495		(800)424-4497		(800)424-4497		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7594	001	0	1	01	01	H7594_001_0	7	1		1			1	07/07/2021	2022.01	07/07/2021 11:46:39 AM Pacific Daylight Time	08/03/2021 07:26:42 PM Pacific Daylight Time	07/30/2021 02:17:40 PM Pacific Daylight Time			08/05/2021 10:42:54 AM Pacific Daylight Time	BRANDMAN HEALTH PLAN	Brandman Health Plan	www.brandmanhealthplan.com	Brandman Health Plan (Arise) (HMO C-SNP)	01	01		1			H7594	001	0	2022	Los Angeles County		2	8700	2			1	4			00000000000000000010		www.Brandmanhealth.com	www.Brandmanhealth.com	www.brandmanhealthplan.com	(888)697-5662		(888)697-5662		(888)697-5662		(888)697-5662		(888)697-5662		(888)697-5662		(888)697-5662		(888)697-5662		(800)735-2929		(711)-		(800)735-2929		(711)-		(800)735-2929		(711)-		(800)735-2929		(711)-		2					2					2	2			
H7594	002	0	1	01	01	H7594_002_0	7	1		1			1	08/09/2021	2022.01	08/09/2021 11:02:35 AM Pacific Daylight Time	08/03/2021 07:27:32 PM Pacific Daylight Time	07/30/2021 02:19:21 PM Pacific Daylight Time			08/09/2021 11:06:36 AM Pacific Daylight Time	BRANDMAN HEALTH PLAN	Brandman Health Plan	www.brandmanhealthplan.com	Brandman Health Plan (Arise-D) (HMO C-SNP)	01	01		1			H7594	002	0	2022	Los Angeles County		2	8700	2			1	4			00000000000000000010		www.Brandmanhealth.com	www.Brandmanhealth.com	www.brandmanhealthplan.com	(888)697-5662		(888)697-5662		(888)697-5662		(888)697-5662		(888)697-5662		(888)697-5662		(888)697-5662		(888)697-5662		(800)735-2929		(711)-		(800)735-2929		(711)-		(800)735-2929		(711)-		(800)735-2929		(711)-		2					2					2	2			
H7594	003	0	1	01	01	H7594_003_0	7	1		1			1	07/07/2021	2022.01	07/07/2021 11:50:56 AM Pacific Daylight Time	08/03/2021 07:28:18 PM Pacific Daylight Time	07/30/2021 02:20:08 PM Pacific Daylight Time			08/05/2021 10:42:54 AM Pacific Daylight Time	BRANDMAN HEALTH PLAN	Brandman Health Plan	www.brandmanhealthplan.com	Brandman Health Plan (Aspire) (HMO C-SNP)	01	01		1			H7594	003	0	2022	Los Angeles County		2	8700	2			1	4			00000100000000000000		www.Brandmanhealth.com	www.Brandmanhealth.com	www.brandmanhealthplan.com	(888)697-5662		(888)697-5662		(888)697-5662		(888)697-5662		(888)697-5662		(888)697-5662		(888)697-5662		(888)697-5662		(800)735-2929		(711)-		(800)735-2929		(711)-		(800)735-2929		(711)-		(800)735-2929		(711)-		2					2					2	2			
H7594	004	0	1	01	01	H7594_004_0	7	1		1			1	07/07/2021	2022.01	07/07/2021 11:51:04 AM Pacific Daylight Time	08/03/2021 07:36:13 PM Pacific Daylight Time	07/30/2021 02:20:58 PM Pacific Daylight Time			08/05/2021 10:42:54 AM Pacific Daylight Time	BRANDMAN HEALTH PLAN	Brandman Health Plan	www.brandmanhealthplan.com	Brandman Health Plan (Aspire-D) (HMO C-SNP)	01	01		1			H7594	004	0	2022	Los Angeles County		2	8700	2			1	4			00000100000000000000		www.Brandmanhealth.com	www.Brandmanhealth.com	www.brandmanhealthplan.com	(888)697-5662		(888)697-5662		(888)697-5662		(888)697-5662		(888)697-5662		(888)697-5662		(888)697-5662		(888)697-5662		(800)735-2929		(711)-		(800)735-2929		(711)-		(800)735-2929		(711)-		(800)735-2929		(711)-		2					2					2	2			
H7598	001	0	1	01	01	H7598_001_0	3	1		1			0	08/04/2021	2022.01	08/04/2021 03:00:31 PM Central Daylight Time	08/04/2021 11:07:26 AM Central Daylight Time	08/04/2021 10:49:53 AM Central Daylight Time			08/05/2021 12:42:17 PM Central Daylight Time	GROUP HEALTH COOPERATIVE OF EAU CLAIRE	Group Health Cooperative of Eau Claire	www.group-health.com	Cooperative Advantage Premium (HMO I-SNP)	01	01		1			H7598	001	0	2022	Wisconsin		2		2			1	1	3				www.group-health.com	www.group-health.com	https://group-health.com/members/find-a-doctor	(888)203-7770		(715)552-4300		(888)203-7770		(715)552-4300		(888)203-7770		(715)552-4300		(888)203-7770		(715)552-4300		(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			
H7598	002	0	1	01	01	H7598_002_0	3	1		1			0	06/02/2021	2022.01	06/02/2021 04:52:57 PM Central Daylight Time	08/04/2021 11:08:48 AM Central Daylight Time	08/04/2021 10:50:52 AM Central Daylight Time			08/05/2021 12:42:17 PM Central Daylight Time	GROUP HEALTH COOPERATIVE OF EAU CLAIRE	Group Health Cooperative of Eau Claire	www.group-health.com	Cooperative Advantage (HMO I-SNP)	01	01		1			H7598	002	0	2022	Wisconsin		2		2			1	1	3				www.group-health.com	www.group-health.com	https://group-health.com/members/find-a-doctor	(888)203-7770		(715)552-4300		(888)203-7770		(715)552-4300		(888)203-7770		(715)552-4300		(888)203-7770		(715)552-4300		(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			
H7607	002	1	1	01	01	H7607_002_1	13	1					1	09/08/2021	2022.01	09/08/2021 01:45:27 PM Eastern Daylight Time	08/03/2021 05:06:09 PM Eastern Daylight Time	08/03/2021 05:35:49 PM Eastern Daylight Time			09/09/2021 10:12:34 AM Eastern Daylight Time	CLEVER CARE OF GOLDEN STATE, INC.	Clever Care Health Plan	www.clevercarehealthplan.com/plans	Clever Care Longevity Medicare Advantage (HMO)	01	01		1			H7607	002	1	2022	Los Angeles, Orange, and San Diego Counties	Los Angeles County	2	25061	2			2						www.clevercarehealthplan.com/pharmacy	www.clevercarehealthplan.com/formulary	www.clevercarehealthplan.com/provider	(833)388-8168		(833)388-8168		(833)388-8168		(833)388-8168		(833)388-8168		(833)388-8168		(833)388-8168		(833)388-8168		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7607	002	2	1	01	01	H7607_002_2	13	1					1	09/08/2021	2022.01	09/08/2021 01:45:53 PM Eastern Daylight Time	08/03/2021 05:06:39 PM Eastern Daylight Time	08/03/2021 05:36:09 PM Eastern Daylight Time			09/09/2021 10:12:34 AM Eastern Daylight Time	CLEVER CARE OF GOLDEN STATE, INC.	Clever Care Health Plan	www.clevercarehealthplan.com/plans	Clever Care Longevity Medicare Advantage (HMO)	01	01		1			H7607	002	2	2022	Los Angeles, Orange, and San Diego Counties	Orange County	2	12920	2			2						www.clevercarehealthplan.com/pharmacy	www.clevercarehealthplan.com/formulary	www.clevercarehealthplan.com/provider	(833)388-8168		(833)388-8168		(833)388-8168		(833)388-8168		(833)388-8168		(833)388-8168		(833)388-8168		(833)388-8168		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7607	002	3	1	01	01	H7607_002_3	13	1					1	09/08/2021	2022.01	09/08/2021 01:45:36 PM Eastern Daylight Time	08/03/2021 05:07:09 PM Eastern Daylight Time	08/03/2021 05:36:30 PM Eastern Daylight Time			09/09/2021 10:12:34 AM Eastern Daylight Time	CLEVER CARE OF GOLDEN STATE, INC.	Clever Care Health Plan	www.clevercarehealthplan.com/plans	Clever Care Longevity Medicare Advantage (HMO)	01	01		1			H7607	002	3	2022	Los Angeles, Orange, and San Diego Counties	San Diego County	2	3787	2			2						www.clevercarehealthplan.com/pharmacy	www.clevercarehealthplan.com/formulary	www.clevercarehealthplan.com/provider	(833)388-8168		(833)388-8168		(833)388-8168		(833)388-8168		(833)388-8168		(833)388-8168		(833)388-8168		(833)388-8168		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7607	003	1	1	01	01	H7607_003_1	13	1					1	09/08/2021	2022.01	09/08/2021 01:46:35 PM Eastern Daylight Time	08/03/2021 05:07:36 PM Eastern Daylight Time	08/03/2021 05:36:50 PM Eastern Daylight Time			09/09/2021 10:12:34 AM Eastern Daylight Time	CLEVER CARE OF GOLDEN STATE, INC.	Clever Care Health Plan	www.clevercarehealthplan.com/plans	Clever Care Balance Medicare Advantage (HMO)	01	01		1			H7607	003	1	2022	Los Angeles, Orange, and San Diego Counties	Los Angeles County	2	20432	2			2						www.clevercarehealthplan.com/pharmacy	www.clevercarehealthplan/formulary	www.clevercarehealthplan.com/provider	(833)388-8168		(833)388-8168		(833)388-8168		(833)388-8168		(833)388-8168		(833)388-8168		(833)388-8168		(833)388-8168		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7607	003	2	1	01	01	H7607_003_2	13	1					1	09/08/2021	2022.01	09/08/2021 01:46:44 PM Eastern Daylight Time	08/03/2021 05:08:04 PM Eastern Daylight Time	08/03/2021 05:37:10 PM Eastern Daylight Time			09/09/2021 10:12:34 AM Eastern Daylight Time	CLEVER CARE OF GOLDEN STATE, INC.	Clever Care Health Plan	www.clevercarehealthplan.com/plans	Clever Care Balance Medicare Advantage (HMO)	01	01		1			H7607	003	2	2022	Los Angeles, Orange, and San Diego Counties	Orange County	2	8292	2			2						www.clevercarehealthplan.com/pharmacy	www.clevercarehealthplan/formulary	www.clevercarehealthplan.com/provider	(833)388-8168		(833)388-8168		(833)388-8168		(833)388-8168		(833)388-8168		(833)388-8168		(833)388-8168		(833)388-8168		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7607	003	3	1	01	01	H7607_003_3	13	1					1	09/08/2021	2022.01	09/08/2021 01:46:45 PM Eastern Daylight Time	08/03/2021 05:08:32 PM Eastern Daylight Time	08/03/2021 05:37:31 PM Eastern Daylight Time			09/09/2021 10:12:34 AM Eastern Daylight Time	CLEVER CARE OF GOLDEN STATE, INC.	Clever Care Health Plan	www.clevercarehealthplan.com/plans	Clever Care Balance Medicare Advantage (HMO)	01	01		1			H7607	003	3	2022	Los Angeles, Orange, and San Diego Counties	San Diego County	2	569	2			2						www.clevercarehealthplan.com/pharmacy	www.clevercarehealthplan/formulary	www.clevercarehealthplan.com/provider	(833)388-8168		(833)388-8168		(833)388-8168		(833)388-8168		(833)388-8168		(833)388-8168		(833)388-8168		(833)388-8168		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7607	007	1	1	01	01	H7607_007_1	13	1					1	09/08/2021	2022.01	09/08/2021 01:47:11 PM Eastern Daylight Time	08/03/2021 05:09:01 PM Eastern Daylight Time	08/03/2021 05:37:51 PM Eastern Daylight Time			09/09/2021 10:12:34 AM Eastern Daylight Time	CLEVER CARE OF GOLDEN STATE, INC.	Clever Care Health Plan	www.clevercarehealthplan.com/plans	Clever Care Fortune Medicare Advantage Plan (HMO)	01	01		1			H7607	007	1	2022	Los Angeles, Orange, and San Diego Counties	Los Angeles County	2	29702	2			2						www.clevercarehealthplan.com/pharmacy	www.clevercarehealthplan.com/formulary	www.clevercarehealthplan.com/provider	(833)388-8168		(833)388-8168		(833)388-8168		(833)388-8168		(833)388-8168		(833)388-8168		(833)388-8168		(833)388-8168		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7607	007	2	1	01	01	H7607_007_2	13	1					1	09/08/2021	2022.01	09/08/2021 01:47:19 PM Eastern Daylight Time	08/03/2021 05:09:29 PM Eastern Daylight Time	08/03/2021 05:38:11 PM Eastern Daylight Time			09/09/2021 10:12:34 AM Eastern Daylight Time	CLEVER CARE OF GOLDEN STATE, INC.	Clever Care Health Plan	www.clevercarehealthplan.com/plans	Clever Care Fortune Medicare Advantage Plan (HMO)	01	01		1			H7607	007	2	2022	Los Angeles, Orange, and San Diego Counties	Orange County	2	15309	2			2						www.clevercarehealthplan.com/pharmacy	www.clevercarehealthplan.com/formulary	www.clevercarehealthplan.com/provider	(833)388-8168		(833)388-8168		(833)388-8168		(833)388-8168		(833)388-8168		(833)388-8168		(833)388-8168		(833)388-8168		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7607	007	3	1	01	01	H7607_007_3	13	1					1	09/08/2021	2022.01	09/08/2021 01:47:20 PM Eastern Daylight Time	08/03/2021 05:09:58 PM Eastern Daylight Time	08/03/2021 05:38:31 PM Eastern Daylight Time			09/09/2021 10:12:34 AM Eastern Daylight Time	CLEVER CARE OF GOLDEN STATE, INC.	Clever Care Health Plan	www.clevercarehealthplan.com/plans	Clever Care Fortune Medicare Advantage Plan (HMO)	01	01		1			H7607	007	3	2022	Los Angeles, Orange, and San Diego Counties	San Diego County	2	4492	2			2						www.clevercarehealthplan.com/pharmacy	www.clevercarehealthplan.com/formulary	www.clevercarehealthplan.com/provider	(833)388-8168		(833)388-8168		(833)388-8168		(833)388-8168		(833)388-8168		(833)388-8168		(833)388-8168		(833)388-8168		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7607	008	1	1	01	01	H7607_008_1	13	1					1	09/08/2021	2022.01	09/08/2021 01:47:45 PM Eastern Daylight Time	08/03/2021 05:10:27 PM Eastern Daylight Time	08/03/2021 05:38:52 PM Eastern Daylight Time			09/09/2021 10:12:34 AM Eastern Daylight Time	CLEVER CARE OF GOLDEN STATE, INC.	Clever Care Health Plan	www.clevercarehealthplan.com/plans	Clever Care Value Medicare Advantage Plan (HMO)	01	01		1			H7607	008	1	2022	Los Angeles, Orange, and San Diego Counties	Los Angeles County	2	7425	2			2						www.clevercarehealthplan.com/pharmacy	www.clevercarehealthplan.com/formulary	www.clevercarehealthplan.com/provider	(833)388-8168		(833)388-8168		(833)388-8168		(833)388-8168		(833)388-8168		(833)388-8168		(833)388-8168		(833)388-8168		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7607	008	2	1	01	01	H7607_008_2	13	1					1	09/08/2021	2022.01	09/08/2021 01:47:55 PM Eastern Daylight Time	08/03/2021 05:10:54 PM Eastern Daylight Time	08/03/2021 05:39:11 PM Eastern Daylight Time			09/09/2021 10:12:34 AM Eastern Daylight Time	CLEVER CARE OF GOLDEN STATE, INC.	Clever Care Health Plan	www.clevercarehealthplan.com/plans	Clever Care Value Medicare Advantage Plan (HMO)	01	01		1			H7607	008	2	2022	Los Angeles, Orange, and San Diego Counties	Orange County	2	3824	2			2						www.clevercarehealthplan.com/pharmacy	www.clevercarehealthplan.com/formulary	www.clevercarehealthplan.com/provider	(833)388-8168		(833)388-8168		(833)388-8168		(833)388-8168		(833)388-8168		(833)388-8168		(833)388-8168		(833)388-8168		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7607	008	3	1	01	01	H7607_008_3	13	1					1	09/08/2021	2022.01	09/08/2021 01:47:56 PM Eastern Daylight Time	08/03/2021 05:11:21 PM Eastern Daylight Time	08/03/2021 05:39:32 PM Eastern Daylight Time			09/09/2021 10:12:34 AM Eastern Daylight Time	CLEVER CARE OF GOLDEN STATE, INC.	Clever Care Health Plan	www.clevercarehealthplan.com/plans	Clever Care Value Medicare Advantage Plan (HMO)	01	01		1			H7607	008	3	2022	Los Angeles, Orange, and San Diego Counties	San Diego County	2	1126	2			2						www.clevercarehealthplan.com/pharmacy	www.clevercarehealthplan.com/formulary	www.clevercarehealthplan.com/provider	(833)388-8168		(833)388-8168		(833)388-8168		(833)388-8168		(833)388-8168		(833)388-8168		(833)388-8168		(833)388-8168		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7617	001	0	1	04	01	H7617_001_0	3	1					0	07/22/2021	2022.01	07/22/2021 04:41:43 PM Eastern Daylight Time	08/03/2021 05:48:06 PM Eastern Daylight Time	07/30/2021 12:03:52 PM Eastern Daylight Time			08/04/2021 02:27:53 PM Eastern Daylight Time	EMPHESYS INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H7617-001 (PPO)	01	04		1			H7617	001	0	2022	Greenville County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7617	801	0	1	04	01	H7617_801_0	1	1						05/26/2021	2022.01	05/26/2021 08:38:31 AM Eastern Daylight Time					06/03/2021 01:38:12 PM Eastern Daylight Time	EMPHESYS INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H7617	801	0	2022	Select Counties in Multi-States		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242		(866)396-8810		(866)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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H7617	802	0	1	04	01	H7617_802_0	1	1				0	0	05/26/2021	2022.01	05/26/2021 08:42:24 AM Eastern Daylight Time					06/03/2021 01:38:12 PM Eastern Daylight Time	EMPHESYS INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H7617	802	0	2022	Select Counties in Multi-States		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H7617	803	0	2	04	01	H7617_803_0	1	1						05/26/2021	2022.01	05/26/2021 08:46:58 AM Eastern Daylight Time					06/03/2021 01:38:12 PM Eastern Daylight Time	EMPHESYS INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		2	1		H7617	803	0	2022	Select Counties in Multi-States		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242		(866)396-8810		(866)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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H7617	804	0	2	04	01	H7617_804_0	1	1				0	0	05/26/2021	2022.01	05/26/2021 08:49:52 AM Eastern Daylight Time					06/03/2021 01:38:12 PM Eastern Daylight Time	EMPHESYS INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		2	1		H7617	804	0	2022	Select Counties in Multi-States		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H7617	805	0	1	04	01	H7617_805_0	1	1						05/26/2021	2022.01	05/26/2021 09:02:38 AM Eastern Daylight Time					06/03/2021 01:38:12 PM Eastern Daylight Time	EMPHESYS INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H7617	805	0	2022	Select Counties in Multi-States		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242		(866)396-8810		(866)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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H7617	806	0	1	04	01	H7617_806_0	1	1				0	0	05/26/2021	2022.01	05/26/2021 09:11:35 AM Eastern Daylight Time					06/03/2021 01:38:12 PM Eastern Daylight Time	EMPHESYS INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H7617	806	0	2022	Select Counties in Multi-States		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H7617	807	0	1	04	01	H7617_807_0	1	1						05/26/2021	2022.01	05/26/2021 09:18:13 AM Eastern Daylight Time					06/03/2021 01:38:12 PM Eastern Daylight Time	EMPHESYS INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H7617	807	0	2022	Select Counties in Multi-States		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242		(866)396-8810		(866)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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H7617	808	0	1	04	01	H7617_808_0	1	1				0	0	05/26/2021	2022.01	05/26/2021 09:25:01 AM Eastern Daylight Time					06/03/2021 01:38:12 PM Eastern Daylight Time	EMPHESYS INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H7617	808	0	2022	Select Counties in Multi-States		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H7617	809	0	1	04	01	H7617_809_0	1	1						05/26/2021	2022.01	05/26/2021 09:31:00 AM Eastern Daylight Time					06/03/2021 01:38:12 PM Eastern Daylight Time	EMPHESYS INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H7617	809	0	2022	Select Counties in Multi-States		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242		(866)396-8810		(866)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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H7617	810	0	1	04	01	H7617_810_0	1	1				0	0	05/26/2021	2022.01	05/26/2021 09:39:20 AM Eastern Daylight Time					06/03/2021 01:38:12 PM Eastern Daylight Time	EMPHESYS INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H7617	810	0	2022	Select Counties in Multi-States		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H7617	811	0	1	04	01	H7617_811_0	1	1						05/26/2021	2022.01	05/26/2021 09:50:38 AM Eastern Daylight Time					06/03/2021 01:38:12 PM Eastern Daylight Time	EMPHESYS INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H7617	811	0	2022	Select Counties in Multi-States		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242		(866)396-8810		(866)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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H7617	812	0	1	04	01	H7617_812_0	1	1				0	0	05/26/2021	2022.01	05/26/2021 09:58:46 AM Eastern Daylight Time					06/03/2021 01:38:12 PM Eastern Daylight Time	EMPHESYS INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	01	04		1			H7617	812	0	2022	Select Counties in Multi-States		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H7619	001	0	1	20	08	H7619_001_0	1	1						06/02/2021	2022.01	06/02/2021 08:32:55 AM Eastern Daylight Time		06/02/2021 08:22:46 AM Eastern Daylight Time			06/02/2021 08:36:18 AM Eastern Daylight Time	ATLANTICARE HEALTH SERVICES, INC.	AtlantiCare LIFE Connection	www.atlanticare.org/services/life-connection/	AtlantiCare LIFE Connection (PACE)	08	20		1			H7619	001	0	2022	Counties: Atlantic, Cape May		2		2			2						NA	NA										(888)569-1000		(609)572-8588		(888)569-1000		(609)407-2052												(800)852-7899				(800)852-7899																
H7619	002	0	1	20	08	H7619_002_0	1	1						06/02/2021	2022.01	06/02/2021 08:33:45 AM Eastern Daylight Time		06/02/2021 08:23:22 AM Eastern Daylight Time			06/02/2021 08:36:18 AM Eastern Daylight Time	ATLANTICARE HEALTH SERVICES, INC.	AtlantiCare LIFE Connection	www.atlanticare.org/services/life-connection/	AtlantiCare LIFE Connection (PACE)	08	20		1			H7619	002	0	2022	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	6	1			1		1	08/02/2021	2022.01	08/02/2021 12:45:18 PM Eastern Daylight Time	08/03/2021 05:44:26 PM Eastern Daylight Time	07/30/2021 12:04:04 PM Eastern Daylight Time			08/04/2021 01:53:51 PM Eastern Daylight Time	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Humana	www.humana.com/medicare	Humana Community (HMO)	01	01		1			H7621	001	0	2022	Select Counties in Kansas City Metro area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			1		1	07/31/2021	2022.01	07/31/2021 01:01:55 PM Eastern Daylight Time	08/03/2021 07:51:07 PM Eastern Daylight Time	07/30/2021 12:04:16 PM Eastern Daylight Time			08/04/2021 03:28:56 PM Eastern Daylight Time	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Humana	www.humana.com/medicare	Humana Community (HMO)	01	01		1			H7621	002	0	2022	Riverside and San Bernardino counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		1	08/02/2021	2022.01	08/02/2021 03:16:05 PM Eastern Daylight Time	08/03/2021 07:39:20 PM Eastern Daylight Time	07/30/2021 12:04:28 PM Eastern Daylight Time			08/04/2021 03:28:56 PM Eastern Daylight Time	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Humana	www.humana.com/medicare	Humana Community (HMO)	01	01		1			H7621	003	0	2022	San Joaquin County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7646	001	0	1	02	01	H7646_001_0	6	1					1	08/02/2021	2022.01	08/02/2021 09:36:39 AM Central Daylight Time	07/30/2021 02:07:07 PM Central Daylight Time	07/30/2021 02:43:55 PM Central Daylight Time			08/02/2021 02:13:37 PM Central Daylight Time	PHP MEDICARE	PHP Medicare	www.sparrowadvantage.com	Sparrow Advantage (HMO-POS)	01	02		1			H7646	001	0	2022	Greater Lansing Area		2		2			2						www.sparrowadvantage.com	www.sparrowadvantage.com	www.phpmichigan.com/myphp	(844)529-3757		(844)529-3757		(844)529-3826		(844)529-3826		(844)529-3757		(844)529-3757		(844)529-3826		(844)529-3826		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7646	002	0	1	02	01	H7646_002_0	6	1					1	08/02/2021	2022.01	08/02/2021 09:36:59 AM Central Daylight Time	07/30/2021 03:35:06 PM Central Daylight Time	07/30/2021 03:40:45 PM Central Daylight Time			08/02/2021 02:13:37 PM Central Daylight Time	PHP MEDICARE	PHP Medicare	www.covenantadvantage.com	Covenant Advantage (HMO-POS)	01	02		1			H7646	002	0	2022	Bay, Saginaw, Tuscola counties		2		2			2						www.covenantadvantage.com	www.covenantadvantage.com	www.phpmichigan.com/myphp	(844)529-3757		(844)529-3757		(844)527-9389		(844)527-9389		(844)529-3757		(844)529-3757		(844)527-9389		(844)527-9389		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7646	003	0	1	02	01	H7646_003_0	6	1					1	08/02/2021	2022.01	08/02/2021 09:37:18 AM Central Daylight Time	07/30/2021 03:48:47 PM Central Daylight Time	07/30/2021 03:52:06 PM Central Daylight Time			08/02/2021 02:13:37 PM Central Daylight Time	PHP MEDICARE	PHP Medicare	www.phpadvantage.com	PHP Advantage (HMO-POS)	01	02		1			H7646	003	0	2022	Calhoun, Jackson and Kalamazoo counties		2		2			2						www.phpadvantage.com	www.phpadvantage.com	www.phpmichigan.com/myphp	(844)529-3757		(844)529-3757		(844)527-9395		(844)527-9395		(844)529-3757		(844)529-3757		(844)527-9395		(844)527-9395		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7646	004	0	1	02	01	H7646_004_0	6	1					1	08/02/2021	2022.01	08/02/2021 09:37:40 AM Central Daylight Time	07/30/2021 04:31:58 PM Central Daylight Time	07/30/2021 04:36:24 PM Central Daylight Time			08/02/2021 02:13:37 PM Central Daylight Time	PHP MEDICARE	PHP Medicare	www.sparrowadvantage.com	Sparrow Advantage Plus (HMO-POS)	01	02		1			H7646	004	0	2022	Greater Lansing Area		2		2			2						www.sparrowadvantage.com	www.sparrowadvantage.com	www.phpmichigan.com/myphp	(844)529-3757		(844)529-3757		(844)529-3826		(844)529-3826		(844)529-3757		(844)529-3757		(844)529-3826		(844)529-3826		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7646	005	0	1	02	01	H7646_005_0	7	1					1	08/02/2021	2022.01	08/02/2021 09:38:04 AM Central Daylight Time	07/30/2021 04:42:28 PM Central Daylight Time	07/30/2021 04:46:20 PM Central Daylight Time			08/02/2021 02:13:37 PM Central Daylight Time	PHP MEDICARE	PHP Medicare	www.covenantadvantage.com	Covenant Advantage Plus (HMO-POS)	01	02		1			H7646	005	0	2022	Bay, Saginaw, Tuscola counties		2		2			2						www.covenantadvantage.com	www.covenantadvantage.com	www.phpmichigan.com/myphp	(844)529-3757		(844)529-3757		(844)527-9389		(844)527-9389		(844)529-3757		(844)529-3757		(844)527-9389		(844)527-9389		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7646	006	0	1	02	01	H7646_006_0	9	1					1	08/02/2021	2022.01	08/02/2021 09:38:32 AM Central Daylight Time	08/09/2021 02:36:33 PM Central Daylight Time	08/09/2021 12:36:56 PM Central Daylight Time			08/09/2021 02:40:46 PM Central Daylight Time	PHP MEDICARE	PHP Medicare	www.phpadvantage.com	PHP Advantage Plus (HMO-POS)	01	02		1			H7646	006	0	2022	Calhoun, Jackson and Kalamazoo counties		2		2			2						www.phpadvantage.com	www.phpadvantage.com	www.phpmichigan.com/myphp	(844)529-3757		(844)529-3757		(844)527-9395		(844)527-9395		(844)529-3757		(844)529-3757		(844)527-9395		(844)527-9395		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7646	007	0	1	02	01	H7646_007_0	5	1					1	08/02/2021	2022.01	08/02/2021 09:38:56 AM Central Daylight Time	07/30/2021 05:12:16 PM Central Daylight Time	07/30/2021 05:17:09 PM Central Daylight Time			08/02/2021 02:13:37 PM Central Daylight Time	PHP MEDICARE	PHP Medicare	www.phpmedicare.com	U-M Health + St. Joe's Advantage (HMO-POS)	01	02		1			H7646	007	0	2022	Livingston and Washtenaw counties		2		2			2						www.phpmedicare.com	www.phpmedicare.com	www.phpmichigan.com/myphp	(844)529-3757		(844)529-3757		(833)245-7097		(833)245-7097		(844)529-3757		(844)529-3757		(833)245-7097		(833)245-7097		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7646	008	0	1	02	01	H7646_008_0	5	1					1	08/02/2021	2022.01	08/02/2021 09:39:19 AM Central Daylight Time	07/30/2021 05:23:35 PM Central Daylight Time	07/30/2021 05:29:00 PM Central Daylight Time			08/02/2021 02:13:37 PM Central Daylight Time	PHP MEDICARE	PHP Medicare	www.phpmedicare.com	U-M Health + St. Joe's Advantage Plus (HMO-POS)	01	02		1			H7646	008	0	2022	Livingston and Washtenaw counties		2		2			2						www.phpmedicare.com	www.phpmedicare.com	www.phpmichigan.com/myphp	(844)529-3757		(844)529-3757		(833)245-7097		(833)245-7097		(844)529-3757		(844)529-3757		(833)245-7097		(833)245-7097		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7646	801	0	1	02	01	H7646_801_0	2	1						05/26/2021	2022.01	05/26/2021 02:21:25 PM Central Daylight Time					06/07/2021 08:41:30 AM Central Daylight Time	PHP MEDICARE	PHP Medicare	www.phpmedicare.com	EGWP MAPD Calendar year (HMO-POS)	01	02		1			H7646	801	0	2022	Certain Counties in Michigan		1	300	2			2						www.phpmedicare.com	www.phpmedicare.com	www.phpmedicare.com	(844)529-3757		(844)529-3757		(844)529-3826		(844)529-3826		(844)529-3757		(844)529-3757		(844)529-3826		(844)529-3826		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;	1				
H7646	802	0	1	02	01	H7646_802_0	2	1						05/26/2021	2022.01	05/26/2021 02:21:57 PM Central Daylight Time					06/07/2021 08:41:30 AM Central Daylight Time	PHP MEDICARE	PHP Medicare	www.phpmedicare.com	EGWP MAPD Non-Calendar year (HMO-POS)	01	02		1			H7646	802	0	2022	Certain Counties in Michigan		1	300	2			2						www.phpmedicare.com	www.phpmedicare.com	www.phpmedicare.com	(844)529-3757		(844)529-3757		(844)529-3826		(844)529-3826		(844)529-3757		(844)529-3757		(844)529-3826		(844)529-3826		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;	1				
H7646	803	0	1	02	01	H7646_803_0	2	1				0	0	05/26/2021	2022.01	05/26/2021 02:22:36 PM Central Daylight Time					06/07/2021 08:41:30 AM Central Daylight Time	PHP MEDICARE	PHP Medicare	www.phpmedicare.com	EGWP MA Only Calendar Year (HMO-POS)	01	02		1			H7646	803	0	2022	Certain Counties in Michigan		1	300	2			2						www.phpmedicare.com	www.phpmedicare.com	www.phpmedicare.com	(844)529-3757		(844)529-3757		(833)245-7097		(833)245-7097										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;	1				
H7646	804	0	1	02	01	H7646_804_0	2	1				0	0	05/26/2021	2022.01	05/26/2021 02:23:06 PM Central Daylight Time					06/07/2021 08:41:30 AM Central Daylight Time	PHP MEDICARE	PHP Medicare	www.phpmedicare.com	EGWP MA Only non-Calendar Year (HMO-POS)	01	02		1			H7646	804	0	2022	Certain Counties in Michigan		1	300	2			2						www.phpmedicare.com	www.phpmedicare.com	www.phpmedicare.com	(844)529-3757		(844)529-3757		(833)245-7097		(833)245-7097										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;	1				
H7660	001	0	1	20	08	H7660_001_0	1	1						06/02/2021	2022.01	06/02/2021 02:41:38 PM Eastern Daylight Time		06/01/2021 06:01:56 PM Eastern Daylight Time			06/02/2021 02:49:43 PM 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	2022	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						06/02/2021	2022.01	06/02/2021 02:42:08 PM Eastern Daylight Time		06/01/2021 06:04:10 PM Eastern Daylight Time			06/02/2021 02:49:43 PM 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	2022	Beaver and Lawrence Counties		2		2			2						www.lutheranseniorlife.org	www.lutheranseniorlife.org												(724)378-5400				(724)378-5400												(711)-				(711)-																
H7670	001	0	1	01	01	H7670_001_0	12	1					0	08/04/2021	2022.01	08/04/2021 02:22:01 PM Eastern Daylight Time	08/04/2021 02:21:45 PM Eastern Daylight Time	08/04/2021 12:20:02 PM Eastern Daylight Time			08/04/2021 03:29:32 PM Eastern Daylight Time	CENTRAL MASS HEALTH, LLC	Central Mass Health	https://www.massadvantage.com	Mass Advantage Basic (HMO)	01	01		1			H7670	001	0	2022	Massachusetts (Partial)		2		2			2						https://www.massadvantage.com	https://www.massadvantage.com	https://www.massadvantage.com	(844)918-0114		(844)918-0114		(844)918-0114		(844)918-0114		(844)918-0114		(844)918-0114		(844)918-0114		(844)918-0114		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7670	002	0	1	01	01	H7670_002_0	12	1					0	08/04/2021	2022.01	08/04/2021 08:47:58 AM Eastern Daylight Time	08/04/2021 02:23:02 PM Eastern Daylight Time	08/04/2021 12:20:27 PM Eastern Daylight Time			08/04/2021 03:29:32 PM Eastern Daylight Time	CENTRAL MASS HEALTH, LLC	Central Mass Health	https://www.massadvantage.com	Mass Advantage Plus (HMO)	01	01		1			H7670	002	0	2022	Massachusetts (Partial)		2		2			2						https://www.massadvantage.com	https://www.massadvantage.com	https://www.massadvantage.com	(844)918-0116		(844)918-0116		(844)918-0116		(844)918-0116		(844)918-0116		(844)918-0116		(844)918-0116		(844)918-0116		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7678	001	0	1	01	01	H7678_001_0	5	1	2	1			0	08/05/2021	2022.01	08/05/2021 11:27:39 AM Pacific Daylight Time	08/04/2021 06:00:38 PM Pacific Daylight Time	08/04/2021 04:44:34 PM Pacific Daylight Time			08/05/2021 03:02:36 PM Pacific Daylight Time	MOLINA HEALTHCARE OF TEXAS, INC.	Molina Healthcare of Texas, Inc.	www.molinahealthcare.com/medicare	Molina Medicare Complete Care (HMO D-SNP)	01	01		1			H7678	001	0	2022	Select Counties in 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			
H7678	003	0	1	01	01	H7678_003_0	5	1		1			0	08/05/2021	2022.01	08/05/2021 11:27:57 AM Pacific Daylight Time	08/04/2021 05:49:06 PM Pacific Daylight Time	08/04/2021 04:45:02 PM Pacific Daylight Time			08/05/2021 03:02:36 PM Pacific Daylight Time	MOLINA HEALTHCARE OF TEXAS, INC.	Molina Healthcare of Texas, Inc.	www.molinahealthcare.com/medicare	Molina Medicare Comfort Care (HMO I-SNP)	01	01		1			H7678	003	0	2022	Select Counties in Texas		2		2			1	1	3				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			
H7678	004	0	1	01	01	H7678_004_0	5	1					1	08/05/2021	2022.01	08/05/2021 11:28:08 AM Pacific Daylight Time	08/04/2021 05:50:50 PM Pacific Daylight Time	08/04/2021 04:45:28 PM Pacific Daylight Time			08/05/2021 03:02:36 PM Pacific Daylight Time	MOLINA HEALTHCARE OF TEXAS, INC.	Molina Healthcare of Texas, Inc.	www.molinahealthcare.com/medicare	Molina Medicare Choice Care (HMO)	01	01		1			H7678	004	0	2022	Select Counties in Texas		2		2			2						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			
H7678	005	0	1	01	01	H7678_005_0	5	1					0	07/20/2021	2022.01	07/20/2021 04:09:51 PM Pacific Daylight Time	08/04/2021 05:51:54 PM Pacific Daylight Time	08/04/2021 04:45:54 PM Pacific Daylight Time			08/05/2021 03:02:36 PM Pacific Daylight Time	MOLINA HEALTHCARE OF TEXAS, INC.	Molina Healthcare of Texas, Inc.	www.molinahealthcare.com/medicare	Molina Medicare Choice Care Select (HMO)	01	01		1			H7678	005	0	2022	Select Counties in Texas		2		2			2						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	11	1					1	08/04/2021	2022.01	08/04/2021 06:45:27 AM Pacific Daylight Time	08/02/2021 02:53:59 PM Pacific Daylight Time	08/02/2021 06:13:19 PM Pacific Daylight Time			08/05/2021 04:14:31 PM Pacific Daylight Time	PROMINENCE HEALTHFIRST OF TEXAS	Prominence Health Plan	www.prominencemedicare.com	Prominence Plus (HMO)	01	01		1			H7680	001	0	2022	Potter,Gray,Moore,DS,Cooke,Fannin,Grayson,Randall		2	11232	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	12	1					1	08/04/2021	2022.01	08/04/2021 06:43:34 AM Pacific Daylight Time	08/02/2021 02:55:54 PM Pacific Daylight Time	08/02/2021 06:16:04 PM Pacific Daylight Time			08/05/2021 04:14:31 PM Pacific Daylight Time	PROMINENCE HEALTHFIRST OF TEXAS	Prominence Health Plan	www.prominencemedicare.com	Prominence Plus (HMO)	01	01		1			H7680	002	0	2022	Hildago, Starr, Brooks, and Webb Counties		2	57096	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	007	0	1	01	01	H7680_007_0	11	1	2	1			0	08/04/2021	2022.01	08/04/2021 06:45:51 AM Pacific Daylight Time	08/03/2021 01:36:30 PM Pacific Daylight Time	08/02/2021 06:17:26 PM Pacific Daylight Time			08/05/2021 04:14:31 PM Pacific Daylight Time	PROMINENCE HEALTHFIRST OF TEXAS	Prominence Health Plan	www.prominencemedicare.com	Prominence Dual (HMO D-SNP)	01	01		1			H7680	007	0	2022	Hildago, Starr, Brooks, and Webb Counties		2	2633	2			1	3		1		1	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	4	1				0	0	06/07/2021	2022.01	06/07/2021 05:58:06 PM Pacific Daylight Time					06/07/2021 06:57:58 PM Pacific Daylight Time	PROMINENCE HEALTHFIRST OF TEXAS	Prominence Health Plan	www.prominencemedicare.com	Prominence Health Plan (HMO)	01	01		1			H7680	801	0	2022	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			
H7728	002	0	1	04	01	H7728_002_0	7	1			2		0	06/04/2021	2022.01	06/04/2021 09:54:44 AM Eastern Daylight Time	08/03/2021 06:04:01 PM Eastern Daylight Time	08/03/2021 06:04:01 PM Eastern Daylight Time			08/04/2021 02:06:25 PM Eastern Daylight Time	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Anthem Blue Cross and Blue Shield	shop.anthem.com/medicare	Anthem MediBlue Access (PPO)	01	04		1			H7728	002	0	2022	State of New Hampshire		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(855)304-1787		(855)304-1787		(855)768-1041		(855)768-1041		(833)343-4760		(833)343-4760		(855)499-1091		(855)499-1091		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7728	004	1	1	04	01	H7728_004_1	7	1			2		0	08/02/2021	2022.01	08/02/2021 12:42:04 PM Eastern Daylight Time	08/03/2021 06:03:59 PM Eastern Daylight Time	08/03/2021 06:03:59 PM Eastern Daylight Time			08/04/2021 02:00:52 PM Eastern Daylight Time	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Anthem Blue Cross and Blue Shield	shop.anthem.com/medicare	Anthem MediBlue Access (PPO)	01	04		1			H7728	004	1	2022	Select Counties in Kentucky	Select Counties in Kentucky	2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(855)690-7795		(855)690-7795		(855)768-1041		(855)768-1041		(833)343-4761		(833)343-4761		(855)499-1091		(855)499-1091		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7728	004	2	1	04	01	H7728_004_2	7	1			2		0	07/16/2021	2022.01	07/16/2021 07:13:26 PM Eastern Daylight Time	08/03/2021 06:03:59 PM Eastern Daylight Time	08/03/2021 06:03:59 PM Eastern Daylight Time			08/04/2021 02:00:52 PM Eastern Daylight Time	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Anthem Blue Cross and Blue Shield	shop.anthem.com/medicare	Anthem MediBlue Access (PPO)	01	04		1			H7728	004	2	2022	Select Counties in Kentucky	Select Counties in Kentucky	2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(855)690-7795		(855)690-7795		(855)768-1041		(855)768-1041		(833)343-4761		(833)343-4761		(855)499-1091		(855)499-1091		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7728	005	0	1	04	01	H7728_005_0	6	1			2		0	06/02/2021	2022.01	06/02/2021 03:21:50 PM Eastern Daylight Time	08/03/2021 06:04:05 PM Eastern Daylight Time	08/03/2021 06:04:05 PM Eastern Daylight Time			08/04/2021 02:27:41 PM Eastern Daylight Time	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Anthem Blue Cross and Blue Shield	shop.anthem.com/medicare	Anthem MediBlue Access (PPO)	01	04		1			H7728	005	0	2022	Select Counties in Georgia		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(866)438-9968		(866)438-9968		(855)768-1041		(855)768-1041		(833)343-4762		(833)343-4762		(855)499-1091		(855)499-1091		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7728	006	0	1	04	01	H7728_006_0	8	1			2		0	06/02/2021	2022.01	06/02/2021 03:22:05 PM Eastern Daylight Time	08/03/2021 06:04:05 PM Eastern Daylight Time	08/03/2021 06:04:05 PM Eastern Daylight Time			08/04/2021 02:27:41 PM Eastern Daylight Time	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Anthem Blue Cross and Blue Shield	shop.anthem.com/medicare	Anthem MediBlue Access Basic (PPO)	01	04		1			H7728	006	0	2022	Select Counties in Georgia		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(866)438-9968		(866)438-9968		(855)768-1041		(855)768-1041		(833)343-4762		(833)343-4762		(855)499-1091		(855)499-1091		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7728	009	0	1	04	01	H7728_009_0	7	1			2		0	08/02/2021	2022.01	08/02/2021 12:41:43 PM Eastern Daylight Time	08/03/2021 06:03:59 PM Eastern Daylight Time	08/03/2021 06:03:59 PM Eastern Daylight Time			08/04/2021 02:00:52 PM Eastern Daylight Time	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Anthem Blue Cross and Blue Shield	shop.anthem.com/medicare	Anthem MediBlue Access Plus (PPO)	01	04		1			H7728	009	0	2022	Kentucky		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(855)690-7795		(855)690-7795		(855)768-1041		(855)768-1041		(833)343-4761		(833)343-4761		(855)499-1091		(855)499-1091		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7728	010	0	1	04	01	H7728_010_0	7	1			2		0	06/04/2021	2022.01	06/04/2021 09:54:55 AM Eastern Daylight Time	08/03/2021 06:04:01 PM Eastern Daylight Time	08/03/2021 06:04:01 PM Eastern Daylight Time			08/04/2021 02:06:25 PM Eastern Daylight Time	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Anthem Blue Cross and Blue Shield	shop.anthem.com/medicare	Anthem MediBlue Access Select Plus (PPO)	01	04		1			H7728	010	0	2022	Select counties in New Hampshire		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(855)304-1787		(855)304-1787		(855)768-1041		(855)768-1041		(833)343-4760		(833)343-4760		(855)499-1091		(855)499-1091		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7728	011	0	1	04	01	H7728_011_0	7	1	2	1	1		0	07/15/2021	2022.01	07/15/2021 10:46:06 AM Eastern Daylight Time	08/03/2021 06:04:05 PM Eastern Daylight Time	08/03/2021 06:04:05 PM Eastern Daylight Time			08/04/2021 02:27:41 PM Eastern Daylight Time	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Anthem Blue Cross and Blue Shield	shop.anthem.com/medicare	Anthem MediBlue Dual Access (PPO D-SNP)	01	04		1			H7728	011	0	2022	Select counties in Georgia		2		2			1	3		1		1	https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(866)438-9968		(866)438-9968		(855)768-1041		(855)768-1041		(833)343-4762		(833)343-4762		(855)499-1091		(855)499-1091		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7728	012	0	1	04	01	H7728_012_0	6	1			2		0	06/03/2021	2022.01	06/03/2021 11:50:08 AM Eastern Daylight Time	08/03/2021 06:04:05 PM Eastern Daylight Time	08/03/2021 06:04:05 PM Eastern Daylight Time			08/04/2021 02:27:41 PM Eastern Daylight Time	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Anthem Blue Cross and Blue Shield	shop.anthem.com/medicare	Anthem MediBlue + Kroger Access (PPO)	01	04		1			H7728	012	0	2022	Select counties in Georgia		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(866)438-9968		(866)438-9968		(855)768-1041		(855)768-1041		(833)343-4762		(833)343-4762		(855)499-1091		(855)499-1091		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7728	801	0	1	04	01	H7728_801_0	1	1						06/02/2021	2022.01	06/02/2021 04:20:20 PM Pacific Daylight Time					06/04/2021 09:22:08 AM Pacific Daylight Time	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H7728	801	0	2022	National		1	600	2			2						www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)360-3667		(833)360-3667		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1									
H7728	802	0	1	04	01	H7728_802_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 04:20:27 PM Pacific Daylight Time					06/04/2021 09:22:08 AM Pacific Daylight Time	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H7728	802	0	2022	National		1	600	2			2						www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1									
H7728	803	0	1	04	01	H7728_803_0	1	1						06/02/2021	2022.01	06/02/2021 04:20:33 PM Pacific Daylight Time					06/04/2021 09:22:08 AM Pacific Daylight Time	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H7728	803	0	2022	National		1	600	2			2						www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)360-3667		(833)360-3667		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1									
H7728	804	0	2	04	01	H7728_804_0	1	1						06/02/2021	2022.01	06/02/2021 04:20:39 PM Pacific Daylight Time					06/04/2021 09:22:08 AM Pacific Daylight Time	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		2	1		H7728	804	0	2022	National		1	600	2			2						www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)360-3667		(833)360-3667		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1									
H7728	805	0	1	04	01	H7728_805_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 04:20:48 PM Pacific Daylight Time					06/04/2021 09:22:08 AM Pacific Daylight Time	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H7728	805	0	2022	National		1	600	2			2						www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1									
H7728	806	0	1	04	01	H7728_806_0	1	1						06/02/2021	2022.01	06/02/2021 04:20:56 PM Pacific Daylight Time					06/04/2021 09:22:08 AM Pacific Daylight Time	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H7728	806	0	2022	National		1	600	2			2						www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)360-3667		(833)360-3667		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1									
H7728	807	0	2	04	01	H7728_807_0	1	1						06/02/2021	2022.01	06/02/2021 04:21:04 PM Pacific Daylight Time					06/04/2021 09:22:08 AM Pacific Daylight Time	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		2	1		H7728	807	0	2022	National		1	600	2			2						www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)360-3667		(833)360-3667		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1									
H7728	808	0	2	04	01	H7728_808_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 04:21:12 PM Pacific Daylight Time					06/04/2021 09:22:08 AM Pacific Daylight Time	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		2	1		H7728	808	0	2022	National		1	600	2			2						www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1									
H7728	809	0	2	04	01	H7728_809_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 04:21:19 PM Pacific Daylight Time					06/04/2021 09:22:08 AM Pacific Daylight Time	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		2	1		H7728	809	0	2022	National		1	600	2			2						www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1									
H7728	810	0	1	04	01	H7728_810_0	1	1						06/02/2021	2022.01	06/02/2021 04:21:25 PM Pacific Daylight Time					06/04/2021 09:22:08 AM Pacific Daylight Time	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H7728	810	0	2022	National		1	600	2			2						www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)360-3667		(833)360-3667		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1									
H7728	811	0	1	04	01	H7728_811_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 04:21:32 PM Pacific Daylight Time					06/04/2021 09:22:08 AM Pacific Daylight Time	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H7728	811	0	2022	National		1	600	2			2						www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1									
H7728	812	0	1	04	01	H7728_812_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 04:21:38 PM Pacific Daylight Time					06/04/2021 09:22:08 AM Pacific Daylight Time	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H7728	812	0	2022	National		1	600	2			2						www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1									
H7746	001	0	1	01	01	H7746_001_0	9	1					1	07/28/2021	2022.01	07/28/2021 01:19:12 PM Eastern Daylight Time	08/03/2021 05:14:48 PM Eastern Daylight Time	08/03/2021 04:07:52 PM Eastern Daylight Time			08/05/2021 05:22:47 PM Eastern Daylight Time	MDWISE, INC	MDwise Medicare	www.mdwise.org	MDwise Medicare Inspire (HMO)	01	01		1			H7746	001	0	2022	Select Mid-Indiana Counties		2		2			2						www.mdwise.org	www.mdwise.org	www.mdwise.org	(833)358-2140		(317)822-7401		(833)358-2140		(317)822-7401		(800)910-4691		(317)822-7401		(800)910-4691		(317)822-7401		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7746	002	0	1	01	01	H7746_002_0	9	1					1	07/08/2021	2022.01	07/08/2021 03:47:24 PM Eastern Daylight Time	08/03/2021 05:18:48 PM Eastern Daylight Time	08/03/2021 04:13:44 PM Eastern Daylight Time			08/05/2021 05:22:47 PM Eastern Daylight Time	MDWISE, INC	MDwise Medicare	www.mdwise.org	MDwise Medicare Inspire Plus (HMO)	01	01		1			H7746	002	0	2022	Select Mid-Indiana Counties		2		2			2						www.mdwise.org	www.mdwise.org	www.mdwise.org	(833)358-2140		(317)822-7401		(833)358-2140		(317)822-7401		(800)910-4691		(317)822-7401		(800)910-4691		(317)822-7401		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7746	003	0	1	02	01	H7746_003_0	9	1					1	07/08/2021	2022.01	07/08/2021 03:15:37 PM Eastern Daylight Time	08/04/2021 09:23:06 AM Eastern Daylight Time	08/03/2021 04:17:32 PM Eastern Daylight Time			08/05/2021 05:22:47 PM Eastern Daylight Time	MDWISE, INC	MDwise Medicare	www.mdwise.org	MDwise Medicare Inspire Flex (HMO-POS)	01	02		1			H7746	003	0	2022	Select Mid-Indiana Counties		2		2			2						www.mdwise.org	www.mdwise.org	www.mdwise.org	(833)358-2140		(317)822-7401		(833)358-2140		(317)822-7401		(800)910-4691		(317)822-7401		(800)910-4691		(317)822-7401		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7746	004	0	1	01	01	H7746_004_0	10	1	2	1			0	08/05/2021	2022.01	08/05/2021 05:17:24 PM Eastern Daylight Time	08/04/2021 09:25:04 AM Eastern Daylight Time	08/03/2021 04:44:42 PM Eastern Daylight Time			08/05/2021 05:22:47 PM Eastern Daylight Time	MDWISE, INC	MDwise Medicare	www.mdwise.org	MDwise Medicare Inspire Duals (HMO D-SNP)	01	01		1			H7746	004	0	2022	Select Mid-Indiana Counties DSNP		2		2			1	3		1		1	www.mdwise.org	www.mdwise.org	www.mdwise.org	(833)358-2140		(317)822-7401		(833)358-2140		(317)822-7401		(800)910-4691		(317)822-7401		(800)910-4691		(317)822-7401		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7779	001	0	1	01	01	H7779_001_0	2	1		1			0	08/03/2021	2022.01	08/03/2021 03:03:24 PM Central Daylight Time	08/05/2021 08:08:03 AM Central Daylight Time	08/05/2021 08:08:22 AM Central Daylight Time			08/05/2021 08:46:17 AM Central Daylight Time	AMERICAN HEALTH PLAN, INC.	American Health Advantage of Tennessee	tn.AmHealthPlans.com	American Health Advantage of Tennessee (HMO I-SNP)	01	01		1			H7779	001	0	2022	Tennessee		2		2			1	1	3				tn.AmHealthPlans.com	tn.AmHealthPlans.com	tn.AmHealthPlans.com	(844)321-1763		(844)321-1763		(844)321-1763		(844)321-1763		(844)321-1763		(844)321-1763		(844)321-1763		(844)321-1763		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7787	001	0	1	04	01	H7787_001_0	6	1					1	08/17/2021	2022.01	08/17/2021 03:53:24 PM Central Daylight Time	08/02/2021 05:35:53 PM Central Daylight Time	07/30/2021 12:05:02 PM Central Daylight Time			08/17/2021 04:34:17 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (PPO)	01	04		1			H7787	001	0	2022	North Texas		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6174		(855)982-6174		(800)668-3813		(800)668-3813		(855)982-6174		(855)982-6174		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7787	002	0	1	04	01	H7787_002_0	7	1				0	0	08/17/2021	2022.01	08/17/2021 03:54:52 PM Central Daylight Time	06/02/2021 05:31:24 PM Central Daylight Time				08/17/2021 04:34:17 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna	www.cignamedicare.com	Cigna Fundamental Medicare (PPO)	01	04		1			H7787	002	0	2022	North Texas		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6174		(855)982-6174										(711)-		(711)-		(711)-		(711)-										2					2						2			
H7833	001	0	1	48	05	H7833_001_0	6	1						07/30/2021	2022.01	07/30/2021 08:23:44 AM Central Daylight Time					07/30/2021 08:23:53 AM Central 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	2022	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	2	1						07/07/2021	2022.01	07/07/2021 01:49:32 PM Pacific Daylight Time					07/08/2021 09:09:03 AM 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	2022	Wayne and Macomb Counties		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)-																
H7849	001	0	1	04	01	H7849_001_0	5	1					1	08/02/2021	2022.01	08/02/2021 06:07:19 PM Central Daylight Time	08/02/2021 04:03:51 PM Central Daylight Time	07/30/2021 12:05:26 PM Central Daylight Time			08/04/2021 01:49:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	001	0	2022	Denver and Boulder Area		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)721-1583		(855)721-1583		(800)668-3813		(800)668-3813		(855)721-1583		(855)721-1583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	002	0	1	04	01	H7849_002_0	4	1					0	08/02/2021	2022.01	08/02/2021 07:49:32 PM Central Daylight Time	08/03/2021 09:47:52 AM Central Daylight Time	07/30/2021 12:05:50 PM Central Daylight Time			08/04/2021 01:49:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	002	0	2022	Chicago Area		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.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			
H7849	003	0	1	04	01	H7849_003_0	4	1					0	08/02/2021	2022.01	08/02/2021 06:37:09 PM Central Daylight Time	08/04/2021 10:53:44 AM Central Daylight Time	07/30/2021 12:06:13 PM Central Daylight Time			08/04/2021 01:49:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	003	0	2022	Georgia		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101		(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	006	0	1	04	01	H7849_006_0	4	1					0	08/02/2021	2022.01	08/02/2021 05:26:27 PM Central Daylight Time	08/02/2021 12:44:45 PM Central Daylight Time	07/30/2021 12:06:37 PM Central Daylight Time			08/04/2021 01:49:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	006	0	2022	Philadelphia Area		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.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			
H7849	007	0	1	04	01	H7849_007_0	4	1					0	07/09/2021	2022.01	07/09/2021 09:56:34 AM Central Daylight Time	08/02/2021 12:45:48 PM Central Daylight Time	07/30/2021 12:07:01 PM Central Daylight Time			08/04/2021 01:49:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Plus Medicare (PPO)	01	04		1			H7849	007	0	2022	Philadelphia Area		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.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			
H7849	008	0	1	04	01	H7849_008_0	4	1					0	08/02/2021	2022.01	08/02/2021 04:18:14 PM Central Daylight Time	08/03/2021 08:41:03 AM Central Daylight Time	07/30/2021 12:07:25 PM Central Daylight Time			08/04/2021 01:49:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	008	0	2022	Washington DC and Delaware		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.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			
H7849	009	0	1	04	01	H7849_009_0	4	1					0	07/09/2021	2022.01	07/09/2021 09:58:18 AM Central Daylight Time	08/03/2021 08:42:16 AM Central Daylight Time	07/30/2021 12:07:49 PM Central Daylight Time			08/04/2021 01:49:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Plus Medicare (PPO)	01	04		1			H7849	009	0	2022	Washington DC and Delaware		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.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			
H7849	010	0	1	04	01	H7849_010_0	4	1					0	08/02/2021	2022.01	08/02/2021 04:53:47 PM Central Daylight Time	08/02/2021 05:56:40 PM Central Daylight Time	07/30/2021 12:08:12 PM Central Daylight Time			08/04/2021 01:49:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	010	0	2022	Middle Tennessee		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.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			
H7849	011	0	1	04	01	H7849_011_0	4	1					0	08/02/2021	2022.01	08/02/2021 03:21:35 PM Central Daylight Time	08/02/2021 05:57:43 PM Central Daylight Time	07/30/2021 12:08:36 PM Central Daylight Time			08/04/2021 01:49:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	011	0	2022	North Carolina		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)980-3049		(855)980-3049		(800)668-3813		(800)668-3813		(855)980-3049		(855)980-3049		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	012	0	1	04	01	H7849_012_0	4	1					0	08/02/2021	2022.01	08/02/2021 06:59:23 PM Central Daylight Time	08/01/2021 10:59:55 PM Central Daylight Time	07/30/2021 12:08:59 PM Central Daylight Time			08/04/2021 01:49:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	012	0	2022	Alabama		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)707-7116		(855)707-7116		(800)668-3813		(800)668-3813		(855)707-7116		(855)707-7116		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	013	0	1	04	01	H7849_013_0	4	1					0	08/02/2021	2022.01	08/02/2021 06:59:39 PM Central Daylight Time	08/01/2021 11:07:01 PM Central Daylight Time	07/30/2021 12:09:23 PM Central Daylight Time			08/04/2021 01:49:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	013	0	2022	Alabama		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)707-7116		(855)707-7116		(800)668-3813		(800)668-3813		(855)707-7116		(855)707-7116		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	014	0	1	04	01	H7849_014_0	4	1					0	08/02/2021	2022.01	08/02/2021 08:01:01 PM Central Daylight Time	08/04/2021 10:37:00 AM Central Daylight Time	07/30/2021 12:09:47 PM Central Daylight Time			08/04/2021 01:49:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	014	0	2022	Treasure Coast		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(866)623-8445		(866)623-8445		(800)668-3813		(800)668-3813		(866)623-8445		(866)623-8445		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	015	0	1	04	01	H7849_015_0	4	1					0	08/03/2021	2022.01	08/03/2021 01:15:06 PM Central Daylight Time	08/03/2021 12:24:56 PM Central Daylight Time	07/30/2021 12:10:11 PM Central Daylight Time			08/04/2021 01:49:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	015	0	2022	Ohio		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)394-0157		(855)394-0157		(800)668-3813		(800)668-3813		(855)394-0157		(855)394-0157		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	016	0	1	04	01	H7849_016_0	5	1					0	08/02/2021	2022.01	08/02/2021 07:00:06 PM Central Daylight Time	08/01/2021 11:09:54 PM Central Daylight Time	07/30/2021 12:10:34 PM Central Daylight Time			08/04/2021 01:49:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	016	0	2022	Southern Mississippi		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)707-7116		(855)707-7116		(800)668-3813		(800)668-3813		(855)707-7116		(855)707-7116		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	017	0	1	04	01	H7849_017_0	4	1					0	08/03/2021	2022.01	08/03/2021 10:35:03 AM Central Daylight Time	08/02/2021 06:44:34 PM Central Daylight Time	07/30/2021 12:10:58 PM Central Daylight Time			08/04/2021 01:49:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	017	0	2022	Orlando Area		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)980-3046		(855)980-3046		(800)668-3813		(800)668-3813		(855)980-3046		(855)980-3046		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	018	0	1	04	01	H7849_018_0	5	1					0	08/02/2021	2022.01	08/02/2021 04:17:37 PM Central Daylight Time	08/02/2021 05:58:48 PM Central Daylight Time	07/30/2021 12:11:21 PM Central Daylight Time			08/04/2021 01:49:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	018	0	2022	South Carolina		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)980-3049		(855)980-3049		(800)668-3813		(800)668-3813		(855)980-3049		(855)980-3049		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	019	0	1	04	01	H7849_019_0	4	1					0	08/02/2021	2022.01	08/02/2021 04:18:48 PM Central Daylight Time	08/02/2021 06:00:04 PM Central Daylight Time	07/30/2021 12:11:44 PM Central Daylight Time			08/04/2021 01:49:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	019	0	2022	North Carolina		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)980-3049		(855)980-3049		(800)668-3813		(800)668-3813		(855)980-3049		(855)980-3049		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	020	0	1	04	01	H7849_020_0	5	1					0	08/09/2021	2022.01	08/09/2021 08:05:31 AM Central Daylight Time	08/04/2021 10:58:17 AM Central Daylight Time	07/30/2021 12:12:22 PM Central Daylight Time			08/09/2021 11:33:33 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	020	0	2022	Georgia		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101		(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	021	0	1	04	01	H7849_021_0	5	1					0	08/09/2021	2022.01	08/09/2021 08:05:44 AM Central Daylight Time	08/04/2021 11:00:28 AM Central Daylight Time	07/30/2021 12:12:45 PM Central Daylight Time			08/09/2021 11:33:33 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	021	0	2022	Georgia		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101		(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	022	0	1	04	01	H7849_022_0	5	1					0	08/09/2021	2022.01	08/09/2021 08:06:03 AM Central Daylight Time	08/04/2021 11:01:43 AM Central Daylight Time	07/30/2021 12:13:09 PM Central Daylight Time			08/09/2021 11:33:33 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	022	0	2022	Georgia		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101		(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	023	0	1	04	01	H7849_023_0	5	1					0	08/09/2021	2022.01	08/09/2021 08:06:16 AM Central Daylight Time	08/04/2021 11:02:36 AM Central Daylight Time	07/30/2021 12:13:32 PM Central Daylight Time			08/09/2021 11:33:33 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	023	0	2022	Georgia		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101		(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	024	0	1	04	01	H7849_024_0	5	1					0	08/03/2021	2022.01	08/03/2021 09:13:42 AM Central Daylight Time	08/03/2021 09:50:25 AM Central Daylight Time	07/30/2021 12:13:55 PM Central Daylight Time			08/04/2021 01:49:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	024	0	2022	Kansas City Area		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(866)612-1391		(866)612-1391		(800)668-3813		(800)668-3813		(866)612-1391		(866)612-1391		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	026	0	1	04	01	H7849_026_0	5	1					1	08/02/2021	2022.01	08/02/2021 05:42:26 PM Central Daylight Time	08/02/2021 04:05:46 PM Central Daylight Time	07/30/2021 12:14:19 PM Central Daylight Time			08/04/2021 01:49:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	026	0	2022	Fort Collins Area		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)952-0786		(855)952-0786		(800)668-3813		(800)668-3813		(855)952-0786		(855)952-0786		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	027	0	1	04	01	H7849_027_0	5	1					1	08/02/2021	2022.01	08/02/2021 05:43:33 PM Central Daylight Time	08/02/2021 04:07:19 PM Central Daylight Time	07/30/2021 12:14:43 PM Central Daylight Time			08/04/2021 01:49:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	027	0	2022	Colorado Springs Area		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)952-0786		(855)952-0786		(800)668-3813		(800)668-3813		(855)952-0786		(855)952-0786		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	028	0	1	04	01	H7849_028_0	5	1					0	08/02/2021	2022.01	08/02/2021 05:44:34 PM Central Daylight Time	08/02/2021 04:09:59 PM Central Daylight Time	07/30/2021 12:15:08 PM Central Daylight Time			08/04/2021 01:49:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	028	0	2022	Albuquerque Area		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)343-8992		(855)343-8992		(800)668-3813		(800)668-3813		(855)343-8992		(855)343-8992		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	029	0	1	04	01	H7849_029_0	6	1					0	08/02/2021	2022.01	08/02/2021 05:45:56 PM Central Daylight Time	08/02/2021 04:12:15 PM Central Daylight Time	07/30/2021 12:15:35 PM Central Daylight Time			08/04/2021 01:49:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	029	0	2022	Salt Lake City Area		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.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			
H7849	030	0	1	04	01	H7849_030_0	5	1					0	08/17/2021	2022.01	08/17/2021 03:51:08 PM Central Daylight Time	08/02/2021 12:46:35 PM Central Daylight Time	07/30/2021 12:15:58 PM Central Daylight Time			08/17/2021 04:34:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Plus Medicare (PPO)	01	04		1			H7849	030	0	2022	Central New Jersey		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.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			
H7849	031	0	1	04	01	H7849_031_0	4	1					0	08/02/2021	2022.01	08/02/2021 05:28:47 PM Central Daylight Time	08/02/2021 12:47:24 PM Central Daylight Time	07/30/2021 12:16:22 PM Central Daylight Time			08/04/2021 01:49:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	031	0	2022	Central Pennsylvania		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.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			
H7849	032	0	1	04	01	H7849_032_0	4	1					0	07/09/2021	2022.01	07/09/2021 11:55:56 AM Central Daylight Time	08/02/2021 12:50:01 PM Central Daylight Time	07/30/2021 12:17:01 PM Central Daylight Time			08/04/2021 01:49:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Plus Medicare (PPO)	01	04		1			H7849	032	0	2022	Central Pennsylvania		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.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			
H7849	033	0	1	04	01	H7849_033_0	4	1					0	07/09/2021	2022.01	07/09/2021 11:55:31 AM Central Daylight Time	08/02/2021 12:51:13 PM Central Daylight Time	07/30/2021 12:17:25 PM Central Daylight Time			08/04/2021 01:49:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Plus Medicare (PPO)	01	04		1			H7849	033	0	2022	Southern New Jersey		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.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			
H7849	034	0	1	04	01	H7849_034_0	4	1					0	08/02/2021	2022.01	08/02/2021 04:54:50 PM Central Daylight Time	08/02/2021 06:01:09 PM Central Daylight Time	07/30/2021 12:17:48 PM Central Daylight Time			08/04/2021 01:49:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	034	0	2022	Tri Cities		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.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			
H7849	035	0	1	04	01	H7849_035_0	4	1					0	08/02/2021	2022.01	08/02/2021 04:59:57 PM Central Daylight Time	08/02/2021 06:02:34 PM Central Daylight Time	07/30/2021 12:18:26 PM Central Daylight Time			08/04/2021 01:49:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	035	0	2022	Northwest Georgia		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.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			
H7849	036	0	1	04	01	H7849_036_0	4	1					0	08/02/2021	2022.01	08/02/2021 05:01:25 PM Central Daylight Time	08/02/2021 06:03:33 PM Central Daylight Time	07/30/2021 12:18:50 PM Central Daylight Time			08/04/2021 01:49:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	036	0	2022	Chattanooga Area		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.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			
H7849	037	0	1	04	01	H7849_037_0	4	1					0	08/02/2021	2022.01	08/02/2021 05:02:31 PM Central Daylight Time	08/02/2021 06:04:30 PM Central Daylight Time	07/30/2021 12:19:13 PM Central Daylight Time			08/04/2021 01:49:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	037	0	2022	West Tennessee		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.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			
H7849	038	0	1	04	01	H7849_038_0	4	1					1	08/02/2021	2022.01	08/02/2021 05:45:19 PM Central Daylight Time	08/02/2021 05:37:43 PM Central Daylight Time	07/30/2021 12:19:37 PM Central Daylight Time			08/04/2021 01:49:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	038	0	2022	Houston		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6174		(855)982-6174		(800)668-3813		(800)668-3813		(855)982-6174		(855)982-6174		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	039	0	1	04	01	H7849_039_0	4	1					1	08/02/2021	2022.01	08/02/2021 05:46:29 PM Central Daylight Time	08/02/2021 05:39:13 PM Central Daylight Time	07/30/2021 12:20:00 PM Central Daylight Time			08/04/2021 01:49:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	039	0	2022	Valley		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6174		(855)982-6174		(800)668-3813		(800)668-3813		(855)982-6174		(855)982-6174		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	040	0	1	04	01	H7849_040_0	4	1					1	08/02/2021	2022.01	08/02/2021 05:51:55 PM Central Daylight Time	08/02/2021 05:40:14 PM Central Daylight Time	07/30/2021 12:20:39 PM Central Daylight Time			08/04/2021 01:49:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	040	0	2022	North Texas		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6174		(855)982-6174		(800)668-3813		(800)668-3813		(855)982-6174		(855)982-6174		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	041	0	1	04	01	H7849_041_0	4	1					1	08/02/2021	2022.01	08/02/2021 05:53:42 PM Central Daylight Time	08/02/2021 05:41:21 PM Central Daylight Time	07/30/2021 12:21:02 PM Central Daylight Time			08/04/2021 01:49:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	041	0	2022	El Paso		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6174		(855)982-6174		(800)668-3813		(800)668-3813		(855)982-6174		(855)982-6174		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	042	0	1	04	01	H7849_042_0	4	1					1	08/02/2021	2022.01	08/02/2021 05:55:42 PM Central Daylight Time	08/02/2021 05:42:15 PM Central Daylight Time	07/30/2021 12:21:25 PM Central Daylight Time			08/04/2021 01:49:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	042	0	2022	Oklahoma City Area		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)593-4468		(855)593-4468		(800)668-3813		(800)668-3813		(855)593-4468		(855)593-4468		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	043	0	1	04	01	H7849_043_0	4	1					0	08/02/2021	2022.01	08/02/2021 05:03:32 PM Central Daylight Time	08/02/2021 06:05:39 PM Central Daylight Time	07/30/2021 12:21:49 PM Central Daylight Time			08/04/2021 01:49:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	043	0	2022	Knoxville Area		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.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			
H7849	044	0	1	04	01	H7849_044_0	4	1					0	08/02/2021	2022.01	08/02/2021 07:01:32 PM Central Daylight Time	08/01/2021 11:18:30 PM Central Daylight Time	07/30/2021 12:22:12 PM Central Daylight Time			08/04/2021 01:49:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	044	0	2022	Northern Florida		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101		(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	045	0	1	04	01	H7849_045_0	9	1					0	08/02/2021	2022.01	08/02/2021 04:19:06 PM Central Daylight Time	08/02/2021 06:06:44 PM Central Daylight Time	07/30/2021 12:22:35 PM Central Daylight Time			08/04/2021 01:49:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	045	0	2022	South Carolina		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101		(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	046	0	1	04	01	H7849_046_0	4	1					0	08/02/2021	2022.01	08/02/2021 03:29:02 PM Central Daylight Time	08/02/2021 06:07:49 PM Central Daylight Time	07/30/2021 12:22:58 PM Central Daylight Time			08/04/2021 01:49:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	046	0	2022	North Carolina		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101		(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	047	0	1	04	01	H7849_047_0	4	1					0	08/02/2021	2022.01	08/02/2021 06:47:32 PM Central Daylight Time	08/02/2021 06:51:10 PM Central Daylight Time	07/30/2021 12:23:21 PM Central Daylight Time			08/04/2021 01:49:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	047	0	2022	Daytona Area		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101		(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	048	0	1	04	01	H7849_048_0	4	1					0	08/03/2021	2022.01	08/03/2021 11:41:23 AM Central Daylight Time	08/02/2021 06:55:01 PM Central Daylight Time	07/30/2021 12:23:45 PM Central Daylight Time			08/04/2021 01:49:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	048	0	2022	Tampa Area		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101		(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	050	0	1	04	01	H7849_050_0	5	1					1	08/02/2021	2022.01	08/02/2021 05:46:33 PM Central Daylight Time	08/02/2021 04:14:10 PM Central Daylight Time	07/30/2021 12:24:10 PM Central Daylight Time			08/04/2021 01:49:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	050	0	2022	Colorado SW Corner Area		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101		(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	051	0	1	04	01	H7849_051_0	5	1					1	08/02/2021	2022.01	08/02/2021 05:47:02 PM Central Daylight Time	08/02/2021 04:16:34 PM Central Daylight Time	07/30/2021 12:24:34 PM Central Daylight Time			08/04/2021 01:49:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	051	0	2022	Colorado Western Slope Area		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101		(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	052	0	1	04	01	H7849_052_0	4	1					0	08/02/2021	2022.01	08/02/2021 04:43:49 PM Central Daylight Time	08/03/2021 08:43:25 AM Central Daylight Time	07/30/2021 12:24:57 PM Central Daylight Time			08/04/2021 01:49:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	052	0	2022	Connecticut		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101		(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	054	0	1	04	01	H7849_054_0	4	1					0	07/09/2021	2022.01	07/09/2021 11:46:20 AM Central Daylight Time	08/03/2021 08:44:30 AM Central Daylight Time	07/30/2021 12:25:21 PM Central Daylight Time			08/04/2021 01:49:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Plus Medicare (PPO)	01	04		1			H7849	054	0	2022	Connecticut		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101		(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	055	0	1	04	01	H7849_055_0	4	1					0	08/02/2021	2022.01	08/02/2021 08:13:04 PM Central Daylight Time	08/02/2021 04:59:45 PM Central Daylight Time	07/30/2021 12:25:48 PM Central Daylight Time			08/04/2021 01:49:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	055	0	2022	Portland		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101		(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	056	0	1	04	01	H7849_056_0	6	1					0	08/02/2021	2022.01	08/02/2021 08:01:44 PM Central Daylight Time	08/04/2021 10:41:09 AM Central Daylight Time	07/30/2021 12:26:13 PM Central Daylight Time			08/04/2021 01:49:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	056	0	2022	Southwest FL		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)721-1583		(855)721-1583		(800)668-3813		(800)668-3813		(855)721-1583		(855)721-1583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	057	0	1	04	01	H7849_057_0	4	1					0	08/02/2021	2022.01	08/02/2021 08:18:13 PM Central Daylight Time	08/03/2021 09:51:52 AM Central Daylight Time	07/30/2021 12:26:51 PM Central Daylight Time			08/04/2021 01:49:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	057	0	2022	St. Louis Area		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)721-1583		(855)721-1583		(800)668-3813		(800)668-3813		(855)721-1583		(855)721-1583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	058	0	1	04	01	H7849_058_0	4	1					0	08/02/2021	2022.01	08/02/2021 08:18:47 PM Central Daylight Time	08/03/2021 09:53:12 AM Central Daylight Time	07/30/2021 12:27:14 PM Central Daylight Time			08/04/2021 01:49:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	058	0	2022	Southern IL		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)721-1583		(855)721-1583		(800)668-3813		(800)668-3813		(855)721-1583		(855)721-1583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	059	0	1	04	01	H7849_059_0	4	1					0	08/02/2021	2022.01	08/02/2021 08:19:14 PM Central Daylight Time	08/03/2021 09:54:29 AM Central Daylight Time	07/30/2021 12:27:38 PM Central Daylight Time			08/04/2021 01:49:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	059	0	2022	Southern IL		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)721-1583		(855)721-1583		(800)668-3813		(800)668-3813		(855)721-1583		(855)721-1583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	060	0	1	04	01	H7849_060_0	4	1					0	08/02/2021	2022.01	08/02/2021 05:05:31 PM Central Daylight Time	08/02/2021 06:08:51 PM Central Daylight Time	07/30/2021 12:28:02 PM Central Daylight Time			08/04/2021 01:49:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	060	0	2022	North Mississippi		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)721-1583		(855)721-1583		(800)668-3813		(800)668-3813		(855)721-1583		(855)721-1583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	062	0	1	04	01	H7849_062_0	4	1					0	08/02/2021	2022.01	08/02/2021 05:57:20 PM Central Daylight Time	08/02/2021 05:43:09 PM Central Daylight Time	07/30/2021 12:28:25 PM Central Daylight Time			08/04/2021 01:49:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Plus Medicare (PPO)	01	04		1			H7849	062	0	2022	Houston & San Antonio		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)721-1583		(855)721-1583		(800)668-3813		(800)668-3813		(855)721-1583		(855)721-1583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	801	0	1	04	01	H7849_801_0	2	1						05/10/2021	2022.01	05/10/2021 12:34:05 PM Central Daylight Time					06/02/2021 05:57:25 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignahealthspring.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	801	0	2022	Statewide TN		1	600	2			2						www.cigna.com/medicare	www.cignahealthspring.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172		(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H7849	802	0	1	04	01	H7849_802_0	2	1				0	0	05/10/2021	2022.01	05/10/2021 12:33:52 PM Central Daylight Time					06/02/2021 05:57:25 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignahealthspring.com	Cigna True Choice Core Medicare (PPO)	01	04		1			H7849	802	0	2022	Statewide TN		1	600	2			2						www.cigna.com/medicare	www.cignahealthspring.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H7849	803	0	1	04	01	H7849_803_0	2	1						05/10/2021	2022.01	05/10/2021 12:33:38 PM Central Daylight Time					06/02/2021 05:57:25 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignahealthspring.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	803	0	2022	Statewide DC, DE, MD, VA		1	600	2			2						www.cigna.com/medicare	www.cignahealthspring.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172		(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H7849	804	0	1	04	01	H7849_804_0	2	1				0	0	05/10/2021	2022.01	05/10/2021 12:33:22 PM Central Daylight Time					06/02/2021 05:57:25 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignahealthspring.com	Cigna True Choice Core Medicare (PPO)	01	04		1			H7849	804	0	2022	Statewide DC, DE, MD, VA		1	600	2			2						www.cigna.com/medicare	www.cignahealthspring.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H7849	805	0	1	04	01	H7849_805_0	2	1						05/10/2021	2022.01	05/10/2021 12:33:09 PM Central Daylight Time					06/02/2021 05:57:25 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignahealthspring.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	805	0	2022	Statewide NJ & PA		1	600	2			2						www.cigna.com/medicare	www.cignahealthspring.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172		(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H7849	806	0	1	04	01	H7849_806_0	2	1				0	0	05/10/2021	2022.01	05/10/2021 12:32:54 PM Central Daylight Time					06/02/2021 05:57:25 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignahealthspring.com	Cigna True Choice Core Medicare (PPO)	01	04		1			H7849	806	0	2022	Statewide NJ & PA		1	600	2			2						www.cigna.com/medicare	www.cignahealthspring.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H7849	807	0	1	04	01	H7849_807_0	2	1						05/10/2021	2022.01	05/10/2021 12:32:35 PM Central Daylight Time					06/02/2021 05:57:25 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignahealthspring.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	807	0	2022	Statewide NC		1	600	2			2						www.cigna.com/medicare	www.cignahealthspring.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172		(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H7849	808	0	1	04	01	H7849_808_0	2	1				0	0	05/10/2021	2022.01	05/10/2021 12:32:04 PM Central Daylight Time					06/02/2021 05:57:25 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignahealthspring.com	Cigna True Choice Core Medicare (PPO)	01	04		1			H7849	808	0	2022	Statewide NC		1	600	2			2						www.cigna.com/medicare	www.cignahealthspring.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H7849	809	0	1	04	01	H7849_809_0	2	1						05/10/2021	2022.01	05/10/2021 12:31:49 PM Central Daylight Time					06/02/2021 05:57:25 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignahealthspring.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	809	0	2022	Statewide IL		1	600	2			2						www.cigna.com/medicare	www.cignahealthspring.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172		(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H7849	810	0	1	04	01	H7849_810_0	2	1				0	0	05/10/2021	2022.01	05/10/2021 12:31:35 PM Central Daylight Time					06/02/2021 05:57:25 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignahealthspring.com	Cigna True Choice Core Medicare (PPO)	01	04		1			H7849	810	0	2022	Statewide IL		1	600	2			2						www.cigna.com/medicare	www.cignahealthspring.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H7849	811	0	1	04	01	H7849_811_0	2	1						05/10/2021	2022.01	05/10/2021 12:31:21 PM Central Daylight Time					06/02/2021 05:57:25 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignahealthspring.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	811	0	2022	Statewide CO		1	600	2			2						www.cigna.com/medicare	www.cignahealthspring.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172		(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H7849	812	0	1	04	01	H7849_812_0	2	1				0	0	05/10/2021	2022.01	05/10/2021 12:31:08 PM Central Daylight Time					06/02/2021 05:57:25 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignahealthspring.com	Cigna True Choice Core Medicare (PPO)	01	04		1			H7849	812	0	2022	Statewide CO		1	600	2			2						www.cigna.com/medicare	www.cignahealthspring.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H7849	813	0	1	04	01	H7849_813_0	2	1						05/10/2021	2022.01	05/10/2021 12:30:54 PM Central Daylight Time					06/02/2021 05:57:25 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignahealthspring.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	813	0	2022	Statewide GA		1	600	2			2						www.cigna.com/medicare	www.cignahealthspring.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172		(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H7849	814	0	1	04	01	H7849_814_0	2	1				0	0	05/10/2021	2022.01	05/10/2021 12:30:40 PM Central Daylight Time					06/02/2021 05:57:25 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignahealthspring.com	Cigna True Choice Core Medicare (PPO)	01	04		1			H7849	814	0	2022	Statewide GA		1	600	2			2						www.cigna.com/medicare	www.cignahealthspring.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H7849	815	0	1	04	01	H7849_815_0	2	1						05/10/2021	2022.01	05/10/2021 12:30:24 PM Central Daylight Time					06/02/2021 05:57:25 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignahealthspring.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	815	0	2022	Statewide AL		1	600	2			2						www.cigna.com/medicare	www.cignahealthspring.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172		(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H7849	816	0	1	04	01	H7849_816_0	2	1				0	0	05/10/2021	2022.01	05/10/2021 12:30:08 PM Central Daylight Time					06/02/2021 05:57:25 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignahealthspring.com	Cigna True Choice Core Medicare (PPO)	01	04		1			H7849	816	0	2022	Statewide AL		1	600	2			2						www.cigna.com/medicare	www.cignahealthspring.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H7849	817	0	1	04	01	H7849_817_0	2	1						05/10/2021	2022.01	05/10/2021 12:29:53 PM Central Daylight Time					06/02/2021 05:57:25 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignahealthspring.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	817	0	2022	Nationwide		1	600	2			2						www.cigna.com/medicare	www.cignahealthspring.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172		(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H7849	818	0	1	04	01	H7849_818_0	2	1				0	0	05/10/2021	2022.01	05/10/2021 12:29:39 PM Central Daylight Time					06/02/2021 05:57:25 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignahealthspring.com	Cigna True Choice Core Medicare (PPO)	01	04		1			H7849	818	0	2022	Nationwide		1	600	2			2						www.cigna.com/medicare	www.cignahealthspring.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H7849	819	0	1	04	01	H7849_819_0	2	1						05/10/2021	2022.01	05/10/2021 12:29:26 PM Central Daylight Time					06/02/2021 05:57:25 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	819	0	2022	Statewide FL		1	600	2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.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)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H7849	820	0	1	04	01	H7849_820_0	2	1				0	0	05/10/2021	2022.01	05/10/2021 12:29:10 PM Central Daylight Time					06/02/2021 05:57:25 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Core Medicare (PPO)	01	04		1			H7849	820	0	2022	Statewide FL		1	600	2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(866)593-4468		(866)593-4468										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H7849	821	0	1	04	01	H7849_821_0	2	1						05/10/2021	2022.01	05/10/2021 12:28:53 PM Central Daylight Time					06/02/2021 05:57:25 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	821	0	2022	Statewide OK & TX		1	600	2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.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)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H7849	822	0	1	04	01	H7849_822_0	2	1				0	0	05/10/2021	2022.01	05/10/2021 12:28:34 PM Central Daylight Time					06/02/2021 05:57:25 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Core Medicare (PPO)	01	04		1			H7849	822	0	2022	Statewide OK & TX		1	600	2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(866)593-4468		(866)593-4468										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H7849	823	0	1	04	01	H7849_823_0	2	1						05/10/2021	2022.01	05/10/2021 12:28:12 PM Central Daylight Time					06/02/2021 05:57:25 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	823	0	2022	Statewide KS & MO		1	600	2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.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)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H7849	824	0	1	04	01	H7849_824_0	2	1				0	0	05/10/2021	2022.01	05/10/2021 12:27:58 PM Central Daylight Time					06/02/2021 05:57:25 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Core Medicare (PPO)	01	04		1			H7849	824	0	2022	Statewide KS & MO		1	600	2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(866)593-4468		(866)593-4468										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H7849	827	0	1	04	01	H7849_827_0	2	1						05/10/2021	2022.01	05/10/2021 11:27:39 AM Central Daylight Time					06/02/2021 05:57:25 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	827	0	2022	Statewide CT		1	600	2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101		(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H7849	828	0	1	04	01	H7849_828_0	2	1				0	0	05/10/2021	2022.01	05/10/2021 12:27:39 PM Central Daylight Time					06/02/2021 05:57:25 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Core Medicare (PPO)	01	04		1			H7849	828	0	2022	Statewide CT		1	600	2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H7849	831	0	1	04	01	H7849_831_0	2	1						05/10/2021	2022.01	05/10/2021 12:25:31 PM Central Daylight Time					06/02/2021 05:57:25 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	831	0	2022	Statewide NY		1	600	2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101		(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H7849	832	0	1	04	01	H7849_832_0	2	1				0	0	05/10/2021	2022.01	05/10/2021 12:09:08 PM Central Daylight Time					06/02/2021 05:57:25 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna True Choice Core Medicare (PPO)	01	04		1			H7849	832	0	2022	Statewide NY		1	600	2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6101		(855)982-6101										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H7849	833	0	1	04	01	H7849_833_0	2	1						05/10/2021	2022.01	05/10/2021 12:08:40 PM Central Daylight Time					06/02/2021 05:57:25 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignahealthspring.com	Cigna True Choice Medicare (PPO)	01	04		1			H7849	833	0	2022	Statewide SC		1	600	2			2						www.cigna.com/medicare	www.cignahealthspring.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172		(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H7849	834	0	1	04	01	H7849_834_0	2	1				0	0	05/10/2021	2022.01	05/10/2021 12:08:25 PM Central Daylight Time					06/02/2021 05:57:25 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignahealthspring.com	Cigna True Choice Core Medicare (PPO)	01	04		1			H7849	834	0	2022	Statewide SC		1	600	2			2						www.cigna.com/medicare	www.cignahealthspring.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H7853	001	0	1	01	01	H7853_001_0	7	1					0	08/03/2021	2022.01	08/03/2021 02:53:43 PM Central Daylight Time	08/05/2021 03:37:49 PM Central Daylight Time	08/05/2021 03:37:52 PM Central Daylight Time			08/05/2021 05:14:03 PM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY	Bright Health	brighthealthcare.com/medicare	Bright Advantage Classic Care Plan (HMO)	01	01		1			H7853	001	0	2022	Greater Denver Area		2	25165	2			2						brighthealthcare.com/madoctors	brighthealthcare.com/drug-search/ma	brighthealthcare.com/madoctors	(844)926-4521		(844)926-4521		(844)679-2028		(844)679-2028		(844)926-4521		(844)926-4521		(844)679-2028		(844)679-2028		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7853	002	0	1	01	01	H7853_002_0	6	1					0	08/05/2021	2022.01	08/05/2021 08:01:03 AM Central Daylight Time	08/05/2021 03:37:49 PM Central Daylight Time	08/05/2021 03:37:52 PM Central Daylight Time			08/05/2021 05:14:03 PM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY	Bright Health	brighthealthcare.com/medicare	Bright Advantage Classic Plus Plan (HMO)	01	01		1			H7853	002	0	2022	Greater Denver Area		2	1480	2			2						brighthealthcare.com/madoctors	brighthealthcare.com/drug-search/ma	brighthealthcare.com/madoctors	(844)926-4521		(844)926-4521		(844)679-2028		(844)679-2028		(844)926-4521		(844)926-4521		(844)679-2028		(844)679-2028		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7853	010	0	1	01	01	H7853_010_0	6	1					0	08/03/2021	2022.01	08/03/2021 03:35:56 PM Central Daylight Time	08/05/2021 03:37:49 PM Central Daylight Time	08/05/2021 03:37:52 PM Central Daylight Time			08/05/2021 05:14:03 PM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY	Bright Health	brighthealthcare.com/medicare	Bright Advantage Part B Savings Plan (HMO)	01	01		1			H7853	010	0	2022	Greater Denver Area		2	2467	2			2						brighthealthcare.com/madoctors	brighthealthcare.com/drug-search/ma	brighthealthcare.com/madoctors	(844)926-4521		(844)926-4521		(844)679-2028		(844)679-2028		(844)926-4521		(844)926-4521		(844)679-2028		(844)679-2028		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7853	011	0	1	01	01	H7853_011_0	6	1	2	1			0	08/03/2021	2022.01	08/03/2021 03:09:46 PM Central Daylight Time	08/05/2021 03:37:49 PM Central Daylight Time	08/05/2021 03:37:52 PM Central Daylight Time			08/05/2021 05:14:03 PM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY	Bright Health	brighthealthcare.com/medicare	Bright Advantage Dual Access Plan (HMO D-SNP)	01	01		1			H7853	011	0	2022	Greater Denver Area		2	5073	2			1	3		1		1	brighthealthcare.com/madoctors	brighthealthcare.com/drug-search/ma	brighthealthcare.com/madoctors	(844)926-4521		(844)926-4521		(844)679-2028		(844)679-2028		(844)926-4521		(844)926-4521		(844)679-2028		(844)679-2028		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7853	012	0	1	01	01	H7853_012_0	6	1		1			1	08/03/2021	2022.01	08/03/2021 03:21:56 PM Central Daylight Time	08/05/2021 05:33:38 PM Central Daylight Time	08/05/2021 05:34:59 PM Central Daylight Time			08/05/2021 06:26:50 PM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY	Bright Health	brighthealthcare.com/medicare	Bright Advantage Embrace Care Plan (HMO C-SNP)	01	01		1			H7853	012	0	2022	Greater Denver Area		2	12683	2			1	4			00000000000000000010		brighthealthcare.com/madoctors	brighthealthcare.com/drug-search/ma	brighthealthcare.com/madoctors	(844)926-4521		(844)926-4521		(844)679-2028		(844)679-2028		(844)926-4521		(844)926-4521		(844)679-2028		(844)679-2028		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7853	013	0	1	01	01	H7853_013_0	7	1		1			0	08/03/2021	2022.01	08/03/2021 04:28:50 PM Central Daylight Time	08/05/2021 05:33:38 PM Central Daylight Time	08/05/2021 05:34:59 PM Central Daylight Time			08/05/2021 06:26:50 PM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY	Bright Health	brighthealthcare.com/medicare	Bright Advantage Embrace Choice Plan (HMO C-SNP)	01	01		1			H7853	013	0	2022	Greater Denver Area		2	2537	2			1	4			00000000000000000010		brighthealthcare.com/madoctors	brighthealthcare.com/drug-search/ma	brighthealthcare.com/madoctors	(844)926-4521		(844)926-4521		(844)679-2028		(844)679-2028		(844)926-4521		(844)926-4521		(844)679-2028		(844)679-2028		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7853	015	0	1	01	01	H7853_015_0	6	1		1			0	08/03/2021	2022.01	08/03/2021 03:25:01 PM Central Daylight Time	08/05/2021 05:33:38 PM Central Daylight Time	08/05/2021 05:34:59 PM Central Daylight Time			08/05/2021 06:26:50 PM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY	Bright Health	brighthealthcare.com/medicare	Bright Advantage Embrace Assist Plan (HMO C-SNP)	01	01		1			H7853	015	0	2022	Greater Denver Area		2	507	2			1	4			00000000000000000010		brighthealthcare.com/madoctors	brighthealthcare.com/drug-search/ma	brighthealthcare.com/madoctors	(844)926-4521		(844)926-4521		(844)679-2028		(844)679-2028		(844)926-4521		(844)926-4521		(844)679-2028		(844)679-2028		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7855	001	0	1	20	08	H7855_001_0	1	1						05/31/2021	2022.01	05/31/2021 08:57:16 AM Pacific Daylight Time		05/28/2021 11:59:32 AM Pacific Daylight Time			05/31/2021 09:12:41 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	2022	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						05/31/2021	2022.01	05/31/2021 08:58:19 AM Pacific Daylight Time		05/28/2021 12:02:46 PM Pacific Daylight Time			05/31/2021 09:12:41 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	2022	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	3	1						07/01/2021	2022.01	07/01/2021 03:22:07 PM Pacific Daylight Time					07/01/2021 04:01:45 PM 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	2022	San Mateo County		2	104011	1	1		2						https://www.hpsm.org/provider	https://www.hpsm.org/member/view-my-medication-benefits	https://www.hpsm.org/provider	(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	5	1						07/06/2021	2022.01	07/06/2021 07:39:59 AM Pacific Daylight Time					07/06/2021 07:40:26 AM Pacific Daylight Time	SANTA CLARA COUNTY HEALTH AUTHORITY	Santa Clara Family Health Plan CalMediConnect Plan	www.scfhp.com	Santa Clara Family Health Plan (Medicare-Medicaid Plan)	05	48		1			H7890	001	0	2022	Santa Clara County		2	126728	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H7917	009	0	1	04	01	H7917_009_0	7	1					1	08/03/2021	2022.01	08/03/2021 07:48:24 PM Eastern Daylight Time	08/04/2021 10:37:10 AM Eastern Daylight Time	08/04/2021 10:31:59 AM Eastern Daylight Time			08/04/2021 03:12:04 PM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Diamond (PPO)	01	04		1			H7917	009	0	2022	Middle and West Tennessee		2		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	7	1					1	08/03/2021	2022.01	08/03/2021 07:47:28 PM Eastern Daylight Time	08/04/2021 10:37:24 AM Eastern Daylight Time	08/04/2021 10:32:12 AM Eastern Daylight Time			08/04/2021 03:12:04 PM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Diamond (PPO)	01	04		1			H7917	010	0	2022	Southeast Tennessee		2		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	7	1					1	08/03/2021	2022.01	08/03/2021 07:42:28 PM Eastern Daylight Time	08/04/2021 10:37:37 AM Eastern Daylight Time	08/04/2021 10:32:26 AM Eastern Daylight Time			08/04/2021 03:12:04 PM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Diamond (PPO)	01	04		1			H7917	011	0	2022	Northeast Tennessee		2		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					1	08/03/2021	2022.01	08/03/2021 07:40:14 PM Eastern Daylight Time	08/04/2021 10:37:52 AM Eastern Daylight Time	08/04/2021 10:32:39 AM Eastern Daylight Time			08/04/2021 03:12:04 PM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Ruby (PPO)	01	04		1			H7917	012	0	2022	West Tennessee		2		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					1	08/03/2021	2022.01	08/03/2021 07:39:10 PM Eastern Daylight Time	08/04/2021 10:38:05 AM Eastern Daylight Time	08/04/2021 10:32:52 AM Eastern Daylight Time			08/04/2021 03:12:04 PM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Ruby (PPO)	01	04		1			H7917	013	0	2022	Middle Tennessee		2		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	7	1					1	08/03/2021	2022.01	08/03/2021 07:37:45 PM Eastern Daylight Time	08/04/2021 10:38:20 AM Eastern Daylight Time	08/04/2021 10:33:05 AM Eastern Daylight Time			08/04/2021 03:12:04 PM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Ruby (PPO)	01	04		1			H7917	014	0	2022	Southeast Tennessee		2		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	7	1					1	08/03/2021	2022.01	08/03/2021 07:36:39 PM Eastern Daylight Time	08/04/2021 10:38:35 AM Eastern Daylight Time	08/04/2021 10:33:19 AM Eastern Daylight Time			08/04/2021 03:12:04 PM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Ruby (PPO)	01	04		1			H7917	015	0	2022	Northeast Tennessee		2		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					1	08/03/2021	2022.01	08/03/2021 07:34:32 PM Eastern Daylight Time	08/04/2021 10:38:50 AM Eastern Daylight Time	08/04/2021 10:33:32 AM Eastern Daylight Time			08/04/2021 03:12:04 PM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Sapphire (PPO)	01	04		1			H7917	030	0	2022	Southeast Tennessee		2		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					1	08/03/2021	2022.01	08/03/2021 07:35:40 PM Eastern Daylight Time	08/04/2021 10:39:04 AM Eastern Daylight Time	08/04/2021 10:33:48 AM Eastern Daylight Time			08/04/2021 03:12:04 PM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Sapphire (PPO)	01	04		1			H7917	031	0	2022	Northeast Tennessee		2		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					1	08/03/2021	2022.01	08/03/2021 07:33:01 PM Eastern Daylight Time	08/04/2021 10:39:17 AM Eastern Daylight Time	08/04/2021 10:34:00 AM Eastern Daylight Time			08/04/2021 03:12:04 PM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Garnet (PPO)	01	04		1			H7917	032	0	2022	Middle Tennessee		2		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					1	08/03/2021	2022.01	08/03/2021 07:32:01 PM Eastern Daylight Time	08/04/2021 10:39:31 AM Eastern Daylight Time	08/04/2021 10:34:14 AM Eastern Daylight Time			08/04/2021 03:12:04 PM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Garnet (PPO)	01	04		1			H7917	033	0	2022	West Tennessee		2		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	034	0	1	04	01	H7917_034_0	7	1					1	08/03/2021	2022.01	08/03/2021 07:30:56 PM Eastern Daylight Time	08/04/2021 10:39:45 AM Eastern Daylight Time	08/04/2021 10:34:27 AM Eastern Daylight Time			08/04/2021 03:12:04 PM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Emerald (PPO)	01	04		1			H7917	034	0	2022	West Tennessee		2		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	035	0	1	04	01	H7917_035_0	7	1					1	08/03/2021	2022.01	08/03/2021 07:17:45 PM Eastern Daylight Time	08/04/2021 10:39:59 AM Eastern Daylight Time	08/04/2021 10:34:40 AM Eastern Daylight Time			08/04/2021 03:12:04 PM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Emerald (PPO)	01	04		1			H7917	035	0	2022	Middle Tennessee		2		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	036	0	1	04	01	H7917_036_0	7	1					1	08/03/2021	2022.01	08/03/2021 07:29:27 PM Eastern Daylight Time	08/04/2021 10:40:12 AM Eastern Daylight Time	08/04/2021 10:34:54 AM Eastern Daylight Time			08/04/2021 03:12:04 PM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Emerald (PPO)	01	04		1			H7917	036	0	2022	Southeast Tennessee		2		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	037	0	1	04	01	H7917_037_0	7	1					1	08/03/2021	2022.01	08/03/2021 07:27:35 PM Eastern Daylight Time	08/04/2021 10:40:27 AM Eastern Daylight Time	08/04/2021 10:35:07 AM Eastern Daylight Time			08/04/2021 03:12:04 PM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Emerald (PPO)	01	04		1			H7917	037	0	2022	Northeast Tennessee		2		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	038	0	1	04	01	H7917_038_0	8	1					1	08/05/2021	2022.01	08/05/2021 09:30:05 AM Eastern Daylight Time	08/04/2021 10:40:40 AM Eastern Daylight Time	08/04/2021 10:35:21 AM Eastern Daylight Time			08/05/2021 10:32:54 AM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Sapphire (PPO)	01	04		1			H7917	038	0	2022	East Tennessee		2		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	039	0	1	04	01	H7917_039_0	6	1				0	0	07/19/2021	2022.01	07/19/2021 08:55:26 PM Eastern Daylight Time	06/04/2021 01:30:09 PM Eastern Daylight Time				07/20/2021 11:38:55 AM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Freedom (PPO)	01	04		1			H7917	039	0	2022	Tennessee		2		2			2						bcbstmedicare.com	bcbstmedicare.com	bcbstmedicare.com	(888)851-2583		(888)851-2583		(888)665-5678		(888)665-5678										(711)-		(711)-		(711)-		(711)-										2					2						2			
H7917	801	0	1	04	01	H7917_801_0	2	1						06/04/2021	2022.01	06/04/2021 09:27:36 AM Eastern Daylight Time					06/04/2021 07:02:15 PM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Plus (PPO)	01	04		1			H7917	801	0	2022	22 County Region		1	39072	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	2	1						06/04/2021	2022.01	06/04/2021 09:33:51 AM Eastern Daylight Time					06/04/2021 07:02:15 PM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Plus (PPO)	01	04		1			H7917	802	0	2022	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	2	1				0	0	05/27/2021	2022.01	05/27/2021 09:55:31 AM Eastern Daylight Time					06/04/2021 07:02:15 PM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Plus (PPO)	01	04		1			H7917	803	0	2022	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			
H7925	001	0	1	01	01	H7925_001_0	4	1					0	08/02/2021	2022.01	08/02/2021 10:37:26 AM Central Daylight Time	08/04/2021 12:36:14 AM Central Daylight Time	07/30/2021 12:51:54 PM Central Daylight Time			08/04/2021 10:17:29 PM Central Daylight Time	CENTENE VENTURE COMPANY INDIANA, INC.	Ascension Complete	ascensioncomplete.com	Ascension Complete St. Vincent Reward (HMO)	01	01		1			H7925	001	0	2022	Central, Southeast and Southwest Indiana Counties		2	1031	2			2						ascensioncomplete.com/findadoctor	ascensioncomplete.com/formulary	ascensioncomplete.com/findadoctor	(833)525-0824		(833)525-0824		(844)578-1929		(844)578-1929		(833)525-0824		(833)525-0824		(844)578-1929		(844)578-1929		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7925	002	0	1	01	01	H7925_002_0	4	1					0	08/02/2021	2022.01	08/02/2021 10:38:33 AM Central Daylight Time	08/04/2021 12:36:43 AM Central Daylight Time	07/30/2021 12:52:14 PM Central Daylight Time			08/04/2021 10:17:29 PM Central Daylight Time	CENTENE VENTURE COMPANY INDIANA, INC.	Ascension Complete	ascensioncomplete.com	Ascension Complete St. Vincent Secure (HMO)	01	01		1			H7925	002	0	2022	Central, Southeast and Southwest Indiana Counties		2	8685	2			2						ascensioncomplete.com/findadoctor	ascensioncomplete.com/formulary	ascensioncomplete.com/findadoctor	(833)525-0824		(833)525-0824		(844)578-1929		(844)578-1929		(833)525-0824		(833)525-0824		(844)578-1929		(844)578-1929		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7925	003	0	1	01	01	H7925_003_0	4	1	2	1			0	08/02/2021	2022.01	08/02/2021 10:39:26 AM Central Daylight Time	08/04/2021 12:37:10 AM Central Daylight Time	07/30/2021 12:52:34 PM Central Daylight Time			08/04/2021 10:17:29 PM Central Daylight Time	CENTENE VENTURE COMPANY INDIANA, INC.	Ascension Complete	ascensioncomplete.com	Ascension Complete St. Vincent DSNP (HMO D-SNP)	01	01		1			H7925	003	0	2022	Central, Southeast and Southwest Indiana		2	3187	2			1	3		1		1	ascensioncomplete.com/findadoctor	ascensioncomplete.com/formulary	ascensioncomplete.com/findadoctor	(833)525-0824		(833)525-0824		(844)578-1929		(844)578-1929		(833)525-0824		(833)525-0824		(844)578-1929		(844)578-1929		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7971	003	0	1	04	01	H7971_003_0	5	1					0	06/03/2021	2022.01	06/03/2021 08:25:23 AM Eastern Daylight Time	08/02/2021 03:28:18 PM Eastern Daylight Time	08/02/2021 03:27:21 PM Eastern Daylight Time			08/02/2021 04:07:25 PM Eastern Daylight Time	HORIZON INSURANCE COMPANY	Horizon Blue Cross Blue Shield of New Jersey	www.HorizonBlue.com/Medicare	Horizon Medicare Blue Access (PPO)	01	04		1			H7971	003	0	2022	South Jersey		2	3300	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	2	1				0	0	06/03/2021	2022.01	06/03/2021 12:30:06 PM Eastern Daylight Time					06/03/2021 07:32:10 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	2022	National		1	7266	2			2						www.horizonblue.com/ma-pharmacy-search	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;7i;8a;8b1;8b2;9a1;9b;9c;10a;11a;11b;11c;15;	2		1									
H7971	802	0	1	04	01	H7971_802_0	2	1						06/03/2021	2022.01	06/03/2021 12:36:55 PM Eastern Daylight Time					06/03/2021 07:32:10 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	2022	National		1	1163	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;7i;8a;8b1;8b2;9a1;9b;9c;10a;11a;11b;11c;15;	2		1									
H7971	807	0	1	04	01	H7971_807_0	2	1						06/03/2021	2022.01	06/03/2021 12:42:50 PM Eastern Daylight Time					06/03/2021 07:32:10 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	2022	National		1	120	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;7i;8a;8b1;8b2;9a1;9b;9c;10a;11a;11b;11c;15;	2		1									
H7971	808	0	1	04	01	H7971_808_0	2	1						06/03/2021	2022.01	06/03/2021 12:46:50 PM Eastern Daylight Time					06/03/2021 07:32:10 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	2022	National		1	120	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;7i;8a;8b1;8b2;9a1;9b;9c;10a;11a;11b;11c;15;	2		1									
H7993	001	0	1	01	01	H7993_001_0	8	1					1	07/15/2021	2022.01	07/15/2021 10:13:10 PM US Eastern Daylight Time	08/04/2021 03:37:12 PM Eastern Daylight Time	07/30/2021 10:23:45 AM Eastern Daylight Time			08/05/2021 09:29:00 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF TEXAS, INC.	Devoted Health	www.Devoted.com	Devoted Health Core Greater Houston (HMO)	01	01		1			H7993	001	0	2022	Greater Houston		2		2			2						www.Devoted.com	www.Devoted.com	www.Devoted.com	(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7993	002	0	1	01	01	H7993_002_0	9	1					1	07/15/2021	2022.01	07/15/2021 10:13:29 PM US Eastern Daylight Time	08/04/2021 03:37:41 PM Eastern Daylight Time	07/30/2021 10:24:05 AM Eastern Daylight Time			08/05/2021 09:29:00 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF TEXAS, INC.	Devoted Health	www.Devoted.com	Devoted Health Prime Greater Houston (HMO)	01	01		1			H7993	002	0	2022	Greater Houston		2		2			2						www.Devoted.com	www.Devoted.com	www.Devoted.com	(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7993	003	0	1	01	01	H7993_003_0	8	1					0	07/15/2021	2022.01	07/15/2021 10:13:54 PM US Eastern Daylight Time	08/04/2021 03:38:09 PM Eastern Daylight Time	07/30/2021 10:24:24 AM Eastern Daylight Time			08/05/2021 09:29:00 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF TEXAS, INC.	Devoted Health	www.Devoted.com	Devoted Health Core San Antonio (HMO)	01	01		1			H7993	003	0	2022	Bexar, Comal, Guadalupe		2		2			2						www.Devoted.com	www.Devoted.com	www.Devoted.com	(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7993	004	0	1	01	01	H7993_004_0	10	1					0	08/03/2021	2022.01	08/03/2021 01:31:30 PM US Eastern Daylight Time	08/04/2021 03:38:38 PM Eastern Daylight Time	07/30/2021 10:24:44 AM Eastern Daylight Time			08/05/2021 09:29:00 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF TEXAS, INC.	Devoted Health	www.Devoted.com	Devoted Health Prime San Antonio (HMO)	01	01		1			H7993	004	0	2022	Bexar, Comal, Guadalupe		2		2			2						www.Devoted.com	www.Devoted.com	www.Devoted.com	(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7993	005	0	1	01	01	H7993_005_0	11	1		1			1	07/20/2021	2022.01	07/20/2021 01:02:53 PM US Eastern Daylight Time	08/04/2021 03:39:05 PM Eastern Daylight Time	07/30/2021 10:25:05 AM Eastern Daylight Time			08/05/2021 09:29:00 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF TEXAS, INC.	Devoted Health	www.Devoted.com	Devoted Health BeWell San Antonio (HMO C-SNP)	01	01		1			H7993	005	0	2022	Bexar, Comal, Guadalupe		2		2			1	4			00000010000000000000		www.Devoted.com	www.Devoted.com	www.Devoted.com	(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8003	001	0	1	04	01	H8003_001_0	5	1					1	08/05/2021	2022.01	08/05/2021 10:21:43 AM Eastern Daylight Time	08/05/2021 11:32:50 AM Eastern Daylight Time	08/05/2021 12:04:49 PM Eastern Daylight Time			08/05/2021 05:28:07 PM Eastern Daylight Time	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Blue Cross Blue Shield of South Carolina	www.scbluesmedadvantage.com/marx22	BlueCross Total (PPO)	01	04		1			H8003	001	0	2022	Upstate		2		2			2						www.scbluesmedadvantage.com/marx22	www.scbluesmedadvantage.com/marx22	www.scbluesmedadvantage.com/marx22	(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	5	1					1	08/05/2021	2022.01	08/05/2021 10:31:44 AM Eastern Daylight Time	08/05/2021 11:33:29 AM Eastern Daylight Time	08/05/2021 12:06:27 PM Eastern Daylight Time			08/05/2021 05:28:07 PM Eastern Daylight Time	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Blue Cross Blue Shield of South Carolina	www.scbluesmedadvantage.com/marx22	BlueCross Total (PPO)	01	04		1			H8003	002	0	2022	Midlands/Coastal		2		2			2						www.scbluesmedadvantage.com/marx22	www.scbluesmedadvantage.com/marx22	www.scbluesmedadvantage.com/marx22	(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	5	1					1	08/05/2021	2022.01	08/05/2021 10:37:40 AM Eastern Daylight Time	08/05/2021 11:34:50 AM Eastern Daylight Time	08/05/2021 12:08:47 PM Eastern Daylight Time			08/05/2021 05:28:07 PM Eastern Daylight Time	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Blue Cross Blue Shield of South Carolina	www.scbluesmedadvantage.com/marx22	BlueCross Total (PPO)	01	04		1			H8003	003	0	2022	Lowcountry		2	12000	2			2						www.scbluesmedadvantage.com/marx22	www.scbluesmedadvantage.com/marx22	www.scbluesmedadvantage.com/marx22	(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	004	0	1	04	01	H8003_004_0	4	1					1	08/05/2021	2022.01	08/05/2021 10:48:38 AM Eastern Daylight Time	08/05/2021 11:36:01 AM Eastern Daylight Time	08/05/2021 12:09:52 PM Eastern Daylight Time			08/05/2021 05:21:29 PM Eastern Daylight Time	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Blue Cross Blue Shield of South Carolina	www.scbluesmedadvantage.com/marx22	BlueCross Total Value (PPO)	01	04		1			H8003	004	0	2022	Upstate		2	12000	2			2						www.scbluesmedadvantage.com/marx22	www.scbluesmedadvantage.com/marx22	www.scbluesmedadvantage.com/marx22	(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	005	0	1	04	01	H8003_005_0	4	1					1	08/05/2021	2022.01	08/05/2021 10:50:47 AM Eastern Daylight Time	08/05/2021 11:37:51 AM Eastern Daylight Time	08/05/2021 12:10:17 PM Eastern Daylight Time			08/05/2021 05:21:29 PM Eastern Daylight Time	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Blue Cross Blue Shield of South Carolina	www.scbluesmedadvantage.com/marx22	BlueCross Total Value (PPO)	01	04		1			H8003	005	0	2022	Midlands/Coastal		2	12000	2			2						www.scbluesmedadvantage.com/marx22	www.scbluesmedadvantage.com/marx22	www.scbluesmedadvantage.com/marx22	(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	006	0	1	04	01	H8003_006_0	4	1					1	08/05/2021	2022.01	08/05/2021 10:52:04 AM Eastern Daylight Time	08/05/2021 11:38:31 AM Eastern Daylight Time	08/05/2021 12:11:02 PM Eastern Daylight Time			08/05/2021 05:21:29 PM Eastern Daylight Time	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Blue Cross Blue Shield of South Carolina	www.scbluesmedadvantage.com/marx22	BlueCross Total Value (PPO)	01	04		1			H8003	006	0	2022	Lowcountry		2	6000	2			2						www.scbluesmedadvantage.com/marx22	www.scbluesmedadvantage.com/marx22	www.scbluesmedadvantage.com/marx22	(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	007	0	1	04	01	H8003_007_0	3	1				0	0	07/08/2021	2022.01	07/08/2021 01:37:57 PM Eastern Daylight Time	06/05/2021 09:24:06 PM Eastern Daylight Time				07/08/2021 01:55:32 PM Eastern Daylight Time	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Blue Cross Blue Shield of South Carolina	www.scbluesmedadvantage.com/marx22	BlueCross Blue Basic (PPO)	01	04		1			H8003	007	0	2022	South Carolina		2	3600	2			2						www.scbluesmedadvantage.com/marx22	www.scbluesmedadvantage.com/marx22	www.scbluesmedadvantage.com/marx22	(855)204-2744		(855)204-2744		(800)930-2836		(800)930-2836										(711)-		(711)-		(711)-		(711)-										2					2						2			
H8003	801	0	1	04	01	H8003_801_0	2	1						05/27/2021	2022.01	05/27/2021 11:42:43 AM Eastern Daylight Time					06/07/2021 01:55:56 PM Eastern Daylight Time	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Blue Cross Blue Shield of South Carolina	www.SCBluesMedAdvantage.com	BlueCross MAPD Calendar Year Group (PPO)	01	04		1			H8003	801	0	2022	Nationwide		1	120	2			2						www.SCBluesMedAdvantage.com	www.SCBluesMedAdvantage.com	www.SCBluesMedAdvantage.com	(855)204-2744		(855)204-2744		(855)204-2744		(855)204-2744		(855)204-2744		(855)204-2744		(855)204-2744		(855)204-2744		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H8003	802	0	1	04	01	H8003_802_0	2	1						05/27/2021	2022.01	05/27/2021 11:43:46 AM Eastern Daylight Time					06/07/2021 01:55:56 PM Eastern Daylight Time	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Blue Cross Blue Shield of South Carolina	www.SCBluesMedAdvantage.com	BlueCross MAPD Non-calendar Year Group (PPO)	01	04		1			H8003	802	0	2022	Nationwide		1	120	2			2						www.SCBluesMedAdvantage.com	www.SCBluesMedAdvantage.com	www.SCBluesMedAdvantage.com	(855)204-2744		(855)204-2744		(855)204-2744		(855)204-2744		(855)204-2744		(855)204-2744		(855)204-2744		(855)204-2744		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H8003	803	0	1	04	01	H8003_803_0	2	1				0	0	05/27/2021	2022.01	05/27/2021 11:45:12 AM Eastern Daylight Time					06/07/2021 01:55:56 PM Eastern Daylight Time	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Blue Cross Blue Shield of South Carolina	www.SCBluesMedAdvantage.com	BlueCross MA Only Calendar Year Group (PPO)	01	04		1			H8003	803	0	2022	Nationwide		1	120	2			2						www.SCBluesMedAdvantage.com	www.SCBluesMedAdvantage.com	www.SCBluesMedAdvantage.com	(855)204-2744		(855)204-2744		(855)204-2744		(855)204-2744										(711)-		(711)-		(711)-		(711)-										1	2		2		1									
H8003	804	0	1	04	01	H8003_804_0	2	1				0	0	05/27/2021	2022.01	05/27/2021 11:46:09 AM Eastern Daylight Time					06/07/2021 01:55:56 PM Eastern Daylight Time	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Blue Cross Blue Shield of South Carolina	www.SCBluesMedAdvantage.com	BlueCross MA Only Non-calendar Year Group (PPO)	01	04		1			H8003	804	0	2022	Nationwide		1	120	2			2						www.SCBluesMedAdvantage.com	www.SCBluesMedAdvantage.com	www.SCBluesMedAdvantage.com	(855)204-2744		(855)204-2744		(855)204-2744		(855)204-2744										(711)-		(711)-		(711)-		(711)-										1	2		2		1									
H8010	002	0	1	01	01	H8010_002_0	13	1					1	08/05/2021	2022.01	08/05/2021 01:40:18 AM Eastern Daylight Time	08/05/2021 02:05:47 PM Eastern Daylight Time	08/05/2021 02:06:04 PM Eastern Daylight Time			08/05/2021 02:23:31 PM Eastern Daylight Time	CLOVER HMO OF NEW JERSEY, INC.	Clover Health	www.cloverhealth.com	Clover Health Classic (HMO)	01	01		1			H8010	002	0	2022	Select NJ Counties		2		2			2						www.cloverhealth.com/en/members/find-pharmacy	www.cloverhealth.com/en/members/formulary	www.cloverhealth.com/en/members/find-provider	(888)778-1478		(201)414-9690		(888)466-5044		(201)425-9257		(844)232-2316		(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	12	1					0	08/05/2021	2022.01	08/05/2021 01:46:14 AM Eastern Daylight Time	08/05/2021 02:05:47 PM Eastern Daylight Time	08/05/2021 02:06:04 PM Eastern Daylight Time			08/05/2021 02:23:31 PM Eastern Daylight Time	CLOVER HMO OF NEW JERSEY, INC.	Clover Health	www.cloverhealth.com	Clover Health Value (HMO)	01	01		1			H8010	003	0	2022	Select NJ Counties		2		2			2						www.cloverhealth.com/en/members/find-pharmacy	www.cloverhealth.com/en/members/formulary	www.cloverhealth.com/en/members/find-provider	(888)778-1478		(201)414-9690		(888)466-5044		(201)425-9257		(844)232-2316		(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					1	08/05/2021	2022.01	08/05/2021 01:49:12 AM Eastern Daylight Time	08/05/2021 02:05:47 PM Eastern Daylight Time	08/05/2021 02:06:04 PM Eastern Daylight Time			08/05/2021 02:23:31 PM Eastern Daylight Time	CLOVER HMO OF NEW JERSEY, INC.	Clover Health	www.cloverhealth.com	Clover Health Classic (HMO)	01	01		1			H8010	005	0	2022	Bexar County		2		2			2						www.cloverhealth.com/en/members/find-pharmacy	www.cloverhealth.com/en/members/formulary	www.cloverhealth.com/en/members/find-provider	(888)778-1478		(201)414-9690		(888)466-5044		(201)425-9257		(844)232-2316		(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					1	08/05/2021	2022.01	08/05/2021 01:52:16 AM Eastern Daylight Time	08/05/2021 02:05:47 PM Eastern Daylight Time	08/05/2021 02:06:04 PM Eastern Daylight Time			08/05/2021 02:23:31 PM Eastern Daylight Time	CLOVER HMO OF NEW JERSEY, INC.	Clover Health	www.cloverhealth.com	Clover Health Classic (HMO)	01	01		1			H8010	008	0	2022	El Paso County		2		2			2						www.cloverhealth.com/en/members/find-pharmacy	www.cloverhealth.com/en/members/formulary	www.cloverhealth.com/en/members/find-provider	(888)778-1478		(201)414-9690		(888)466-5044		(201)425-9257		(844)232-2316		(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	2	1						07/01/2021	2022.01	07/01/2021 05:30:47 PM Pacific Daylight Time					07/01/2021 05:43:22 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	2022	Orange County, California		2		2			2						https://www.caloptima.org/en/ForMembers/OneCareConnect/FindAProvider/PharmacySearch.aspx	https://www.caloptima.org/en/ForMembers/OneCareConnect/Pharmacy.aspx	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H8019	002	0	1	02	01	H8019_002_0	4	1					1	08/04/2021	2022.01	08/04/2021 09:14:37 AM Central Daylight Time	08/02/2021 02:33:07 PM Central Daylight Time	08/02/2021 04:05:46 PM Central Daylight Time			08/05/2021 12:48:08 PM Central Daylight Time	SSM HEALTH PLAN	WellFirst Health	wellfirsthealth.com	SSM Health Plan Integrity (HMO-POS)	01	02		1			H8019	002	0	2022	St. Louis Metro Area		2		2			2						wellfirstbenefits.com	wellfirstbenefits.com	wellfirsthealth.com/doctors	(877)301-3326		(877)301-3326		(833)551-0565		(833)551-0565		(877)301-3326		(877)301-3326		(833)551-0565		(833)551-0565		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8019	003	0	1	02	01	H8019_003_0	4	1				0	0	07/19/2021	2022.01	07/19/2021 03:27:29 PM Central Daylight Time	06/06/2021 07:08:15 PM Central Daylight Time				07/19/2021 03:56:33 PM Central Daylight Time	SSM HEALTH PLAN	WellFirst Health	wellfirsthealth.com	SSM Health Plan Harmony (HMO-POS)	01	02		1			H8019	003	0	2022	St. Louis Metro Area		2		2			2						wellfirstbenefits.com	wellfirstbenefits.com	wellfirsthealth.com/doctors	(877)301-3326		(877)301-3326		(833)551-0565		(833)551-0565										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H8019	801	0	1	01	01	H8019_801_0	3	1						05/11/2021	2022.01	05/11/2021 10:04:38 AM Central Daylight Time					06/06/2021 10:19:53 PM Central Daylight Time	SSM HEALTH PLAN	WellFirst Health	wellfirstbenefits.com	SSM EGWP MAPD CY (HMO)	01	01		1			H8019	801	0	2022	St. Louis Metro Area		1	1	2			2						wellfirstbenefits.com	wellfirstbenefits.com	wellfirstbenefits.com/doctors	(877)301-3326		(877)301-3326		(877)234-0126		(608)828-1941		(877)301-3326		(877)301-3326		(877)234-0126		(608)828-1941		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8019	802	0	1	01	01	H8019_802_0	3	1						05/27/2021	2022.01	05/27/2021 03:16:37 PM Central Daylight Time					06/06/2021 10:19:53 PM Central Daylight Time	SSM HEALTH PLAN	WellFirst Health	wellfirstbenefits.com	SSM EGWP MAPD Non CY (HMO)	01	01		1			H8019	802	0	2022	St. Louis Metro Area		1	1	2			2						wellfirstbenefits.com	wellfirstbenefits.com	wellfirstbenefits.com/doctors	(877)301-3326		(877)301-3326		(877)234-0126		(608)828-1941		(877)301-3326		(877)301-3326		(877)234-0126		(608)828-1941		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8019	803	0	1	01	01	H8019_803_0	3	1				0	0	05/27/2021	2022.01	05/27/2021 03:14:34 PM Central Daylight Time					06/06/2021 10:19:53 PM Central Daylight Time	SSM HEALTH PLAN	WellFirst Health	wellfirstbenefits.com	SSM EGWP MA Only (HMO)	01	01		1			H8019	803	0	2022	St. Louis Metro Area		1	1	2			2						wellfirstbenefits.com	wellfirstbenefits.com	wellfirstbenefits.com/doctors	(877)301-3326		(877)301-3326		(877)234-0126		(608)828-1941										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H8019	804	0	1	02	01	H8019_804_0	3	1						05/27/2021	2022.01	05/27/2021 11:15:51 AM Central Daylight Time					06/06/2021 10:19:53 PM Central Daylight Time	SSM HEALTH PLAN	WellFirst Health	wellfirstbenefits.com	SSM EGWP MAPD CY (HMO-POS)	01	02		1			H8019	804	0	2022	St. Louis Metro Area		1	1	2			2						wellfirstbenefits.com	wellfirstbenefits.com	wellfirstbenefits.com/doctors	(877)301-3326		(877)301-3326		(877)234-0126		(608)828-1941		(877)301-3326		(877)301-3326		(877)234-0126		(608)828-1941		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8019	805	0	1	02	01	H8019_805_0	3	1						05/27/2021	2022.01	05/27/2021 11:16:06 AM Central Daylight Time					06/06/2021 10:19:53 PM Central Daylight Time	SSM HEALTH PLAN	WellFirst Health	wellfirstbenefits.com	SSM EGWP MAPD Non CY (HMO-POS)	01	02		1			H8019	805	0	2022	St. Louis Metro Area		1	1	2			2						wellfirstbenefits.com	wellfirstbenefits.com	wellfirstbenefits.com/doctors	(877)301-3326		(877)301-3326		(877)234-0126		(608)828-1941		(877)301-3326		(877)301-3326		(877)234-0126		(608)828-1941		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8019	806	0	1	02	01	H8019_806_0	3	1				0	0	05/24/2021	2022.01	05/24/2021 02:17:01 PM Central Daylight Time					06/06/2021 10:19:53 PM Central Daylight Time	SSM HEALTH PLAN	WellFirst Health	wellfirstbenefits.com	SSM EGWP MA Only (HMO-POS)	01	02		1			H8019	806	0	2022	St. Louis Metro Area		1	1	2			2						wellfirstbenefits.com	wellfirstbenefits.com	wellfirstbenefits.com/doctors	(877)301-3326		(877)301-3326		(877)234-0126		(608)828-1941										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H8026	001	0	1	48	05	H8026_001_0	2	1						07/08/2021	2022.01	07/08/2021 10:53:55 AM Central Daylight Time					07/08/2021 10:55:02 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	2022	Wayne, Macomb and Southwest Michigan Regions		2	92957	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)-																
H8046	001	0	1	48	05	H8046_001_0	2	1						07/16/2021	2022.01	07/16/2021 10:18:43 AM Pacific Daylight Time					07/19/2021 12:50:30 AM 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	2022	Select counties in Illinois		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	9	1					1	07/15/2021	2022.01	07/15/2021 12:28:54 PM Central Daylight Time	08/03/2021 12:20:49 AM Central Daylight Time	07/30/2021 02:16:43 PM Central Daylight Time			08/04/2021 11:16:11 PM Central Daylight Time	FIRSTCAROLINACARE INSURANCE COMPANY	FirstMedicare Direct	www.firstmedicare.com	FirstMedicare Direct PPO Plus (PPO)	01	04		1			H8064	002	0	2022	Sandhills		2	7144	2			2						www.firstmedicare.com	www.firstmedicare.com	www.firstmedicare.com	(877)210-9167		(877)210-9167		(888)382-9781		(888)382-9781		(877)210-9167		(877)210-9167		(888)382-9781		(888)382-9781		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8064	004	0	1	04	01	H8064_004_0	9	1					1	07/15/2021	2022.01	07/15/2021 02:07:28 PM Central Daylight Time	08/03/2021 12:59:54 PM Central Daylight Time	07/30/2021 02:17:11 PM Central Daylight Time			08/04/2021 11:16:11 PM Central Daylight Time	FIRSTCAROLINACARE INSURANCE COMPANY	FirstMedicare Direct	www.firstmedicare.com	FirstMedicare Direct PPO Premier (PPO)	01	04		1			H8064	004	0	2022	Sandhills		2	364	2			2						www.firstmedicare.com	www.firstmedicare.com	www.firstmedicare.com	(877)210-9167		(877)210-9167		(888)382-9781		(888)382-9781		(877)210-9167		(877)210-9167		(888)382-9781		(888)382-9781		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8067	001	0	1	01	01	H8067_001_0	18	1		1			0	08/05/2021	2022.01	08/05/2021 05:32:48 PM Eastern Daylight Time	08/05/2021 07:33:38 PM Eastern Daylight Time	08/05/2021 07:33:38 PM Eastern Daylight Time			08/05/2021 07:41:08 PM Eastern Daylight Time	PROVIDER PARTNERS HEALTH PLAN, INC.	Provider Partners Health Plans	www.pphealthplan.com	Provider Partners Maryland Advantage Plan (HMO I-SNP)	01	01		1			H8067	001	0	2022	Western & Central Maryland		2		2			1	1	1				www.pphealthplan.com	www.pphealthplan.com	www.pphealthplan.com	(800)405-9681		(800)405-9681		(800)405-9681		(800)405-9681		(844)846-8007		(844)846-8007		(800)405-9681		(800)405-9681		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8067	003	0	1	01	01	H8067_003_0	18	1		1			0	08/05/2021	2022.01	08/05/2021 05:34:10 PM Eastern Daylight Time	08/05/2021 07:33:37 PM Eastern Daylight Time	08/05/2021 07:33:37 PM Eastern Daylight Time			08/05/2021 07:41:08 PM Eastern Daylight Time	PROVIDER PARTNERS HEALTH PLAN, INC.	Provider Partners Health Plans	www.pphealthplan.com	Provider Partners Maryland Community Plan (HMO I-SNP)	01	01		1			H8067	003	0	2022	Western & Central Maryland		2		2			1	1	2				www.pphealthplan.com	www.pphealthplan.com	www.pphealthplan.com	(800)405-9681		(800)405-9681		(800)405-9681		(800)405-9681		(844)846-8007		(844)846-8007		(800)405-9681		(800)405-9681		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8082	001	0	1	20	08	H8082_001_0	1	1						06/01/2021	2022.01	06/01/2021 03:41:06 PM Mountain Daylight Time		06/01/2021 10:02:30 AM Mountain Daylight Time			06/01/2021 03:42:48 PM Mountain Daylight Time	STOCKTON PACE	WelbeHealth Sierra PACE	https://welbehealth.com/sierra/	WelbeHealth Sierra PACE (PACE)	08	20		1			H8082	001	0	2022	Parts of Stanislaus and San Joaquin County in CA		2		2			2						https://www.omnicare.com/	N/A												(209)442-6077				(209)442-6077												(209)932-0357				(209)932-0357																
H8082	002	0	1	20	08	H8082_002_0	1	1						06/01/2021	2022.01	06/01/2021 03:40:58 PM Mountain Daylight Time		06/01/2021 10:02:30 AM Mountain Daylight Time			06/01/2021 03:42:48 PM Mountain Daylight Time	STOCKTON PACE	WelbeHealth Sierra PACE	https://welbehealth.com/sierra/	WelbeHealth Sierra PACE (PACE)	08	20		1			H8082	002	0	2022	Parts of Stanislaus and San Joaquin County in CA		2		2			2						https://www.omnicare.com/	N/A												(209)442-6077				(209)442-6077												(209)932-0357				(209)932-0357																
H8087	001	0	1	04	01	H8087_001_0	3	1			2		0	07/31/2021	2022.01	07/31/2021 02:48:35 PM Eastern Daylight Time	08/03/2021 06:06:40 PM Eastern Daylight Time	07/30/2021 12:04:40 PM Eastern Daylight Time			08/04/2021 01:54:36 PM Eastern Daylight Time	HUMANADENTAL INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H8087-001 (PPO)	01	04		1			H8087	001	0	2022	Select Counties in Michigan		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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			2		0	06/03/2021	2022.01	06/03/2021 02:34:17 PM Eastern Daylight Time	08/03/2021 06:14:33 PM Eastern Daylight Time	07/30/2021 12:04:52 PM Eastern Daylight Time			08/04/2021 01:54:36 PM Eastern Daylight Time	HUMANADENTAL INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Value Plus H8087-002 (PPO)	01	04		1			H8087	002	0	2022	Select counties in Michigan		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8087	003	0	1	04	01	H8087_003_0	4	1	2	1	1		0	07/09/2021	2022.01	07/09/2021 11:54:28 AM Eastern Daylight Time	08/03/2021 06:19:48 PM Eastern Daylight Time	07/30/2021 12:05:04 PM Eastern Daylight Time			08/04/2021 01:54:36 PM Eastern Daylight Time	HUMANADENTAL INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice SNP-DE H8087-003 (PPO D-SNP)	01	04		1			H8087	003	0	2022	Select Counties in Michigan		2		2			1	3		2		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8087	004	0	1	04	01	H8087_004_0	3	1			2		0	08/02/2021	2022.01	08/02/2021 03:17:38 PM Eastern Daylight Time	08/03/2021 06:25:55 PM Eastern Daylight Time	07/30/2021 12:05:16 PM Eastern Daylight Time			08/04/2021 02:15:03 PM Eastern Daylight Time	HUMANADENTAL INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H8087-004 (PPO)	01	04		1			H8087	004	0	2022	Michigan (Non-Detroit)		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8093	001	0	1	01	01	H8093_001_0	2	1		1			0	08/03/2021	2022.01	08/03/2021 03:03:56 PM Central Daylight Time	08/05/2021 08:08:04 AM Central Daylight Time	08/05/2021 08:08:22 AM Central Daylight Time			08/05/2021 08:48:06 AM Central Daylight Time	GEORGIA ASSURANCE, INC.	Georgia Health Advantage	GeorgiaHealthAdvantage.com	Georgia Health Advantage (HMO I-SNP)	01	01		1			H8093	001	0	2022	Georgia		2		2			1	1	3				GeorgiaHealthAdvantage.com	GeorgiaHealthAdvantage.com	GeorgiaHealthAdvantage.com	(844)917-0645		(844)917-0645		(844)917-0645		(844)917-0645		(844)917-0645		(844)917-0645		(844)917-0645		(844)917-0645		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8093	002	0	1	01	01	H8093_002_0	2	1		1			0	08/03/2021	2022.01	08/03/2021 03:04:40 PM Central Daylight Time	08/05/2021 08:08:04 AM Central Daylight Time	08/05/2021 08:08:22 AM Central Daylight Time			08/05/2021 08:48:06 AM Central Daylight Time	GEORGIA ASSURANCE, INC.	Georgia Health Advantage	GeorgiaHealthAdvantage.com	Georgia Health Advantage Silver (HMO I-SNP)	01	01		1			H8093	002	0	2022	Georgia		2		2			1	1	3				GeorgiaHealthAdvantage.com	GeorgiaHealthAdvantage.com	GeorgiaHealthAdvantage.com	(844)917-0645		(844)917-0645		(844)917-0645		(844)917-0645		(844)917-0645		(844)917-0645		(844)917-0645		(844)917-0645		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8095	001	0	1	01	01	H8095_001_0	8	1					0	07/06/2021	2022.01	07/06/2021 02:56:42 PM Eastern Daylight Time	07/30/2021 03:16:06 PM Eastern Daylight Time	07/30/2021 03:15:40 PM Eastern Daylight Time			07/30/2021 03:40:17 PM Eastern Daylight Time	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Wellmark Advantage Health Plan	www.Wellmark.com	Blue Medicare Advantage HMO (HMO)	01	01		1			H8095	001	0	2022	Iowa		2	12938	2			2						www.Wellmark.com/Finder-Medicare	www.Wellmark.com/Finder-Medicare	www.Wellmark.com/Finder-Medicare	(855)716-2555		(855)716-2555		(800)213-3771		(800)213-3771		(800)323-3098		(800)323-3098		(800)213-3771		(800)213-3771		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8095	801	0	1	01	01	H8095_801_0	5	1						05/20/2021	2022.01	05/20/2021 10:50:13 AM Eastern Daylight Time					06/07/2021 02:26:36 PM Eastern Daylight Time	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Wellmark Advantage Health Plan	www.Wellmark.com	Blue Medicare Advantage Group HMO (HMO)	01	01		1			H8095	801	0	2022	State of Iowa		1	0	2			2						www.Wellmark.com/Finder-Medicare	www.Wellmark.com/Finder-Medicare	www.Wellmark.com/Finder-Medicare	(855)716-2555		(855)716-2555		(800)213-3771		(800)213-3771		(800)323-3098		(800)323-3098		(800)213-3771		(800)213-3771		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;2;9a1;11a;15;	2		1					1				
H8095	802	0	1	01	01	H8095_802_0	5	1				0	0	05/24/2021	2022.01	05/24/2021 05:22:33 PM Eastern Daylight Time					06/07/2021 02:26:36 PM Eastern Daylight Time	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Wellmark Advantage Health Plan	www.Wellmark.com	Blue Medicare Advantage Group HMO (HMO)	01	01		1			H8095	802	0	2022	State of Iowa		1	0	2			2						WellmarkAdvantage.com/Pharmacies	WellmarkAdvantage.com/Formularies	www.Wellmark.com/Finder-Medicare	(855)716-2555		(855)716-2555		(800)213-3771		(800)213-3771										(711)-		(711)-		(711)-		(711)-										1	1	1a;2;9a1;11a;15;	2		1					1				
H8095	807	0	1	02	01	H8095_807_0	5	1						05/20/2021	2022.01	05/20/2021 10:48:59 AM Eastern Daylight Time					06/07/2021 02:26:36 PM Eastern Daylight Time	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Wellmark Advantage Health Plan	www.Wellmark.com	Blue Medicare Advantage Group HMOPOS (HMO-POS)	01	02		1			H8095	807	0	2022	State of Iowa		1	0	2			2						www.Wellmark.com/Finder-Medicare	www.Wellmark.com/Finder-Medicare	www.Wellmark.com/Finder-Medicare	(855)716-2555		(855)716-2555		(800)213-3771		(800)213-3771		(800)323-3098		(800)323-3098		(800)213-3771		(800)213-3771		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;2;9a1;11a;15;	2		1	1	1a;2;9a1;11a;15;	2		1				
H8095	808	0	1	02	01	H8095_808_0	5	1				0	0	05/24/2021	2022.01	05/24/2021 05:23:08 PM Eastern Daylight Time					06/07/2021 02:26:36 PM Eastern Daylight Time	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Wellmark Advantage Health Plan	www.Wellmark.com	Blue Medicare Advantage Group HMOPOS (HMO-POS)	01	02		1			H8095	808	0	2022	State of Iowa		1	0	2			2						WellmarkAdvantage.com/Pharmacies	WellmarkAdvantage.com/Formularies	www.Wellmark.com/Finder-Medicare	(855)716-2555		(855)716-2555		(800)213-3771		(800)213-3771										(711)-		(711)-		(711)-		(711)-										1	1	1a;2;9a1;11a;15;	2		1	1	1a;2;9a1;11a;15;	2		1				
H8096	001	0	1	20	08	H8096_001_0	1	1						06/02/2021	2022.01	06/02/2021 01:22:41 PM Eastern Daylight Time		05/26/2021 12:51:44 PM Eastern Daylight Time			06/02/2021 01:46:14 PM Eastern Daylight Time	CENTRA HEALTH, INC.	Centra PACE	http://www.centrapace.com	Centra PACE - Dual (PACE)	08	20		1			H8096	001	0	2022	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						06/02/2021	2022.01	06/02/2021 01:23:01 PM Eastern Daylight Time		05/26/2021 12:54:27 PM Eastern Daylight Time			06/02/2021 01:46:14 PM Eastern Daylight Time	CENTRA HEALTH, INC.	Centra PACE	http://www.centrapace.com	Centra PACE - Medicare only (PACE)	08	20		1			H8096	002	0	2022	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																
H8121	001	0	1	04	01	H8121_001_0	4	1					0	08/02/2021	2022.01	08/02/2021 10:41:06 AM Central Daylight Time	08/04/2021 12:37:38 AM Central Daylight Time	07/30/2021 12:52:56 PM Central Daylight Time			08/04/2021 10:17:29 PM Central Daylight Time	CENTENE VENTURE COMPANY TENNESSEE	Ascension Complete	ascensioncomplete.com	Ascension Complete Saint Thomas Access Plus (PPO)	01	04		1			H8121	001	0	2022	10 counties in Central Tennessee		2	1036	2			2						ascensioncomplete.com/findadoctor	ascensioncomplete.com/formulary	ascensioncomplete.com/findadoctor	(833)906-2876		(833)906-2876		(844)578-1927		(844)578-1927		(833)906-2876		(833)906-2876		(844)578-1927		(844)578-1927		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8121	002	0	1	04	01	H8121_002_0	4	1					0	08/02/2021	2022.01	08/02/2021 10:42:43 AM Central Daylight Time	08/04/2021 12:38:06 AM Central Daylight Time	07/30/2021 12:53:16 PM Central Daylight Time			08/04/2021 10:17:29 PM Central Daylight Time	CENTENE VENTURE COMPANY TENNESSEE	Ascension Complete	ascensioncomplete.com	Ascension Complete Saint Thomas Access (PPO)	01	04		1			H8121	002	0	2022	10 counties in Central Tennessee		2	1036	2			2						ascensioncomplete.com/findadoctor	ascensioncomplete.com/formulary	ascensioncomplete.com/findadoctor	(833)906-2876		(833)906-2876		(844)578-1927		(844)578-1927		(833)906-2876		(833)906-2876		(844)578-1927		(844)578-1927		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8121	801	0	1	04	01	H8121_801_0	2	1						05/04/2021	2022.01	05/04/2021 08:45:38 AM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	CENTENE VENTURE COMPANY TENNESSEE	Ascension Complete	https://www.ascensioncomplete.com	Ascension Complete Group Medicare Advantage (PPO)	01	04		1			H8121	801	0	2022	10 Counties in Central Tennessee		1	100	2			2						In development	In development	https://www.ascensioncomplete.com/findadoctor	(855)848-6940		(855)848-6940		(844)942-0039		(844)942-0039		(855)848-6940		(855)848-6940		(844)942-0039		(844)942-0039		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H8121	802	0	1	04	01	H8121_802_0	2	1				0	0	05/04/2021	2022.01	05/04/2021 08:45:53 AM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	CENTENE VENTURE COMPANY TENNESSEE	Ascension Complete	https://www.ascensioncomplete.com	Ascension Complete Group Medicare Advantage (PPO)	01	04		1			H8121	802	0	2022	10 Counties in Central Tennessee		1	100	2			2						In development	In development	https://www.ascensioncomplete.com/findadoctor	(855)848-6940		(855)848-6940		(844)942-0039		(844)942-0039										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H8121	803	0	1	04	01	H8121_803_0	2	1						05/04/2021	2022.01	05/04/2021 08:46:10 AM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	CENTENE VENTURE COMPANY TENNESSEE	Ascension Complete	https://www.ascensioncomplete.com	Ascension Complete Group Medicare Advantage (PPO)	01	04		1			H8121	803	0	2022	10 Counties in Central Tennessee		1	100	2			2						In development	In development	https://www.ascensioncomplete.com/findadoctor	(855)848-6940		(855)848-6940		(844)942-0039		(844)942-0039		(855)848-6940		(855)848-6940		(844)942-0039		(844)942-0039		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
H8125	002	0	1	01	01	H8125_002_0	4	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 11:02:37 AM Central Daylight Time	08/03/2021 12:31:53 PM Central Daylight Time	07/29/2021 09:18:44 PM Central Daylight Time			08/04/2021 04:48:24 PM Central Daylight Time	UnitedHealthcare Insurance Company of America	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete LP1 (HMO D-SNP)	01	01		1			H8125	002	0	2022	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			
H8125	003	0	1	01	01	H8125_003_0	6	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 11:20:28 AM Central Daylight Time	08/03/2021 12:32:26 PM Central Daylight Time	07/29/2021 09:19:01 PM Central Daylight Time			08/05/2021 01:05:44 PM Central Daylight Time	UnitedHealthcare Insurance Company of America	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete LP1 (HMO D-SNP)	01	01		1			H8125	003	0	2022	Select counties in Oklahoma		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			
H8130	001	0	1	01	01	H8130_001_0	5	1	2	1			0	08/05/2021	2022.01	08/05/2021 11:30:10 AM Pacific Daylight Time	08/04/2021 05:52:36 PM Pacific Daylight Time	08/04/2021 04:46:20 PM Pacific Daylight Time			08/05/2021 03:02:36 PM Pacific Daylight Time	MOLINA HEALTHCARE OF FLORIDA, INC.	Molina Healthcare of Florida	www.molinahealthcare.com/medicare	Molina Medicare Complete Care (HMO D-SNP)	01	01		1			H8130	001	0	2022	Tampa, West Palm Beach and Miami Metro Areas		2		2			1	3		1		1	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			
H8130	008	0	1	01	01	H8130_008_0	5	1		1			0	08/05/2021	2022.01	08/05/2021 11:30:47 AM Pacific Daylight Time	08/04/2021 05:53:18 PM Pacific Daylight Time	08/04/2021 04:46:44 PM Pacific Daylight Time			08/05/2021 03:02:36 PM Pacific Daylight Time	MOLINA HEALTHCARE OF FLORIDA, INC.	Molina Healthcare of Florida	www.molinahealthcare.com/medicare	Molina Medicare Connect Care (HMO C-SNP)	01	01		1			H8130	008	0	2022	Select Counties in Florida		2		2			1	4			00000000000010000000		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			
H8130	009	0	1	01	01	H8130_009_0	5	1	2	1			0	08/05/2021	2022.01	08/05/2021 11:31:26 AM Pacific Daylight Time	08/04/2021 05:53:56 PM Pacific Daylight Time	08/04/2021 04:47:10 PM Pacific Daylight Time			08/05/2021 03:02:36 PM Pacific Daylight Time	MOLINA HEALTHCARE OF FLORIDA, INC.	Molina Healthcare of Florida	www.molinahealthcare.com/medicare	Molina Medicare Complete Care Select (HMO D-SNP)	01	01		1			H8130	009	0	2022	Select Counties in Florida		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			
H8130	010	0	1	01	01	H8130_010_0	5	1					1	08/05/2021	2022.01	08/05/2021 11:31:52 AM Pacific Daylight Time	08/04/2021 05:54:44 PM Pacific Daylight Time	08/04/2021 04:47:36 PM Pacific Daylight Time			08/05/2021 03:02:36 PM Pacific Daylight Time	MOLINA HEALTHCARE OF FLORIDA, INC.	Molina Healthcare of Florida	www.molinahealthcare.com/medicare	Molina Medicare Choice Care (HMO)	01	01		1			H8130	010	0	2022	Select Counties in Florida		2		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			
H8130	011	0	1	01	01	H8130_011_0	5	1					0	07/20/2021	2022.01	07/20/2021 04:29:09 PM Pacific Daylight Time	08/04/2021 05:55:30 PM Pacific Daylight Time	08/04/2021 04:48:02 PM Pacific Daylight Time			08/05/2021 03:02:36 PM Pacific Daylight Time	MOLINA HEALTHCARE OF FLORIDA, INC.	Molina Healthcare of Florida	www.molinahealthcare.com/medicare	Molina Medicare Choice Care Select (HMO)	01	01		1			H8130	011	0	2022	Select Counties in Florida		2		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	3	1					0	06/03/2021	2022.01	06/03/2021 01:42:26 PM Central Daylight Time	08/03/2021 10:44:08 AM Central Daylight Time	08/04/2021 05:08:48 PM Central Daylight Time			08/05/2021 05:38:13 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	2022	Houston Metro Area		2	45745	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	3	1					0	06/03/2021	2022.01	06/03/2021 01:43:08 PM Central Daylight Time	08/03/2021 10:44:32 AM Central Daylight Time	08/04/2021 05:09:06 PM Central Daylight Time			08/05/2021 05:38:13 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	2022	El Paso		2	1235	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	3	1					0	06/03/2021	2022.01	06/03/2021 01:43:37 PM Central Daylight Time	08/03/2021 10:44:56 AM Central Daylight Time	08/04/2021 05:09:26 PM Central Daylight Time			08/05/2021 05:38:13 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	2022	South Texas		2	3624	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	801	0	1	01	01	H8133_801_0	1	1						05/26/2021	2022.01	05/26/2021 09:45:47 AM Central Daylight Time					05/28/2021 11:36:07 AM Central Daylight Time	GHS INSURANCE COMPANY	Blue Cross and Blue Shield of Texas	www.getbluetx.com/mapd	Blue Cross Group Medicare Advantage Plan (HMO)	01	01		1			H8133	801	0	2022	Statewide in Texas		1	1	2			2						www.getbluetx/mapd/pharmacies	www.getbluetx/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)-		2					2					2	2			
H8133	803	0	1	01	01	H8133_803_0	1	1						05/26/2021	2022.01	05/26/2021 09:45:54 AM Central Daylight Time					05/28/2021 11:36:07 AM Central Daylight Time	GHS INSURANCE COMPANY	Blue Cross and Blue Shield of Texas	www.getbluetx.com/mapd	Blue Cross Group Medicare Advantage Plan (HMO)	01	01		1			H8133	803	0	2022	Statewide in Texas		1	1	2			2						www.getbluetx/mapd/pharmacies	www.getbluetx/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)-		2					2					2	2			
H8133	805	0	1	01	01	H8133_805_0	1	1				0	0	05/26/2021	2022.01	05/26/2021 09:46:00 AM Central Daylight Time					05/28/2021 11:36:07 AM Central Daylight Time	GHS INSURANCE COMPANY	Blue Cross and Blue Shield of Texas	www.getbluetx.com/mapd	Blue Cross Group Medicare Advantage Plan (HMO)	01	01		1			H8133	805	0	2022	Statewide in Texas		1	1	2			2						www.getbluetx/mapd/pharmacies	www.getbluetx/mapd/druglist	www.getbluetx.com/mapd/providers	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H8142	001	0	1	01	01	H8142_001_0	6	1					1	08/05/2021	2022.01	08/05/2021 08:03:39 AM Central Daylight Time	08/04/2021 09:40:00 AM Central Daylight Time	08/04/2021 09:56:26 AM Central Daylight Time			08/05/2021 09:00:08 AM Central Daylight Time	SCOTT AND WHITE HEALTH PLAN	Scott and White Health Plan	advantage.swhp.org	BSW SeniorCare Advantage Select Rx (HMO)	01	01		1			H8142	001	0	2022	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	6	1					1	08/05/2021	2022.01	08/05/2021 08:07:35 AM Central Daylight Time	08/04/2021 09:44:48 AM Central Daylight Time	08/04/2021 09:56:56 AM Central Daylight Time			08/05/2021 09:00:08 AM Central Daylight Time	SCOTT AND WHITE HEALTH PLAN	Scott and White Health Plan	advantage.swhp.org	BSW SeniorCare Advantage Preferred Rx (HMO)	01	01		1			H8142	002	0	2022	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	6	1					1	08/05/2021	2022.01	08/05/2021 08:12:02 AM Central Daylight Time	08/04/2021 09:49:36 AM Central Daylight Time	08/04/2021 09:57:22 AM Central Daylight Time			08/05/2021 09:00:08 AM Central Daylight Time	SCOTT AND WHITE HEALTH PLAN	Scott and White Health Plan	advantage.swhp.org	BSW SeniorCare Advantage Premium Rx (HMO)	01	01		1			H8142	003	0	2022	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	5	1				0	0	07/13/2021	2022.01	07/13/2021 01:54:39 PM Central Daylight Time	07/08/2021 10:11:18 AM Central Daylight Time				07/16/2021 04:09:30 PM Central Daylight Time	SCOTT AND WHITE HEALTH PLAN	Scott and White Health Plan	advantage.swhp.org	BSW SeniorCare Advantage Select (HMO)	01	01		1			H8142	004	0	2022	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	5	1				0	0	07/13/2021	2022.01	07/13/2021 02:37:46 PM Central Daylight Time	07/08/2021 10:15:54 AM Central Daylight Time				07/16/2021 04:09:30 PM Central Daylight Time	SCOTT AND WHITE HEALTH PLAN	Scott and White Health Plan	advantage.swhp.org	BSW SeniorCare Advantage Preferred (HMO)	01	01		1			H8142	005	0	2022	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	5	1				0	0	07/13/2021	2022.01	07/13/2021 02:39:36 PM Central Daylight Time	07/08/2021 10:16:38 AM Central Daylight Time				07/16/2021 04:09:30 PM Central Daylight Time	SCOTT AND WHITE HEALTH PLAN	Scott and White Health Plan	advantage.swhp.org	BSW SeniorCare Advantage Premium (HMO)	01	01		1			H8142	006	0	2022	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	007	0	1	01	01	H8142_007_0	6	1					1	08/05/2021	2022.01	08/05/2021 08:15:20 AM Central Daylight Time	08/04/2021 09:51:04 AM Central Daylight Time	08/04/2021 09:57:52 AM Central Daylight Time			08/05/2021 09:00:08 AM Central Daylight Time	SCOTT AND WHITE HEALTH PLAN	Scott and White Health Plan	advantage.swhp.org	BSW SeniorCare Advantage Select Rx (HMO)	01	01		1			H8142	007	0	2022	North 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	008	0	1	01	01	H8142_008_0	5	1				0	0	07/13/2021	2022.01	07/13/2021 02:43:33 PM Central Daylight Time	07/08/2021 10:20:10 AM Central Daylight Time				07/16/2021 04:09:30 PM Central Daylight Time	SCOTT AND WHITE HEALTH PLAN	Scott and White Health Plan	advantage.swhp.org	BSW SeniorCare Advantage Select (HMO)	01	01		1			H8142	008	0	2022	North 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	801	0	1	01	01	H8142_801_0	3	1						05/12/2021	2022.01	05/12/2021 03:08:49 PM Central Daylight Time					06/07/2021 03:27:16 PM Central Daylight Time	SCOTT AND WHITE HEALTH PLAN	Scott and White Health Plan	advantage.swhp.org	BSW SeniorCare Advantage EGWP CY Rx (HMO)	01	01		1			H8142	801	0	2022	Central Texas		1	1200	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)-		1	2		2		1					2				
H8142	802	0	1	01	01	H8142_802_0	3	1				0	0	05/13/2021	2022.01	05/13/2021 09:29:52 AM Central Daylight Time					06/07/2021 03:27:16 PM Central Daylight Time	SCOTT AND WHITE HEALTH PLAN	Scott and White Health Plan	advantage.swhp.org	BSW SeniorCare Advantage EGWP CY (HMO)	01	01		1			H8142	802	0	2022	Central Texas		1	1200	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)-										1	2		2		1					2				
H8142	803	0	1	01	01	H8142_803_0	3	1						05/13/2021	2022.01	05/13/2021 09:52:41 AM Central Daylight Time					06/07/2021 03:27:16 PM Central Daylight Time	SCOTT AND WHITE HEALTH PLAN	Scott and White Health Plan	advantage.swhp.org	BSW SeniorCare Advantage EGWP FY Rx (HMO)	01	01		1			H8142	803	0	2022	Central Texas		1	1200	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)-		1	2		2		1					2				
H8142	804	0	1	01	01	H8142_804_0	3	1				0	0	05/13/2021	2022.01	05/13/2021 10:07:34 AM Central Daylight Time					06/07/2021 03:27:16 PM Central Daylight Time	SCOTT AND WHITE HEALTH PLAN	Scott and White Health Plan	advantage.swhp.org	BSW SeniorCare Advantage EGWP FY (HMO)	01	01		1			H8142	804	0	2022	Central Texas		1	1200	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)-										1	2		2		1					2				
H8145	004	0	1	09	04	H8145_004_0	4	1						07/22/2021	2022.01	07/22/2021 01:44:02 PM Eastern Daylight Time	08/03/2021 09:41:54 PM Eastern Daylight Time	07/30/2021 12:05:28 PM Eastern Daylight Time			08/04/2021 02:22:33 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H8145-004 (PFFS)	04	09	1	1			H8145	004	0	2022	North Carolina-Virginia		2		2			2						https://www.humana.com/pharmacy/	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						07/22/2021	2022.01	07/22/2021 01:27:04 PM Eastern Daylight Time	08/03/2021 07:47:43 PM Eastern Daylight Time	07/30/2021 12:05:40 PM Eastern Daylight Time			08/04/2021 06:29:06 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H8145-006 (PFFS)	04	09	1	1			H8145	006	0	2022	Select Counties in Michigan and Wisconsin		2		2			2						https://www.humana.com/pharmacy/	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	3	1						08/03/2021	2022.01	08/03/2021 10:35:49 AM Eastern Daylight Time	08/03/2021 07:44:53 PM Eastern Daylight Time	07/30/2021 12:05:52 PM Eastern Daylight Time			08/04/2021 06:29:06 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H8145-008 (PFFS)	04	09	1	1			H8145	008	0	2022	Select Counties in Illinois		2		2			2						https://www.humana.com/pharmacy/	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						07/15/2021	2022.01	07/15/2021 04:35:51 PM Eastern Daylight Time	08/03/2021 06:08:48 PM Eastern Daylight Time	07/30/2021 12:06:04 PM Eastern Daylight Time			08/04/2021 01:54:36 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H8145-032 (PFFS)	04	09	1	1			H8145	032	0	2022	Select counties in Ohio and Indiana		2		2			2						https://www.humana.com/pharmacy/	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	3	1				0	0	07/22/2021	2022.01	07/22/2021 01:44:16 PM Eastern Daylight Time	07/22/2021 09:05:47 AM Eastern Daylight Time				07/22/2021 02:17:50 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	2022	Select Counties in Virginia		2		2			2						https://www.humana.com/pharmacy/	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	052	0	1	09	04	H8145_052_0	4	1						08/04/2021	2022.01	08/04/2021 01:44:52 PM Eastern Daylight Time	08/03/2021 05:25:48 PM Eastern Daylight Time	07/30/2021 12:06:16 PM Eastern Daylight Time			08/04/2021 01:59:57 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H8145-052 (PFFS)	04	09	1	1			H8145	052	0	2022	Select Counties in KY, PA, WV		2		2			2						https://www.humana.com/pharmacy/	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				0	0	07/22/2021	2022.01	07/22/2021 01:26:47 PM Eastern Daylight Time	07/22/2021 09:46:21 AM Eastern Daylight Time				07/22/2021 01:39:56 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	2022	Pennsylvania and West Virginia		2		2			2						https://www.humana.com/pharmacy/	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	4	1						08/02/2021	2022.01	08/02/2021 10:43:36 AM Eastern Daylight Time	08/03/2021 05:31:39 PM Eastern Daylight Time	07/30/2021 12:06:28 PM Eastern Daylight Time			08/04/2021 01:39:21 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H8145-061 (PFFS)	04	09	1	1			H8145	061	0	2022	Select Counties in Florida		2		2			2						https://www.humana.com/pharmacy/	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						07/22/2021	2022.01	07/22/2021 04:57:27 PM Eastern Daylight Time	08/03/2021 05:32:03 PM Eastern Daylight Time	07/30/2021 12:06:40 PM Eastern Daylight Time			08/04/2021 01:54:37 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H8145-069 (PFFS)	04	09	1	1			H8145	069	0	2022	Select Counties in Georgia and South Carolina		2		2			2						https://www.humana.com/pharmacy/	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	3	1						06/03/2021	2022.01	06/03/2021 06:09:39 PM Eastern Daylight Time	08/03/2021 05:55:16 PM Eastern Daylight Time	07/30/2021 12:06:52 PM Eastern Daylight Time			08/04/2021 02:00:17 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	2022	Select Counties in Texas		2		2			2						https://www.humana.com/pharmacy/	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	4	1						08/04/2021	2022.01	08/04/2021 02:20:20 PM Eastern Daylight Time	08/03/2021 06:02:21 PM Eastern Daylight Time	07/30/2021 12:07:04 PM Eastern Daylight Time			08/04/2021 02:33:41 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H8145-089 (PFFS)	04	09	1	1			H8145	089	0	2022	Select Counties in IA, MN, MT, ND, SD		2		2			2						https://www.humana.com/pharmacy/	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						06/03/2021	2022.01	06/03/2021 09:28:02 PM Eastern Daylight Time	08/03/2021 06:39:15 PM Eastern Daylight Time	07/30/2021 12:07:16 PM Eastern Daylight Time			08/04/2021 01:47:16 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H8145-091 (PFFS)	04	09	1	1			H8145	091	0	2022	Select Counties in Virginia		2		2			2						https://www.humana.com/pharmacy/	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	120	0	1	09	04	H8145_120_0	3	1				0	0	07/23/2021	2022.01	07/23/2021 01:48:34 PM Eastern Daylight Time	07/24/2021 03:12:10 PM Eastern Daylight Time				07/26/2021 03:51:15 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	2022	Select Counties in AR, KS, MO and OK		2		2			2						https://www.humana.com/pharmacy/	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				0	0	07/22/2021	2022.01	07/22/2021 01:27:14 PM Eastern Daylight Time	07/22/2021 10:15:45 AM Eastern Daylight Time				07/22/2021 03:51:59 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	2022	Select Counties in Illinois		2		2			2						https://www.humana.com/pharmacy/	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	5	1						07/19/2021	2022.01	07/19/2021 08:50:03 PM Eastern Daylight Time	08/03/2021 05:33:29 PM Eastern Daylight Time	07/30/2021 12:07:26 PM Eastern Daylight Time			08/04/2021 01:53:51 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H8145-122 (PFFS)	04	09	1	1			H8145	122	0	2022	Select Counties in Arkansas, Kansas and Oklahoma		2		2			2						https://www.humana.com/pharmacy/	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						07/15/2021	2022.01	07/15/2021 02:36:31 PM Eastern Daylight Time	08/03/2021 06:52:43 PM Eastern Daylight Time	07/30/2021 12:07:38 PM Eastern Daylight Time			08/04/2021 01:36:12 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	2022	Select Counties in Colorado and New Mexico		2		2			2						https://www.humana.com/pharmacy/	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	3	1						06/03/2021	2022.01	06/03/2021 02:54:24 PM Eastern Daylight Time	08/03/2021 05:34:26 PM Eastern Daylight Time	07/30/2021 12:07:50 PM Eastern Daylight Time			08/04/2021 01:53:51 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H8145-125 (PFFS)	04	09	1	1			H8145	125	0	2022	Select Counties in Missouri		2		2			2						https://www.humana.com/pharmacy/	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	2	1				0	0	06/03/2021	2022.01	06/03/2021 06:11:17 PM Eastern Daylight Time	07/22/2021 10:06:00 AM Eastern Daylight Time				07/22/2021 02:49:09 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	2022	Select Counties in Texas		2		2			2						https://www.humana.com/pharmacy/	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			
H8166	001	0	1	04	01	H8166_001_0	6	1					0	08/04/2021	2022.01	08/04/2021 09:29:12 AM Eastern Daylight Time	08/03/2021 01:49:47 PM Eastern Daylight Time	08/03/2021 06:39:39 PM Eastern Daylight Time			08/05/2021 08:12:54 AM Eastern Daylight Time	HIGHMARK BCBSD, INC.	Highmark Inc.	medicare.highmark.com	Freedom Blue PPO Signature (PPO)	01	04		1			H8166	001	0	2022	Delaware		2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(844)576-1246		(844)576-1246		(833)611-7926		(833)611-7926		(844)576-1246		(844)576-1246		(833)611-7926		(833)611-7926		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8166	002	0	1	04	01	H8166_002_0	6	1					1	08/04/2021	2022.01	08/04/2021 09:30:56 AM Eastern Daylight Time	08/03/2021 01:47:03 PM Eastern Daylight Time	08/03/2021 06:37:46 PM Eastern Daylight Time			08/05/2021 08:12:54 AM Eastern Daylight Time	HIGHMARK BCBSD, INC.	Highmark Inc.	medicare.highmark.com	Freedom Blue PPO Distinct (PPO)	01	04		1			H8166	002	0	2022	Delaware		2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(844)576-1246		(844)576-1246		(833)611-7926		(833)611-7926		(844)576-1246		(844)576-1246		(833)611-7926		(833)611-7926		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8166	801	0	1	04	01	H8166_801_0	1	1				0	0	05/07/2021	2022.01	05/07/2021 12:09:28 PM Eastern Daylight Time					06/04/2021 01:39:56 PM Eastern Daylight Time	HIGHMARK BCBSD, INC.	Highmark Inc.	medicare.highmark.com	Freedom Blue PPO MA DE CALENDAR (PPO)	01	04		1			H8166	801	0	2022	Delaware		1	0	2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(844)576-1246		(844)576-1246		(833)611-7926		(833)611-7926										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;15;16b;	2		1									
H8166	802	0	1	04	01	H8166_802_0	1	1						05/07/2021	2022.01	05/07/2021 12:10:12 PM Eastern Daylight Time					06/04/2021 01:39:56 PM Eastern Daylight Time	HIGHMARK BCBSD, INC.	Highmark Inc.	medicare.highmark.com	Freedom Blue PPO MAPD DE CALENDAR (PPO)	01	04		1			H8166	802	0	2022	Delaware		1	0	2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(844)576-1246		(844)576-1246		(833)611-7926		(833)611-7926		(844)576-1246		(844)576-1246		(833)611-7926		(833)611-7926		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;15;16b;	2		1									
H8166	803	0	1	04	01	H8166_803_0	1	1						05/07/2021	2022.01	05/07/2021 12:11:04 PM Eastern Daylight Time					06/04/2021 01:39:56 PM Eastern Daylight Time	HIGHMARK BCBSD, INC.	Highmark Inc.	medicare.highmark.com	Freedom Blue PPO MAPD DE Non-Calendar (PPO)	01	04		1			H8166	803	0	2022	Delaware		1	0	2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(844)576-1246		(844)576-1246		(833)611-7926		(833)611-7926		(844)576-1246		(844)576-1246		(833)611-7926		(833)611-7926		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;15;16b;	2		1									
H8173	001	0	1	01	01	H8173_001_0	8	1					0	08/04/2021	2022.01	08/04/2021 11:48:35 AM US Eastern Daylight Time	08/04/2021 03:39:32 PM Eastern Daylight Time	07/30/2021 10:25:25 AM Eastern Daylight Time			08/05/2021 09:29:00 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Devoted Health	www.Devoted.com	Devoted Health Core (HMO)	01	01		1			H8173	001	0	2022	Maricopa and Pinal counties		2		2			2						www.Devoted.com	www.Devoted.com	www.Devoted.com	(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8173	002	0	1	01	01	H8173_002_0	11	1					0	08/04/2021	2022.01	08/04/2021 12:12:24 PM US Eastern Daylight Time	08/09/2021 02:05:48 PM Eastern Daylight Time	07/30/2021 10:25:45 AM Eastern Daylight Time			08/11/2021 05:18:42 PM Eastern Daylight Time	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Devoted Health	www.Devoted.com	Devoted Health Select (HMO)	01	01		1			H8173	002	0	2022	Maricopa and Pinal counties		2		2			2						www.Devoted.com	www.Devoted.com	www.Devoted.com	(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8173	003	0	1	01	01	H8173_003_0	9	1					0	09/27/2021	2022.01	09/27/2021 10:06:36 AM US Eastern Daylight Time	08/04/2021 03:40:28 PM Eastern Daylight Time	07/30/2021 10:26:05 AM Eastern Daylight Time			09/28/2021 12:44:50 PM Eastern Daylight Time	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Devoted Health	www.Devoted.com	Devoted Health Flex (HMO)	01	01		1			H8173	003	0	2022	Maricopa and Pinal counties		2		2			2						www.Devoted.com	www.Devoted.com	www.Devoted.com	(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8173	004	0	1	01	01	H8173_004_0	10	1		1			1	08/03/2021	2022.01	08/03/2021 01:40:07 PM US Eastern Daylight Time	08/04/2021 03:40:56 PM Eastern Daylight Time	07/30/2021 10:26:24 AM Eastern Daylight Time			08/05/2021 09:29:00 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Devoted Health	www.Devoted.com	Devoted Health Advance (HMO C-SNP)	01	01		1			H8173	004	0	2022	Maricopa and Pinal counties		2		2			1	4			00000010000000000000		www.Devoted.com	www.Devoted.com	www.Devoted.com	(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8173	005	0	1	01	01	H8173_005_0	7	1				0	0	07/15/2021	2022.01	07/15/2021 10:35:41 PM US Eastern Daylight Time	06/05/2021 08:05:31 PM Eastern Daylight Time				07/16/2021 12:33:12 PM Eastern Daylight Time	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Devoted Health	www.Devoted.com	Devoted Health Liberty (HMO)	01	01		1			H8173	005	0	2022	Maricopa and Pinal counties		2		2			2						www.Devoted.com	www.Devoted.com	www.Devoted.com	(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H8173	006	0	1	01	01	H8173_006_0	10	1		1			1	08/03/2021	2022.01	08/03/2021 01:41:04 PM US Eastern Daylight Time	08/04/2021 03:41:53 PM Eastern Daylight Time	07/30/2021 10:26:44 AM Eastern Daylight Time			08/05/2021 09:29:00 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Devoted Health	www.Devoted.com	Devoted Health Essence (HMO C-SNP)	01	01		1			H8173	006	0	2022	Maricopa		2		2			1	4			00000000000000010000		www.Devoted.com	www.Devoted.com	www.Devoted.com	(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8173	007	0	1	01	01	H8173_007_0	8	1					0	08/03/2021	2022.01	08/03/2021 01:46:44 PM US Eastern Daylight Time	08/04/2021 03:42:20 PM Eastern Daylight Time	07/30/2021 10:27:04 AM Eastern Daylight Time			08/05/2021 09:29:00 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Devoted Health	www.Devoted.com	Devoted Health Core (HMO)	01	01		1			H8173	007	0	2022	Yavapai		2		2			2						www.Devoted.com	www.Devoted.com	www.Devoted.com	(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8173	008	0	1	01	01	H8173_008_0	10	1					0	08/04/2021	2022.01	08/04/2021 12:22:32 PM US Eastern Daylight Time	08/04/2021 03:42:48 PM Eastern Daylight Time	07/30/2021 10:27:23 AM Eastern Daylight Time			08/05/2021 09:29:00 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Devoted Health	www.Devoted.com	Devoted Health Select (HMO)	01	01		1			H8173	008	0	2022	Yavapai		2		2			2						www.Devoted.com	www.Devoted.com	www.Devoted.com	(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8173	010	0	1	01	01	H8173_010_0	10	1		1			1	08/03/2021	2022.01	08/03/2021 01:50:13 PM US Eastern Daylight Time	08/04/2021 03:43:15 PM Eastern Daylight Time	07/30/2021 10:27:43 AM Eastern Daylight Time			08/05/2021 09:29:00 AM Eastern Daylight Time	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Devoted Health	www.Devoted.com	Devoted Health Advance (HMO C-SNP)	01	01		1			H8173	010	0	2022	Yavapai		2		2			1	4			00000010000000000000		www.Devoted.com	www.Devoted.com	www.Devoted.com	(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8176	001	0	1	01	01	H8176_001_0	5	1	2	1			0	08/05/2021	2022.01	08/05/2021 02:28:53 PM Pacific Daylight Time	08/04/2021 05:56:16 PM Pacific Daylight Time	08/04/2021 04:48:28 PM Pacific Daylight Time			08/05/2021 03:02:36 PM Pacific Daylight Time	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Molina Healthcare of South Carolina	www.molinahealthcare.com/medicare	Molina Medicare Complete Care (HMO D-SNP)	01	01		1			H8176	001	0	2022	Select Counties in South Carolina		2		2			1	3		1		1	www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	(844)526-3195		(844)526-3195		(866)403-8293		(866)403-8293		(844)526-3195		(844)526-3195		(866)403-8293		(866)403-8293		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8176	003	0	1	01	01	H8176_003_0	5	1					1	08/05/2021	2022.01	08/05/2021 02:29:29 PM Pacific Daylight Time	08/04/2021 05:56:58 PM Pacific Daylight Time	08/04/2021 04:48:54 PM Pacific Daylight Time			08/05/2021 03:02:36 PM Pacific Daylight Time	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Molina Healthcare of South Carolina	www.molinahealthcare.com/medicare	Molina Medicare Choice Care (HMO)	01	01		1			H8176	003	0	2022	Select Counties in South Carolina		2		2			2						www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	(844)526-3195		(844)526-3195		(866)403-8293		(866)403-8293		(844)526-3195		(844)526-3195		(866)403-8293		(866)403-8293		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8181	001	0	1	04	01	H8181_001_0	5	1					0	07/09/2021	2022.01	07/09/2021 10:42:25 AM Eastern Daylight Time	08/03/2021 10:03:48 AM Eastern Daylight Time	08/03/2021 10:03:48 AM Eastern Daylight Time			08/03/2021 10:06:49 AM Eastern Daylight Time	SAPPHIRE EDGE, INC.	Blue Cross and Blue Shield of Nebraska	https://Medicare.NebraskaBlue.com	Blue Cross Blue Shield Nebraska MA Access PPO (PPO)	01	04		1			H8181	001	0	2022	Omaha/ Lincoln Metro Area and Central Nebraska		2	94383	2			2						https://Medicare.NebraskaBlue.com/MedicareAdvantage/FindAPharmacy	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			
H8181	801	0	1	04	01	H8181_801_0	3	1						04/22/2021	2022.01	04/22/2021 11:26:26 AM Eastern Daylight Time					06/05/2021 07:16:27 PM Eastern Daylight Time	SAPPHIRE EDGE, INC.	Blue Cross and Blue Shield of Nebraska	https://Medicare.NebraskaBlue.com	BCBSNE Employer Group PPO Rx CY (PPO)	01	04		1			H8181	801	0	2022	Omaha/ Lincoln Metro Area and Central Nebraska		1	1440	2			2						https//Medicare.NebraskaBlue.com/MedicareAdvantage/FindAPharmacy	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)-		1	1	1a;2;8a;8b1;8b2;9a1;9b;10a;11a;11b;15;	2		1									
H8181	802	0	1	04	01	H8181_802_0	3	1				0	0	04/21/2021	2022.01	04/21/2021 10:26:43 AM Eastern Daylight Time					06/05/2021 07:16:27 PM Eastern Daylight Time	SAPPHIRE EDGE, INC.	Blue Cross and Blue Shield of Nebraska	https://Medicare.NebraskaBlue.com	BCBSNE Employer Group PPO CY (PPO)	01	04		1			H8181	802	0	2022	Omaha/ Lincoln Metro Area and Central Nebraska		1	1200	2			2						https://Medicare.NebraskaBlue.com/MedicareAdvantage/FindAPharmacy	https://Medicare.NebraskaBlue.com/MedicareAdvantage/RXCost	https://Medicare.NebraskaBlue.com/MedicareAdvantage/FindADoc	(888)488-9850		(888)488-9850		(844)899-6060		(844)899-6060										(711)-		(711)-		(711)-		(711)-										1	1	1a;2;8a;8b1;8b2;9a1;9b;10a;11a;11b;15;	2		1									
H8181	803	0	1	04	01	H8181_803_0	3	1						04/22/2021	2022.01	04/22/2021 11:27:22 AM Eastern Daylight Time					06/05/2021 07:16:27 PM Eastern Daylight Time	SAPPHIRE EDGE, INC.	Blue Cross and Blue Shield of Nebraska	https://Medicare.NebraskaBlue.com	BCBSNE Employer Group PPO Rx CY (PPO)	01	04		1			H8181	803	0	2022	Omaha/ Lincoln Metro Area and Central Nebraska		1	1200	2			2						https://Medicare.NebraskaBlue.com/MedicareAdvantage/FindAPharmacy	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)-		1	1	1a;2;8a;8b1;8b2;9a1;9b;10a;11a;11b;15;	2		1									
H8181	804	0	1	04	01	H8181_804_0	3	1						04/21/2021	2022.01	04/21/2021 10:27:41 AM Eastern Daylight Time					06/05/2021 07:16:27 PM Eastern Daylight Time	SAPPHIRE EDGE, INC.	Blue Cross and Blue Shield of Nebraska	https://Medicare.NebraskaBlue.com	BCBSNE Employer Group PPO Rx CY (PPO)	01	04		1			H8181	804	0	2022	Omaha/ Lincoln Metro Area and Central Nebraska		1	1200	2			2						https://Medicare.NebraskaBlue.com/MedicareAdvantage/FindAPharmacy	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)-		1	1	1a;2;8a;8b1;8b2;9a1;9b;10a;11a;11b;15;	2		1									
H8189	001	0	1	01	01	H8189_001_0	6	1	2	1			0	08/04/2021	2022.01	08/04/2021 09:44:26 AM Eastern Daylight Time	08/04/2021 01:38:34 AM Eastern Daylight Time	07/30/2021 01:53:36 PM Eastern Daylight Time			08/04/2021 10:05:38 PM Eastern Daylight Time	MANAGED HEALTH SERVICES, WISCONSIN	Wellcare by Allwell	www.wellcare.com/allwellWI	Wellcare Dual Access (HMO D-SNP)	01	01		1			H8189	001	0	2022	Select counties in WI		2	29648	2			1	3		1		1	www.wellcare.com/allwellWI	www.wellcare.com/allwellWI	www.wellcare.com/allwellWI	(877)935-8024		(877)935-8024		(866)277-6583		(866)277-6583		(877)935-8024		(877)935-8024		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8197	002	1	1	48	05	H8197_002_1	2	1						07/02/2021	2022.01	07/02/2021 10:05:10 AM Pacific Daylight Time					07/02/2021 10:20:54 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	002	1	2022	Bexar, Dallas, El Paso, Harris & Hidalgo counties	Dallas, El Paso and Hidalgo counties	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)-																
H8197	002	2	1	48	05	H8197_002_2	2	1						07/02/2021	2022.01	07/02/2021 10:05:26 AM Pacific Daylight Time					07/02/2021 10:20:54 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	002	2	2022	Bexar, Dallas, El Paso, Harris & Hidalgo counties	Bexar and Harris counties	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	3	1					1	08/04/2021	2022.01	08/04/2021 11:01:06 AM Central Daylight Time	08/03/2021 01:09:06 PM Central Daylight Time	07/29/2021 09:19:17 PM Central Daylight Time			08/04/2021 04:59:49 PM Central Daylight Time	MAMSI LIFE AND HEALTH INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 1 (PPO)	01	04		1			H8211	001	0	2022	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	3	1					1	08/04/2021	2022.01	08/04/2021 11:03:34 AM Central Daylight Time	08/03/2021 01:09:35 PM Central Daylight Time	07/29/2021 09:19:33 PM Central Daylight Time			08/04/2021 04:59:49 PM Central Daylight Time	MAMSI LIFE AND HEALTH INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 2 (PPO)	01	04		1			H8211	002	0	2022	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	005	0	1	04	01	H8211_005_0	3	1				0	0	07/15/2021	2022.01	07/15/2021 03:58:02 PM Central Daylight Time	06/03/2021 03:45:05 PM Central Daylight Time				07/16/2021 01:56:35 PM Central Daylight Time	MAMSI LIFE AND HEALTH INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (PPO)	01	04		1			H8211	005	0	2022	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										(711)-		(711)-		(711)-		(711)-										2					2						2			
H8211	006	0	1	04	01	H8211_006_0	4	1					1	08/04/2021	2022.01	08/04/2021 11:07:50 AM Central Daylight Time	08/03/2021 01:10:06 PM Central Daylight Time	07/29/2021 09:19:49 PM Central Daylight Time			08/04/2021 04:59:49 PM Central Daylight Time	MAMSI LIFE AND HEALTH INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 3 (PPO)	01	04		1			H8211	006	0	2022	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	007	0	1	04	01	H8211_007_0	3	1					1	08/04/2021	2022.01	08/04/2021 11:53:54 AM Central Daylight Time	08/03/2021 01:10:35 PM Central Daylight Time	07/29/2021 09:20:05 PM Central Daylight Time			08/04/2021 08:05:11 PM Central Daylight Time	MAMSI LIFE AND HEALTH INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 2 (PPO)	01	04		1			H8211	007	0	2022	Select Counties in Montana		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	009	0	1	04	01	H8211_009_0	3	1					1	08/04/2021	2022.01	08/04/2021 11:54:52 AM Central Daylight Time	08/03/2021 01:11:05 PM Central Daylight Time	07/29/2021 09:20:21 PM Central Daylight Time			08/04/2021 08:05:11 PM Central Daylight Time	MAMSI LIFE AND HEALTH INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 1 (PPO)	01	04		1			H8211	009	0	2022	Select Counties in Montana		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	010	0	1	04	01	H8211_010_0	2	1				0	0	07/14/2021	2022.01	07/14/2021 04:40:52 PM Central Daylight Time	06/03/2021 03:46:34 PM Central Daylight Time				07/15/2021 06:54:47 PM Central Daylight Time	MAMSI LIFE AND HEALTH INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (PPO)	01	04		1			H8211	010	0	2022	Select Counties in Montana		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			
H8213	001	0	1	48	05	H8213_001_0	3	1						06/30/2021	2022.01	06/30/2021 11:50:06 AM Central Daylight Time					07/01/2021 10:28:59 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	2022	SC - 42 of 46 counties		2		2			2						http://www.firstchoicevipcareplus.com	http://www.firstchoicevipcareplus.com	http://www.firstchoicevipcareplus.com	(888)978-0862		(888)978-0862		(877)703-9109		(877)703-9109		(888)978-0862		(888)978-0862		(877)703-9109		(877)703-9109		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H8225	001	0	1	01	01	H8225_001_0	4	1					0	08/02/2021	2022.01	08/02/2021 10:44:20 AM Central Daylight Time	08/04/2021 12:39:01 AM Central Daylight Time	07/30/2021 12:53:56 PM Central Daylight Time			08/04/2021 10:17:29 PM Central Daylight Time	CENTENE VENTURE COMPANY FLORIDA	Ascension Complete	ascensioncomplete.com	Ascension Complete St. Vincent's Reward (HMO)	01	01		1			H8225	001	0	2022	Jacksonville Metro Area		2	715	2			2						ascensioncomplete.com/findadoctor	ascensioncomplete.com/formulary	ascensioncomplete.com/findadoctor	(833)603-2971		(833)603-2971		(877)831-9406		(877)831-9406		(833)603-2971		(833)603-2971		(877)831-9406		(877)831-9406		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8225	002	0	1	01	01	H8225_002_0	4	1					0	08/02/2021	2022.01	08/02/2021 10:44:59 AM Central Daylight Time	08/04/2021 12:39:30 AM Central Daylight Time	07/30/2021 12:54:14 PM Central Daylight Time			08/04/2021 10:17:29 PM Central Daylight Time	CENTENE VENTURE COMPANY FLORIDA	Ascension Complete	ascensioncomplete.com	Ascension Complete Sacred Heart Reward (HMO)	01	01		1			H8225	002	0	2022	Pensacola Metro Area		2	522	2			2						ascensioncomplete.com/findadoctor	ascensioncomplete.com/formulary	ascensioncomplete.com/findadoctor	(833)603-2971		(833)603-2971		(877)831-9406		(877)831-9406		(833)603-2971		(833)603-2971		(877)831-9406		(877)831-9406		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8225	003	0	1	01	01	H8225_003_0	4	1					0	08/02/2021	2022.01	08/02/2021 10:45:39 AM Central Daylight Time	08/04/2021 12:39:59 AM Central Daylight Time	07/30/2021 12:54:34 PM Central Daylight Time			08/04/2021 10:17:29 PM Central Daylight Time	CENTENE VENTURE COMPANY FLORIDA	Ascension Complete	ascensioncomplete.com	Ascension Complete St. Vincent's Secure (HMO)	01	01		1			H8225	003	0	2022	Jacksonville Metro Area		2	7791	2			2						ascensioncomplete.com/findadoctor	ascensioncomplete.com/formulary	ascensioncomplete.com/findadoctor	(833)603-2971		(833)603-2971		(877)831-9406		(877)831-9406		(833)603-2971		(833)603-2971		(877)831-9406		(877)831-9406		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8225	004	0	1	01	01	H8225_004_0	4	1					0	08/02/2021	2022.01	08/02/2021 10:46:08 AM Central Daylight Time	08/04/2021 12:40:28 AM Central Daylight Time	07/30/2021 12:54:54 PM Central Daylight Time			08/04/2021 10:17:29 PM Central Daylight Time	CENTENE VENTURE COMPANY FLORIDA	Ascension Complete	ascensioncomplete.com	Ascension Complete Sacred Heart Secure (HMO)	01	01		1			H8225	004	0	2022	Pensacola Metro Area		2	7713	2			2						ascensioncomplete.com/findadoctor	ascensioncomplete.com/formulary	ascensioncomplete.com/findadoctor	(833)603-2971		(833)603-2971		(877)831-9406		(877)831-9406		(833)603-2971		(833)603-2971		(877)831-9406		(877)831-9406		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8225	005	0	1	01	01	H8225_005_0	4	1	2	1			0	06/02/2021	2022.01	06/02/2021 09:41:08 PM Eastern Daylight Time	08/04/2021 12:40:57 AM Central Daylight Time	07/30/2021 12:55:16 PM Central Daylight Time			08/04/2021 10:17:29 PM Central Daylight Time	CENTENE VENTURE COMPANY FLORIDA	Ascension Complete	ascensioncomplete.com	Ascension Complete St. Vincent's DSNP (HMO D-SNP)	01	01		1			H8225	005	0	2022	Jacksonville Metro Area		2	3417	2			1	3		1		1	ascensioncomplete.com/findadoctor	ascensioncomplete.com/formulary	ascensioncomplete.com/findadoctor	(833)603-2971		(833)603-2971		(877)831-9406		(877)831-9406		(833)603-2971		(833)603-2971		(877)831-9406		(877)831-9406		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8225	006	0	1	01	01	H8225_006_0	4	1	2	1			0	06/02/2021	2022.01	06/02/2021 09:44:29 PM Eastern Daylight Time	08/04/2021 12:41:27 AM Central Daylight Time	07/30/2021 12:55:36 PM Central Daylight Time			08/04/2021 10:17:29 PM Central Daylight Time	CENTENE VENTURE COMPANY FLORIDA	Ascension Complete	ascensioncomplete.com	Ascension Complete Sacred Heart DSNP (HMO D-SNP)	01	01		1			H8225	006	0	2022	Pensacola Area		2	3005	2			1	3		1		1	ascensioncomplete.com/findadoctor	ascensioncomplete.com/formulary	ascensioncomplete.com/findadoctor	(833)603-2971		(833)603-2971		(877)831-9406		(877)831-9406		(833)603-2971		(833)603-2971		(877)831-9406		(877)831-9406		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8225	007	0	1	02	01	H8225_007_0	4	1					0	08/02/2021	2022.01	08/02/2021 10:47:08 AM Central Daylight Time	08/04/2021 12:41:55 AM Central Daylight Time	07/30/2021 12:55:58 PM Central Daylight Time			08/04/2021 10:17:29 PM Central Daylight Time	CENTENE VENTURE COMPANY FLORIDA	Ascension Complete	ascensioncomplete.com	Ascension Complete St. Vincent's Access POS (HMO-POS)	01	02		1			H8225	007	0	2022	Jacksonville Metro Area		2	1430	2			2						ascensioncomplete.com/findadoctor	ascensioncomplete.com/formulary	ascensioncomplete.com/findadoctor	(833)603-2971		(833)603-2971		(877)831-9406		(877)831-9406		(833)603-2971		(833)603-2971		(877)831-9406		(877)831-9406		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8225	008	0	1	02	01	H8225_008_0	4	1					0	08/02/2021	2022.01	08/02/2021 10:47:39 AM Central Daylight Time	08/04/2021 12:42:24 AM Central Daylight Time	07/30/2021 12:56:20 PM Central Daylight Time			08/04/2021 10:17:29 PM Central Daylight Time	CENTENE VENTURE COMPANY FLORIDA	Ascension Complete	ascensioncomplete.com	Ascension Complete Sacred Heart Access POS (HMO-POS)	01	02		1			H8225	008	0	2022	Pensacola Area		2	2207	2			2						ascensioncomplete.com/findadoctor	ascensioncomplete.com/formulary	ascensioncomplete.com/findadoctor	(833)603-2971		(833)603-2971		(877)831-9406		(877)831-9406		(833)603-2971		(833)603-2971		(877)831-9406		(877)831-9406		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8258	001	0	1	48	05	H8258_001_0	4	1						07/01/2021	2022.01	07/01/2021 03:50:05 PM Pacific Daylight Time					07/01/2021 04:29:44 PM 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	2022	Los Angeles County		2	220000	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)-																
H8293	001	0	1	01	01	H8293_001_0	5	1					1	08/05/2021	2022.01	08/05/2021 08:46:46 AM Central Daylight Time	08/05/2021 02:09:27 PM Central Daylight Time	08/05/2021 02:08:09 PM Central Daylight Time			08/05/2021 06:05:28 PM Central Daylight Time	CLEAR SPRING HEALTH (VA), INC.	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Essential (HMO)	01	01		1			H8293	001	0	2022	Central, Southern and Shenandoah Valley Virginia		2		2			2						www.clearspringhealthcare.com	www.clearspringhealthcare.com	www.clearspringhealthcare.com	(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8298	001	0	1	01	01	H8298_001_0	7	1	2	1			0	06/03/2021	2022.01	06/03/2021 10:37:38 AM Eastern Daylight Time	08/02/2021 03:26:29 PM Eastern Daylight Time	08/02/2021 03:25:57 PM Eastern Daylight Time			08/02/2021 04:07:25 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 D-SNP)	01	01		1			H8298	001	0	2022	New Jersey		2	210105	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			
H8330	001	0	1	01	01	H8330_001_0	7	1	2	1			0	08/04/2021	2022.01	08/04/2021 06:01:44 PM Eastern Daylight Time	08/03/2021 02:46:28 PM Eastern Daylight Time	08/02/2021 01:38:48 PM Eastern Daylight Time			08/05/2021 11:00:35 AM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan	tuftsmedicarepreferred.org/sco	Tufts Health Plan Senior Care Options (HMO D-SNP)	01	01		1			H8330	001	0	2022	Most of Massachusetts		2		2			1	3		1		1	www.tuftsmedicarepreferred.org/doctor-search	tuftsmedicarepreferred.org/drug-coverage	www.tuftsmedicarepreferred.org/doctor-search	(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			
H8332	001	0	1	01	01	H8332_001_0	2	1					0	08/02/2021	2022.01	08/02/2021 03:25:20 PM Eastern Daylight Time	08/02/2021 03:31:14 PM Eastern Daylight Time	08/02/2021 09:57:36 AM Eastern Daylight Time			08/04/2021 02:44:24 PM Eastern Daylight Time	AETNA BETTER HEALTH OF KANSAS, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H8332	001	0	2022	San Antonio area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8332	002	0	1	01	01	H8332_002_0	2	1					0	08/02/2021	2022.01	08/02/2021 03:26:00 PM Eastern Daylight Time	08/02/2021 03:32:18 PM Eastern Daylight Time	08/02/2021 09:57:41 AM Eastern Daylight Time			08/04/2021 02:44:24 PM Eastern Daylight Time	AETNA BETTER HEALTH OF KANSAS, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H8332	002	0	2022	Dallas and Surrounding Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8332	003	0	1	01	01	H8332_003_0	2	1					0	08/02/2021	2022.01	08/02/2021 03:26:57 PM Eastern Daylight Time	08/02/2021 03:33:29 PM Eastern Daylight Time	08/02/2021 09:57:45 AM Eastern Daylight Time			08/04/2021 02:44:24 PM Eastern Daylight Time	AETNA BETTER HEALTH OF KANSAS, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	01	01		1			H8332	003	0	2022	Houston and Surrounding Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8332	004	0	1	01	01	H8332_004_0	3	1					0	08/02/2021	2022.01	08/02/2021 03:27:26 PM Eastern Daylight Time	08/02/2021 03:34:41 PM Eastern Daylight Time	08/02/2021 09:57:49 AM Eastern Daylight Time			08/04/2021 02:44:24 PM Eastern Daylight Time	AETNA BETTER HEALTH OF KANSAS, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H8332	004	0	2022	El Paso		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8332	801	0	1	01	01	H8332_801_0	1	1				0	0	05/28/2021	2022.01	05/28/2021 02:10:10 PM Eastern Daylight Time					06/03/2021 01:53:09 PM Eastern Daylight Time	AETNA BETTER HEALTH OF KANSAS, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (HMO)	01	01		1			H8332	801	0	2022	Texas		1	120	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H8332	802	0	1	01	01	H8332_802_0	1	1						05/28/2021	2022.01	05/28/2021 02:10:52 PM Eastern Daylight Time					06/03/2021 01:53:09 PM Eastern Daylight Time	AETNA BETTER HEALTH OF KANSAS, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan w/Rx (HMO)	01	01		1			H8332	802	0	2022	Texas		1	120	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H8343	001	0	1	04	01	H8343_001_0	8	1					0	07/31/2021	2022.01	07/31/2021 05:09:39 PM Pacific Daylight Time	08/03/2021 03:04:04 PM Pacific Daylight Time	08/03/2021 03:04:04 PM Pacific Daylight Time			08/04/2021 12:07:42 PM Pacific Daylight Time	AMERIGROUP INSURANCE COMPANY	Amerigroup Insurance Company	https://shop.amerigroup.com/medicare	Amerivantage Choice (PPO)	01	04		1			H8343	001	0	2022	Fort Bend Galveston Harris and Montgomery Counties		2		2			2						https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	(833)713-1307		(833)713-1307		(855)768-1046		(855)768-1046		(833)371-1079		(833)371-1079		(855)499-1092		(855)499-1092		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8343	002	0	1	04	01	H8343_002_0	8	1					0	07/31/2021	2022.01	07/31/2021 05:10:13 PM Pacific Daylight Time	08/03/2021 03:04:04 PM Pacific Daylight Time	08/03/2021 03:04:04 PM Pacific Daylight Time			08/04/2021 12:07:42 PM Pacific Daylight Time	AMERIGROUP INSURANCE COMPANY	Amerigroup Insurance Company	https://shop.amerigroup.com/medicare	Amerivantage Choice (PPO)	01	04		1			H8343	002	0	2022	Dallas, Denton, Tarrant Counties		2		2			2						https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	(833)713-1307		(833)713-1307		(855)768-1046		(855)768-1046		(833)371-1079		(833)371-1079		(855)499-1092		(855)499-1092		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8343	003	0	1	04	01	H8343_003_0	8	1					0	07/31/2021	2022.01	07/31/2021 05:12:09 PM Pacific Daylight Time	08/03/2021 03:04:04 PM Pacific Daylight Time	08/03/2021 03:04:04 PM Pacific Daylight Time			08/04/2021 12:07:42 PM Pacific Daylight Time	AMERIGROUP INSURANCE COMPANY	Amerigroup Insurance Company	https://shop.amerigroup.com/medicare	Amerivantage Choice (PPO)	01	04		1			H8343	003	0	2022	Bexar County		2		2			2						https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	(833)713-1307		(833)713-1307		(855)768-1046		(855)768-1046		(833)371-1079		(833)371-1079		(855)499-1092		(855)499-1092		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8343	007	0	1	04	01	H8343_007_0	6	1					0	08/02/2021	2022.01	08/02/2021 11:33:41 AM Eastern Daylight Time	08/03/2021 06:04:05 PM Eastern Daylight Time	08/03/2021 06:04:05 PM Eastern Daylight Time			08/04/2021 02:27:41 PM Eastern Daylight Time	AMERIGROUP INSURANCE COMPANY	Amerigroup Insurance Company	https://shop.amerigroup.com/medicare	Amerivantage Choice (PPO)	01	04		1			H8343	007	0	2022	Select counties in New Jersey		2		2			2						https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	(866)805-4589		(866)805-4589		(855)593-0921		(855)593-0921		(833)337-1269		(833)337-1269		(855)485-0945		(855)485-0945		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8379	001	0	1	01	01	H8379_001_0	11	1	2	1			0	07/19/2021	2022.01	07/19/2021 03:18:09 PM Eastern Daylight Time	08/03/2021 11:59:34 PM Eastern Daylight Time	07/30/2021 02:33:58 PM Eastern Daylight Time			08/05/2021 11:58:59 AM Eastern Daylight Time	PRIORITY HEALTH CHOICE, INC.	Priority Health Medicare	www.priorityhealth.com/dsnp	PriorityMedicare D-SNP (HMO D-SNP)	01	01		1			H8379	001	0	2022	68 lower peninsula Michigan counties		2	108667	2			1	3		1		1	www.priorityhealth.com/dsnp	www.priorityhealth.com/dsnp	www.priorityhealth.com/dsnp	(833)939-0983		(616)464-8820		(877)729-4124		(616)464-8850		(833)939-0983		(616)464-8820		(877)729-4124		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8385	001	0	1	04	01	H8385_001_0	12	1					1	08/04/2021	2022.01	08/04/2021 12:00:33 PM Central Daylight Time	08/04/2021 12:32:11 PM Central Daylight Time	08/02/2021 12:38:41 PM Central Daylight Time			08/05/2021 11:18:13 AM Central Daylight Time	SANFORD HEALTH PLAN	Sanford Health Plan	www.sanfordhealthplan.com	Align ChoiceElite (PPO)	01	04		1			H8385	001	0	2022	South Dakota		2		2			2						www.sanfordhealthplan.com	www.sanfordhealthplan.com	www.sanfordhealthplan.com	(888)279-1549		(423)427-3977		(888)279-1549		(423)427-3977		(800)498-5428		(520)918-1254		(800)498-5428		(520)918-1254		(888)279-1549		(423)427-3993		(888)279-1549		(423)427-3993		(800)498-5428		(711)-		(800)498-5428		(711)-		2					2						2			
H8385	002	0	1	04	01	H8385_002_0	12	1					1	08/04/2021	2022.01	08/04/2021 12:01:22 PM Central Daylight Time	08/04/2021 12:35:50 PM Central Daylight Time	08/02/2021 12:35:32 PM Central Daylight Time			08/05/2021 11:18:13 AM Central Daylight Time	SANFORD HEALTH PLAN	Sanford Health Plan	www.sanfordhealthplan.com	Align ChoiceElite (PPO)	01	04		1			H8385	002	0	2022	North Dakota		2		2			2						www.sanfordhealthplan.com	www.sanfordhealthplan.com	www.sanfordhealthplan.com	(888)279-1549		(423)427-3977		(888)279-1549		(423)427-3977		(800)498-5428		(520)918-1254		(800)498-5428		(520)918-1254		(888)279-1549		(423)427-3993		(888)279-1549		(423)427-3993		(800)498-5428		(711)-		(800)498-5428		(711)-		2					2						2			
H8385	003	0	1	04	01	H8385_003_0	12	1					1	08/04/2021	2022.01	08/04/2021 12:01:48 PM Central Daylight Time	08/04/2021 04:58:59 PM Central Daylight Time	08/03/2021 01:34:41 PM Central Daylight Time			08/05/2021 11:18:13 AM Central Daylight Time	SANFORD HEALTH PLAN	Sanford Health Plan	www.sanfordhealthplan.com	Align ChoicePlus (PPO)	01	04		1			H8385	003	0	2022	South Dakota		2		2			2						www.sanfordhealthplan.com	www.sanfordhealthplan.com	www.sanfordhealthplan.com	(888)279-1549		(423)427-3977		(888)279-1549		(423)427-3977		(800)498-5428		(520)918-1254		(800)498-5428		(520)918-1254		(888)279-1549		(423)427-3993		(888)279-1549		(423)427-3993		(800)498-5428		(711)-		(800)498-5428		(711)-		2					2						2			
H8385	004	0	1	04	01	H8385_004_0	12	1					1	08/04/2021	2022.01	08/04/2021 12:02:11 PM Central Daylight Time	08/04/2021 12:43:06 PM Central Daylight Time	08/02/2021 12:40:24 PM Central Daylight Time			08/05/2021 11:18:13 AM Central Daylight Time	SANFORD HEALTH PLAN	Sanford Health Plan	www.sanfordhealthplan.com	Align ChoicePlus (PPO)	01	04		1			H8385	004	0	2022	North Dakota		2		2			2						www.sanfordhealthplan.com	www.sanfordhealthplan.com	www.sanfordhealthplan.com	(888)279-1549		(423)427-3977		(888)279-1549		(423)427-3977		(800)498-5428		(520)918-1254		(800)498-5428		(520)918-1254		(888)279-1549		(423)427-3993		(888)279-1549		(423)427-3993		(800)498-5428		(711)-		(800)498-5428		(711)-		2					2						2			
H8390	015	0	1	01	01	H8390_015_0	5	1	2	1			0	08/03/2021	2022.01	08/03/2021 02:24:34 PM Eastern Daylight Time	08/03/2021 01:41:34 PM Eastern Daylight Time	07/30/2021 03:34:18 PM Eastern Daylight Time			08/05/2021 04:23:16 PM Eastern Daylight Time	CARESOURCE GEORGIA CO.	CareSource	www.caresource.com/ga/plans/dsnp/	CareSource Dual Advantage (HMO D-SNP)	01	01		1			H8390	015	0	2022	Region 1		2		2			1	3		1		1	www.caresource.com	www.caresource.com/ga/plans/dsnp/pharmacy/drug-formulary/	www.caresource.com/providers	(833)230-2020		(833)230-2020		(844)607-2830		(844)607-2830		(833)230-2020		(833)230-2020		(844)607-2830		(844)607-2830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8390	016	0	1	01	01	H8390_016_0	5	1	2	1			0	08/03/2021	2022.01	08/03/2021 01:22:28 PM Eastern Daylight Time	08/03/2021 01:43:32 PM Eastern Daylight Time	07/30/2021 03:35:08 PM Eastern Daylight Time			08/05/2021 04:23:16 PM Eastern Daylight Time	CARESOURCE GEORGIA CO.	CareSource	www.caresource.com/ga/plans/dsnp/	CareSource Dual Advantage (HMO D-SNP)	01	01		1			H8390	016	0	2022	Region 2		2		2			1	3		1		1	www.caresource.com	www.caresource.com/ga/plans/dsnp/pharmacy/drug-formulary/	www.caresource.com/providers	(833)230-2020		(833)230-2020		(844)607-2830		(844)607-2830		(833)230-2020		(833)230-2020		(844)607-2830		(844)607-2830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8423	001	0	1	48	05	H8423_001_0	3	1						07/20/2021	2022.01	07/20/2021 07:49:32 AM Central Daylight Time					07/20/2021 11:28:46 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna CarePlan	www.CarePlanTX.com	Cigna CarePlan MMP (Medicare-Medicaid Plan)	05	48		1			H8423	001	0	2022	Valley		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)653-0327		(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						06/02/2021	2022.01	06/02/2021 12:08:46 PM Central Daylight Time		06/02/2021 12:25:58 PM Central Daylight Time			06/02/2021 12:28:30 PM 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	2022	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)735-2942		(800)735-2942		(800)735-2942		(800)735-2942																
H8424	002	0	1	20	08	H8424_002_0	1	1						06/02/2021	2022.01	06/02/2021 12:09:02 PM Central Daylight Time		06/02/2021 12:25:58 PM Central Daylight Time			06/02/2021 12:28:30 PM Central Daylight Time	SIOUXLAND PACE, INC.	SIOUXLAND PACE, INC.	https://www.unitypoint.org/siouxcity/services-pace	Siouxland PACE, INC (PACE)	08	20		1			H8424	002	0	2022	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)735-2942		(800)735-2942		(800)735-2942		(800)735-2942																
H8432	007	0	1	01	01	H8432_007_0	6	1	2	1			0	06/02/2021	2022.01	06/02/2021 05:03:49 PM Eastern Daylight Time	08/03/2021 06:04:05 PM Eastern Daylight Time	08/03/2021 06:04:05 PM Eastern Daylight Time			08/04/2021 02:27:41 PM Eastern Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	www.empireblue.com/shop	Empire MediBlue Dual Advantage (HMO D-SNP)	01	01		1			H8432	007	0	2022	New York City Area		2		2			1	3		1		1	https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(877)269-5706		(877)269-5706		(855)768-1047		(855)768-1047		(833)344-1010		(833)344-1010		(855)499-1093		(855)499-1093		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8432	008	5	1	01	01	H8432_008_5	6	1					0	06/04/2021	2022.01	06/04/2021 09:55:15 AM Eastern Daylight Time	08/03/2021 06:04:01 PM Eastern Daylight Time	08/03/2021 06:04:01 PM Eastern Daylight Time			08/04/2021 02:06:25 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	2022	New York City Area	Bronx County	2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(800)499-9554		(800)499-9554		(855)768-1049		(855)768-1049		(833)343-4763		(833)343-4763		(855)499-1094		(855)499-1094		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8432	008	6	1	01	01	H8432_008_6	7	1					0	06/04/2021	2022.01	06/04/2021 09:55:31 AM Eastern Daylight Time	08/03/2021 06:04:01 PM Eastern Daylight Time	08/03/2021 06:04:01 PM Eastern Daylight Time			08/04/2021 02:06:25 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	2022	New York City Area	Queens County	2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(800)499-9554		(800)499-9554		(855)768-1049		(855)768-1049		(833)343-4763		(833)343-4763		(855)499-1094		(855)499-1094		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8432	008	7	1	01	01	H8432_008_7	6	1					0	08/03/2021	2022.01	08/03/2021 01:39:11 PM Eastern Daylight Time	08/03/2021 06:04:01 PM Eastern Daylight Time	08/03/2021 06:04:01 PM Eastern Daylight Time			08/04/2021 02:06:25 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	2022	New York City Area	Kings County	2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(800)499-9554		(800)499-9554		(855)768-1049		(855)768-1049		(833)343-4763		(833)343-4763		(855)499-1094		(855)499-1094		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8432	009	0	1	01	01	H8432_009_0	6	1					0	06/04/2021	2022.01	06/04/2021 09:55:57 AM Eastern Daylight Time	08/03/2021 06:04:01 PM Eastern Daylight Time	08/03/2021 06:04:01 PM Eastern Daylight Time			08/04/2021 02:06:25 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	2022	Rockland and Westchester Counties		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(800)499-9554		(800)499-9554		(855)768-1049		(855)768-1049		(833)343-4763		(833)343-4763		(855)499-1094		(855)499-1094		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8432	010	0	1	01	01	H8432_010_0	6	1					0	07/15/2021	2022.01	07/15/2021 10:31:52 AM Eastern Daylight Time	08/03/2021 06:04:01 PM Eastern Daylight Time	08/03/2021 06:04:01 PM Eastern Daylight Time			08/04/2021 02:06:25 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	2022	Nassau County		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(800)499-9554		(800)499-9554		(855)768-1049		(855)768-1049		(833)343-4763		(833)343-4763		(855)499-1094		(855)499-1094		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8432	011	0	1	01	01	H8432_011_0	6	1					0	06/04/2021	2022.01	06/04/2021 09:56:26 AM Eastern Daylight Time	08/03/2021 06:04:01 PM Eastern Daylight Time	08/03/2021 06:04:01 PM Eastern Daylight Time			08/04/2021 02:06:25 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	2022	Suffolk County		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(800)499-9554		(800)499-9554		(855)768-1049		(855)768-1049		(833)343-4763		(833)343-4763		(855)499-1094		(855)499-1094		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8432	015	0	1	02	01	H8432_015_0	8	1					0	07/19/2021	2022.01	07/19/2021 03:05:47 PM Eastern Daylight Time	08/03/2021 06:04:01 PM Eastern Daylight Time	08/03/2021 06:04:01 PM Eastern Daylight Time			08/04/2021 02:06:25 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	2022	Kings County		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(800)499-9554		(800)499-9554		(855)768-1052		(855)768-1052		(833)343-4763		(833)343-4763		(855)499-1095		(855)499-1095		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8432	016	0	1	01	01	H8432_016_0	6	1					0	06/04/2021	2022.01	06/04/2021 09:57:27 AM Eastern Daylight Time	08/03/2021 06:04:01 PM Eastern Daylight Time	08/03/2021 06:04:01 PM Eastern Daylight Time			08/04/2021 02:06:25 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	2022	Select Counties in New York		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(800)499-9554		(800)499-9554		(855)768-1049		(855)768-1049		(833)343-4763		(833)343-4763		(855)499-1094		(855)499-1094		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8432	027	0	1	01	01	H8432_027_0	6	1					0	06/04/2021	2022.01	06/04/2021 09:57:42 AM Eastern Daylight Time	08/03/2021 06:04:01 PM Eastern Daylight Time	08/03/2021 06:04:01 PM Eastern Daylight Time			08/04/2021 02:06:25 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	2022	Select Counties in New York City		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(800)499-9554		(800)499-9554		(855)768-1049		(855)768-1049		(833)343-4763		(833)343-4763		(855)499-1094		(855)499-1094		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8432	028	0	1	01	01	H8432_028_0	6	1	2	1			0	06/02/2021	2022.01	06/02/2021 05:04:05 PM Eastern Daylight Time	08/03/2021 06:04:05 PM Eastern Daylight Time	08/03/2021 06:04:05 PM Eastern Daylight Time			08/04/2021 02:27:41 PM Eastern Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	www.empireblue.com/shop	Empire MediBlue Dual Advantage Select (HMO D-SNP)	01	01		1			H8432	028	0	2022	Select Counties in New York		2		2			1	3		1		1	https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(844)469-1762		(844)469-1762		(855)768-1047		(855)768-1047		(833)370-7465		(833)370-7465		(855)499-1093		(855)499-1093		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8432	032	0	1	01	01	H8432_032_0	6	1					0	06/04/2021	2022.01	06/04/2021 09:57:56 AM Eastern Daylight Time	08/03/2021 06:04:01 PM Eastern Daylight Time	08/03/2021 06:04:01 PM Eastern Daylight Time			08/04/2021 02:06:25 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	2022	Nassau County		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(800)499-9554		(800)499-9554		(855)768-1049		(855)768-1049		(833)343-4763		(833)343-4763		(855)499-1094		(855)499-1094		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8432	033	0	1	01	01	H8432_033_0	6	1					0	06/04/2021	2022.01	06/04/2021 09:58:09 AM Eastern Daylight Time	08/03/2021 06:04:01 PM Eastern Daylight Time	08/03/2021 06:04:01 PM Eastern Daylight Time			08/04/2021 02:06:25 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	2022	Suffolk County		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(800)499-9554		(800)499-9554		(855)768-1049		(855)768-1049		(833)343-4763		(833)343-4763		(855)499-1094		(855)499-1094		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8432	034	0	1	01	01	H8432_034_0	6	1	2	1			0	07/18/2021	2022.01	07/18/2021 01:08:31 PM Eastern Daylight Time	08/03/2021 06:04:05 PM Eastern Daylight Time	08/03/2021 06:04:05 PM Eastern Daylight Time			08/04/2021 02:27:41 PM Eastern Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	shop.anthem.com/medicare	Empire MediBlue Dual Advantage Select (HMO D-SNP)	01	01		1			H8432	034	0	2022	Suffolk County		2		2			1	3		1		1	https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(877)269-5706		(877)269-5706		(855)768-1047		(855)768-1047		(833)344-1010		(833)344-1010		(855)499-1093		(855)499-1093		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8432	035	0	1	01	01	H8432_035_0	6	1					0	07/18/2021	2022.01	07/18/2021 12:50:31 PM Eastern Daylight Time	08/03/2021 06:04:01 PM Eastern Daylight Time	08/03/2021 06:04:01 PM Eastern Daylight Time			08/04/2021 02:06:25 PM Eastern Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	shop.anthem.com/medicare	Empire MediBlue Extra Select (HMO)	01	01		1			H8432	035	0	2022	Select Counties in New York		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(800)499-9554		(800)499-9554		(855)768-1049		(855)768-1049		(833)343-4763		(833)343-4763		(855)499-1094		(855)499-1094		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8432	036	0	1	01	01	H8432_036_0	5	1				0	0	06/04/2021	2022.01	06/04/2021 09:58:39 AM Eastern Daylight Time	07/16/2021 06:58:53 PM Eastern Daylight Time				07/19/2021 03:23:37 PM Eastern Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	shop.anthem.com/medicare	Empire MediBlue Service Select (HMO)	01	01		1			H8432	036	0	2022	Select Counties in New York		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(800)499-9554		(800)499-9554		(855)768-1049		(855)768-1049										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H8432	037	1	1	01	01	H8432_037_1	7	1				0	0	06/04/2021	2022.01	06/04/2021 09:58:54 AM Eastern Daylight Time	07/16/2021 06:58:53 PM Eastern Daylight Time				07/19/2021 03:23:37 PM Eastern Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	shop.anthem.com/medicare	Empire MediBlue Service (HMO)	01	01		1			H8432	037	1	2022	Select Plans in New York	Select Counties in New York	2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(800)499-9554		(800)499-9554		(855)768-1049		(855)768-1049										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H8432	037	2	1	01	01	H8432_037_2	5	1				0	0	06/04/2021	2022.01	06/04/2021 09:59:08 AM Eastern Daylight Time	07/16/2021 06:58:53 PM Eastern Daylight Time				07/19/2021 03:23:37 PM Eastern Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	shop.anthem.com/medicare	Empire MediBlue Service (HMO)	01	01		1			H8432	037	2	2022	Select Plans in New York	Saratoga County	2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(800)499-9554		(800)499-9554		(855)768-1049		(855)768-1049										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H8432	038	1	1	01	01	H8432_038_1	7	1					0	07/18/2021	2022.01	07/18/2021 01:04:06 PM Eastern Daylight Time	08/03/2021 06:04:01 PM Eastern Daylight Time	08/03/2021 06:04:01 PM Eastern Daylight Time			08/04/2021 02:06:25 PM Eastern Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	shop.anthem.com/medicare	Empire MediBlue Plus (HMO)	01	01		1			H8432	038	1	2022	Select Counties in New York	Columbia, Delaware and Greene	2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(800)499-9554		(800)499-9554		(855)768-1049		(855)768-1049		(833)343-4763		(833)343-4763		(855)499-1094		(855)499-1094		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8432	038	2	1	01	01	H8432_038_2	6	1					0	07/18/2021	2022.01	07/18/2021 01:04:21 PM Eastern Daylight Time	08/03/2021 06:04:01 PM Eastern Daylight Time	08/03/2021 06:04:01 PM Eastern Daylight Time			08/04/2021 02:06:25 PM Eastern Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	shop.anthem.com/medicare	Empire MediBlue Plus (HMO)	01	01		1			H8432	038	2	2022	Select Counties in New York	Select Counties in New York	2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(800)499-9554		(800)499-9554		(855)768-1049		(855)768-1049		(833)343-4763		(833)343-4763		(855)499-1094		(855)499-1094		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8432	039	1	1	01	01	H8432_039_1	6	1	2	1			0	06/02/2021	2022.01	06/02/2021 05:04:43 PM Eastern Daylight Time	08/03/2021 06:04:05 PM Eastern Daylight Time	08/03/2021 06:04:05 PM Eastern Daylight Time			08/04/2021 02:27:41 PM Eastern Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	shop.anthem.com/medicare	Empire MediBlue Dual Advantage (HMO D-SNP)	01	01		1			H8432	039	1	2022	Select Counties in New York	Columbia, Delaware, Greene	2		2			1	3		1		1	https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(877)269-5706		(877)269-5706		(855)768-1047		(855)768-1047		(833)344-1010		(833)344-1010		(855)499-1093		(855)499-1093		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8432	039	2	1	01	01	H8432_039_2	7	1	2	1			0	06/02/2021	2022.01	06/02/2021 05:04:55 PM Eastern Daylight Time	08/03/2021 06:04:05 PM Eastern Daylight Time	08/03/2021 06:04:05 PM Eastern Daylight Time			08/04/2021 02:27:41 PM Eastern Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	shop.anthem.com/medicare	Empire MediBlue Dual Advantage (HMO D-SNP)	01	01		1			H8432	039	2	2022	Select Counties in New York	Upstate Counties in New York	2		2			1	3		1		1	https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(877)269-5706		(877)269-5706		(855)768-1047		(855)768-1047		(833)344-1010		(833)344-1010		(855)499-1093		(855)499-1093		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8432	801	0	1	01	01	H8432_801_0	1	1						06/02/2021	2022.01	06/02/2021 03:58:52 PM Pacific Daylight Time					06/04/2021 10:42:11 AM Pacific Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	www.anthem.com/me/medicare	Anthem MediBlue (HMO)	01	01		1			H8432	801	0	2022	Select Counties in Maine		1	600	2			2						www.anthem.com/me/medicare	www.anthem.com/me/medicare	www.anthem.com/me/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)285-4631		(833)285-4631		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1					1				
H8432	802	0	1	01	01	H8432_802_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 03:59:02 PM Pacific Daylight Time					06/04/2021 10:42:11 AM Pacific Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	www.anthem.com/me/medicare	Anthem MediBlue (HMO)	01	01		1			H8432	802	0	2022	Select Counties in Maine		1	600	2			2						www.anthem.com/me/medicare	www.anthem.com/me/medicare	www.anthem.com/me/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1					1				
H8432	803	0	2	01	01	H8432_803_0	1	1						06/02/2021	2022.01	06/02/2021 03:59:10 PM Pacific Daylight Time					06/04/2021 10:42:11 AM 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	2022	Maine - Select Counties		1	600	2			2						www.anthem.com/me/medicare	www.anthem.com/me/medicare	www.anthem.com/me/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)285-4631		(833)285-4631		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1					1				
H8432	804	0	1	01	01	H8432_804_0	1	1						06/02/2021	2022.01	06/02/2021 04:00:30 PM Pacific Daylight Time					06/04/2021 10:42:11 AM Pacific Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	www.empireblue.com/ny/medicare	Empire MediBlue (HMO)	01	01		1			H8432	804	0	2022	New York - Select Counties		1	600	2			2						www.empireblue.com/ny/medicare	www.empireblue.com/ny/medicare	www.empireblue.com/ny/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)285-4631		(833)285-4631		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1					1				
H8432	805	0	1	01	01	H8432_805_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 04:00:41 PM Pacific Daylight Time					06/04/2021 10:42:11 AM Pacific Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	www.empireblue.com/ny/medicare	Empire MediBlue (HMO)	01	01		1			H8432	805	0	2022	New York - Select Counties		1	600	2			2						www.empireblue.com/ny/medicare	www.empireblue.com/ny/medicare	www.empireblue.com/ny/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1					1				
H8432	806	0	2	01	01	H8432_806_0	1	1						06/02/2021	2022.01	06/02/2021 04:00:52 PM Pacific Daylight Time					06/04/2021 10:42:11 AM 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	2022	New York - Select Counties		1	600	2			2						www.empireblue.com/ny/medicare	www.empireblue.com/ny/medicare	www.empireblue.com/ny/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)285-4631		(833)285-4631		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1					1				
H8432	807	0	2	01	01	H8432_807_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 03:59:26 PM Pacific Daylight Time					06/04/2021 10:42:11 AM 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	2022	Select Maine Counties		1	600	2			2						www.anthem.com/me/medicare	www.anthem.com/me/medicare	www.anthem.com/me/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1					1				
H8432	809	0	1	01	01	H8432_809_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 03:59:44 PM Pacific Daylight Time					06/04/2021 10:42:11 AM Pacific Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	www.anthem.com/me/medicare	Anthem MediBlue (HMO)	01	01		1			H8432	809	0	2022	Select Maine Counties		1	600	2			2						www.anthem.com/me/medicare	www.anthem.com/me/medicare	www.anthem.com/me/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1					1				
H8432	811	0	2	01	01	H8432_811_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 04:01:04 PM Pacific Daylight Time					06/04/2021 10:42:11 AM 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	2022	Select New York Counties		1	600	2			2						www.empireblue.com/ny/medicare	www.empireblue.com/ny/medicare	www.empireblue.com/ny/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1					1				
H8432	813	0	1	01	01	H8432_813_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 04:01:25 PM Pacific Daylight Time					06/04/2021 10:42:11 AM Pacific Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	www.empireblue.com/ny/medicare	Empire MediBlue (HMO)	01	01		1			H8432	813	0	2022	Select New York Counties		1	600	2			2						www.empireblue.com/ny/medicare	www.empireblue.com/ny/medicare	www.empireblue.com/ny/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1					1				
H8432	815	0	2	01	01	H8432_815_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 03:59:57 PM Pacific Daylight Time					06/04/2021 10:42:11 AM 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	2022	Select Maine Counties		1	600	2			2						www.anthem.com/me/medicare	www.anthem.com/me/medicare	www.anthem.com/me/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1					1				
H8432	816	0	2	01	01	H8432_816_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 04:01:38 PM Pacific Daylight Time					06/04/2021 10:42:11 AM 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	2022	Select NY Counties		1	600	2			2						www.empireblue.com/ny/medicare	www.empireblue.com/ny/medicare	www.empireblue.com/ny/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1					1				
H8452	001	0	1	48	05	H8452_001_0	2	1						07/13/2021	2022.01	07/13/2021 11:32:34 AM Eastern Daylight Time					07/13/2021 03:40:27 PM Eastern Daylight Time	CARESOURCE	CareSource MyCare Ohio	www.caresource.com/MyCare/	CareSource MyCare Ohio (Medicare-Medicaid Plan)	05	48		1			H8452	001	0	2022	Northeast, Northeast Central, East Central Ohio		2	298000	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			0	07/02/2021	2022.01	07/02/2021 03:25:43 PM Central Daylight Time	06/03/2021 01:07:54 PM Central Daylight Time	06/03/2021 01:05:18 PM Central Daylight Time			07/02/2021 06:14:02 PM Central Daylight Time	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Longevity Health Plan	www.longevityhealthplan.com	Longevity Health Plan (HMO I-SNP)	01	01		1			H8457	001	0	2022	New York (partial)		2	2041	2			1	1	1				www.longevityhealthplan.com	www.longevityhealthplan.com	www.longevityhealthplan.com	(888)885-7337		(888)885-7337		(888)885-7337		(888)885-7337		(888)885-7337		(888)885-7337		(888)885-7337		(888)885-7337		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8458	001	0	1	04	01	H8458_001_0	4	1					0	08/03/2021	2022.01	08/03/2021 02:41:00 PM Central Daylight Time	08/04/2021 01:42:54 AM Eastern Daylight Time	07/30/2021 01:56:40 PM Eastern Daylight Time			08/04/2021 10:40:50 PM Eastern Daylight Time	SILVERSUMMIT HEALTH PLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellNV	Wellcare No Premium Open (PPO)	01	04		1			H8458	001	0	2022	Select counties in NV		2	741	2			2						www.wellcare.com/allwellNV	www.wellcare.com/allwellNV	www.wellcare.com/allwellNV	(833)854-4766		(833)854-4766		(866)277-6583		(866)277-6583		(833)854-4766		(833)854-4766		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8458	002	0	1	04	01	H8458_002_0	3	1				0	0	06/01/2021	2022.01	06/01/2021 02:19:20 PM Eastern Daylight Time	06/04/2021 03:09:28 PM Eastern Daylight Time				07/19/2021 06:53:05 PM Eastern Daylight Time	SILVERSUMMIT HEALTH PLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellNV	Wellcare Patriot Giveback Open (PPO)	01	04		1			H8458	002	0	2022	Select counties in NV		2	257	2			2						www.wellcare.com/allwellNV	www.wellcare.com/allwellNV	www.wellcare.com/allwellNV	(833)854-4766		(833)854-4766		(866)277-6583		(866)277-6583										(711)-		(711)-		(711)-		(711)-										2					2						2			
H8458	003	0	1	04	01	H8458_003_0	4	1					0	08/03/2021	2022.01	08/03/2021 02:43:50 PM Central Daylight Time	08/04/2021 01:43:50 AM Eastern Daylight Time	07/30/2021 01:57:00 PM Eastern Daylight Time			08/04/2021 10:40:50 PM Eastern Daylight Time	SILVERSUMMIT HEALTH PLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellNV	Wellcare No Premium Open (PPO)	01	04		1			H8458	003	0	2022	Select counties in NV		2	741	2			2						www.wellcare.com/allwellNV	www.wellcare.com/allwellNV	www.wellcare.com/allwellNV	(833)854-4766		(833)854-4766		(866)277-6583		(866)277-6583		(833)854-4766		(833)854-4766		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8492	001	0	1	01	01	H8492_001_0	6	1		1			0	08/20/2021	2022.01	08/20/2021 03:02:03 PM Central Daylight Time	08/20/2021 03:18:03 PM Central Daylight Time	08/20/2021 03:18:04 PM Central Daylight Time			08/20/2021 03:20:01 PM Central Daylight Time	DIGNITY CARE CORPORATION	Dignity Health Plan	www.dignityhealthplan.com	Dignity Health Plan (HMO I-SNP)	01	01		1			H8492	001	0	2022	Select Parishes in Louisiana		2	4410	2			1	1	1				www.dignityhealthplan.com	www.dignityhealthplan.com	www.dignityhealthplan.com	(866)266-6010		(225)964-8581		(866)266-6010		(225)964-8581		(833)661-1989		(225)964-8581		(833)661-1989		(225)964-8581		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8547	001	0	1	01	01	H8547_001_0	4	1					0	06/03/2021	2022.01	06/03/2021 12:01:49 PM Central Daylight Time	08/03/2021 10:45:22 AM Central Daylight Time	08/04/2021 05:09:44 PM Central Daylight Time			08/05/2021 05:27:00 PM Central Daylight Time	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Blue Cross and Blue Shield of Illinois	www.getblueil.com/mapd	Blue Medicare Advocate Health (HMO)	01	01		1			H8547	001	0	2022	Chicago Metro Area		2	10894	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			
H8552	020	0	1	04	01	H8552_020_0	6	1					0	07/12/2021	2022.01	07/12/2021 04:06:11 PM Pacific Daylight Time	08/03/2021 03:03:59 PM Pacific Daylight Time	08/03/2021 03:03:59 PM Pacific Daylight Time			08/04/2021 10:54:45 AM 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	2022	Orange County		2		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		(855)768-1053		(855)768-1053		(833)344-1012		(833)344-1012		(855)499-1096		(855)499-1096		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8552	028	0	1	04	01	H8552_028_0	10	1		1			0	07/16/2021	2022.01	07/16/2021 10:58:52 AM Pacific Daylight Time		08/03/2021 03:04:04 PM Pacific Daylight Time		08/03/2021 03:04:04 PM Pacific Daylight Time	08/04/2021 12:07:42 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 Care (PPO C-SNP)	01	04		1			H8552	028	0	2022	Select Counties in California		2		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		(855)768-1054		(855)768-1054		(833)344-1011		(833)344-1011		(855)499-1097		(855)499-1097		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8552	029	0	1	04	01	H8552_029_0	6	1					0	06/02/2021	2022.01	06/02/2021 06:23:20 PM Pacific Daylight Time	08/03/2021 03:03:59 PM Pacific Daylight Time	08/03/2021 03:03:59 PM Pacific Daylight Time			08/04/2021 10:54:45 AM 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	029	0	2022	Select Counties in Northern California		2		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		(855)768-1053		(855)768-1053		(833)344-1012		(833)344-1012		(855)499-1096		(855)499-1096		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8552	030	0	1	04	01	H8552_030_0	9	1	2	1			0	08/02/2021	2022.01	08/02/2021 10:42:36 AM Eastern Daylight Time	08/03/2021 06:03:58 PM Eastern Daylight Time	08/03/2021 06:03:58 PM Eastern Daylight Time			08/04/2021 03:50:55 PM Eastern 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 Dual Access (PPO D-SNP)	01	04		1			H8552	030	0	2022	Select Counties in California		2		2			1	3		2		2	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	www.anthem.com/ca/medicare	(844)209-5409		(844)209-5409		(855)768-1059		(855)768-1059		(833)344-1011		(833)344-1011		(855)499-1098		(855)499-1098		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8552	801	0	1	04	01	H8552_801_0	1	1						06/02/2021	2022.01	06/02/2021 04:21:47 PM Pacific Daylight Time					06/04/2021 09:25:53 AM Pacific Daylight Time	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Anthem Blue Cross Life and Health Insurance Co.	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H8552	801	0	2022	National		1	600	2			2						www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)360-3668		(833)360-3668		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1									
H8552	802	0	1	04	01	H8552_802_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 04:21:52 PM Pacific Daylight Time					06/04/2021 09:25:53 AM Pacific Daylight Time	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Anthem Blue Cross Life and Health Insurance Co.	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H8552	802	0	2022	National		1	600	2			2						www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1									
H8552	803	0	1	04	01	H8552_803_0	1	1						06/02/2021	2022.01	06/02/2021 04:21:58 PM Pacific Daylight Time					06/04/2021 09:25:53 AM Pacific Daylight Time	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Anthem Blue Cross Life and Health Insurance Co.	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H8552	803	0	2022	National		1	600	2			2						www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)360-3668		(833)360-3668		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1									
H8552	805	0	2	04	01	H8552_805_0	1	1						06/02/2021	2022.01	06/02/2021 04:22:05 PM Pacific Daylight Time					06/04/2021 09:25:53 AM Pacific Daylight Time	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Anthem Blue Cross Life and Health Insurance Co.	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		2	1		H8552	805	0	2022	National		1	600	2			2						www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)360-3668		(833)360-3668		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1									
H8552	806	0	1	04	01	H8552_806_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 04:22:11 PM Pacific Daylight Time					06/04/2021 09:25:53 AM Pacific Daylight Time	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Anthem Blue Cross Life and Health Insurance Co.	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H8552	806	0	2022	National		1	600	2			2						www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1									
H8552	807	0	2	04	01	H8552_807_0	1	1						06/02/2021	2022.01	06/02/2021 04:22:18 PM Pacific Daylight Time					06/04/2021 09:25:53 AM Pacific Daylight Time	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Anthem Blue Cross Life and Health Insurance Co.	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		2	1		H8552	807	0	2022	National		1	600	2			2						www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)360-3668		(833)360-3668		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1									
H8552	808	0	2	04	01	H8552_808_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 04:22:24 PM Pacific Daylight Time					06/04/2021 09:25:53 AM Pacific Daylight Time	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Anthem Blue Cross Life and Health Insurance Co.	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		2	1		H8552	808	0	2022	National		1	600	2			2						www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1									
H8552	809	0	2	04	01	H8552_809_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 04:22:31 PM Pacific Daylight Time					06/04/2021 09:25:53 AM Pacific Daylight Time	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Anthem Blue Cross Life and Health Insurance Co.	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		2	1		H8552	809	0	2022	National		1	600	2			2						www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1									
H8552	810	0	1	04	01	H8552_810_0	1	1						06/02/2021	2022.01	06/02/2021 04:22:37 PM Pacific Daylight Time					06/04/2021 09:25:53 AM Pacific Daylight Time	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Anthem Blue Cross Life and Health Insurance Co.	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H8552	810	0	2022	National		1	600	2			2						www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)360-3668		(833)360-3668		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1									
H8552	811	0	1	04	01	H8552_811_0	1	1						06/02/2021	2022.01	06/02/2021 04:22:45 PM Pacific Daylight Time					06/04/2021 09:25:53 AM Pacific Daylight Time	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Anthem Blue Cross Life and Health Insurance Co.	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H8552	811	0	2022	National		1	600	2			2						www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)360-3668		(833)360-3668		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1									
H8552	812	0	1	04	01	H8552_812_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 04:22:54 PM Pacific Daylight Time					06/04/2021 09:25:53 AM Pacific Daylight Time	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Anthem Blue Cross Life and Health Insurance Co.	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H8552	812	0	2022	National		1	600	2			2						www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1									
H8552	813	0	1	04	01	H8552_813_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 04:23:02 PM Pacific Daylight Time					06/04/2021 09:25:53 AM Pacific Daylight Time	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Anthem Blue Cross Life and Health Insurance Co.	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H8552	813	0	2022	National		1	600	2			2						www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1									
H8553	001	0	1	04	01	H8553_001_0	4	1					0	08/03/2021	2022.01	08/03/2021 02:14:29 PM Central Daylight Time	08/04/2021 01:44:22 AM Eastern Daylight Time	07/30/2021 01:57:22 PM Eastern Daylight Time			08/04/2021 10:40:50 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium Open (PPO)	01	04		1			H8553	001	0	2022	Select counties in AZ		2	9701	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8553	002	0	1	04	01	H8553_002_0	3	1				0	0	06/01/2021	2022.01	06/01/2021 01:46:46 PM Eastern Daylight Time	06/04/2021 03:12:05 PM Eastern Daylight Time				07/19/2021 06:53:05 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Patriot Giveback Open (PPO)	01	04		1			H8553	002	0	2022	Select counties in AZ		2	6210	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175										(711)-		(711)-		(711)-		(711)-										2					2						2			
H8553	003	0	1	04	01	H8553_003_0	4	1					0	08/03/2021	2022.01	08/03/2021 02:08:35 PM Central Daylight Time	08/04/2021 01:45:22 AM Eastern Daylight Time	07/30/2021 01:57:42 PM Eastern Daylight Time			08/04/2021 10:40:50 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium Rx Plus Open (PPO)	01	04		1			H8553	003	0	2022	Select counties in AZ		2	1065	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8554	001	0	1	01	01	H8554_001_0	3	1					0	06/03/2021	2022.01	06/03/2021 01:41:49 PM Central Daylight Time	08/03/2021 10:45:48 AM Central Daylight Time	08/04/2021 05:10:02 PM Central Daylight Time			08/05/2021 05:38:13 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	2022	San Antonio		2	9913	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					0	07/13/2021	2022.01	07/13/2021 04:54:29 PM Eastern Daylight Time	08/04/2021 03:30:42 PM Eastern Daylight Time	07/30/2021 11:00:38 AM Eastern Daylight Time			08/05/2021 03:35:56 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	2022	Hampden, Hampshire, Franklin, Berkshire Counties		2	31112	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)393-0395		(800)393-0395		(800)393-0395		(800)393-0395		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8578	003	0	1	01	01	H8578_003_0	5	1				0	0	07/13/2021	2022.01	07/13/2021 04:54:37 PM Eastern Daylight Time	07/19/2021 11:48:38 AM Eastern Daylight Time				07/19/2021 03:35:26 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	2022	Hampden, Hampshire, Franklin, Berkshire Counties		2	1868	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					0	07/13/2021	2022.01	07/13/2021 04:54:46 PM Eastern Daylight Time	08/04/2021 03:37:22 PM Eastern Daylight Time	07/30/2021 11:02:08 AM Eastern Daylight Time			08/05/2021 03:35:56 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	2022	Hampden, Hampshire, Franklin, Berkshire Counties		2	37555	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)393-0395		(800)393-0395		(800)393-0395		(800)393-0395		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8578	009	0	1	01	01	H8578_009_0	5	1				0	0	07/13/2021	2022.01	07/13/2021 04:54:55 PM Eastern Daylight Time	07/19/2021 11:48:39 AM Eastern Daylight Time				07/19/2021 03:35:26 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	2022	Hampden, Hampshire, Franklin, Berkshire Counties		2	2781	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					0	08/04/2021	2022.01	08/04/2021 01:44:26 PM Eastern Daylight Time	08/04/2021 03:44:30 PM Eastern Daylight Time	07/30/2021 11:07:02 AM Eastern Daylight Time			08/05/2021 03:35:56 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	2022	Hampden, Hampshire, Franklin, Berkshire Counties		2	39044	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)393-0395		(800)393-0395		(800)393-0395		(800)393-0395		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8578	017	0	1	01	01	H8578_017_0	7	1					0	07/13/2021	2022.01	07/13/2021 04:55:11 PM Eastern Daylight Time	08/04/2021 03:59:34 PM Eastern Daylight Time	07/30/2021 11:08:42 AM Eastern Daylight Time			08/05/2021 03:35:56 PM Eastern Daylight Time	HEALTH NEW ENGLAND, INC.	Health New England Medicare Advantage Plans	www.healthnewengland.org/medicare	Health New England Medicare Choice (HMO)	01	01		1			H8578	017	0	2022	Hampden, Hampshire, Franklin, Berkshire Counties		2	3829	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)393-0395		(800)393-0395		(800)393-0395		(800)393-0395		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8578	801	0	1	02	01	H8578_801_0	3	1						06/03/2021	2022.01	06/03/2021 10:10:00 AM Eastern Daylight Time					06/06/2021 09:12:17 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	2022	United States		1	5978	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)393-0395		(800)393-0395		(800)393-0395		(800)393-0395		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	2;5;6;7c;7i;8a;8b1;9a1;9a2;9b;10a;11a;11b;11c;14a;15;	2		1	1	2;5;6;7c;7i;8a;8b1;9a1;9a2;9b;10a;11a;11b;11c;14a;15;	2		1				
H8578	802	0	1	02	01	H8578_802_0	3	1				0	0	06/02/2021	2022.01	06/02/2021 02:49:06 PM Eastern Daylight Time					06/06/2021 09:12:17 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	2022	United States		1	61	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;14a;15;	2		1	1	2;5;6;7c;7i;8a;8b1;9a1;9a2;9b;10a;11a;11b;11c;14a;15;	2		1				
H8578	803	0	1	02	01	H8578_803_0	3	1						06/03/2021	2022.01	06/03/2021 10:08:12 AM Eastern Daylight Time					06/06/2021 09:12:17 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	2022	United States		1	61	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)393-0395		(800)393-0395		(800)393-0395		(800)393-0395		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	2;6;7c;7i;8a;8b1;9a1;9a2;9b;10a;11a;11b;11c;14a;15;	2		1	1	2;6;7c;7i;8a;8b1;9a1;9a2;9b;10a;11a;11b;11c;14a;15;	2		1				
H8597	001	0	1	01	01	H8597_001_0	3	1	2	1	1		0	07/08/2021	2022.01	07/08/2021 11:12:57 AM Eastern Daylight Time	08/02/2021 02:45:18 PM Eastern Daylight Time	08/02/2021 09:57:53 AM Eastern Daylight Time			08/04/2021 02:44:24 PM Eastern Daylight Time	AETNA BETTER HEALTH OF TEXAS INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Dual Complete Plan (HMO D-SNP)	01	01		1			H8597	001	0	2022	Select Texas counties		2		2			1	3		1		1	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8597	002	0	1	01	01	H8597_002_0	3	1	2	1	1		0	07/08/2021	2022.01	07/08/2021 11:12:07 AM Eastern Daylight Time	08/02/2021 02:46:33 PM Eastern Daylight Time	08/02/2021 09:57:57 AM Eastern Daylight Time			08/04/2021 02:44:24 PM Eastern Daylight Time	AETNA BETTER HEALTH OF TEXAS INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Dual Complete Plan (HMO D-SNP)	01	01		1			H8597	002	0	2022	Dallas and Surrounding counties		2		2			1	3		1		1	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8597	003	0	1	01	01	H8597_003_0	4	1	2	1	1		0	07/08/2021	2022.01	07/08/2021 11:19:33 AM Eastern Daylight Time	08/02/2021 02:47:53 PM Eastern Daylight Time	08/02/2021 09:58:02 AM Eastern Daylight Time			08/04/2021 02:44:24 PM Eastern Daylight Time	AETNA BETTER HEALTH OF TEXAS INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Dual Complete Plan (HMO D-SNP)	01	01		1			H8597	003	0	2022	Houston and Surrounding Counties		2		2			1	3		1		1	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(866)409-1221		(866)409-1221		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8604	010	0	1	04	01	H8604_010_0	7	1					0	08/04/2021	2022.01	08/04/2021 01:24:31 PM Eastern Daylight Time	08/05/2021 10:29:22 AM Eastern Daylight Time	07/30/2021 08:07:58 AM Eastern Daylight Time			08/05/2021 02:04:52 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	2022	East Central OH		2	2830	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	7	1					0	08/04/2021	2022.01	08/04/2021 01:25:05 PM Eastern Daylight Time	08/05/2021 10:30:28 AM Eastern Daylight Time	07/30/2021 08:08:30 AM Eastern Daylight Time			08/05/2021 02:04:52 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	2022	Southeastern OH, West Virginia		2	7597	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	7	1					0	08/04/2021	2022.01	08/04/2021 01:25:31 PM Eastern Daylight Time	08/05/2021 10:31:42 AM Eastern Daylight Time	07/30/2021 08:09:02 AM Eastern Daylight Time			08/05/2021 02:04:52 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	2022	Kanawha and Surrounding Counties		2	1324	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	5	1						06/04/2021	2022.01	06/04/2021 03:11:25 PM Eastern Daylight Time					06/04/2021 03:17:07 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	2022	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	3	1					0	07/15/2021	2022.01	07/15/2021 09:46:15 AM Mountain Daylight Time	08/03/2021 09:46:12 AM Mountain Daylight Time	08/04/2021 04:10:22 PM Mountain Daylight Time			08/05/2021 04:53:55 PM Mountain Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM	www.getbluenm.com/mapd	Blue Cross Medicare Advantage Choice Plus (PPO)	01	04		1			H8634	002	0	2022	Bernalillo, Sandoval, Torrance and Valencia cntys		2	6745	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	3	1					0	07/16/2021	2022.01	07/16/2021 11:35:24 AM Central Daylight Time	08/03/2021 10:46:38 AM Central Daylight Time	08/04/2021 05:10:40 PM Central Daylight Time			08/05/2021 05:27:00 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM	www.getblueil.com/mapd	Blue Cross Medicare Advantage Choice Plus (PPO)	01	04		1			H8634	003	0	2022	Chicago Metro Area		2	66297	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	4	1					0	06/03/2021	2022.01	06/03/2021 12:02:33 PM Central Daylight Time	08/03/2021 10:47:04 AM Central Daylight Time	08/04/2021 05:11:00 PM Central Daylight Time			08/05/2021 05:27:00 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM	www.getblueil.com/mapd	Blue Cross Medicare Advantage Choice Premier (PPO)	01	04		1			H8634	004	0	2022	Chicago Metro Area		2	34934	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	007	0	1	04	01	H8634_007_0	4	1					0	06/03/2021	2022.01	06/03/2021 12:02:52 PM Central Daylight Time	08/03/2021 10:47:30 AM Central Daylight Time	08/04/2021 05:11:18 PM Central Daylight Time			08/05/2021 05:27:00 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM	www.getblueil.com/mapd	Blue Cross Medicare Advantage Choice Plus (PPO)	01	04		1			H8634	007	0	2022	Springfield and Central Illinois		2	2005	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	008	0	1	04	01	H8634_008_0	3	1					0	06/03/2021	2022.01	06/03/2021 12:03:12 PM Central Daylight Time	08/03/2021 10:47:54 AM Central Daylight Time	08/04/2021 05:11:36 PM Central Daylight Time			08/05/2021 05:27:00 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM	www.getblueil.com/mapd	Blue Cross Medicare Advantage Classic (PPO)	01	04		1			H8634	008	0	2022	Chicago Metro Area		2	27959	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	009	0	1	04	01	H8634_009_0	12	1	2	1			0	07/16/2021	2022.01	07/16/2021 09:08:55 AM Mountain Daylight Time	07/01/2021 08:17:17 AM Mountain Daylight Time	06/05/2021 03:23:06 PM Mountain Daylight Time			07/16/2021 09:24:10 AM Mountain Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM	www.hcsc.com	Blue Cross MA Dual Care Plus Preferred (PPO D-SNP)	01	04		1			H8634	009	0	2022	Bernalillo Counties		2	4380	2			1	3		2		2	www.myprime.com	www.myprime.com	www.hcsc.com	(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			
H8634	010	0	1	04	01	H8634_010_0	3	1					0	07/16/2021	2022.01	07/16/2021 10:32:20 AM Mountain Daylight Time	08/03/2021 09:48:44 AM Mountain Daylight Time	08/04/2021 04:12:14 PM Mountain Daylight Time			08/05/2021 04:53:55 PM Mountain Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM	www.hcsc.com	Blue Cross Medicare Advantage Classic (PPO)	01	04		1			H8634	010	0	2022	Bernalillo Counties		2	10310	2			2						www.myprime.com	www.myprime.com	www.hcsc.com	(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	011	0	1	04	01	H8634_011_0	3	1					0	06/03/2021	2022.01	06/03/2021 12:03:33 PM Central Daylight Time	08/03/2021 10:49:10 AM Central Daylight Time	08/04/2021 05:12:32 PM Central Daylight Time			08/05/2021 05:27:00 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM	www.getblueil.com/mapd	Blue Cross Medicare Advantage Classic (PPO)	01	04		1			H8634	011	0	2022	Macoupin, Madison, Monroe, & St. Clair Counties		2	2704	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	012	0	1	04	01	H8634_012_0	3	1					0	06/03/2021	2022.01	06/03/2021 12:03:55 PM Central Daylight Time	08/03/2021 10:49:34 AM Central Daylight Time	08/04/2021 05:12:50 PM Central Daylight Time			08/05/2021 05:27:00 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM	www.getblueil.com/mapd	Blue Cross Medicare Advantage Classic (PPO)	01	04		1			H8634	012	0	2022	Rockford Metro Market		2	6852	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	013	0	1	04	01	H8634_013_0	3	1					0	06/03/2021	2022.01	06/03/2021 12:04:19 PM Central Daylight Time	08/03/2021 10:50:00 AM Central Daylight Time	08/04/2021 05:13:08 PM Central Daylight Time			08/05/2021 05:27:00 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM	www.getblueil.com/mapd	Blue Cross Medicare Advantage Classic (PPO)	01	04		1			H8634	013	0	2022	Peoria, Tazewell, McLean, & Williamson Counties		2	1695	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	014	0	1	04	01	H8634_014_0	4	1					0	06/03/2021	2022.01	06/03/2021 12:04:42 PM Central Daylight Time	08/03/2021 10:50:26 AM Central Daylight Time	08/04/2021 05:13:28 PM Central Daylight Time			08/05/2021 05:27:00 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM	www.getblueil.com/mapd	Blue Cross Medicare Advantage Flex (PPO)	01	04		1			H8634	014	0	2022	Chicago, Rockford, Springfield, St. Louis Metros		2	18749	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	015	0	1	04	01	H8634_015_0	6	1					0	08/05/2021	2022.01	08/05/2021 09:52:55 AM Mountain Daylight Time	08/03/2021 09:50:52 AM Mountain Daylight Time	08/04/2021 04:13:46 PM Mountain Daylight Time			08/05/2021 05:17:50 PM Mountain Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM	www.hcsc.com	Blue Cross Medicare Advantage Flex (PPO)	01	04		1			H8634	015	0	2022	Bernalillo Counties		2	370	2			2						www.myprime.com	www.myprime.com	www.hcsc.com	(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	016	0	1	04	01	H8634_016_0	3	1					0	06/03/2021	2022.01	06/03/2021 12:05:06 PM Central Daylight Time	08/03/2021 10:51:16 AM Central Daylight Time	08/04/2021 05:14:04 PM Central Daylight Time			08/05/2021 05:27:00 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM	www.getblueil.com/mapd	Blue Cross Medicare Advantage Elite (PPO)	01	04		1			H8634	016	0	2022	DuPage & Will Counties		2	4456	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	1	1						05/26/2021	2022.01	05/26/2021 09:46:42 AM Central Daylight Time					05/28/2021 11:36:07 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM	www.mybluemedicarenm.com	Blue Cross Group Medicare Advantage Plan (PPO)	01	04		1			H8634	801	0	2022	Nationwide		1	1051	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)-		2					2						2			
H8634	803	0	1	04	01	H8634_803_0	1	1						05/26/2021	2022.01	05/26/2021 09:46:57 AM Central Daylight Time					05/28/2021 11:36:07 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM	www.mybluemedicarenm.com	Blue Cross Group Medicare Advantage Plan (PPO)	01	04		1			H8634	803	0	2022	Nationwide		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)-		2					2						2			
H8634	805	0	1	04	01	H8634_805_0	1	1				0	0	05/26/2021	2022.01	05/26/2021 09:47:04 AM Central Daylight Time					05/28/2021 11:36:07 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM	www.mybluemedicarenm.com	Blue Cross Group Medicare Advantage Plan (PPO)	01	04		1			H8634	805	0	2022	Nationwide		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)-										2					2						2			
H8634	807	0	1	04	01	H8634_807_0	2	1						05/25/2021	2022.01	05/25/2021 01:56:17 PM Central Daylight Time					06/03/2021 05:04:16 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM	www.mybluemedicareok.com	Blue Cross Group Medicare Advantage Plan (PPO)	01	04		1			H8634	807	0	2022	State of Oklahoma		1	2261	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)-		2					2						2			
H8634	809	0	1	04	01	H8634_809_0	2	1						05/25/2021	2022.01	05/25/2021 01:56:29 PM Central Daylight Time					06/03/2021 05:04:16 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM	www.mybluemedicareok.com	Blue Cross Group Medicare Advantage Plan (PPO)	01	04		1			H8634	809	0	2022	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)-		2					2						2			
H8634	811	0	1	04	01	H8634_811_0	2	1				0	0	05/25/2021	2022.01	05/25/2021 01:56:49 PM Central Daylight Time					06/03/2021 05:04:16 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM	www.mybluemedicareok.com	Blue Cross Group Medicare Advantage Plan (PPO)	01	04		1			H8634	811	0	2022	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)-										2					2						2			
H8634	813	0	1	04	01	H8634_813_0	1	1						05/26/2021	2022.01	05/26/2021 09:47:24 AM Central Daylight Time					05/28/2021 11:36:07 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM	www.hcsc.com	Blue Cross Group Medicare Advantage Plan (PPO)	01	04		1			H8634	813	0	2022	Nationwide		1	35085	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)-		2					2						2			
H8634	815	0	1	04	01	H8634_815_0	1	1						05/26/2021	2022.01	05/26/2021 09:47:55 AM Central Daylight Time					05/28/2021 11:36:07 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM	www.hcsc.com	Blue Cross Group Medicare Advantage Plan (PPO)	01	04		1			H8634	815	0	2022	Nationwide		1	54718	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)-		2					2						2			
H8634	817	0	1	04	01	H8634_817_0	1	1				0	0	05/26/2021	2022.01	05/26/2021 09:48:13 AM Central Daylight Time					05/28/2021 11:36:07 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM	www.hcsc.com	Blue Cross Group Medicare Advantage Plan (PPO)	01	04		1			H8634	817	0	2022	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)-										2					2						2			
H8649	003	0	1	02	01	H8649_003_0	2	1					0	08/02/2021	2022.01	08/02/2021 05:28:53 PM Eastern Daylight Time	08/02/2021 03:26:48 PM Eastern Daylight Time	08/02/2021 09:58:06 AM Eastern Daylight Time			08/04/2021 01:48:44 PM Eastern Daylight Time	AETNA HEALTH OF UTAH INC	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra (HMO-POS)	01	02		1			H8649	003	0	2022	Northern Utah		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8649	008	0	1	02	01	H8649_008_0	3	1					0	08/02/2021	2022.01	08/02/2021 05:29:21 PM Eastern Daylight Time	08/02/2021 03:27:35 PM Eastern Daylight Time	08/02/2021 09:58:10 AM Eastern Daylight Time			08/04/2021 01:48:44 PM Eastern Daylight Time	AETNA HEALTH OF UTAH INC	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Select (HMO-POS)	01	02		1			H8649	008	0	2022	Northeastern Utah		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8649	801	0	1	01	01	H8649_801_0	1	1						05/28/2021	2022.01	05/28/2021 02:11:46 PM Eastern Daylight Time					06/03/2021 02:01:28 PM Eastern Daylight Time	AETNA HEALTH OF UTAH INC	Aetna Medicare	www.aetnamedicare.com	Aetna Altius Medicare Plan w/Rx (HMO)	01	01		1			H8649	801	0	2022	Utah		1	120	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H8649	803	0	1	01	01	H8649_803_0	1	1				0	0	05/28/2021	2022.01	05/28/2021 02:18:19 PM Eastern Daylight Time					06/03/2021 02:01:28 PM Eastern Daylight Time	AETNA HEALTH OF UTAH INC	Aetna Medicare	www.aetnamedicare.com	Aetna Altius Medicare Plan (HMO)	01	01		1			H8649	803	0	2022	Utah		1	120	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H8655	004	0	1	20	08	H8655_004_0	1	1						05/27/2021	2022.01	05/27/2021 09:19:35 AM Mountain Daylight Time		05/27/2021 08:41:41 AM Mountain Daylight Time			05/27/2021 09:22:18 AM Mountain Daylight Time	INNOVAGE VIRGINIA PACE II, LLC	InnovAge Virginia PACE - Richmond and Peninsula	www.MyInnovAge.com	InnovAge Virginia PACE II, LLC (PACE)	08	20		1			H8655	004	0	2022	InnovAge Virginia- Richmond and Peninsula		2		2			2						https://www.granerx.com/	N/A - no formulary										(844)704-9613	711	(844)704-9613		(844)704-9613		(844)704-9613										(844)704-9613	711	(844)704-9613	711	(844)704-9613		(844)704-9613																
H8655	005	0	1	20	08	H8655_005_0	1	1						05/27/2021	2022.01	05/27/2021 09:19:46 AM Mountain Daylight Time		05/27/2021 08:41:41 AM Mountain Daylight Time			05/27/2021 09:22:18 AM Mountain Daylight Time	INNOVAGE VIRGINIA PACE II, LLC	InnovAge Virginia PACE - Richmond and Peninsula	www.MyInnovAge.com	InnovAge Virginia PACE II, LLC Medicare ONLY (PACE)	08	20		1			H8655	005	0	2022	InnovAge Virginia-Richmond and Peninsula		2		2			2						https://www.granerx.com/	N/A - no formulary										(844)704-9613	711	(844)704-9613		(844)704-9613		(844)704-9613										(844)704-9613	711	(844)704-9613	711	(844)704-9613		(844)704-9613																
H8677	001	0	1	48	05	H8677_001_0	3	1						07/02/2021	2022.01	07/02/2021 10:35:59 AM Pacific Daylight Time					07/02/2021 10:20:54 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	2022	Counties: San Diego, parts of Riv. & S. Bernardino		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	3	1						07/02/2021	2022.01	07/02/2021 10:34:16 AM Pacific Daylight Time					07/02/2021 10:20:54 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	2022	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)-																
H8711	001	0	1	04	01	H8711_001_0	6	1					0	08/03/2021	2022.01	08/03/2021 02:26:33 PM Eastern Daylight Time	08/04/2021 01:45:48 AM Eastern Daylight Time	07/30/2021 01:58:02 PM Eastern Daylight Time			08/04/2021 10:12:55 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Wellcare	www.wellcare.com/medicare	Wellcare No Premium Open (PPO)	01	04		1			H8711	001	0	2022	Select counties in NJ		2	68000	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8711	002	0	1	04	01	H8711_002_0	6	1					0	08/03/2021	2022.01	08/03/2021 03:12:16 PM Eastern Daylight Time	08/04/2021 01:46:17 AM Eastern Daylight Time	07/30/2021 01:58:22 PM Eastern Daylight Time			08/04/2021 10:12:55 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Wellcare	www.wellcare.com/medicare	Wellcare Giveback Open (PPO)	01	04		1			H8711	002	0	2022	Select counties in NJ		2	64728	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8748	002	0	1	02	01	H8748_002_0	3	1					1	08/04/2021	2022.01	08/04/2021 11:10:42 AM Central Daylight Time	08/03/2021 07:48:54 PM Central Daylight Time	07/29/2021 09:20:37 PM Central Daylight Time			08/04/2021 04:59:49 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO-POS)	01	02		1			H8748	002	0	2022	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		(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					1	08/04/2021	2022.01	08/04/2021 10:02:15 AM Central Daylight Time	08/03/2021 01:30:51 PM Central Daylight Time	07/29/2021 09:20:52 PM Central Daylight Time			08/04/2021 02:05:05 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plus Plan 1 (HMO-POS)	01	02		1			H8748	008	0	2022	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			
H8748	009	0	1	02	01	H8748_009_0	3	1					1	08/04/2021	2022.01	08/04/2021 10:00:46 AM Central Daylight Time	08/03/2021 01:31:27 PM Central Daylight Time	07/29/2021 09:21:08 PM Central Daylight Time			08/04/2021 02:05:05 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plus Plan 2 (HMO-POS)	01	02		1			H8748	009	0	2022	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			
H8748	019	0	1	02	01	H8748_019_0	2	1				0	0	07/15/2021	2022.01	07/15/2021 03:58:11 PM Central Daylight Time	06/03/2021 04:01:22 PM Central Daylight Time				07/16/2021 01:56:35 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (HMO-POS)	01	02		1			H8748	019	0	2022	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	025	0	1	02	01	H8748_025_0	3	1					1	08/04/2021	2022.01	08/04/2021 11:15:08 AM Central Daylight Time	08/03/2021 07:49:26 PM Central Daylight Time	07/29/2021 09:21:25 PM Central Daylight Time			08/04/2021 04:59:49 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO-POS)	01	02		1			H8748	025	0	2022	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		(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	7	1					0	07/12/2021	2022.01	07/12/2021 02:11:44 PM Pacific Daylight Time	08/04/2021 05:55:21 PM Pacific Daylight Time	08/04/2021 05:56:43 PM Pacific Daylight Time			08/04/2021 06:12:00 PM Pacific Daylight Time	ASPIRE HEALTH PLAN	Aspire Health	www.aspirehealthplan.org	Aspire Health Advantage (HMO)	01	01		1			H8764	001	0	2022	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		(888)495-3160		(888)495-3160		(888)839-3991		(831)375-1462		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8764	002	0	1	02	01	H8764_002_0	7	1					0	07/12/2021	2022.01	07/12/2021 10:14:17 PM Pacific Daylight Time	08/04/2021 05:58:14 PM Pacific Daylight Time	08/04/2021 05:59:46 PM Pacific Daylight Time			08/04/2021 06:12:00 PM Pacific Daylight Time	ASPIRE HEALTH PLAN	Aspire Health	www.aspirehealthplan.org	Aspire Health Plus (HMO-POS)	01	02		1			H8764	002	0	2022	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		(888)495-3160		(888)495-3160		(888)839-3991		(831)375-1462		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8764	003	0	1	01	01	H8764_003_0	7	1					0	07/12/2021	2022.01	07/12/2021 10:18:28 PM Pacific Daylight Time	08/04/2021 06:02:19 PM Pacific Daylight Time	08/04/2021 06:03:44 PM Pacific Daylight Time			08/04/2021 06:12:00 PM Pacific Daylight Time	ASPIRE HEALTH PLAN	Aspire Health	www.aspirehealthplan.org	Aspire Health Value (HMO)	01	01		1			H8764	003	0	2022	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		(888)495-3160		(888)495-3160		(888)839-3991		(831)375-1462		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8764	801	0	1	02	01	H8764_801_0	3	1						06/04/2021	2022.01	06/04/2021 05:33:47 PM Pacific Daylight Time					06/07/2021 04:31:05 PM Pacific Daylight Time	ASPIRE HEALTH PLAN	Aspire Health	www.aspirehealthplan.org	Aspire Health Group Plus (HMO-POS)	01	02		1			H8764	801	0	2022	Monterey County		1	3180	2			2						www.aspirehealthplan.org	www.aspirehealthplan.org	www.aspirehealthplan.org	(855)570-1600		(831)574-4938		(888)839-3991		(831)375-1462		(888)495-3160		(888)495-3160		(888)839-3991		(831)375-1462		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8768	003	0	1	04	01	H8768_003_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 11:04:16 AM Central Daylight Time	08/03/2021 01:11:42 PM Central Daylight Time	07/29/2021 09:21:41 PM Central Daylight Time			08/04/2021 04:48:24 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE CO. OF THE RIVER VALLEY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H8768	003	0	2022	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	005	0	1	04	01	H8768_005_0	4	1			1		1	08/04/2021	2022.01	08/04/2021 11:06:11 AM Central Daylight Time	08/03/2021 01:12:14 PM Central Daylight Time	07/29/2021 09:21:57 PM Central Daylight Time			08/04/2021 04:48:24 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE CO. OF THE RIVER VALLEY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H8768	005	0	2022	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			
H8768	006	0	1	04	01	H8768_006_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 11:08:00 AM Central Daylight Time	08/03/2021 01:12:47 PM Central Daylight Time	07/29/2021 09:22:13 PM Central Daylight Time			08/04/2021 04:48:24 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE CO. OF THE RIVER VALLEY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H8768	006	0	2022	Toledo 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			
H8768	007	0	1	04	01	H8768_007_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 11:11:28 AM Central Daylight Time	08/03/2021 01:13:19 PM Central Daylight Time	07/29/2021 09:22:29 PM Central Daylight Time			08/04/2021 04:48:24 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE CO. OF THE RIVER VALLEY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H8768	007	0	2022	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	5	1			1		1	08/04/2021	2022.01	08/04/2021 11:22:17 AM Central Daylight Time	08/03/2021 01:13:52 PM Central Daylight Time	07/29/2021 09:22:45 PM Central Daylight Time			08/05/2021 01:29:51 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE CO. OF THE RIVER VALLEY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 1 (PPO)	01	04		1			H8768	008	0	2022	Oklahoma 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			
H8768	009	0	1	04	01	H8768_009_0	5	1			1		1	08/04/2021	2022.01	08/04/2021 11:23:44 AM Central Daylight Time	08/03/2021 01:14:25 PM Central Daylight Time	07/29/2021 09:23:01 PM Central Daylight Time			08/05/2021 01:29:51 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE CO. OF THE RIVER VALLEY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H8768	009	0	2022	Tulsa 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			
H8768	010	0	1	04	01	H8768_010_0	4	1			1		1	08/04/2021	2022.01	08/04/2021 11:13:50 AM Central Daylight Time	08/03/2021 01:14:58 PM Central Daylight Time	07/29/2021 09:23:17 PM Central Daylight Time			08/04/2021 04:48:24 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE CO. OF THE RIVER VALLEY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Walgreens (PPO)	01	04		1			H8768	010	0	2022	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			
H8768	011	0	1	04	01	H8768_011_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 11:15:51 AM Central Daylight Time	08/03/2021 01:15:32 PM Central Daylight Time	07/29/2021 09:23:33 PM Central Daylight Time			08/04/2021 04:48:24 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE CO. OF THE RIVER VALLEY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Walgreens (PPO)	01	04		1			H8768	011	0	2022	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	013	0	1	04	01	H8768_013_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 11:18:46 AM Central Daylight Time	08/03/2021 01:16:05 PM Central Daylight Time	07/29/2021 09:23:49 PM Central Daylight Time			08/04/2021 04:48:24 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE CO. OF THE RIVER VALLEY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H8768	013	0	2022	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			
H8768	014	0	1	04	01	H8768_014_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 11:20:52 AM Central Daylight Time	08/03/2021 01:16:38 PM Central Daylight Time	07/29/2021 09:24:05 PM Central Daylight Time			08/04/2021 04:48:24 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE CO. OF THE RIVER VALLEY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Walgreens (PPO)	01	04		1			H8768	014	0	2022	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			
H8768	015	0	1	04	01	H8768_015_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 11:31:28 AM Central Daylight Time	08/03/2021 01:17:12 PM Central Daylight Time	07/29/2021 09:24:21 PM Central Daylight Time			08/04/2021 04:48:24 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE CO. OF THE RIVER VALLEY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Walgreens (PPO)	01	04		1			H8768	015	0	2022	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			
H8768	016	0	1	04	01	H8768_016_0	5	1			1		1	08/04/2021	2022.01	08/04/2021 11:41:43 AM Central Daylight Time	08/03/2021 01:17:47 PM Central Daylight Time	07/29/2021 09:24:38 PM Central Daylight Time			08/05/2021 01:29:51 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE CO. OF THE RIVER VALLEY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 2 (PPO)	01	04		1			H8768	016	0	2022	Oklahoma 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			
H8768	017	1	1	04	01	H8768_017_1	3	1			2		1	08/04/2021	2022.01	08/04/2021 03:20:04 PM Central Daylight Time	08/03/2021 01:18:19 PM Central Daylight Time	07/29/2021 09:24:53 PM Central Daylight Time			08/05/2021 11:08:55 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE CO. OF THE RIVER VALLEY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 1 (PPO)	01	04		1			H8768	017	1	2022	Select Counties in IA	IA/IL Metros	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	017	2	1	04	01	H8768_017_2	3	1			2		1	08/04/2021	2022.01	08/04/2021 03:18:50 PM Central Daylight Time	08/03/2021 01:18:54 PM Central Daylight Time	07/29/2021 09:25:10 PM Central Daylight Time			08/05/2021 11:08:55 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE CO. OF THE RIVER VALLEY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 1 (PPO)	01	04		1			H8768	017	2	2022	Select Counties in IA	IA Rural	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	018	0	1	04	01	H8768_018_0	2	1			2	0	0	07/15/2021	2022.01	07/15/2021 04:21:27 PM Central Daylight Time	06/03/2021 03:13:36 PM Central Daylight Time				07/16/2021 10:38:48 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE CO. OF THE RIVER VALLEY	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP Medicare Advantage Patriot (PPO)	01	04		1			H8768	018	0	2022	Select Counties in IA		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757										(711)-		(711)-		(711)-		(711)-										2					2						2			
H8768	019	0	1	04	01	H8768_019_0	2	1			2	0	0	07/15/2021	2022.01	07/15/2021 10:10:04 AM Central Daylight Time	06/03/2021 03:14:06 PM Central Daylight Time				07/15/2021 04:00:03 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE CO. OF THE RIVER VALLEY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (PPO)	01	04		1			H8768	019	0	2022	Select Counties servicing 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										(711)-		(711)-		(711)-		(711)-										2					2						2			
H8768	020	0	1	04	01	H8768_020_0	2	1			2	0	0	07/15/2021	2022.01	07/15/2021 10:11:53 AM Central Daylight Time	06/03/2021 03:14:37 PM Central Daylight Time				07/15/2021 04:00:03 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE CO. OF THE RIVER VALLEY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (PPO)	01	04		1			H8768	020	0	2022	Select Counties servicing 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										(711)-		(711)-		(711)-		(711)-										2					2						2			
H8768	021	0	1	04	01	H8768_021_0	2	1			2	0	0	07/15/2021	2022.01	07/15/2021 10:13:50 AM Central Daylight Time	06/03/2021 03:15:08 PM Central Daylight Time				07/15/2021 04:00:03 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE CO. OF THE RIVER VALLEY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (PPO)	01	04		1			H8768	021	0	2022	Select Counties servicing Ohio & 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										(711)-		(711)-		(711)-		(711)-										2					2						2			
H8768	022	0	1	04	01	H8768_022_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 10:39:32 AM Central Daylight Time	08/03/2021 01:19:27 PM Central Daylight Time	07/29/2021 09:25:26 PM Central Daylight Time			08/05/2021 02:33:51 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE CO. OF THE RIVER VALLEY	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H8768	022	0	2022	State of New Jersey		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			
H8768	023	0	1	04	01	H8768_023_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 11:44:05 AM Central Daylight Time	08/03/2021 01:20:02 PM Central Daylight Time	07/29/2021 09:25:42 PM Central Daylight Time			08/05/2021 01:29:51 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE CO. OF THE RIVER VALLEY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 2 (PPO)	01	04		1			H8768	023	0	2022	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			
H8768	024	0	1	04	01	H8768_024_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 11:46:40 AM Central Daylight Time	08/03/2021 01:20:35 PM Central Daylight Time	07/29/2021 09:25:58 PM Central Daylight Time			08/05/2021 01:29:51 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE CO. OF THE RIVER VALLEY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 1 (PPO)	01	04		1			H8768	024	0	2022	Wichita 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			
H8768	025	0	1	04	01	H8768_025_0	2	1			2	0	0	07/15/2021	2022.01	07/15/2021 03:55:31 PM Central Daylight Time	06/03/2021 03:17:25 PM Central Daylight Time				07/15/2021 06:17:30 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE CO. OF THE RIVER VALLEY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (PPO)	01	04		1			H8768	025	0	2022	Select Counties in Kansas		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			
H8768	026	0	1	04	01	H8768_026_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 11:49:53 AM Central Daylight Time	08/03/2021 01:21:09 PM Central Daylight Time	07/29/2021 09:26:14 PM Central Daylight Time			08/05/2021 01:29:51 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE CO. OF THE RIVER VALLEY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H8768	026	0	2022	Central Missouri 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			
H8768	027	0	1	04	01	H8768_027_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 11:52:27 AM Central Daylight Time	08/03/2021 01:21:42 PM Central Daylight Time	07/29/2021 09:26:30 PM Central Daylight Time			08/05/2021 01:29:51 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE CO. OF THE RIVER VALLEY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H8768	027	0	2022	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			
H8768	028	0	1	04	01	H8768_028_0	4	1			1	0	0	07/15/2021	2022.01	07/15/2021 03:56:23 PM Central Daylight Time	06/03/2021 03:19:14 PM Central Daylight Time				07/15/2021 06:17:30 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE CO. OF THE RIVER VALLEY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (PPO)	01	04		1			H8768	028	0	2022	Oklahoma 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										(711)-		(711)-		(711)-		(711)-										2					2						2			
H8768	029	0	1	04	01	H8768_029_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 12:41:38 PM Central Daylight Time	08/03/2021 01:22:15 PM Central Daylight Time	07/29/2021 09:26:45 PM Central Daylight Time			08/04/2021 07:39:56 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE CO. OF THE RIVER VALLEY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H8768	029	0	2022	Select Counties in North Mississippi		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	030	0	1	04	01	H8768_030_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 12:41:55 PM Central Daylight Time	08/03/2021 01:22:48 PM Central Daylight Time	07/29/2021 09:27:01 PM Central Daylight Time			08/04/2021 07:39:56 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE CO. OF THE RIVER VALLEY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	01	04		1			H8768	030	0	2022	Select Counties in South Mississippi		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	031	0	1	04	01	H8768_031_0	2	1			2	0	0	07/14/2021	2022.01	07/14/2021 04:42:13 PM Central Daylight Time	06/03/2021 03:21:00 PM Central Daylight Time				07/15/2021 11:44:43 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE CO. OF THE RIVER VALLEY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (PPO)	01	04		1			H8768	031	0	2022	Select Counties in Mississippi		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			
H8768	032	0	1	04	01	H8768_032_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 03:16:32 PM Central Daylight Time	08/03/2021 01:23:23 PM Central Daylight Time	07/29/2021 09:27:17 PM Central Daylight Time			08/05/2021 11:08:55 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE CO. OF THE RIVER VALLEY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 2 (PPO)	01	04		1			H8768	032	0	2022	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	033	0	1	04	01	H8768_033_0	3	1			2		1	08/04/2021	2022.01	08/04/2021 11:38:24 AM Central Daylight Time	08/03/2021 01:23:56 PM Central Daylight Time	07/29/2021 09:27:33 PM Central Daylight Time			08/04/2021 04:48:24 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE CO. OF THE RIVER VALLEY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 4 (PPO)	01	04		1			H8768	033	0	2022	Select Counties in 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			
H8769	001	0	1	20	08	H8769_001_0	2	1						06/02/2021	2022.01	06/02/2021 12:59:12 PM Central Daylight Time		05/28/2021 12:56:58 PM Central Daylight Time			06/02/2021 01:01:24 PM Central Daylight Time	Center for Gerontology	Ascension Living PACE of Michigan	ascension.org/GenesysPACE	Genesys PACE of Genesee County (PACE)	08	20		1			H8769	001	0	2022	Counties: Genesee, Lap, Liv,  Shi, Tus		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	2	1						06/02/2021	2022.01	06/02/2021 12:59:23 PM Central Daylight Time		05/28/2021 12:57:14 PM Central Daylight Time			06/02/2021 01:01:24 PM Central Daylight Time	Center for Gerontology	Ascension Living PACE of Michigan	ascension.org/GenesysPACE	Genesys PACE of Genesee County (PACE)	08	20		1			H8769	002	0	2022	Counties: Genesee, Lap, Liv, Shi, Tus		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						06/04/2021	2022.01	06/04/2021 02:42:11 PM Eastern Daylight Time		06/04/2021 02:44:34 PM Eastern Daylight Time			06/04/2021 02:52:05 PM Eastern Daylight Time	COMPLETE SENIOR CARE, INC.	Complete Senior Care	https://www.completeseniorcare.org/	Complete Senior Care Dual (PACE)	08	20		1			H8777	001	0	2022	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						06/04/2021	2022.01	06/04/2021 02:42:27 PM Eastern Daylight Time		06/04/2021 02:44:34 PM Eastern Daylight Time			06/04/2021 02:52:05 PM Eastern Daylight Time	COMPLETE SENIOR CARE, INC.	Complete Senior Care	https://www.completeseniorcare.org	Complete Senior Care Medicare Only (PACE)	08	20		1			H8777	002	0	2022	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	8	1					1	08/05/2021	2022.01	08/05/2021 05:27:02 PM Central Daylight Time	08/05/2021 02:22:39 PM Central Daylight Time	07/29/2021 08:11:26 PM Central Daylight Time			08/05/2021 07:14:41 PM Central Daylight Time	UCARE HEALTH, INC.	UCare	https://home.ucare.org	EssentiaCare Secure (PPO)	01	04		1			H8783	001	0	2022	Northern MN and 3 County WI		2		2			2						https://home.ucare.org	https://home.ucare.org/en-us/search-network/formulary	https://search.ucare.org	(855)432-7025		(218)722-4915		(877)671-1061		(612)676-6640		(855)432-7025		(218)722-4915		(877)671-1061		(612)676-6640		(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	9	1					1	08/05/2021	2022.01	08/05/2021 05:32:37 PM Central Daylight Time	08/05/2021 02:24:54 PM Central Daylight Time	07/29/2021 08:16:35 PM Central Daylight Time			08/05/2021 07:14:41 PM Central Daylight Time	UCARE HEALTH, INC.	UCare	https://home.ucare.org	EssentiaCare Grand (PPO)	01	04		1			H8783	002	0	2022	Northern MN and 3 County WI		2		2			2						https://home.ucare.org	https://home.ucare.org/en-us/search-network/formulary	home.ucare.org/en-us/search-network	(855)432-7025		(218)722-4915		(877)671-1061		(612)676-6640		(855)432-7025		(218)722-4915		(877)671-1061		(612)676-6640		(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	003	0	1	04	01	H8783_003_0	9	1					1	08/10/2021	2022.01	08/10/2021 10:38:35 AM Central Daylight Time	08/05/2021 02:48:38 PM Central Daylight Time	07/29/2021 08:21:32 PM Central Daylight Time			08/10/2021 10:45:39 AM Central Daylight Time	UCARE HEALTH, INC.	UCare	https://home.ucare.org	EssentiaCare Access (PPO)	01	04		1			H8783	003	0	2022	St. Louis County, MN and 3 County WI		2		2			2						https://home.ucare.org	https://home.ucare.org/en-us/search-network/formulary	https://search.ucare.org	(855)432-7025		(218)722-4915		(877)671-1061		(612)676-6640		(855)432-7025		(218)722-4915		(877)671-1061		(612)676-6640		(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	5	1						07/19/2021	2022.01	07/19/2021 11:47:26 AM Eastern Daylight Time					07/19/2021 05:05:23 PM Eastern 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	2022	Select TX Service Areas		2	133883	2			2						https://www.myamerigroup.com/txmmp/	www.myamerigroup.com/txmmp	www.myamerigroup.com/txmmp	(855)878-1784		(855)878-1784		(855)878-1784		(855)878-1784		(833)232-1711		(833)232-1711		(855)878-1784		(855)878-1784		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H8797	001	0	1	01	01	H8797_001_0	6	1		1			0	07/22/2021	2022.01	07/22/2021 02:57:36 PM Eastern Daylight Time	08/05/2021 01:18:08 PM Eastern Daylight Time	08/02/2021 03:17:48 PM Eastern Daylight Time			08/05/2021 04:38:50 PM Eastern Daylight Time	PERENNIAL ADVANTAGE OF OHIO, INC.	Perennial Advantage	www.perennialadvantage.com	Perennial Advantage Strive (HMO I-SNP)	01	01		1			H8797	001	0	2022	Ohio (partial)		2	6794	2			1	1	3				www.placeholder.com	www.perennialadvantage.com	www.perennialadvantage.com	(844)788-6986		(844)788-6986		(844)788-6986		(844)788-6986		(844)788-6986		(844)788-6986		(844)788-6986		(844)788-6986		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8797	002	0	1	01	01	H8797_002_0	7	1		1			0	07/22/2021	2022.01	07/22/2021 02:57:56 PM Eastern Daylight Time	08/05/2021 01:18:44 PM Eastern Daylight Time	08/04/2021 06:26:09 PM Eastern Daylight Time			08/05/2021 04:38:50 PM Eastern Daylight Time	PERENNIAL ADVANTAGE OF OHIO, INC.	Perennial Advantage	www.perennialadvantage.com	Perennial Advantage Concierge (HMO C-SNP)	01	01		1			H8797	002	0	2022	Ohio (partial)		2	1345	2			1	4			00000000000000000010		www.placeholder.com	www.perennialadvantage.com	www.perennialadvantage.com	(844)788-6986		(844)788-6986		(844)788-6986		(844)788-6986		(844)788-6986		(844)788-6986		(844)788-6986		(844)788-6986		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8800	001	0	1	20	08	H8800_001_0	1	1						05/28/2021	2022.01	05/28/2021 02:13:36 PM Eastern Daylight Time		05/28/2021 02:05:56 PM Eastern Daylight Time			05/28/2021 02:16:59 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	2022	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						05/28/2021	2022.01	05/28/2021 02:14:11 PM Eastern Daylight Time		05/28/2021 02:05:58 PM Eastern Daylight Time			05/28/2021 02:16:59 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	2022	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																
H8845	001	0	1	01	01	H8845_001_0	7	1	2	1			0	08/04/2021	2022.01	08/04/2021 06:21:33 PM Pacific Daylight Time	08/04/2021 05:23:32 PM Pacific Daylight Time	08/02/2021 11:48:30 AM Pacific Daylight Time			08/05/2021 03:02:36 PM Pacific Daylight Time	MAGELLAN COMPLETE CARE OF ARIZONA, INC.	Magellan Complete Care	mccofaz.com	Molina Medicare Complete Care (HMO D-SNP)	01	01		1			H8845	001	0	2022	Gila, Maricopa, Pinal		2	1431	2			1	3		1		1	mccofaz.com	mccofaz.com	mccofaz.com	(800)424-4509		(800)424-4509		(800)424-4505		(800)424-4505		(800)424-4509		(800)424-4509		(800)424-4505		(800)424-4505		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8849	001	0	1	01	01	H8849_001_0	8	1		1	2		1	07/16/2021	2022.01	07/16/2021 10:59:13 AM Pacific Daylight Time	08/03/2021 03:04:04 PM Pacific Daylight Time	08/03/2021 03:04:04 PM Pacific Daylight Time			08/04/2021 12:07:42 PM Pacific Daylight Time	AMERIGROUP INSURANCE COMPANY	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Diabetes Care Plus (HMO C-SNP)	01	01		1			H8849	001	0	2022	Tarrant County		2		2			1	4			00000010000000000000		https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	(833)713-1306		(833)713-1306		(855)793-1925		(855)793-1925		(833)371-1079		(833)371-1079		(855)499-1102		(855)499-1102		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8849	002	0	1	01	01	H8849_002_0	10	1		1	2		0	06/04/2021	2022.01	06/04/2021 08:06:01 AM Pacific Daylight Time	08/03/2021 03:04:04 PM Pacific Daylight Time	08/03/2021 03:04:04 PM Pacific Daylight Time			08/04/2021 12:07:42 PM Pacific Daylight Time	AMERIGROUP INSURANCE COMPANY	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Comfort Plus (HMO I-SNP)	01	01		1			H8849	002	0	2022	Harris, Tarrant, Bexar, Dallas, Travis Counties		2		2			1	1	3				https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	(833)713-1306		(833)713-1306		(855)793-1926		(855)793-1926		(833)371-1079		(833)371-1079		(855)499-1103		(855)499-1103		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8849	003	0	1	01	01	H8849_003_0	8	1		1	2		1	07/16/2021	2022.01	07/16/2021 11:18:45 AM Pacific Daylight Time	08/03/2021 03:04:04 PM Pacific Daylight Time	08/03/2021 03:04:04 PM Pacific Daylight Time			08/04/2021 12:07:42 PM Pacific Daylight Time	AMERIGROUP INSURANCE COMPANY	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Diabetes Care Plus (HMO C-SNP)	01	01		1			H8849	003	0	2022	Harris County		2		2			1	4			00000010000000000000		https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	(833)713-1306		(833)713-1306		(855)793-1925		(855)793-1925		(833)371-1079		(833)371-1079		(855)499-1102		(855)499-1102		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8849	004	0	1	01	01	H8849_004_0	8	1		1	2		0	07/16/2021	2022.01	07/16/2021 11:19:24 AM Pacific Daylight Time	08/03/2021 03:04:04 PM Pacific Daylight Time	08/03/2021 03:04:04 PM Pacific Daylight Time			08/04/2021 12:07:42 PM Pacific Daylight Time	AMERIGROUP INSURANCE COMPANY	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Heart Care Plus (HMO C-SNP)	01	01		1			H8849	004	0	2022	Harris County		2		2			1	4			00000000000000010000		https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	(833)713-1306		(833)713-1306		(855)793-1925		(855)793-1925		(833)371-1079		(833)371-1079		(855)499-1102		(855)499-1102		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8849	005	0	1	01	01	H8849_005_0	8	1		1	2		0	07/16/2021	2022.01	07/16/2021 11:20:40 AM Pacific Daylight Time	08/03/2021 03:04:04 PM Pacific Daylight Time	08/03/2021 03:04:04 PM Pacific Daylight Time			08/04/2021 12:07:42 PM Pacific Daylight Time	AMERIGROUP INSURANCE COMPANY	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Lung Care Plus (HMO C-SNP)	01	01		1			H8849	005	0	2022	Harris County		2		2			1	4			00000000000100000000		https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	(833)713-1306		(833)713-1306		(855)793-1925		(855)793-1925		(833)371-1079		(833)371-1079		(855)499-1102		(855)499-1102		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8849	006	0	1	01	01	H8849_006_0	9	1			2		0	07/18/2021	2022.01	07/18/2021 04:39:14 PM Pacific Daylight Time	08/03/2021 03:04:04 PM Pacific Daylight Time	08/03/2021 03:04:04 PM Pacific Daylight Time			08/04/2021 12:07:42 PM Pacific Daylight Time	AMERIGROUP INSURANCE COMPANY	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Select Plus (HMO)	01	01		1			H8849	006	0	2022	Bexar County		2		2			2						https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	(833)713-1304		(833)713-1304		(855)793-1927		(855)793-1927		(833)713-1304		(833)713-1304		(855)499-1104		(855)499-1104		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8849	008	1	1	01	01	H8849_008_1	8	1			2		0	07/31/2021	2022.01	07/31/2021 05:13:48 PM Pacific Daylight Time	08/03/2021 03:04:04 PM Pacific Daylight Time	08/03/2021 03:04:04 PM Pacific Daylight Time			08/04/2021 12:07:42 PM Pacific Daylight Time	AMERIGROUP INSURANCE COMPANY	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Classic Plus (HMO)	01	01		1			H8849	008	1	2022	Select Counties in TX	Houston MSA	2		2			2						https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	(833)713-1304		(833)713-1304		(855)793-1927		(855)793-1927		(833)371-1079		(833)371-1079		(855)499-1104		(855)499-1104		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8849	008	2	1	01	01	H8849_008_2	9	1			2		0	07/31/2021	2022.01	07/31/2021 05:14:39 PM Pacific Daylight Time	08/03/2021 03:04:04 PM Pacific Daylight Time	08/03/2021 03:04:04 PM Pacific Daylight Time			08/04/2021 12:07:42 PM Pacific Daylight Time	AMERIGROUP INSURANCE COMPANY	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Classic Plus (HMO)	01	01		1			H8849	008	2	2022	Select Counties in TX	Dallas Fort Worth MSA	2		2			2						https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	(833)713-1304		(833)713-1304		(855)793-1927		(855)793-1927		(833)371-1079		(833)371-1079		(855)499-1104		(855)499-1104		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8849	008	3	1	01	01	H8849_008_3	8	1			2		0	07/31/2021	2022.01	07/31/2021 05:16:56 PM Pacific Daylight Time	08/03/2021 03:04:04 PM Pacific Daylight Time	08/03/2021 03:04:04 PM Pacific Daylight Time			08/04/2021 12:07:42 PM Pacific Daylight Time	AMERIGROUP INSURANCE COMPANY	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Classic Plus (HMO)	01	01		1			H8849	008	3	2022	Select Counties in TX	San Antonio MSA	2		2			2						https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	(833)713-1304		(833)713-1304		(855)793-1927		(855)793-1927		(833)371-1079		(833)371-1079		(855)499-1104		(855)499-1104		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8849	008	4	1	01	01	H8849_008_4	9	1			2		0	07/18/2021	2022.01	07/18/2021 04:54:16 PM Pacific Daylight Time	08/03/2021 03:04:04 PM Pacific Daylight Time	08/03/2021 03:04:04 PM Pacific Daylight Time			08/04/2021 12:07:42 PM Pacific Daylight Time	AMERIGROUP INSURANCE COMPANY	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Classic Plus (HMO)	01	01		1			H8849	008	4	2022	Select Counties in TX	El Paso MSA	2		2			2						https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	(833)713-1304		(833)713-1304		(855)793-1927		(855)793-1927		(833)371-1079		(833)371-1079		(855)499-1104		(855)499-1104		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8849	008	5	1	01	01	H8849_008_5	8	1			2		0	07/31/2021	2022.01	07/31/2021 05:17:44 PM Pacific Daylight Time	08/03/2021 03:04:04 PM Pacific Daylight Time	08/03/2021 03:04:04 PM Pacific Daylight Time			08/04/2021 12:07:42 PM Pacific Daylight Time	AMERIGROUP INSURANCE COMPANY	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Classic Plus (HMO)	01	01		1			H8849	008	5	2022	Select Counties in TX	Lubbock MSA	2		2			2						https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	(833)713-1304		(833)713-1304		(855)793-1927		(855)793-1927		(833)371-1079		(833)371-1079		(855)499-1104		(855)499-1104		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8849	008	6	1	01	01	H8849_008_6	8	1			2		0	07/31/2021	2022.01	07/31/2021 05:18:28 PM Pacific Daylight Time	08/03/2021 03:04:04 PM Pacific Daylight Time	08/03/2021 03:04:04 PM Pacific Daylight Time			08/04/2021 12:07:42 PM Pacific Daylight Time	AMERIGROUP INSURANCE COMPANY	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Classic Plus (HMO)	01	01		1			H8849	008	6	2022	Select Counties in TX	Austin MSA	2		2			2						https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	(833)713-1304		(833)713-1304		(855)793-1927		(855)793-1927		(833)371-1079		(833)371-1079		(855)499-1104		(855)499-1104		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8849	009	0	1	01	01	H8849_009_0	9	1			2		0	07/18/2021	2022.01	07/18/2021 09:19:59 PM Pacific Daylight Time	08/03/2021 03:04:04 PM Pacific Daylight Time	08/03/2021 03:04:04 PM Pacific Daylight Time			08/04/2021 12:07:42 PM Pacific Daylight Time	AMERIGROUP INSURANCE COMPANY	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Select Plus (HMO)	01	01		1			H8849	009	0	2022	Fort Bend, Harris, Montgomery Counties		2		2			2						https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	(833)713-1304		(833)713-1304		(855)793-1927		(855)793-1927		(833)371-1079		(833)371-1079		(855)499-1104		(855)499-1104		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8849	010	1	1	01	01	H8849_010_1	6	1	2	1	1		0	08/02/2021	2022.01	08/02/2021 10:45:50 AM Eastern Daylight Time	08/03/2021 06:03:58 PM Eastern Daylight Time	08/03/2021 06:03:58 PM Eastern Daylight Time			08/04/2021 03:50:55 PM Eastern Daylight Time	AMERIGROUP INSURANCE COMPANY	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Dual Coordination Plus (HMO D-SNP)	01	01		1			H8849	010	1	2022	Select Counties in TX	Houston MSA	2		2			1	3		1		1	https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	(833)713-1305		(833)713-1305		(855)793-1928		(855)793-1928		(833)371-1079		(833)371-1079		(855)499-1105		(855)499-1105		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8849	010	2	1	01	01	H8849_010_2	7	1	2	1	1		0	08/02/2021	2022.01	08/02/2021 10:47:17 AM Eastern Daylight Time	08/03/2021 06:03:58 PM Eastern Daylight Time	08/03/2021 06:03:58 PM Eastern Daylight Time			08/04/2021 03:50:55 PM Eastern Daylight Time	AMERIGROUP INSURANCE COMPANY	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Dual Coordination Plus (HMO D-SNP)	01	01		1			H8849	010	2	2022	Select Counties in TX	Dallas Fort Worth MSA	2		2			1	3		1		1	https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	(833)713-1305		(833)713-1305		(855)793-1928		(855)793-1928		(833)371-1079		(833)371-1079		(855)499-1105		(855)499-1105		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8849	010	3	1	01	01	H8849_010_3	7	1	2	1	1		0	07/19/2021	2022.01	07/19/2021 03:15:09 PM Eastern Daylight Time	08/03/2021 06:03:58 PM Eastern Daylight Time	08/03/2021 06:03:58 PM Eastern Daylight Time			08/04/2021 03:50:55 PM Eastern Daylight Time	AMERIGROUP INSURANCE COMPANY	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Dual Coordination Plus (HMO D-SNP)	01	01		1			H8849	010	3	2022	Select Counties in TX	San Antonio MSA	2		2			1	3		1		1	https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	(833)713-1305		(833)713-1305		(855)793-1928		(855)793-1928		(833)371-1079		(833)371-1079		(855)499-1105		(855)499-1105		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8849	010	4	1	01	01	H8849_010_4	9	1	2	1	1		0	08/02/2021	2022.01	08/02/2021 10:48:24 AM Eastern Daylight Time	08/03/2021 06:03:58 PM Eastern Daylight Time	08/03/2021 06:03:58 PM Eastern Daylight Time			08/04/2021 03:50:55 PM Eastern Daylight Time	AMERIGROUP INSURANCE COMPANY	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Dual Coordination Plus (HMO D-SNP)	01	01		1			H8849	010	4	2022	Select Counties in TX	El Paso MSA	2		2			1	3		1		1	https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	(833)713-1305		(833)713-1305		(855)793-1928		(855)793-1928		(833)371-1079		(833)371-1079		(855)499-1105		(855)499-1105		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8849	010	5	1	01	01	H8849_010_5	7	1	2	1	1		0	08/02/2021	2022.01	08/02/2021 10:50:50 AM Eastern Daylight Time	08/03/2021 06:03:58 PM Eastern Daylight Time	08/03/2021 06:03:58 PM Eastern Daylight Time			08/04/2021 03:50:55 PM Eastern Daylight Time	AMERIGROUP INSURANCE COMPANY	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Dual Coordination Plus (HMO D-SNP)	01	01		1			H8849	010	5	2022	Select Counties in TX	Lubbock MSA	2		2			1	3		1		1	https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	(833)713-1305		(833)713-1305		(855)793-1928		(855)793-1928		(833)371-1079		(833)371-1079		(855)499-1105		(855)499-1105		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8849	010	6	1	01	01	H8849_010_6	7	1	2	1	1		0	08/02/2021	2022.01	08/02/2021 10:52:14 AM Eastern Daylight Time	08/03/2021 06:03:58 PM Eastern Daylight Time	08/03/2021 06:03:58 PM Eastern Daylight Time			08/04/2021 03:50:55 PM Eastern Daylight Time	AMERIGROUP INSURANCE COMPANY	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Dual Coordination Plus (HMO D-SNP)	01	01		1			H8849	010	6	2022	Select Counties in TX	Austin MSA	2		2			1	3		1		1	https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	(833)713-1305		(833)713-1305		(855)793-1928		(855)793-1928		(833)371-1079		(833)371-1079		(855)499-1105		(855)499-1105		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8849	011	1	1	01	01	H8849_011_1	6	1	2	1	1		0	08/02/2021	2022.01	08/02/2021 05:56:37 PM Eastern Daylight Time	08/03/2021 06:03:58 PM Eastern Daylight Time	08/03/2021 06:03:58 PM Eastern Daylight Time			08/04/2021 03:50:55 PM Eastern Daylight Time	AMERIGROUP INSURANCE COMPANY	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Dual Secure Plus (HMO D-SNP)	01	01		1			H8849	011	1	2022	Select Counties in TX	Houston MSA	2		2			1	3		2		2	https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	(833)713-1305		(833)713-1305		(855)793-1928		(855)793-1928		(833)371-1079		(833)371-1079		(855)499-1105		(855)499-1105		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8849	011	2	1	01	01	H8849_011_2	7	1	2	1	1		0	08/02/2021	2022.01	08/02/2021 10:59:17 AM Eastern Daylight Time	08/03/2021 06:03:58 PM Eastern Daylight Time	08/03/2021 06:03:58 PM Eastern Daylight Time			08/04/2021 03:50:55 PM Eastern Daylight Time	AMERIGROUP INSURANCE COMPANY	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Dual Secure Plus (HMO D-SNP)	01	01		1			H8849	011	2	2022	Select Counties in TX	Dallas Fort Worth MSA	2		2			1	3		2		2	https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	(833)713-1305		(833)713-1305		(855)793-1928		(855)793-1928		(833)371-1079		(833)371-1079		(855)499-1105		(855)499-1105		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8849	011	3	1	01	01	H8849_011_3	9	1	2	1	1		0	08/02/2021	2022.01	08/02/2021 10:59:08 AM Eastern Daylight Time	08/03/2021 06:03:58 PM Eastern Daylight Time	08/03/2021 06:03:58 PM Eastern Daylight Time			08/04/2021 03:50:55 PM Eastern Daylight Time	AMERIGROUP INSURANCE COMPANY	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Dual Secure Plus (HMO D-SNP)	01	01		1			H8849	011	3	2022	Select Counties in TX	San Antonio MSA	2		2			1	3		2		2	https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	(833)713-1305		(833)713-1305		(855)793-1928		(855)793-1928		(833)371-1079		(833)371-1079		(855)499-1105		(855)499-1105		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8849	011	4	1	01	01	H8849_011_4	9	1	2	1	1		0	08/02/2021	2022.01	08/02/2021 10:58:56 AM Eastern Daylight Time	08/03/2021 06:03:58 PM Eastern Daylight Time	08/03/2021 06:03:58 PM Eastern Daylight Time			08/04/2021 03:50:55 PM Eastern Daylight Time	AMERIGROUP INSURANCE COMPANY	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Dual Secure Plus (HMO D-SNP)	01	01		1			H8849	011	4	2022	Select Counties in TX	El Paso MSA	2		2			1	3		2		2	https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	(833)713-1305		(833)713-1305		(855)793-1928		(855)793-1928		(833)371-1079		(833)371-1079		(855)499-1105		(855)499-1105		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8849	011	5	1	01	01	H8849_011_5	7	1	2	1	1		0	08/02/2021	2022.01	08/02/2021 11:02:33 AM Eastern Daylight Time	08/03/2021 06:03:58 PM Eastern Daylight Time	08/03/2021 06:03:58 PM Eastern Daylight Time			08/04/2021 03:50:55 PM Eastern Daylight Time	AMERIGROUP INSURANCE COMPANY	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Dual Secure Plus (HMO D-SNP)	01	01		1			H8849	011	5	2022	Select Counties in TX	Lubbock MSA	2		2			1	3		2		2	https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	(833)713-1305		(833)713-1305		(855)793-1928		(855)793-1928		(833)371-1079		(833)371-1079		(855)499-1105		(855)499-1105		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8849	011	6	1	01	01	H8849_011_6	7	1	2	1	1		0	08/02/2021	2022.01	08/02/2021 11:03:59 AM Eastern Daylight Time	08/03/2021 06:03:58 PM Eastern Daylight Time	08/03/2021 06:03:58 PM Eastern Daylight Time			08/04/2021 03:50:55 PM Eastern Daylight Time	AMERIGROUP INSURANCE COMPANY	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Dual Secure Plus (HMO D-SNP)	01	01		1			H8849	011	6	2022	Select Counties in TX	Austin MSA	2		2			1	3		2		2	https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	(833)713-1305		(833)713-1305		(855)793-1928		(855)793-1928		(833)371-1079		(833)371-1079		(855)499-1105		(855)499-1105		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8849	012	0	1	01	01	H8849_012_0	10	1		1	2		0	07/16/2021	2022.01	07/16/2021 11:32:56 AM Pacific Daylight Time	08/03/2021 03:04:04 PM Pacific Daylight Time	08/03/2021 03:04:04 PM Pacific Daylight Time			08/04/2021 12:07:42 PM Pacific Daylight Time	AMERIGROUP INSURANCE COMPANY	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Heart Care Plus (HMO C-SNP)	01	01		1			H8849	012	0	2022	Select Counties in TX		2		2			1	4			00000000000000010000		https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	(833)713-1306		(833)713-1306		(855)793-1925		(855)793-1925		(833)371-1079		(833)371-1079		(855)499-1102		(855)499-1102		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8849	013	0	1	01	01	H8849_013_0	8	1		1	2		0	07/16/2021	2022.01	07/16/2021 11:33:38 AM Pacific Daylight Time	08/03/2021 03:04:04 PM Pacific Daylight Time	08/03/2021 03:04:04 PM Pacific Daylight Time			08/04/2021 12:07:42 PM Pacific Daylight Time	AMERIGROUP INSURANCE COMPANY	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Lung Care Plus (HMO C-SNP)	01	01		1			H8849	013	0	2022	Select Counties in TX		2		2			1	4			00000000000100000000		https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare	(833)713-1306		(833)713-1306		(855)793-1925		(855)793-1925		(833)371-1079		(833)371-1079		(855)499-1102		(855)499-1102		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8854	002	0	1	01	01	H8854_002_0	7	1	2	1			0	08/04/2021	2022.01	08/04/2021 03:53:16 PM Eastern Daylight Time	08/05/2021 10:43:58 AM Eastern Daylight Time	08/05/2021 10:43:58 AM Eastern Daylight Time			08/05/2021 01:35:54 PM Eastern Daylight Time	CareFirst Advantage DSNP, Inc.	CareFirst BlueCross BlueShield Medicare Advantage	carefirst.com/mddsnp	CareFirst BlueCross BlueShield Advantage DualPrime (HMO D-SNP)	01	01		1			H8854	002	0	2022	Select Maryland Counties		2	101256	2			1	3		2		1	carefirst.com/mddsnp	carefirst.com/mddsnp	carefirst.com/mddsnp	(844)386-6762		(410)779-9932		(844)386-6762		(410)779-9932		(844)386-6762		(410)779-9932		(844)386-6762		(410)779-9932		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8889	001	0	1	04	01	H8889_001_0	4	1					1	07/14/2021	2022.01	07/14/2021 01:51:44 PM Central Daylight Time	08/05/2021 08:33:04 AM Central Daylight Time	08/05/2021 08:33:44 AM Central Daylight Time			08/05/2021 10:37:46 AM Central Daylight Time	MEDICA HEALTH PLANS	Medica	medica.com	Medica Advantage Solution H8889-001 (PPO)	01	04		1			H8889	001	0	2022	Minneapolis/St. Paul Metro Area		2		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	4	1					1	07/14/2021	2022.01	07/14/2021 01:52:54 PM Central Daylight Time	08/05/2021 08:33:05 AM Central Daylight Time	08/05/2021 08:33:41 AM Central Daylight Time			08/05/2021 10:37:46 AM Central Daylight Time	MEDICA HEALTH PLANS	Medica	medica.com	Medica Advantage Solution H8889-002 (PPO)	01	04		1			H8889	002	0	2022	Select Counties in MN		2		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	4	1					1	07/14/2021	2022.01	07/14/2021 01:55:13 PM Central Daylight Time	08/05/2021 08:33:05 AM Central Daylight Time	08/05/2021 08:33:41 AM Central Daylight Time			08/05/2021 10:37:46 AM Central Daylight Time	MEDICA HEALTH PLANS	Medica	medica.com	Medica Advantage Solution H8889-003 (PPO)	01	04		1			H8889	003	0	2022	Minneapolis/St. Paul Metro Area		2		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	5	1					1	08/04/2021	2022.01	08/04/2021 09:23:57 AM Central Daylight Time	08/05/2021 08:33:06 AM Central Daylight Time	08/05/2021 08:33:42 AM Central Daylight Time			08/05/2021 10:37:46 AM Central Daylight Time	MEDICA HEALTH PLANS	Medica	medica.com	Medica Advantage Solution H8889-004 (PPO)	01	04		1			H8889	004	0	2022	Southern Minnesota		2		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	005	0	1	04	01	H8889_005_0	4	1					1	07/14/2021	2022.01	07/14/2021 01:58:33 PM Central Daylight Time	08/05/2021 08:33:01 AM Central Daylight Time	08/05/2021 08:33:42 AM Central Daylight Time			08/05/2021 10:37:46 AM Central Daylight Time	MEDICA HEALTH PLANS	Medica	medica.com	Medica Advantage Solution H8889-005 (PPO)	01	04		1			H8889	005	0	2022	Minneapolis/St. Paul Metro Area		2		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	008	0	1	04	01	H8889_008_0	3	1					1	07/14/2021	2022.01	07/14/2021 01:59:27 PM Central Daylight Time	08/05/2021 08:33:02 AM Central Daylight Time	08/05/2021 08:33:42 AM Central Daylight Time			08/05/2021 10:37:46 AM Central Daylight Time	MEDICA HEALTH PLANS	Medica	medica.com	Medica Advantage Solution H8889-008 (PPO)	01	04		1			H8889	008	0	2022	Select counties in MN		2		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	009	0	1	04	01	H8889_009_0	2	1				0	0	07/14/2021	2022.01	07/14/2021 02:00:16 PM Central Daylight Time	06/04/2021 02:47:33 PM Central Daylight Time				07/14/2021 09:09:18 PM Central Daylight Time	MEDICA HEALTH PLANS	Medica	medica.com	Medica Advantage Solution H8889-009 (PPO)	01	04		1			H8889	009	0	2022	Select counties in MN		2		2			2						medica.com/Members	medica.com/Members	medica.com/Members	(866)269-6804		(952)992-2134		(800)906-5432		(952)992-2345										(711)-		(711)-		(711)-		(711)-										2					2						2			
H8889	801	0	1	04	01	H8889_801_0	1	1						05/20/2021	2022.01	05/20/2021 09:34:45 AM Central Daylight Time					06/02/2021 08:35:19 AM Central Daylight Time	MEDICA HEALTH PLANS	Medica	medica.com	Medica Group Advantage Solution (PPO)	01	04		1			H8889	801	0	2022	Select Counties in the US		1	59748	2			2						medica.com/Members	medica.com/Members	medica.com/Members	(800)575-2330		(952)992-2330		(800)906-5432		(952)992-2345		(800)575-2330		(952)992-2330		(800)906-5432		(952)992-2345		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8908	001	0	1	01	01	H8908_001_0	5	1			1		1	07/15/2021	2022.01	07/15/2021 11:07:04 AM Eastern Daylight Time	08/03/2021 05:57:24 PM Eastern Daylight Time	07/30/2021 12:08:02 PM Eastern Daylight Time			08/04/2021 01:22:33 PM 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	2022	Detroit Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		1	07/15/2021	2022.01	07/15/2021 11:08:01 AM Eastern Daylight Time	08/03/2021 06:15:16 PM Eastern Daylight Time	07/30/2021 12:08:14 PM Eastern Daylight Time			08/04/2021 01:22:33 PM 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	2022	Grand Rapids area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	1			1		1	07/31/2021	2022.01	07/31/2021 02:52:15 PM Eastern Daylight Time	08/03/2021 06:01:58 PM Eastern Daylight Time	07/30/2021 12:08:26 PM Eastern Daylight Time			08/04/2021 01:22:33 PM 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	2022	Southeast Michigan		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	1		0	07/08/2021	2022.01	07/08/2021 04:13:16 PM Eastern Daylight Time	08/03/2021 06:04:09 PM Eastern Daylight Time	07/30/2021 12:08:38 PM Eastern Daylight Time			08/04/2021 01:54:36 PM Eastern Daylight Time	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H8908-005 (HMO D-SNP)	01	01		1			H8908	005	0	2022	Select counties in Michigan		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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						05/25/2021	2022.01	05/25/2021 04:13:50 PM Eastern Daylight Time					06/04/2021 08:33:40 AM Eastern Daylight Time	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H8908	801	0	2022	Select Counties in Michigan		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242		(866)396-8810		(866)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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H8908	802	0	1	01	01	H8908_802_0	1	1				0	0	05/25/2021	2022.01	05/25/2021 04:15:35 PM Eastern Daylight Time					06/04/2021 08:33:40 AM Eastern Daylight Time	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H8908	802	0	2022	Select Counties in Michigan		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H8908	804	0	1	01	01	H8908_804_0	1	1						05/27/2021	2022.01	05/27/2021 04:21:17 PM Eastern Daylight Time					06/04/2021 08:33:40 AM Eastern Daylight Time	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H8908	804	0	2022	Select Counties in Michigan		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242		(866)396-8810		(866)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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					2				
H8908	805	0	1	01	01	H8908_805_0	1	1				0	0	05/27/2021	2022.01	05/27/2021 04:22:47 PM Eastern Daylight Time					06/04/2021 08:33:40 AM Eastern Daylight Time	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	01	01		1			H8908	805	0	2022	Select Counties in Michigan		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					2				
H8928	001	0	1	01	01	H8928_001_0	7	1	2	1			0	08/03/2021	2022.01	08/03/2021 12:01:53 PM Eastern Daylight Time	08/05/2021 12:56:05 PM Eastern Daylight Time	08/05/2021 12:55:27 PM Eastern Daylight Time			08/05/2021 01:32:54 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/navicare	NaviCare (HMO D-SNP)	01	01		1			H8928	001	0	2022	Massachusetts except Dukes and Nantucket counties		2	109378	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					2	2			
H8961	001	0	1	01	01	H8961_001_0	6	1					0	08/05/2021	2022.01	08/05/2021 08:27:33 AM Eastern Daylight Time	08/05/2021 07:05:43 AM Eastern Daylight Time	08/05/2021 07:05:51 AM Eastern Daylight Time			08/05/2021 08:36:05 AM Eastern Daylight Time	OSCAR MANAGED CARE OF SOUTH FLORIDA, INC	Oscar	www.hioscar.com/medicare	Oscar + Holy Cross + Memorial (HMO)	01	01		1			H8961	001	0	2022	Broward County		2	19781	2			2						www.hioscar.com/search	www.hioscar.com/search	www.hioscar.com/search	(855)672-2720		(855)672-2720		(855)672-2710		(855)672-2710		(855)672-2720		(855)672-2720		(855)672-2710		(855)672-2710		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8961	002	0	1	01	01	H8961_002_0	7	1					0	08/05/2021	2022.01	08/05/2021 08:27:45 AM Eastern Daylight Time	08/05/2021 07:05:58 AM Eastern Daylight Time	08/05/2021 07:06:07 AM Eastern Daylight Time			08/05/2021 08:36:05 AM Eastern Daylight Time	OSCAR MANAGED CARE OF SOUTH FLORIDA, INC	Oscar	www.hioscar.com/medicare	Oscar + Holy Cross + Memorial - with $1500 O-Card (HMO)	01	01		1			H8961	002	0	2022	Broward county		2	6463	2			2						www.hioscar.com/search	www.hioscar.com/search	www.hioscar.com/search	(855)672-2720		(855)672-2720		(855)672-2710		(855)672-2710		(855)672-2720		(855)672-2720		(855)672-2710		(855)672-2710		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8961	003	0	1	01	01	H8961_003_0	7	1					0	08/05/2021	2022.01	08/05/2021 08:27:55 AM Eastern Daylight Time	08/05/2021 07:06:15 AM Eastern Daylight Time	08/05/2021 07:06:23 AM Eastern Daylight Time			08/05/2021 08:36:05 AM Eastern Daylight Time	OSCAR MANAGED CARE OF SOUTH FLORIDA, INC	Oscar	www.hioscar.com/medicare	Oscar + Holy Cross + Memorial - with Refund Bonus (HMO)	01	01		1			H8961	003	0	2022	Broward county		2	4534	2			2						www.hioscar.com/search	www.hioscar.com/search	www.hioscar.com/search	(855)672-2720		(855)672-2720		(855)672-2710		(855)672-2710		(855)672-2720		(855)672-2720		(855)672-2710		(855)672-2710		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8967	001	0	1	01	01	H8967_001_0	8	1		1			0	07/15/2021	2022.01	07/15/2021 12:21:37 PM Central Daylight Time	08/04/2021 12:45:46 PM Central Daylight Time	08/02/2021 12:00:55 PM Central Daylight Time			08/05/2021 11:18:13 AM Central Daylight Time	GOOD SAMARITAN INSURANCE PLAN OF NORTH DAKOTA, LLC	Great Plains Medicare Advantage	www.greatplainsmedicareadvantage.com	Great Plains Medicare Advantage (HMO I-SNP)	01	01		1			H8967	001	0	2022	North Dakota (partial)		2		2			1	1	3				www.greatplainsmedicareadvantage.com	www.greatplainsmedicareadvantage.com	www.greatplainsmedicareadvantage.com	(844)637-4760		(844)637-4760		(844)637-4760		(844)637-4760		(800)498-5428		(520)918-1254		(800)498-5428		(520)918-1254		(711)-		(711)-		(711)-		(711)-		(800)498-5428		(711)-		(800)498-5428		(711)-		2					2					2	2			
H8967	002	0	1	01	01	H8967_002_0	9	1		1			0	07/15/2021	2022.01	07/15/2021 12:21:55 PM Central Daylight Time	08/04/2021 04:18:41 PM Central Daylight Time	08/02/2021 11:51:45 AM Central Daylight Time			08/05/2021 11:18:13 AM Central Daylight Time	GOOD SAMARITAN INSURANCE PLAN OF NORTH DAKOTA, LLC	Great Plains Medicare Advantage	www.greatplainsmedicareadvantage.com	Great Plains Medicare Advantage Gold (HMO I-SNP)	01	01		1			H8967	002	0	2022	North Dakota (partial)		2		2			1	1	3				www.greatplainsmedicareadvantage.com	www.greatplainsmedicareadvantage.com	www.greatplainsmedicareadvantage.com	(844)637-4760		(844)637-4760		(844)637-4760		(844)637-4760		(800)498-5428		(520)918-1254		(800)498-5428		(520)918-1254		(711)-		(711)-		(711)-		(711)-		(800)498-5428		(711)-		(800)498-5428		(711)-		2					2					2	2			
H9001	029	14	1	01	01	H9001_029_14	3	1				0	0	07/13/2021	2022.01	07/13/2021 05:03:54 PM Eastern Daylight Time	06/07/2021 12:33:11 PM Eastern Daylight Time				07/14/2021 03:47:30 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/medicare	Fallon Medicare Plus Saver No Rx HMO (HMO)	01	01		1			H9001	029	14	2022	Massachusetts except Dukes and Nantucket Counties	Barnstable and Berkshire Counties	2	24	2			2						fallonhealth.org/medicare-pharmacy	www.fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H9001	029	15	1	01	01	H9001_029_15	3	1				0	0	07/13/2021	2022.01	07/13/2021 06:12:09 PM Eastern Daylight Time	06/07/2021 12:33:15 PM Eastern Daylight Time				07/14/2021 03:47:30 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/medicare	Fallon Medicare Plus Saver No Rx HMO (HMO)	01	01		1			H9001	029	15	2022	Massachusetts except Dukes and Nantucket Counties	Worcester County	2	1598	2			2						fallonhealth.org/medicare-pharmacy	www.fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H9001	029	16	1	01	01	H9001_029_16	3	1				0	0	07/13/2021	2022.01	07/13/2021 06:12:19 PM Eastern Daylight Time	06/07/2021 12:33:19 PM Eastern Daylight Time				07/14/2021 03:47:30 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/medicare	Fallon Medicare Plus Saver No Rx HMO (HMO)	01	01		1			H9001	029	16	2022	Massachusetts except Dukes and Nantucket Counties	Franklin, Hampden and Hampshire Counties	2	300	2			2						fallonhealth.org/medicare-pharmacy	www.fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H9001	029	17	1	01	01	H9001_029_17	3	1				0	0	07/13/2021	2022.01	07/13/2021 06:12:31 PM Eastern Daylight Time	06/07/2021 12:33:22 PM Eastern Daylight Time				07/14/2021 03:47:30 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/medicare	Fallon Medicare Plus Saver No Rx HMO (HMO)	01	01		1			H9001	029	17	2022	Massachusetts except Dukes and Nantucket Counties	BRI, ESS, MID, NOR, PLY and SUF Counties	2	374	2			2						fallonhealth.org/medicare-pharmacy	www.fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H9001	030	14	1	01	01	H9001_030_14	4	1					0	07/13/2021	2022.01	07/13/2021 05:04:39 PM Eastern Daylight Time	08/05/2021 12:56:10 PM Eastern Daylight Time	08/05/2021 12:55:32 PM Eastern Daylight Time			08/05/2021 01:13:11 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/medicare	Fallon Medicare Plus Green HMO (HMO)	01	01		1			H9001	030	14	2022	Massachusetts except Dukes and Nantucket Counties	Barnstable and Berkshire Counties	2	501	2			2						fallonhealth.org/medicare-pharmacy	fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9001	030	15	1	01	01	H9001_030_15	4	1					0	07/13/2021	2022.01	07/13/2021 06:12:54 PM Eastern Daylight Time	08/05/2021 12:56:15 PM Eastern Daylight Time	08/05/2021 12:55:36 PM Eastern Daylight Time			08/05/2021 01:13:11 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/medicare	Fallon Medicare Plus Green HMO (HMO)	01	01		1			H9001	030	15	2022	Massachusetts except Dukes and Nantucket Counties	Worcester County	2	22184	2			2						fallonhealth.org/medicare-pharmacy	fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9001	030	16	1	01	01	H9001_030_16	4	1					0	07/13/2021	2022.01	07/13/2021 06:12:54 PM Eastern Daylight Time	08/05/2021 12:56:20 PM Eastern Daylight Time	08/05/2021 12:54:13 PM Eastern Daylight Time			08/05/2021 01:13:11 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/medicare	Fallon Medicare Plus Green HMO (HMO)	01	01		1			H9001	030	16	2022	Massachusetts except Dukes and Nantucket Counties	Franklin, Hampden and Hampshire Counties	2	3415	2			2						fallonhealth.org/medicare-pharmacy	fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9001	030	17	1	01	01	H9001_030_17	4	1					0	07/13/2021	2022.01	07/13/2021 06:12:54 PM Eastern Daylight Time	08/05/2021 12:56:24 PM Eastern Daylight Time	08/05/2021 12:54:17 PM Eastern Daylight Time			08/05/2021 01:13:11 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/medicare	Fallon Medicare Plus Green HMO (HMO)	01	01		1			H9001	030	17	2022	Massachusetts except Dukes and Nantucket Counties	BRI, ESS, MID, NOR, PLY and SUF Counties	2	4220	2			2						fallonhealth.org/medicare-pharmacy	fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9001	031	14	1	01	01	H9001_031_14	4	1					0	07/13/2021	2022.01	07/13/2021 05:05:19 PM Eastern Daylight Time	08/05/2021 12:56:29 PM Eastern Daylight Time	08/05/2021 12:54:21 PM Eastern Daylight Time			08/05/2021 01:13:11 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/medicare	Fallon Medicare Plus Blue HMO (HMO)	01	01		1			H9001	031	14	2022	Massachusetts except Dukes and Nantucket Counties	Barnstable and Berkshire Counties	2	229	2			2						fallonhealth.org/medicare-pharmacy	fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9001	031	15	1	01	01	H9001_031_15	4	1					0	07/13/2021	2022.01	07/13/2021 06:13:12 PM Eastern Daylight Time	08/05/2021 12:56:34 PM Eastern Daylight Time	08/05/2021 12:54:25 PM Eastern Daylight Time			08/05/2021 01:13:11 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/medicare	Fallon Medicare Plus Blue HMO (HMO)	01	01		1			H9001	031	15	2022	Massachusetts except Dukes and Nantucket Counties	Worcester County	2	13020	2			2						fallonhealth.org/medicare-pharmacy	fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9001	031	16	1	01	01	H9001_031_16	4	1					0	07/13/2021	2022.01	07/13/2021 06:13:12 PM Eastern Daylight Time	08/05/2021 12:56:39 PM Eastern Daylight Time	08/05/2021 12:54:29 PM Eastern Daylight Time			08/05/2021 01:13:11 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/medicare	Fallon Medicare Plus Blue HMO (HMO)	01	01		1			H9001	031	16	2022	Massachusetts except Dukes and Nantucket Counties	Franklin, Hampden and Hampshire Counties	2	5341	2			2						fallonhealth.org/medicare-pharmacy	fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9001	031	17	1	01	01	H9001_031_17	4	1					0	07/13/2021	2022.01	07/13/2021 06:13:12 PM Eastern Daylight Time	08/05/2021 12:56:45 PM Eastern Daylight Time	08/05/2021 12:54:33 PM Eastern Daylight Time			08/05/2021 01:13:11 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/medicare	Fallon Medicare Plus Blue HMO (HMO)	01	01		1			H9001	031	17	2022	Massachusetts except Dukes and Nantucket Counties	BRI, ESS, MID, NOR, PLY and SUF Counties	2	7091	2			2						fallonhealth.org/medicare-pharmacy	fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9001	032	14	1	01	01	H9001_032_14	4	1					0	07/13/2021	2022.01	07/13/2021 05:06:00 PM Eastern Daylight Time	08/05/2021 12:56:49 PM Eastern Daylight Time	08/05/2021 12:54:38 PM Eastern Daylight Time			08/05/2021 01:13:11 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/medicare	Fallon Medicare Plus Super Saver HMO (HMO)	01	01		1			H9001	032	14	2022	Massachusetts except Dukes and Nantucket Counties	Barnstable and Berkshire Counties	2	849	2			2						fallonhealth.org/medicare-pharmacy	fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9001	032	15	1	01	01	H9001_032_15	4	1					0	07/13/2021	2022.01	07/13/2021 06:14:02 PM Eastern Daylight Time	08/05/2021 12:56:55 PM Eastern Daylight Time	08/05/2021 12:54:42 PM Eastern Daylight Time			08/05/2021 01:13:11 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/medicare	Fallon Medicare Plus Super Saver HMO (HMO)	01	01		1			H9001	032	15	2022	Massachusetts except Dukes and Nantucket Counties	Worcester County	2	1802	2			2						fallonhealth.org/medicare-pharmacy	fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9001	032	16	1	01	01	H9001_032_16	4	1					0	07/13/2021	2022.01	07/13/2021 06:14:02 PM Eastern Daylight Time	08/05/2021 12:57:00 PM Eastern Daylight Time	08/05/2021 12:54:47 PM Eastern Daylight Time			08/05/2021 01:13:11 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/medicare	Fallon Medicare Plus Super Saver HMO (HMO)	01	01		1			H9001	032	16	2022	Massachusetts except Dukes and Nantucket Counties	Franklin, Hampden and Hampshire Counties	2	509	2			2						fallonhealth.org/medicare-pharmacy	fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9001	032	17	1	01	01	H9001_032_17	4	1					0	07/13/2021	2022.01	07/13/2021 06:14:02 PM Eastern Daylight Time	08/05/2021 12:57:04 PM Eastern Daylight Time	08/05/2021 12:54:51 PM Eastern Daylight Time			08/05/2021 01:13:11 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/medicare	Fallon Medicare Plus Super Saver HMO (HMO)	01	01		1			H9001	032	17	2022	Massachusetts except Dukes and Nantucket Counties	BRI, ESS, MID, NOR, PLY and SUF Counties	2	1320	2			2						fallonhealth.org/medicare-pharmacy	fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9001	034	14	1	01	01	H9001_034_14	5	1					0	09/28/2021	2022.01	09/28/2021 08:04:40 AM Eastern Daylight Time	08/05/2021 12:57:09 PM Eastern Daylight Time	08/05/2021 12:54:56 PM Eastern Daylight Time			09/28/2021 04:07:41 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/medicare	Fallon Medicare Plus Orange HMO (HMO)	01	01		1			H9001	034	14	2022	Massachusetts except Dukes and Nantucket Counties	Barnstable and Berkshire Counties	2	4282	2			2						fallonhealth.org/medicare-pharmacy	fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9001	034	15	1	01	01	H9001_034_15	5	1					0	09/28/2021	2022.01	09/28/2021 08:11:56 AM Eastern Daylight Time	08/05/2021 12:57:14 PM Eastern Daylight Time	08/05/2021 12:55:00 PM Eastern Daylight Time			09/28/2021 04:07:41 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/medicare	Fallon Medicare Plus Orange HMO (HMO)	01	01		1			H9001	034	15	2022	Massachusetts except Dukes and Nantucket Counties	Worcester County	2	35648	2			2						fallonhealth.org/medicare-pharmacy	fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9001	034	16	1	01	01	H9001_034_16	5	1					0	09/28/2021	2022.01	09/28/2021 08:11:56 AM Eastern Daylight Time	08/05/2021 12:57:21 PM Eastern Daylight Time	08/05/2021 12:55:03 PM Eastern Daylight Time			09/28/2021 04:07:41 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/medicare	Fallon Medicare Plus Orange HMO (HMO)	01	01		1			H9001	034	16	2022	Massachusetts except Dukes and Nantucket Counties	Franklin, Hampden and Hampshire Counties	2	6663	2			2						fallonhealth.org/medicare-pharmacy	fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9001	034	17	1	01	01	H9001_034_17	5	1					0	09/28/2021	2022.01	09/28/2021 08:11:57 AM Eastern Daylight Time	08/05/2021 12:57:27 PM Eastern Daylight Time	08/05/2021 12:55:07 PM Eastern Daylight Time			09/28/2021 04:07:41 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/medicare	Fallon Medicare Plus Orange HMO (HMO)	01	01		1			H9001	034	17	2022	Massachusetts except Dukes and Nantucket Counties	BRI, ESS, MID, NOR, PLY and SUF Counties	2	16901	2			2						fallonhealth.org/medicare-pharmacy	fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9001	035	0	1	01	01	H9001_035_0	4	1					0	07/13/2021	2022.01	07/13/2021 04:59:44 PM Eastern Daylight Time	08/05/2021 12:57:32 PM Eastern Daylight Time	08/05/2021 12:55:13 PM Eastern Daylight Time			08/05/2021 01:13:11 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/medicare	Fallon Medicare Plus Central Blue HMO (HMO)	01	01		1			H9001	035	0	2022	Worcester County		2	3630	2			2						www.fallonhealth.org/medicare-pharmacy	www.fallonhealth.org/medicare-formulary	www.fallonhealth.org/FindPhysician	(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9001	036	0	1	01	01	H9001_036_0	4	1					0	07/13/2021	2022.01	07/13/2021 05:01:26 PM Eastern Daylight Time	08/05/2021 12:57:38 PM Eastern Daylight Time	08/05/2021 12:55:18 PM Eastern Daylight Time			08/05/2021 01:13:11 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/medicare	Fallon Medicare Plus Central Green HMO (HMO)	01	01		1			H9001	036	0	2022	Worcester County		2	2271	2			2						fallonhealth.org/medicare-pharmacy	fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9001	037	0	1	01	01	H9001_037_0	5	1					0	09/28/2021	2022.01	09/28/2021 08:10:31 AM Eastern Daylight Time	08/05/2021 12:57:42 PM Eastern Daylight Time	08/05/2021 12:55:23 PM Eastern Daylight Time			09/28/2021 04:07:41 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/medicare	Fallon Medicare Plus Central Orange HMO (HMO)	01	01		1			H9001	037	0	2022	Worcester County		2	11435	2			2						fallonhealth.org/medicare-pharmacy	fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9001	803	0	1	01	01	H9001_803_0	2	1						06/03/2021	2022.01	06/03/2021 07:25:37 AM Eastern Daylight Time					06/04/2021 09:40:15 AM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/medicare	MA-PD HMO (HMO)	01	01		1			H9001	803	0	2022	Full Service Area - Employer Groups		1	6708	2			2						fallonhealth.org/medicare-pharmacy	fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7d;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;8a;8b1;8b2;8b3;9a1;9b;18a;	2					1				
H9001	804	0	1	01	01	H9001_804_0	2	1						06/03/2021	2022.01	06/03/2021 07:25:47 AM Eastern Daylight Time					06/04/2021 09:40:15 AM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/medicare	MA-PD HMO PSP (HMO)	01	01		1			H9001	804	0	2022	Full Service Area - Employer Groups		1	751	2			2						fallonhealth.org/medicare-pharmacy	fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(800)325-5669		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7d;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				0	0	06/03/2021	2022.01	06/03/2021 07:25:54 AM Eastern Daylight Time					06/04/2021 09:40:15 AM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/medicare	MA-only HMO (HMO)	01	01		1			H9001	805	0	2022	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		(800)325-5669		(800)325-5669										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7d;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;8a;8b1;8b2;8b3;9a1;9b;18a;	2					1				
H9001	806	0	1	01	01	H9001_806_0	2	1				0	0	06/03/2021	2022.01	06/03/2021 07:26:01 AM Eastern Daylight Time					06/04/2021 09:40:15 AM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/medicare	MA-only non-calendar HMO (HMO)	01	01		1			H9001	806	0	2022	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		(800)325-5669		(800)325-5669										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7c;7d;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;8a;8b1;8b2;8b3;9a1;9b;18a;	2					1				
H9001	807	0	1	01	01	H9001_807_0	2	1				0	0	06/03/2021	2022.01	06/03/2021 07:26:08 AM Eastern Daylight Time					06/04/2021 09:40:15 AM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/medicare	MA-only HMO PSP (HMO)	01	01		1			H9001	807	0	2022	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		(800)325-5669		(800)325-5669										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7d;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;8a;8b1;8b2;8b3;9a1;9b;18a;	2					1				
H9001	808	0	1	01	01	H9001_808_0	2	1				0	0	06/03/2021	2022.01	06/03/2021 07:26:15 AM Eastern Daylight Time					06/04/2021 09:40:15 AM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/medicare	MA-only non-calendar HMO PSP (HMO)	01	01		1			H9001	808	0	2022	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		(800)325-5669		(800)325-5669										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7d;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;8a;8b1;8b2;8b3;9a1;9b;18a;	2					1				
H9003	001	0	1	01	01	H9003_001_0	8	1					0	08/02/2021	2022.01	08/02/2021 01:55:24 PM Pacific Daylight Time	08/02/2021 10:46:39 AM Pacific Daylight Time	08/02/2021 10:52:59 AM Pacific Daylight Time			08/04/2021 12:05:39 PM Pacific Daylight Time	KAISER FOUNDATION HP OF THE N W	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Enhanced (HMO)	01	01		1			H9003	001	0	2022	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	8	1					0	08/02/2021	2022.01	08/02/2021 02:57:33 PM Pacific Daylight Time	08/02/2021 10:47:08 AM Pacific Daylight Time	08/02/2021 10:54:12 AM Pacific Daylight Time			08/04/2021 12:05:39 PM Pacific Daylight Time	KAISER FOUNDATION HP OF THE N W	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Standard (HMO)	01	01		1			H9003	006	0	2022	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	007	0	1	01	01	H9003_007_0	8	1					0	08/02/2021	2022.01	08/02/2021 11:16:11 AM Pacific Daylight Time	08/02/2021 10:47:37 AM Pacific Daylight Time	08/02/2021 10:55:20 AM Pacific Daylight Time			08/04/2021 12:05:39 PM Pacific Daylight Time	KAISER FOUNDATION HP OF THE N W	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Standard Lane (HMO)	01	01		1			H9003	007	0	2022	Lane County		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	008	0	1	01	01	H9003_008_0	8	1					0	08/02/2021	2022.01	08/02/2021 11:16:46 AM Pacific Daylight Time	08/02/2021 10:48:10 AM Pacific Daylight Time	08/02/2021 10:56:29 AM Pacific Daylight Time			08/04/2021 12:05:39 PM Pacific Daylight Time	KAISER FOUNDATION HP OF THE N W	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Value Lane (HMO)	01	01		1			H9003	008	0	2022	Lane County		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	009	0	1	01	01	H9003_009_0	8	1					0	08/02/2021	2022.01	08/02/2021 02:58:36 PM Pacific Daylight Time	08/02/2021 10:48:41 AM Pacific Daylight Time	08/02/2021 10:58:31 AM Pacific Daylight Time			08/04/2021 12:05:39 PM Pacific Daylight Time	KAISER FOUNDATION HP OF THE N W	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Value (HMO)	01	01		1			H9003	009	0	2022	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	5	1						05/18/2021	2022.01	05/18/2021 03:42:22 PM Pacific Daylight Time					06/04/2021 11:42:42 AM 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	2022	Portland Metro, SW WA, Marion and Lane Counties		1	243334	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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;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;3-4;5;6;7b;7c;7d;7f;7g;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;16b;	1					2				
H9003	802	0	1	01	01	H9003_802_0	5	1				0	0	05/18/2021	2022.01	05/18/2021 03:43:36 PM Pacific Daylight Time					06/04/2021 11:42:42 AM 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	2022	Portland Metro, SW WA, Marion and Lane Counties		1	44659	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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;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;3-4;5;6;7b;7c;7d;7f;7g;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;16b;	1					2				
H9003	805	0	1	01	01	H9003_805_0	5	1						05/18/2021	2022.01	05/18/2021 03:43:47 PM Pacific Daylight Time					06/04/2021 11:42:42 AM 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	2022	Portland Metro, SW WA, Marion and Lane Counties		1	51479	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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;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;3-4;5;6;7b;7c;7d;7f;7g;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;16b;	1					2				
H9042	001	1	1	04	01	H9042_001_1	7	1					1	08/05/2021	2022.01	08/05/2021 12:54:34 PM Central Daylight Time	08/05/2021 11:52:59 AM Central Daylight Time	08/04/2021 11:55:52 AM Central Daylight Time			08/05/2021 03:25:40 PM Central Daylight Time	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	MyTruAdvantage	www.mytruadvantage.com	MyTruAdvantage Choice (PPO)	01	04		1			H9042	001	1	2022	Select Counties in Indiana	Segment 1	2		2			2						www.mytruadvantage.com	www.mytruadvantage.com	www.mytruadvantage.com	(844)425-4280		(812)348-4576		(833)213-6731		(812)314-2505		(844)283-2788		(844)283-2788		(833)213-6731		(812)314-2505		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9042	001	2	1	04	01	H9042_001_2	7	1					1	08/05/2021	2022.01	08/05/2021 12:56:49 PM Central Daylight Time	08/05/2021 11:55:10 AM Central Daylight Time	08/04/2021 11:57:27 AM Central Daylight Time			08/05/2021 03:25:40 PM Central Daylight Time	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	MyTruAdvantage	www.mytruadvantage.com	MyTruAdvantage Choice (PPO)	01	04		1			H9042	001	2	2022	Select Counties in Indiana	Segment 2	2		2			2						www.mytruadvantage.com	www.mytruadvantage.com	www.mytruadvantage.com	(844)425-4280		(812)348-4576		(833)213-6731		(812)314-2505		(844)283-2788		(844)283-2788		(833)213-6731		(812)314-2505		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9047	013	0	2	01	01	H9047_013_0	6	1					0	08/05/2021	2022.01	08/05/2021 09:35:41 AM Pacific Daylight Time	08/04/2021 01:11:36 PM Pacific Daylight Time	08/04/2021 02:04:18 PM Pacific Daylight Time			08/05/2021 01:53:06 PM Pacific Daylight Time	PROVIDENCE HEALTH ASSURANCE	Providence Medicare Advantage Plans	www.ProvidenceHealthAssurance.com	Providence Medicare Extra Part B Only + RX (HMO)	01	01		2	1		H9047	013	0	2022	Portland Metro and Willamette Valley		2	12	2			2						providencehealthassurance.com	providencehealthassurance.com	www.providencehealthassurance.com/findaprovider	(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	6	1				0	0	07/15/2021	2022.01	07/15/2021 02:16:20 PM Pacific Daylight Time	06/23/2021 09:46:25 PM Pacific Daylight Time				07/16/2021 02:50:54 PM Pacific Daylight Time	PROVIDENCE HEALTH ASSURANCE	Providence Medicare Advantage Plans	www.ProvidenceHealthAssurance.com	Providence Medicare Focus Medical (HMO)	01	01		1			H9047	033	0	2022	Portland Metro, Willamette Valley, Clark County		2	4519	2			2						providencehealthassurance.com	providencehealthassurance.com	www.providencehealthassurance.com/findaprovider	(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	6	1				0	0	07/15/2021	2022.01	07/15/2021 02:16:44 PM Pacific Daylight Time	06/23/2021 09:47:27 PM Pacific Daylight Time				07/16/2021 02:50:54 PM Pacific Daylight Time	PROVIDENCE HEALTH ASSURANCE	Providence Medicare Advantage Plans	www.ProvidenceHealthAssurance.com	Providence Medicare Select Medical (HMO-POS)	01	02		1			H9047	035	0	2022	Portland Metro, Willamette Valley, Clark County		2	8707	2			2						providencehealthassurance.com	providencehealthassurance.com	www.providencehealthassurance.com/findaprovider	(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	7	1					1	08/05/2021	2022.01	08/05/2021 08:48:01 AM Pacific Daylight Time	08/04/2021 01:12:24 PM Pacific Daylight Time	08/04/2021 02:04:18 PM Pacific Daylight Time			08/05/2021 01:53:06 PM Pacific Daylight Time	PROVIDENCE HEALTH ASSURANCE	Providence Medicare Advantage Plans	www.ProvidenceHealthAssurance.com	Providence Medicare Prime + RX (HMO)	01	01		1			H9047	037	0	2022	Portland Metro		2	164478	2			2						providencehealthassurance.com	providencehealthassurance.com	www.providencehealthassurance.com/findaprovider	(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	8	1					1	08/05/2021	2022.01	08/05/2021 08:48:12 AM Pacific Daylight Time	08/04/2021 01:13:15 PM Pacific Daylight Time	08/04/2021 02:04:18 PM Pacific Daylight Time			08/05/2021 01:53:06 PM Pacific Daylight Time	PROVIDENCE HEALTH ASSURANCE	Providence Medicare Advantage Plans	www.ProvidenceHealthAssurance.com	Providence Medicare Latitude + RX (HMO-POS)	01	02		1			H9047	038	0	2022	Central OR, Hood River		2	2406	2			2						providencehealthassurance.com	providencehealthassurance.com	www.providencehealthassurance.com/findaprovider	(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	7	1					1	08/05/2021	2022.01	08/05/2021 08:48:21 AM Pacific Daylight Time	08/04/2021 01:13:59 PM Pacific Daylight Time	08/04/2021 02:04:18 PM Pacific Daylight Time			08/05/2021 01:53:06 PM Pacific Daylight Time	PROVIDENCE HEALTH ASSURANCE	Providence Medicare Advantage Plans	www.ProvidenceHealthAssurance.com	Providence Medicare Compass + RX (HMO-POS)	01	02		1			H9047	039	0	2022	Central OR, Hood River		2	14290	2			2						providencehealthassurance.com	providencehealthassurance.com	www.providencehealthassurance.com/findaprovider	(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			0	08/04/2021	2022.01	08/04/2021 03:44:41 PM Pacific Daylight Time	08/04/2021 01:14:38 PM Pacific Daylight Time	08/04/2021 02:04:19 PM Pacific Daylight Time			08/05/2021 01:53:06 PM Pacific Daylight Time	PROVIDENCE HEALTH ASSURANCE	Providence Medicare Advantage Plans	www.ProvidenceHealthAssurance.com	Providence Medicare Dual Plus (HMO D-SNP)	01	01		1			H9047	043	0	2022	Portland Metro		2	19236	2			1	3		2		2	providencehealthassurance.com	providencehealthassurance.com	www.providencehealthassurance.com/findaprovider	(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	7	1					0	08/05/2021	2022.01	08/05/2021 09:47:55 AM Pacific Daylight Time	08/05/2021 08:42:15 AM Pacific Daylight Time	08/04/2021 02:04:19 PM Pacific Daylight Time			08/05/2021 01:53:06 PM Pacific Daylight Time	PROVIDENCE HEALTH ASSURANCE	Providence Medicare Advantage Plans	www.ProvidenceHealthAssurance.com	Providence Medicare Enrich + RX (HMO)	01	01		1			H9047	045	0	2022	Linn and Benton Counties		2	1059	2			2						providencehealthassurance.com	providencehealthassurance.com	www.providencehealthassurance.com/findaprovider	(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					1	08/05/2021	2022.01	08/05/2021 08:48:56 AM Pacific Daylight Time	08/04/2021 01:33:08 PM Pacific Daylight Time	08/04/2021 02:04:19 PM Pacific Daylight Time			08/05/2021 01:53:06 PM Pacific Daylight Time	PROVIDENCE HEALTH ASSURANCE	Providence Medicare Advantage Plans	www.ProvidenceHealthAssurance.com	Providence Medicare Summit + RX (HMO-POS)	01	02		1			H9047	047	0	2022	Snohomish County		2	999	2			2						providencehealthassurance.com	providencehealthassurance.com	www.providencehealthassurance.com/findaprovider	(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					1	08/05/2021	2022.01	08/05/2021 08:49:06 AM Pacific Daylight Time	08/04/2021 01:33:53 PM Pacific Daylight Time	08/04/2021 02:04:20 PM Pacific Daylight Time			08/05/2021 01:53:06 PM Pacific Daylight Time	PROVIDENCE HEALTH ASSURANCE	Providence Medicare Advantage Plans	www.ProvidenceHealthAssurance.com	Providence Medicare Harbor + RX (HMO)	01	01		1			H9047	049	0	2022	Snohomish County		2	3647	2			2						providencehealthassurance.com	providencehealthassurance.com	www.providencehealthassurance.com/findaprovider	(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					1	08/05/2021	2022.01	08/05/2021 08:49:15 AM Pacific Daylight Time	08/04/2021 01:34:39 PM Pacific Daylight Time	08/04/2021 02:04:20 PM Pacific Daylight Time			08/05/2021 01:53:06 PM Pacific Daylight Time	PROVIDENCE HEALTH ASSURANCE	Providence Medicare Advantage Plans	www.ProvidenceHealthAssurance.com	Providence Medicare Timber + RX (HMO)	01	01		1			H9047	054	0	2022	Columbia, Lane, Marion, Polk, Clark Counties		2	62061	2			2						providencehealthassurance.com	providencehealthassurance.com	www.providencehealthassurance.com/findaprovider	(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	055	1	1	01	01	H9047_055_1	7	1					1	08/05/2021	2022.01	08/05/2021 08:49:25 AM Pacific Daylight Time	08/04/2021 01:35:18 PM Pacific Daylight Time	08/04/2021 02:04:21 PM Pacific Daylight Time			08/05/2021 01:53:06 PM Pacific Daylight Time	PROVIDENCE HEALTH ASSURANCE	Providence Medicare Advantage Plans	www.ProvidenceHealthAssurance.com	Providence Medicare Extra + RX (HMO)	01	01		1			H9047	055	1	2022	Portland Metro, Clark, Columbia, Lane, Marion,Polk	Portland Metro Area	2	60588	2			2						providencehealthassurance.com	providencehealthassurance.com	www.providencehealthassurance.com/findaprovider	(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	055	2	1	01	01	H9047_055_2	7	1					1	08/05/2021	2022.01	08/05/2021 08:49:36 AM Pacific Daylight Time	08/04/2021 01:35:59 PM Pacific Daylight Time	08/04/2021 02:04:21 PM Pacific Daylight Time			08/05/2021 01:53:06 PM Pacific Daylight Time	PROVIDENCE HEALTH ASSURANCE	Providence Medicare Advantage Plans	www.ProvidenceHealthAssurance.com	Providence Medicare Extra + RX (HMO)	01	01		1			H9047	055	2	2022	Portland Metro, Clark, Columbia, Lane, Marion,Polk	Willamette Valley, Clark + Columbia Counties	2	8877	2			2						providencehealthassurance.com	providencehealthassurance.com	www.providencehealthassurance.com/findaprovider	(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	056	1	1	02	01	H9047_056_1	7	1					1	08/05/2021	2022.01	08/05/2021 08:49:46 AM Pacific Daylight Time	08/04/2021 01:45:18 PM Pacific Daylight Time	08/04/2021 02:04:21 PM Pacific Daylight Time			08/05/2021 01:53:06 PM Pacific Daylight Time	PROVIDENCE HEALTH ASSURANCE	Providence Medicare Advantage Plans	www.ProvidenceHealthAssurance.com	Providence Medicare Choice + RX (HMO-POS)	01	02		1			H9047	056	1	2022	Portland Metro, Clark, Columbia, Lane, Marion,Polk	Portland Metro Area	2	174660	2			2						providencehealthassurance.com	providencehealthassurance.com	www.providencehealthassurance.com/findaprovider	(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	056	2	1	02	01	H9047_056_2	7	1					1	08/05/2021	2022.01	08/05/2021 08:49:55 AM Pacific Daylight Time	08/04/2021 01:39:21 PM Pacific Daylight Time	08/04/2021 02:04:22 PM Pacific Daylight Time			08/05/2021 01:53:06 PM Pacific Daylight Time	PROVIDENCE HEALTH ASSURANCE	Providence Medicare Advantage Plans	www.ProvidenceHealthAssurance.com	Providence Medicare Choice + RX (HMO-POS)	01	02		1			H9047	056	2	2022	Portland Metro, Clark, Columbia, Lane, Marion,Polk	Columbia, Lane, Marion, Polk, Clark Counties	2	37355	2			2						providencehealthassurance.com	providencehealthassurance.com	www.providencehealthassurance.com/findaprovider	(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	059	0	1	02	01	H9047_059_0	7	1					1	08/05/2021	2022.01	08/05/2021 08:50:04 AM Pacific Daylight Time	08/04/2021 01:42:57 PM Pacific Daylight Time	08/04/2021 02:04:22 PM Pacific Daylight Time			08/05/2021 01:53:06 PM Pacific Daylight Time	PROVIDENCE HEALTH ASSURANCE	Providence Medicare Advantage Plans	www.ProvidenceHealthAssurance.com	Providence Medicare Bridge 1 + RX (HMO-POS)	01	02		1			H9047	059	0	2022	Portland Metro Area		2	65738	2			2						providencehealthassurance.com	providencehealthassurance.com	www.providencehealthassurance.com/findaprovider	(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	060	0	1	02	01	H9047_060_0	7	1					1	08/05/2021	2022.01	08/05/2021 08:50:13 AM Pacific Daylight Time	08/04/2021 01:46:24 PM Pacific Daylight Time	08/04/2021 02:04:22 PM Pacific Daylight Time			08/05/2021 01:53:06 PM Pacific Daylight Time	PROVIDENCE HEALTH ASSURANCE	Providence Medicare Advantage Plans	www.ProvidenceHealthAssurance.com	Providence Medicare Bridge 2 + RX (HMO-POS)	01	02		1			H9047	060	0	2022	Clark, Columbia, Lane, Marion, Polk Counties		2	17274	2			2						providencehealthassurance.com	providencehealthassurance.com	www.providencehealthassurance.com/findaprovider	(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	062	0	1	02	01	H9047_062_0	7	1					1	08/05/2021	2022.01	08/05/2021 08:50:23 AM Pacific Daylight Time	08/04/2021 01:47:04 PM Pacific Daylight Time	08/04/2021 02:04:23 PM Pacific Daylight Time			08/05/2021 01:53:06 PM Pacific Daylight Time	PROVIDENCE HEALTH ASSURANCE	Providence Medicare Advantage Plans	www.ProvidenceHealthAssurance.com	Providence Medicare Cottonwood + RX (HMO-POS)	01	02		1			H9047	062	0	2022	Spokane		2	4327	2			2						providencehealthassurance.com	providencehealthassurance.com	www.providencehealthassurance.com/findaprovider	(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	063	0	1	01	01	H9047_063_0	7	1					1	08/05/2021	2022.01	08/05/2021 08:50:33 AM Pacific Daylight Time	08/04/2021 01:48:38 PM Pacific Daylight Time	08/04/2021 02:04:23 PM Pacific Daylight Time			08/05/2021 01:53:06 PM Pacific Daylight Time	PROVIDENCE HEALTH ASSURANCE	Providence Medicare Advantage Plans	www.ProvidenceHealthAssurance.com	Providence Medicare Pine + RX (HMO)	01	01		1			H9047	063	0	2022	Spokane		2	3468	2			2						providencehealthassurance.com	providencehealthassurance.com	www.providencehealthassurance.com/findaprovider	(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						07/15/2021	2022.01	07/15/2021 01:13:33 PM Pacific Daylight Time					07/16/2021 02:50:54 PM Pacific Daylight Time	PROVIDENCE HEALTH ASSURANCE	Providence Medicare Advantage Plans	www.ProvidenceHealthAssurance.com	Providence Medicare Align Group Plan + RX (HMO)	01	01		1			H9047	804	0	2022	Portland, Willamette Valley,Central OR, Washington		1	12540	2			2						providencehealthassurance.com	providencehealthassurance.com	www.providencehealthassurance.com/findaprovider	(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	5	1						07/16/2021	2022.01	07/16/2021 09:58:21 AM Pacific Daylight Time					07/16/2021 02:50:54 PM Pacific Daylight Time	PROVIDENCE HEALTH ASSURANCE	Providence Medicare Advantage Plans	www.ProvidenceHealthAssurance.com	Providence Medicare Discover Group Plan + RX (HMO-POS)	01	02		1			H9047	805	0	2022	Portland, Willamette Valley,Central OR, Washington		1	3180	2			2						providencehealthassurance.com	providencehealthassurance.com	www.providencehealthassurance.com/findaprovider	(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	808	0	1	01	01	H9047_808_0	5	1						07/15/2021	2022.01	07/15/2021 01:06:25 PM Pacific Daylight Time					07/16/2021 02:50:54 PM Pacific Daylight Time	PROVIDENCE HEALTH ASSURANCE	Providence Medicare Advantage Plans	www.ProvidenceHealthAssurance.com	Providence Medicare Align Group Plan + RX (HMO)	01	01		1			H9047	808	0	2022	Portland, Willamette Valley,Central OR, Washington		1	91872	2			2						providencehealthassurance.com	providencehealthassurance.com	www.providencehealthassurance.com/findaprovider	(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	5	1						07/15/2021	2022.01	07/15/2021 01:47:22 PM Pacific Daylight Time					07/16/2021 02:50:54 PM Pacific Daylight Time	PROVIDENCE HEALTH ASSURANCE	Providence Medicare Advantage Plans	www.ProvidenceHealthAssurance.com	Providence Medicare Flex Group Plan + RX (HMO-POS)	01	02		1			H9047	809	0	2022	Portland, Willamette Valley,Central OR, Washington		1	51456	2			2						providencehealthassurance.com	providencehealthassurance.com	www.providencehealthassurance.com/findaprovider	(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			
H9052	001	0	1	20	08	H9052_001_0	1	1						09/08/2021	2022.01	09/08/2021 04:21:39 PM Eastern Daylight Time		09/08/2021 03:36:46 PM Eastern Daylight Time			09/08/2021 04:22:37 PM Eastern Daylight Time	REGION VII AREA AGENCY ON AGING	Sunrise PACE	https://region7aaa.org/	Dual Eligible Plan 01 (PACE)	08	20		1			H9052	001	0	2022	Huron, Sanilac, Tuscola, St. Clair		2		2			2						N/A	N/A										(888)291-2647		(810)388-6300		(888)291-2647		(810)388-6300												(810)388-6300				(810)388-6300																
H9052	002	0	1	20	08	H9052_002_0	1	1						09/08/2021	2022.01	09/08/2021 04:21:56 PM Eastern Daylight Time		09/08/2021 03:36:46 PM Eastern Daylight Time			09/08/2021 04:22:37 PM Eastern Daylight Time	REGION VII AREA AGENCY ON AGING	Sunrise PACE	https://region7aaa.org/	Medicare Only 02 (PACE)	08	20		1			H9052	002	0	2022	Huron, Sanilac, Tuscola, St. Clair		2		2			2						N/A	N/A										(888)291-2647		(810)388-6300		(888)291-2647		(810)388-6300												(810)388-6300				(810)388-6300																
H9065	001	0	1	01	01	H9065_001_0	7	1	2	1	1		0	07/18/2021	2022.01	07/18/2021 01:04:46 PM Eastern Daylight Time	08/03/2021 06:04:01 PM Eastern Daylight Time	08/03/2021 06:04:01 PM Eastern Daylight Time			08/04/2021 02:06:25 PM Eastern Daylight Time	AMH HEALTH, LLC	AMH Health	https://shop.anthem.com/medicare	Anthem l MaineHealth Advantage Dual Plus (HMO D-SNP)	01	01		1			H9065	001	0	2022	State of Maine		2		2			1	3		1		1	https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	(844)231-0247		(844)231-0247		(855)793-1929		(855)793-1929		(833)377-4263		(833)377-4263		(855)499-1106		(855)499-1106		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9065	002	0	1	02	01	H9065_002_0	7	1			2		1	07/18/2021	2022.01	07/18/2021 01:05:01 PM Eastern Daylight Time	08/03/2021 06:04:01 PM Eastern Daylight Time	08/03/2021 06:04:01 PM Eastern Daylight Time			08/04/2021 02:06:25 PM Eastern Daylight Time	AMH HEALTH, LLC	AMH Health	https://shop.anthem.com/medicare	Anthem l MaineHealth Advantage Choice (HMO-POS)	01	02		1			H9065	002	0	2022	Cumberland and York Counties		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	(844)209-6376		(844)209-6376		(855)793-1930		(855)793-1930		(833)377-4263		(833)377-4263		(855)523-0678		(855)523-0678		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9065	003	0	1	02	01	H9065_003_0	6	1			2		0	07/18/2021	2022.01	07/18/2021 01:05:11 PM Eastern Daylight Time	08/03/2021 06:04:01 PM Eastern Daylight Time	08/03/2021 06:04:01 PM Eastern Daylight Time			08/04/2021 02:06:25 PM Eastern Daylight Time	AMH HEALTH, LLC	AMH Health	https://shop.anthem.com/medicare	Anthem l MaineHealth Advantage Choice (HMO-POS)	01	02		1			H9065	003	0	2022	Select Counties in ME		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	(844)209-6376		(844)209-6376		(855)793-1930		(855)793-1930		(833)377-4263		(833)377-4263		(855)523-0678		(855)523-0678		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9065	004	0	1	02	01	H9065_004_0	7	1			2		0	07/18/2021	2022.01	07/18/2021 01:05:22 PM Eastern Daylight Time	08/03/2021 06:04:01 PM Eastern Daylight Time	08/03/2021 06:04:01 PM Eastern Daylight Time			08/04/2021 02:06:25 PM Eastern Daylight Time	AMH HEALTH, LLC	AMH Health	https://shop.anthem.com/medicare	Anthem l MaineHealth Advantage Choice (HMO-POS)	01	02		1			H9065	004	0	2022	Select Counties in ME		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	(844)209-6376		(844)209-6376		(855)793-1930		(855)793-1930		(833)377-4263		(833)377-4263		(855)523-0678		(855)523-0678		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9065	005	0	1	01	01	H9065_005_0	6	1			2		0	07/15/2021	2022.01	07/15/2021 10:33:39 AM Eastern Daylight Time	08/03/2021 06:04:01 PM Eastern Daylight Time	08/03/2021 06:04:01 PM Eastern Daylight Time			08/04/2021 02:06:25 PM Eastern Daylight Time	AMH HEALTH, LLC	AMH Health	https://shop.anthem.com/medicare	Anthem l MaineHealth Advantage Extra (HMO)	01	01		1			H9065	005	0	2022	Cumberland and York Counties		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	(844)209-6376		(844)209-6376		(855)793-1931		(855)793-1931		(833)377-4263		(833)377-4263		(855)523-0679		(855)523-0679		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9065	006	0	1	01	01	H9065_006_0	6	1			2		0	07/15/2021	2022.01	07/15/2021 10:34:37 AM Eastern Daylight Time	08/03/2021 06:04:01 PM Eastern Daylight Time	08/03/2021 06:04:01 PM Eastern Daylight Time			08/04/2021 02:06:25 PM Eastern Daylight Time	AMH HEALTH, LLC	AMH Health	https://shop.anthem.com/medicare	Anthem l MaineHealth Advantage Extra (HMO)	01	01		1			H9065	006	0	2022	Select Counties in ME		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	(844)209-6376		(844)209-6376		(855)793-1931		(855)793-1931		(833)377-4263		(833)377-4263		(855)523-0679		(855)523-0679		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9065	007	0	1	01	01	H9065_007_0	6	1			2		0	07/15/2021	2022.01	07/15/2021 10:35:10 AM Eastern Daylight Time	08/03/2021 06:04:01 PM Eastern Daylight Time	08/03/2021 06:04:01 PM Eastern Daylight Time			08/04/2021 02:06:25 PM Eastern Daylight Time	AMH HEALTH, LLC	AMH Health	https://shop.anthem.com/medicare	Anthem l MaineHealth Advantage Extra (HMO)	01	01		1			H9065	007	0	2022	Select Counties in ME		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	(844)209-6376		(844)209-6376		(855)793-1931		(855)793-1931		(833)377-4263		(833)377-4263		(855)523-0679		(855)523-0679		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9065	008	0	1	01	01	H9065_008_0	7	1			2		1	08/03/2021	2022.01	08/03/2021 01:21:12 PM Eastern Daylight Time	08/03/2021 06:04:01 PM Eastern Daylight Time	08/03/2021 06:04:01 PM Eastern Daylight Time			08/04/2021 02:06:25 PM Eastern Daylight Time	AMH HEALTH, LLC	AMH Health	https://shop.anthem.com/medicare	Anthem l MaineHealth Advantage Plus (HMO)	01	01		1			H9065	008	0	2022	Select Counties in Maine		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	(844)209-6376		(844)209-6376		(855)793-1931		(855)793-1931		(833)377-4263		(833)377-4263		(855)523-0679		(855)523-0679		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9066	001	0	1	01	01	H9066_001_0	6	1	2	1			0	08/02/2021	2022.01	08/02/2021 09:09:19 AM Eastern Daylight Time	07/30/2021 04:05:00 PM Eastern Daylight Time	08/13/2021 03:48:54 PM Eastern Daylight Time			08/13/2021 04:04:29 PM Eastern Daylight Time	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Nascentia Health Plus	www.Nascentiahealthplus.org	Nascentia Medicaid Advantage Plus (HMO D-SNP)	01	01		1			H9066	001	0	2022	Upstate New York		2	4864	2			1	3		1		1	www.envisionrx.com	www.envisionrx.com	www.Nascentiahealthplus.org	(888)477-4663		(888)477-4663		(888)477-4663		(888)477-4663		(833)459-4424		(833)459-4424		(888)477-4663		(888)477-4663		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9066	002	0	1	01	01	H9066_002_0	5	1		1			0	08/02/2021	2022.01	08/02/2021 09:10:57 AM Eastern Daylight Time	07/30/2021 04:06:44 PM Eastern Daylight Time	07/30/2021 11:07:00 AM Eastern Daylight Time			08/03/2021 11:01:45 AM Eastern Daylight Time	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Nascentia Health Plus	www.Nascentiahealthplus.org	Nascentia Skilled Nursing Facility (HMO I-SNP)	01	01		1			H9066	002	0	2022	Upstate New York		2	1425	2			1	1	1				www.envisionrx.com	www.envisionrx.com	www.Nascentiahealthplus.org	(888)477-4663		(888)477-4663		(888)477-4663		(888)477-4663		(833)459-4424		(833)459-4424		(888)477-4663		(888)477-4663		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9066	003	0	1	01	01	H9066_003_0	5	1	2	1			0	08/02/2021	2022.01	08/02/2021 09:09:46 AM Eastern Daylight Time	07/30/2021 04:08:26 PM Eastern Daylight Time	07/30/2021 11:08:50 AM Eastern Daylight Time			08/03/2021 11:01:45 AM Eastern Daylight Time	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Nascentia Health Plus	www.Nascentiahealthplus.org	Nascentia Dual Advantage (HMO D-SNP)	01	01		1			H9066	003	0	2022	Upstate New York		2	2796	2			1	3		2		1	www.envisionrx.com	www.envisionrx.com	www.Nascentiahealthplus.org	(888)477-4663		(888)477-4663		(888)477-4663		(888)477-4663		(833)459-4424		(833)459-4424		(888)477-4663		(888)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						06/03/2021	2022.01	06/03/2021 01:16:58 PM Eastern Daylight Time		06/03/2021 12:38:28 PM Eastern Daylight Time			06/03/2021 01:19:35 PM Eastern Daylight Time	ALBRIGHT CARE SERVICES	ALBRIGHT CARE SERVICES	www.albrightlife.org	Albright LIFE (PACE)	08	20		1			H9068	001	0	2022	Lanc,Leb,Lyco,Union, part Chester,Clinton,North'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						06/03/2021	2022.01	06/03/2021 01:17:15 PM Eastern Daylight Time		06/03/2021 12:38:28 PM Eastern Daylight Time			06/03/2021 01:19:35 PM Eastern Daylight Time	ALBRIGHT CARE SERVICES	ALBRIGHT CARE SERVICES	www.albrightlife.org	Albright LIFE Medicare Only (PACE)	08	20		1			H9068	002	0	2022	Lanc,Leb,Lyco,Union, part Chester,Clinton,North'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	002	0	1	04	01	H9070_002_0	5	1			1		0	07/09/2021	2022.01	07/09/2021 02:49:11 PM Eastern Daylight Time	08/03/2021 05:45:30 PM Eastern Daylight Time	07/30/2021 12:08:50 PM Eastern Daylight Time			08/04/2021 02:54:56 PM Eastern Daylight Time	COMPBENEFITS INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Value Plus H9070-002 (PPO)	01	04		1			H9070	002	0	2022	Select Counties in Oklahoma		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9070	003	0	1	04	01	H9070_003_0	6	1			1		0	08/01/2021	2022.01	08/01/2021 12:58:15 PM Eastern Daylight Time	08/03/2021 05:59:20 PM Eastern Daylight Time	07/30/2021 12:09:04 PM Eastern Daylight Time			08/04/2021 02:54:56 PM Eastern Daylight Time	COMPBENEFITS INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H9070-003 (PPO)	01	04		1			H9070	003	0	2022	Select Counties in Kansas and Missouri		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9070	004	0	1	04	01	H9070_004_0	6	1			1		1	08/02/2021	2022.01	08/02/2021 12:37:43 PM Eastern Daylight Time	08/03/2021 06:03:22 PM Eastern Daylight Time	07/30/2021 12:09:14 PM Eastern Daylight Time			08/04/2021 02:54:56 PM Eastern Daylight Time	COMPBENEFITS INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H9070-004 (PPO)	01	04		1			H9070	004	0	2022	Select Counties in Kansas		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9070	005	0	1	04	01	H9070_005_0	5	1			1		1	08/02/2021	2022.01	08/02/2021 04:32:41 PM Eastern Daylight Time	08/03/2021 06:27:07 PM Eastern Daylight Time	07/30/2021 12:09:26 PM Eastern Daylight Time			08/04/2021 02:23:59 PM Eastern Daylight Time	COMPBENEFITS INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H9070-005 (PPO)	01	04		1			H9070	005	0	2022	Select Counties in Arkansas		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9070	006	1	1	04	01	H9070_006_1	6	1			1		1	08/02/2021	2022.01	08/02/2021 12:39:29 PM Eastern Daylight Time	08/03/2021 06:07:20 PM Eastern Daylight Time	07/30/2021 12:09:38 PM Eastern Daylight Time			08/04/2021 02:54:56 PM Eastern Daylight Time	COMPBENEFITS INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H9070-006 (PPO)	01	04		1			H9070	006	1	2022	Select Counties in Oklahoma	Oklahoma Rural	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9070	006	2	1	04	01	H9070_006_2	4	1			1		1	08/02/2021	2022.01	08/02/2021 04:36:02 PM Eastern Daylight Time	08/03/2021 06:32:48 PM Eastern Daylight Time	07/30/2021 12:09:52 PM Eastern Daylight Time			08/04/2021 02:54:56 PM Eastern Daylight Time	COMPBENEFITS INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H9070-006 (PPO)	01	04		1			H9070	006	2	2022	Select Counties in Oklahoma	Oklahoma City	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9070	006	3	1	04	01	H9070_006_3	6	1			1		1	08/01/2021	2022.01	08/01/2021 01:05:35 PM Eastern Daylight Time	08/03/2021 06:08:39 PM Eastern Daylight Time	07/30/2021 12:10:04 PM Eastern Daylight Time			08/04/2021 02:54:56 PM Eastern Daylight Time	COMPBENEFITS INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H9070-006 (PPO)	01	04		1			H9070	006	3	2022	Select Counties in Oklahoma	Tulsa	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9078	001	0	1	01	01	H9078_001_0	7	1					0	06/02/2021	2022.01	06/02/2021 04:21:18 PM Central Daylight Time	07/30/2021 06:22:14 PM Central Daylight Time	07/30/2021 02:00:50 PM Central Daylight Time			08/04/2021 02:20:08 PM Central Daylight Time	GLOBALHEALTH OF ARIZONA, INC.	GlobalHealth	www.GlobalHealth.com/medicare	Global Classic (HMO)	01	01		1			H9078	001	0	2022	Maricopa County		2	3611	2			2						www.GlobalHealth.com/pharmacy-directories	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)-		2					2					2	2			
H9078	003	0	1	01	01	H9078_003_0	7	1					0	06/02/2021	2022.01	06/02/2021 04:21:27 PM Central Daylight Time	07/30/2021 06:23:16 PM Central Daylight Time	07/30/2021 02:01:04 PM Central Daylight Time			08/04/2021 02:20:08 PM Central Daylight Time	GLOBALHEALTH OF ARIZONA, INC.	GlobalHealth	www.GlobalHealth.com/medicare	Global Classic (HMO)	01	01		1			H9078	003	0	2022	Pima County		2	1295	2			2						www.GlobalHealth.com/pharmacy-directories	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)-		2					2					2	2			
H9078	007	0	1	01	01	H9078_007_0	7	1		1			1	06/03/2021	2022.01	06/03/2021 06:39:08 AM Central Daylight Time	07/30/2021 06:24:10 PM Central Daylight Time	07/30/2021 02:01:18 PM Central Daylight Time			08/04/2021 02:20:08 PM Central Daylight Time	GLOBALHEALTH OF ARIZONA, INC.	GlobalHealth	www.GlobalHealth.com/medicare	Global Special Care (HMO C-SNP)	01	01		1			H9078	007	0	2022	Maricopa County		2	451	2			1	4			00000000000000000010		www.GlobalHealth.com/pharmacy-directories	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)-		2					2					2	2			
H9078	008	0	1	01	01	H9078_008_0	8	1		1			1	06/03/2021	2022.01	06/03/2021 06:39:13 AM Central Daylight Time	07/30/2021 06:24:50 PM Central Daylight Time	07/30/2021 02:01:32 PM Central Daylight Time			08/04/2021 02:20:08 PM Central Daylight Time	GLOBALHEALTH OF ARIZONA, INC.	GlobalHealth	www.GlobalHealth.com/medicare	Global Special Care Savings (HMO C-SNP)	01	01		1			H9078	008	0	2022	Maricopa County		2	451	2			1	4			00000000000000000010		www.GlobalHealth.com/pharmacy-directories	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)-		2					2					2	2			
H9078	009	0	1	01	01	H9078_009_0	7	1		1			1	06/03/2021	2022.01	06/03/2021 06:39:20 AM Central Daylight Time	07/30/2021 06:25:28 PM Central Daylight Time	07/30/2021 02:01:46 PM Central Daylight Time			08/04/2021 02:20:08 PM Central Daylight Time	GLOBALHEALTH OF ARIZONA, INC.	GlobalHealth	www.GlobalHealth.com/medicare	Global Special Care (HMO C-SNP)	01	01		1			H9078	009	0	2022	Pima County		2	162	2			1	4			00000000000000000010		www.GlobalHealth.com/pharmacy-directories	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)-		2					2					2	2			
H9078	010	0	1	01	01	H9078_010_0	8	1		1			1	06/03/2021	2022.01	06/03/2021 06:39:25 AM Central Daylight Time	07/30/2021 06:26:26 PM Central Daylight Time	07/30/2021 02:02:02 PM Central Daylight Time			08/04/2021 02:20:08 PM Central Daylight Time	GLOBALHEALTH OF ARIZONA, INC.	GlobalHealth	www.GlobalHealth.com/medicare	Global Special Care Savings (HMO C-SNP)	01	01		1			H9078	010	0	2022	Pima County		2	162	2			1	4			00000000000000000010		www.GlobalHealth.com/pharmacy-directories	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)-		2					2					2	2			
H9082	009	0	1	01	01	H9082_009_0	5	1					0	08/05/2021	2022.01	08/05/2021 02:30:19 PM Pacific Daylight Time	08/04/2021 05:57:38 PM Pacific Daylight Time	08/04/2021 04:49:20 PM Pacific Daylight Time			08/05/2021 03:02:36 PM Pacific Daylight Time	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Molina Healthcare of New Mexico, Inc.	www.molinahealthcare.com/medicare	Molina Medicare Choice Care (HMO)	01	01		1			H9082	009	0	2022	Select Counties in New Mexico		2		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			
H9082	010	0	1	01	01	H9082_010_0	5	1					1	08/05/2021	2022.01	08/05/2021 02:30:51 PM Pacific Daylight Time	08/04/2021 05:58:28 PM Pacific Daylight Time	08/04/2021 04:49:46 PM Pacific Daylight Time			08/05/2021 03:02:36 PM Pacific Daylight Time	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Molina Healthcare of New Mexico, Inc.	www.molinahealthcare.com/medicare	Molina Medicare Choice Care Plus (HMO)	01	01		1			H9082	010	0	2022	Select Counties in New Mexico		2		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			
H9082	011	0	1	01	01	H9082_011_0	5	1					0	07/20/2021	2022.01	07/20/2021 03:50:17 PM Pacific Daylight Time	08/04/2021 05:59:38 PM Pacific Daylight Time	08/04/2021 04:50:10 PM Pacific Daylight Time			08/05/2021 03:02:36 PM Pacific Daylight Time	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Molina Healthcare of New Mexico, Inc.	www.molinahealthcare.com/medicare	Molina Medicare Choice Care Select (HMO)	01	01		1			H9082	011	0	2022	Select Counties in New Mexico		2		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	02	01	H9096_001_0	7	1					1	08/04/2021	2022.01	08/04/2021 09:15:26 AM Central Daylight Time	08/04/2021 09:26:04 AM Central Daylight Time	08/02/2021 08:23:09 PM Central Daylight Time			08/05/2021 12:48:08 PM Central Daylight Time	DEAN HEALTH PLAN, INC.	Dean Advantage, Prevea360 Medicare Advantage	www.deancare.com/medicare	Dean Advantage Assurance (HMO-POS)	01	02		1			H9096	001	0	2022	South Central Wisconsin		2		2			2						www.deancare.com	www.deancare.com	www.deancare.com/doctors	(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	02	01	H9096_002_0	7	1					1	08/04/2021	2022.01	08/04/2021 09:15:58 AM Central Daylight Time	08/04/2021 09:28:38 AM Central Daylight Time	08/02/2021 08:23:16 PM Central Daylight Time			08/05/2021 12:48:08 PM Central Daylight Time	DEAN HEALTH PLAN, INC.	Dean Advantage, Prevea360 Medicare Advantage	www.deancare.com/medicare	Dean Advantage Balance (HMO-POS)	01	02		1			H9096	002	0	2022	South Central Wisconsin		2		2			2						www.deancare.com	www.deancare.com	www.deancare.com/doctors	(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					1	08/04/2021	2022.01	08/04/2021 09:16:33 AM Central Daylight Time	08/02/2021 02:40:37 PM Central Daylight Time	08/02/2021 08:24:42 PM Central Daylight Time			08/05/2021 12:48:08 PM Central Daylight Time	DEAN HEALTH PLAN, INC.	Dean Advantage, Prevea360 Medicare Advantage	www.deancare.com/medicare	Dean Advantage Essential (HMO)	01	01		1			H9096	004	0	2022	South Central Wisconsin		2		2			2						www.deancare.com	www.deancare.com	www.deancare.com/doctors	(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					1	08/04/2021	2022.01	08/04/2021 09:16:57 AM Central Daylight Time	08/05/2021 09:18:12 AM Central Daylight Time	08/02/2021 08:24:11 PM Central Daylight Time			08/05/2021 12:48:08 PM Central Daylight Time	DEAN HEALTH PLAN, INC.	Dean Advantage, Prevea360 Medicare Advantage	www.deancare.com/medicare	Dean Advantage Complete (HMO)	01	01		1			H9096	005	0	2022	South Central Wisconsin		2		2			2						www.deancare.com	www.deancare.com	www.deancare.com/doctors	(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	02	01	H9096_006_0	7	1					1	08/04/2021	2022.01	08/04/2021 09:17:25 AM Central Daylight Time	08/02/2021 02:44:20 PM Central Daylight Time	08/02/2021 08:26:00 PM Central Daylight Time			08/05/2021 12:48:08 PM Central Daylight Time	DEAN HEALTH PLAN, INC.	Dean Advantage, Prevea360 Medicare Advantage	www.prevea360.com/medicare	Prevea360 Essential (HMO-POS)	01	02		1			H9096	006	0	2022	North Eastern Wisconsin, Eau Claire, Chippewa		2		2			2						www.deancare.com	www.deancare.com	www.prevea360.com/doctors	(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	010	0	1	02	01	H9096_010_0	5	1				0	0	07/22/2021	2022.01	07/22/2021 11:46:38 AM Central Daylight Time	07/19/2021 12:13:56 PM Central Daylight Time				07/22/2021 11:54:01 AM Central Daylight Time	DEAN HEALTH PLAN, INC.	Dean Advantage, Prevea360 Medicare Advantage	deancare.com/medicare	Dean Advantage Harmony (HMO-POS)	01	02		1			H9096	010	0	2022	South Central Wisconsin		2		2			2						deancare.com/doctors	www.deancare.com	www.exploreyouradvantage.com/doctors	(877)232-7566		(608)828-1978		(877)234-0126		(608)828-1941										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H9096	011	0	1	02	01	H9096_011_0	5	1				0	0	07/21/2021	2022.01	07/21/2021 09:04:16 AM Central Daylight Time	07/19/2021 12:13:59 PM Central Daylight Time				07/22/2021 11:54:01 AM Central Daylight Time	DEAN HEALTH PLAN, INC.	Dean Advantage, Prevea360 Medicare Advantage	prevea360.com/medicare	Prevea360 Harmony (HMO-POS)	01	02		1			H9096	011	0	2022	North Eastern Wisconsin, Eau Claire, Chippewa		2		2			2						www.deancare.com	www.deancare.com	prevea360.com/doctors	(877)232-7566		(608)828-1978		(877)234-0126		(608)828-1941										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H9096	012	0	1	02	01	H9096_012_0	7	1					1	08/04/2021	2022.01	08/04/2021 09:18:00 AM Central Daylight Time	08/02/2021 02:49:47 PM Central Daylight Time	08/02/2021 08:25:19 PM Central Daylight Time			08/05/2021 12:48:08 PM Central Daylight Time	DEAN HEALTH PLAN, INC.	Dean Advantage, Prevea360 Medicare Advantage	deancare.com/medicare	Dean Advantage SSM Presence (HMO-POS)	01	02		1			H9096	012	0	2022	Fond du Lac and Dodge Counties		2		2			2						www.deancare.com	www.deancare.com	deancare.com/doctors	(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	3	1						05/18/2021	2022.01	05/18/2021 08:30:01 PM Central Daylight Time					06/06/2021 10:19:53 PM Central Daylight Time	DEAN HEALTH PLAN, INC.	Dean Advantage, Prevea360 Medicare Advantage	www.exploreyouradvantage.com	Dean Advantage - EGWP MAPD CY (HMO)	01	01		1			H9096	801	0	2022	South Central Wisconsin		1	1	2			2						www.deancare.com	www.deancare.com	www.exploreyouradvantage.com/doctors	(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	3	1						05/21/2021	2022.01	05/21/2021 09:05:47 AM Central Daylight Time					06/06/2021 10:19:53 PM Central Daylight Time	DEAN HEALTH PLAN, INC.	Dean Advantage, Prevea360 Medicare Advantage	www.exploreyouradvantage.com	Dean Advantage - EGWP MAPD Non CY (HMO)	01	01		1			H9096	802	0	2022	South Central Wisconsin		1	1	2			2						www.deancare.com	www.deancare.com	www.exploreyouradvantage.com/doctors	(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	3	1				0	0	05/21/2021	2022.01	05/21/2021 11:34:07 AM Central Daylight Time					06/06/2021 10:19:53 PM Central Daylight Time	DEAN HEALTH PLAN, INC.	Dean Advantage, Prevea360 Medicare Advantage	www.exploreyouradvantage.com	Dean Advantage - EGWP MA only (HMO)	01	01		1			H9096	803	0	2022	South Central Wisconsin		1	1	2			2						www.deancare.com	www.deancare.com	www.exploreyouradvantage.com/doctors	(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	3	1						05/24/2021	2022.01	05/24/2021 04:24:04 PM Central Daylight Time					06/06/2021 10:19:53 PM Central Daylight Time	DEAN HEALTH PLAN, INC.	Dean Advantage, Prevea360 Medicare Advantage	www.exploreyouradvantage.com	Dean Advantage EGWP CY HMOPOS (HMO-POS)	01	02		1			H9096	804	0	2022	South Central Wisconsin		1	1	2			2						www.deancare.com	www.deancare.com	www.exploreyouradvantage.com/doctors	(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	3	1						05/26/2021	2022.01	05/26/2021 05:02:02 PM Central Daylight Time					06/06/2021 10:19:53 PM Central Daylight Time	DEAN HEALTH PLAN, INC.	Dean Advantage, Prevea360 Medicare Advantage	www.exploreyouradvantage.com	Dean Advantage EGWP Non CY HMOPOS (HMO-POS)	01	02		1			H9096	805	0	2022	South Central Wisconsin		1	1	2			2						www.deancare.com	www.deancare.com	www.exploreyouradvantage.com/doctors	(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	3	1				0	0	05/26/2021	2022.01	05/26/2021 03:50:36 PM Central Daylight Time					06/06/2021 10:19:53 PM Central Daylight Time	DEAN HEALTH PLAN, INC.	Dean Advantage, Prevea360 Medicare Advantage	www.exploreyouradvantage.com	Dean Advantage EGWP MA Only HMOPOS (HMO-POS)	01	02		1			H9096	806	0	2022	South Central Wisconsin		1	1	2			2						www.deancare.com	www.deancare.com	www.exploreyouradvantage.com/doctors	(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	3	1						05/26/2021	2022.01	05/26/2021 02:18:25 PM Central Daylight Time					06/06/2021 10:19:53 PM Central Daylight Time	DEAN HEALTH PLAN, INC.	Dean Advantage, Prevea360 Medicare Advantage	www.exploreyouradvantage.com	Prevea360 Medicare Advantage - EGWP MAPD CY (HMO)	01	01		1			H9096	807	0	2022	North Eastern Wisconsin		1	1	2			2						www.deancare.com	www.deancare.com	www.exploreyouradvantage.com/doctors	(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	3	1						05/26/2021	2022.01	05/26/2021 01:28:10 PM Central Daylight Time					06/06/2021 10:19:53 PM Central Daylight Time	DEAN HEALTH PLAN, INC.	Dean Advantage, Prevea360 Medicare Advantage	www.exploreyouradvantage.com	Prevea360 Medicare Advantage - EGWP MAPD Non CY (HMO)	01	01		1			H9096	808	0	2022	North Eastern Wisconsin		1	1	2			2						www.deancare.com	www.deancare.com	www.exploreyouradvantage.com/doctors	(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	3	1				0	0	05/26/2021	2022.01	05/26/2021 08:10:17 AM Central Daylight Time					06/06/2021 10:19:53 PM Central Daylight Time	DEAN HEALTH PLAN, INC.	Dean Advantage, Prevea360 Medicare Advantage	www.exploreyouradvantage.com	Prevea360 Medicare Advantage - EGWP MA Only (HMO)	01	01		1			H9096	809	0	2022	North Eastern Wisconsin		1	1	2			2						www.deancare.com	www.deancare.com	www.exploreyouradvantage.com/doctors	(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	3	1						05/25/2021	2022.01	05/25/2021 03:05:06 PM Central Daylight Time					06/06/2021 10:19:53 PM Central Daylight Time	DEAN HEALTH PLAN, INC.	Dean Advantage, Prevea360 Medicare Advantage	www.exploreyouradvantage.com	Prevea360 Medicare Advantage EGWP CY HMOPOS (HMO-POS)	01	02		1			H9096	810	0	2022	North Eastern Wisconsin		1	1	2			2						www.deancare.com	www.deancare.com	www.exploreyouradvantage.com/doctors	(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	3	1						05/25/2021	2022.01	05/25/2021 09:47:35 AM Central Daylight Time					06/06/2021 10:19:53 PM Central Daylight Time	DEAN HEALTH PLAN, INC.	Dean Advantage, Prevea360 Medicare Advantage	www.exploreyouradvantage.com	Prevea360 Medicare Advantage EGWP Non CY HMOPOS (HMO-POS)	01	02		1			H9096	811	0	2022	North Eastern Wisconsin		1	1	2			2						www.deancare.com	www.deancare.com	www.exploreyouradvantage.com/doctors	(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	3	1				0	0	05/25/2021	2022.01	05/25/2021 07:57:58 AM Central Daylight Time					06/06/2021 10:19:53 PM Central Daylight Time	DEAN HEALTH PLAN, INC.	Dean Advantage, Prevea360 Medicare Advantage	www.exploreyouradvantage.com	Prevea360 Medicare Advantage EGWP MA Only HMOPOS (HMO-POS)	01	02		1			H9096	812	0	2022	North Eastern Wisconsin		1	1	2			2						www.deancare.com	www.deancare.com	www.exploreyouradvantage.com/doctors	(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			1	08/05/2021	2022.01	08/05/2021 10:08:17 AM Pacific Daylight Time	08/05/2021 01:59:35 PM Pacific Daylight Time	07/29/2021 04:20:34 PM Pacific Daylight Time			08/05/2021 05:39:13 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Healthy at Home (HMO I-SNP)	01	01		1			H9104	006	0	2022	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		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9147	001	0	1	01	01	H9147_001_0	5	1	2	1			0	08/03/2021	2022.01	08/03/2021 09:24:42 AM Eastern Daylight Time	08/04/2021 09:19:27 AM Eastern Daylight Time	08/04/2021 09:19:09 AM Eastern Daylight Time			08/05/2021 02:34:32 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Blue Cross and Blue Shield of NC Senior Health	https://www.bluecrossnc.com/medicare	Healthy Blue + Medicare (HMO D-SNP)	01	01		1			H9147	001	0	2022	Select North Carolina Counties		2		2			1	3		1		1	https://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	(833)713-1078		(833)713-1078		(800)400-8745		(800)400-8745		(800)725-7710		(800)725-7710		(800)400-8745		(800)400-8745		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9153	001	0	1	01	01	H9153_001_0	9	1		1			0	08/05/2021	2022.01	08/05/2021 03:43:32 PM Central Daylight Time	08/05/2021 03:33:20 PM Central Daylight Time	07/30/2021 11:21:37 AM Central Daylight Time			08/05/2021 04:13:12 PM Central Daylight Time	WEST VIRGINIA SENIOR ADVANTAGE, INC.	West Virginia Senior Advantage	www.wvsenioradvantage.com	WV Senior Advantage (HMO I-SNP)	01	01		1			H9153	001	0	2022	West Virginia (partial)		2		2			1	1	1				www.wvsenioradvantage.com	www.wvsenioradvantage.com	www.wvsenioradvantage.com	(844)854-6888		(844)854-6888		(844)854-6888	4	(844)854-6888	4	(833)665-5423		(833)665-5423		(844)854-6888	4	(844)854-6888	4	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9185	001	0	1	20	08	H9185_001_0	1	1						05/27/2021	2022.01	05/27/2021 02:36:00 PM Eastern Daylight Time		05/27/2021 02:34:15 PM Eastern Daylight Time			05/27/2021 02:36:54 PM 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	2022	Great Lakes Bay Region: Saginaw, Midland, Bay, Tus		2		2			2						www.greatlakespace.org	www.greatlakespace.org										(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						05/27/2021	2022.01	05/27/2021 02:36:12 PM Eastern Daylight Time		05/27/2021 02:34:15 PM Eastern Daylight Time			05/27/2021 02:36:54 PM 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	2022	Great Lakes Bay Region: Saginaw, Midland, Bay, Tus		2		2			2						www.greatlakespace.org	www.greatlakespace.org										(844)445-7223		(989)272-7610		(844)445-7223		(989)272-7610										(844)445-7223		(989)272-7610		(844)445-7223		(989)272-7610																
H9191	001	0	1	01	01	H9191_001_0	18	1		1			0	08/05/2021	2022.01	08/05/2021 05:35:11 PM Eastern Daylight Time	08/05/2021 07:33:37 PM Eastern Daylight Time	08/05/2021 07:33:37 PM Eastern Daylight Time			08/05/2021 07:41:08 PM Eastern Daylight Time	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Provider Partners Health Plans	www.pphealthplan.com	Provider Partners Missouri Advantage Plan (HMO I-SNP)	01	01		1			H9191	001	0	2022	Select Missouri Counties		2		2			1	1	1				www.pphealthplan.com	www.pphealthplan.com	www.pphealthplan.com	(800)405-9681		(800)405-9681		(800)405-9681		(800)405-9681		(844)846-8007		(844)846-8007		(800)405-9681		(800)405-9681		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9207	002	0	1	02	01	H9207_002_0	5	1			2		0	08/19/2021	2022.01	08/19/2021 03:35:12 PM Eastern Daylight Time	08/04/2021 07:56:14 AM Eastern Daylight Time	07/30/2021 01:44:36 PM Eastern Daylight Time			08/19/2021 03:50:25 PM Eastern Daylight Time	HEALTH PARTNERS PLANS, INC.	Health Partners Medicare	HPPMedicare.com	Health Partners Medicare Prime (HMO-POS)	01	02		1			H9207	002	0	2022	Southeastern PA,Lehigh Capital PA,Carbon County PA		2	49935	2			2						HPPMedicare.com	HPPMedicare.com	HPPMedicare.com	(866)901-8000		(866)901-8000		(833)477-4773		(833)477-4773		(866)901-8000		(866)901-8000		(833)477-4773		(833)477-4773		(877)454-8477		(877)454-8477		(877)454-8477		(877)454-8477		(877)454-8477		(877)454-8477		(877)454-8477		(877)454-8477		2					2					2	2			
H9207	004	0	1	01	01	H9207_004_0	8	1	2	1	1		0	08/05/2021	2022.01	08/05/2021 12:36:45 PM Eastern Daylight Time	08/05/2021 11:55:23 AM Eastern Daylight Time	07/30/2021 01:44:10 PM Eastern Daylight Time			08/05/2021 12:49:02 PM Eastern Daylight Time	HEALTH PARTNERS PLANS, INC.	Health Partners Medicare	HPPMedicare.com	Health Partners Medicare Special (HMO D-SNP)	01	01		1			H9207	004	0	2022	Southeastern PA,Lehigh Capital PA,Carbon County PA		2	131052	2			1	3		1		2	HPPMedicare.com	HPPMedicare.com	HPPMedicare.com	(866)901-8000		(866)901-8000		(833)477-4773		(833)477-4773		(866)901-8000		(866)901-8000		(833)477-4773		(833)477-4773		(877)454-8477		(877)454-8477		(877)454-8477		(877)454-8477		(877)454-8477		(877)454-8477		(877)454-8477		(877)454-8477		2					2					2	2			
H9207	012	0	1	02	01	H9207_012_0	5	1			2		0	08/19/2021	2022.01	08/19/2021 03:36:21 PM Eastern Daylight Time	08/04/2021 07:57:18 AM Eastern Daylight Time	07/30/2021 01:45:04 PM Eastern Daylight Time			08/19/2021 03:50:25 PM Eastern Daylight Time	HEALTH PARTNERS PLANS, INC.	Health Partners Medicare	HPPMedicare.com	Health Partners Medicare Complete (HMO-POS)	01	02		1			H9207	012	0	2022	Southeastern PA, Lehigh Capital PA, Carbon County		2	3947	2			2						HPPMedicare.com	HPPMedicare.com	HPPMedicare.com	(866)901-8000		(866)901-8000		(833)477-4773		(833)477-4773		(866)901-8000		(866)901-8000		(833)477-4773		(833)477-4773		(877)454-8477		(877)454-8477		(877)454-8477		(877)454-8477		(877)454-8477		(877)454-8477		(877)454-8477		(877)454-8477		2					2					2	2			
H9219	001	0	1	04	01	H9219_001_0	7	1					0	08/03/2021	2022.01	08/03/2021 01:21:37 PM Eastern Daylight Time	08/03/2021 06:04:01 PM Eastern Daylight Time	08/03/2021 06:04:01 PM Eastern Daylight Time			08/04/2021 02:06:25 PM Eastern Daylight Time	AMH HEALTH PLANS OF MAINE, INC.	AMH Health	https://shop.anthem.com/medicare	Anthem l MaineHealth Advantage Access (PPO)	01	04		1			H9219	001	0	2022	Select Counties in Maine		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	(833)713-1077		(833)713-1077		(855)793-1932		(855)793-1932		(833)371-1081		(833)371-1081		(855)523-0680		(855)523-0680		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9219	002	0	1	04	01	H9219_002_0	6	1					0	08/03/2021	2022.01	08/03/2021 02:15:11 PM Eastern Daylight Time	08/03/2021 06:04:01 PM Eastern Daylight Time	08/03/2021 06:04:02 PM Eastern Daylight Time			08/04/2021 02:06:25 PM Eastern Daylight Time	AMH HEALTH PLANS OF MAINE, INC.	AMH Health	https://shop.anthem.com/medicare	Anthem l MaineHealth Advantage Access (PPO)	01	04		1			H9219	002	0	2022	Select Counties in Maine		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	(833)713-1077		(833)713-1077		(855)793-1932		(855)793-1932		(833)371-1081		(833)371-1081		(855)523-0680		(855)523-0680		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9239	001	0	1	48	05	H9239_001_0	3	1						07/29/2021	2022.01	07/29/2021 03:24:08 PM Central Daylight Time					07/29/2021 03:27:51 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.uhccommunityplan.com	UnitedHealthcare Connected for One Care (Medicare-Medicaid Plan)	05	48		1			H9239	001	0	2022	Select counties in Massachusetts		2	12	2			2						www.optumrx.com	www.uhccommunityplan.com	www.uhccommunityplan.com	(866)633-4454		(866)633-4454		(866)633-4454		(866)633-4454		(866)633-4454		(866)633-4454		(866)633-4454		(866)633-4454		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H9258	001	0	1	01	01	H9258_001_0	5	1					0	08/03/2021	2022.01	08/03/2021 09:17:44 AM Eastern Daylight Time	08/04/2021 01:46:46 AM Eastern Daylight Time	07/30/2021 01:58:40 PM Eastern Daylight Time			08/04/2021 11:21:47 PM Eastern Daylight Time	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO)	01	01		1			H9258	001	0	2022	All counties in RI		2	3121	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9266	001	0	1	20	08	H9266_001_0	1	1						06/02/2021	2022.01	06/02/2021 01:54:33 PM Eastern Daylight Time		06/02/2021 01:52:33 PM Eastern Daylight Time			06/02/2021 02:05:04 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	2022	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						06/02/2021	2022.01	06/02/2021 01:55:18 PM Eastern Daylight Time		06/02/2021 01:52:33 PM Eastern Daylight Time			06/02/2021 02:05:04 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	2022	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	805	0	1	01	01	H9276_805_0	2	1						06/02/2021	2022.01	06/02/2021 08:13:28 AM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Allwell	allwell.sunshinehealth.com	WellCare Group Medicare Advantage (HMO)	01	01		1			H9276	805	0	2022	Palm Beach County		1	100	2			2						allwell.sunshinehealth.com/findadoctor	allwell.sunshinehealth.com/formulary	allwell.sunshinehealth.com/findadoctor	(877)935-8022		(877)935-8022		(866)277-6583		(866)277-6583		(877)935-8022		(877)935-8022		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H9276	806	0	1	01	01	H9276_806_0	2	1				0	0	06/02/2021	2022.01	06/02/2021 08:15:19 AM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Allwell	allwell.sunshinehealth.com	WellCare Group Medicare Advantage (HMO)	01	01		1			H9276	806	0	2022	Palm Beach County		1	100	2			2						allwell.sunshinehealth.com/findadoctor	allwell.sunshinehealth.com/formulary	allwell.sunshinehealth.com/findadoctor	(877)935-8022		(877)935-8022		(866)277-6583		(866)277-6583										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H9276	807	0	1	01	01	H9276_807_0	2	1						06/02/2021	2022.01	06/02/2021 08:15:04 AM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Allwell	allwell.sunshinehealth.com	WellCare Group Medicare Advantage (HMO)	01	01		1			H9276	807	0	2022	Palm Beach County		1	100	2			2						allwell.sunshinehealth.com/findadoctor	allwell.sunshinehealth.com/formulary	allwell.sunshinehealth.com/findadoctor	(877)935-8022		(877)935-8022		(866)277-6583		(866)277-6583		(877)935-8022		(877)935-8022		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H9302	003	0	1	01	01	H9302_003_0	7	1					1	08/04/2021	2022.01	08/04/2021 08:38:19 AM Pacific Daylight Time	08/05/2021 09:13:26 AM Pacific Daylight Time	08/04/2021 10:17:44 AM Pacific Daylight Time			08/05/2021 12:50:06 PM Pacific Daylight Time	PREMERA BLUE CROSS	Premera Blue Cross Medicare Advantage	premera.com/ma	Premera Blue Cross Medicare Advantage Charter + Rx (HMO)	01	01		1			H9302	003	0	2022	Various Counties in Western WA		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			
H9302	004	0	1	01	01	H9302_004_0	6	1				0	0	08/10/2021	2022.01	08/10/2021 10:06:32 AM Pacific Daylight Time	06/06/2021 11:52:22 AM Pacific Daylight Time				08/10/2021 10:09:10 AM Pacific Daylight Time	PREMERA BLUE CROSS	Premera Blue Cross Medicare Advantage	premera.com/ma	Premera Blue Cross Medicare Advantage Alpine (HMO)	01	01		1			H9302	004	0	2022	Various Counties in Western WA		2		2			2						premera.com/ma	premera.com/ma	premera.com/ma	(888)850-8526		(888)850-8526		(888)868-7767		(888)868-7767										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H9302	007	0	1	01	01	H9302_007_0	7	1					1	08/04/2021	2022.01	08/04/2021 03:34:29 PM Pacific Daylight Time	08/05/2021 09:14:26 AM Pacific Daylight Time	08/04/2021 10:17:58 AM Pacific Daylight Time			08/05/2021 12:50:06 PM Pacific Daylight Time	PREMERA BLUE CROSS	Premera Blue Cross Medicare Advantage	premera.com/ma	Premera Blue Cross Medicare Advantage Sound + Rx (HMO)	01	01		1			H9302	007	0	2022	Various Counties in Western WA		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			
H9302	011	0	1	01	01	H9302_011_0	8	1					1	08/04/2021	2022.01	08/04/2021 08:29:34 AM Pacific Daylight Time	08/05/2021 09:15:20 AM Pacific Daylight Time	08/04/2021 10:18:14 AM Pacific Daylight Time			08/05/2021 12:50:06 PM Pacific Daylight Time	PREMERA BLUE CROSS	Premera Blue Cross Medicare Advantage	premera.com/ma	Premera Blue Cross Medicare Advantage Peak + Rx (HMO)	01	01		1			H9302	011	0	2022	Various Counties in Western WA		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			
H9302	801	0	1	01	01	H9302_801_0	1	1						06/04/2021	2022.01	06/04/2021 11:14:02 PM Pacific Daylight Time					06/04/2021 11:15:14 PM Pacific Daylight Time	PREMERA BLUE CROSS	Premera Blue Cross Medicare Advantage	premera.com/ma	Premera Blue Cross Medicare Advantage + Rx (HMO)	01	01		1			H9302	801	0	2022	Various Counties in Western WA		1	0	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			
H9306	001	0	1	01	01	H9306_001_0	6	1					0	08/04/2021	2022.01	08/04/2021 10:33:11 AM Eastern Daylight Time	08/05/2021 10:01:44 AM Eastern Daylight Time	08/05/2021 10:01:44 AM Eastern Daylight Time			08/05/2021 06:13:57 PM Eastern Daylight Time	ALTERWOOD ADVANTAGE, INC.	Alterwood Advantage	www.alterwoodhealth.com	Alterwood Advantage Choice (HMO)	01	01		1			H9306	001	0	2022	Select Maryland Counties		2	40912	2			2						www.alterwoodhealth.com	www.alterwoodhealth.com	www.alterwoodhealth.com	(866)675-3944		(667)262-9412		(866)273-7834		(866)273-7834		(866)267-3144		(866)267-3144		(866)273-7834		(866)273-7834		(771)-		(771)-		(771)-		(771)-		(771)-		(771)-		(771)-		(771)-		2					2					2	2			
H9306	002	0	1	01	01	H9306_002_0	7	1					0	08/04/2021	2022.01	08/04/2021 10:34:21 AM Eastern Daylight Time	08/05/2021 10:01:44 AM Eastern Daylight Time	08/05/2021 10:01:44 AM Eastern Daylight Time			08/05/2021 06:13:57 PM Eastern Daylight Time	ALTERWOOD ADVANTAGE, INC.	Alterwood Advantage	www.alterwoodhealth.com	Alterwood Advantage Choice Plus (HMO)	01	01		1			H9306	002	0	2022	Select Maryland Counties		2	11961	2			2						www.alterwoodhealth.com	www.alterwoodhealth.com	www.alterwoodhealth.com	(866)675-3944		(667)262-9412		(866)273-7834		(866)273-7834		(866)267-3144		(866)267-3144		(866)273-7834		(866)273-7834		(771)-		(771)-		(771)-		(771)-		(771)-		(771)-		(771)-		(771)-		2					2					2	2			
H9306	003	0	1	01	01	H9306_003_0	5	1				0	0	08/04/2021	2022.01	08/04/2021 10:34:39 AM Eastern Daylight Time	06/06/2021 04:27:04 PM Eastern Daylight Time				08/05/2021 06:13:57 PM Eastern Daylight Time	ALTERWOOD ADVANTAGE, INC.	Alterwood Advantage	www.alterwoodhealth.com	Alterwood Advantage Freedom (HMO)	01	01		1			H9306	003	0	2022	Select Maryland Counties		2	4689	2			2						www.alterwoodhealth.com	www.alterwoodhealth.com	www.alterwoodhealth.com	(866)675-3944		(667)262-9412		(866)273-7834		(866)273-7834										(771)-		(771)-		(771)-		(771)-										2					2					2	2			
H9306	004	0	1	01	01	H9306_004_0	9	1	2	1			0	08/04/2021	2022.01	08/04/2021 10:36:03 AM Eastern Daylight Time	08/05/2021 10:01:44 AM Eastern Daylight Time	08/05/2021 10:01:44 AM Eastern Daylight Time			08/05/2021 06:13:57 PM Eastern Daylight Time	ALTERWOOD ADVANTAGE, INC.	Alterwood Advantage	www.alterwoodhealth.com	Alterwood Advantage Dual Secure (HMO D-SNP)	01	01		1			H9306	004	0	2022	Select Maryland Counties		2	10838	2			1	3		2		1	www.alterwoodhealth.com	www.alterwoodhealth.com	www.alterwoodhealth.com	(866)675-3944		(667)262-9412		(866)273-7834		(866)273-7834		(866)267-3144		(866)267-3144		(866)273-7834		(866)273-7834		(771)-		(771)-		(771)-		(771)-		(771)-		(771)-		(771)-		(771)-		2					2					2	2			
H9323	001	0	1	20	08	H9323_001_0	1	1						06/06/2021	2022.01	06/06/2021 01:40:34 PM Eastern Daylight Time		06/06/2021 01:34:48 PM Eastern Daylight Time			06/06/2021 01:43:33 PM Eastern Daylight Time	ACUTE CARE HEALTH SYSTEM, LLC	Beacon of LIFE	beaconpace.com	Beacon of LIFE (PACE)	08	20		1			H9323	001	0	2022	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						06/06/2021	2022.01	06/06/2021 01:41:40 PM Eastern Daylight Time		06/06/2021 01:34:48 PM Eastern Daylight Time			06/06/2021 01:43:33 PM Eastern Daylight Time	ACUTE CARE HEALTH SYSTEM, LLC	Beacon of LIFE	beaconpace.com	Beacon of LIFE (PACE)	08	20		1			H9323	002	0	2022	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																
H9335	001	0	1	01	01	H9335_001_0	4	1					0	08/02/2021	2022.01	08/02/2021 04:13:39 PM Eastern Daylight Time	08/04/2021 01:47:15 AM Eastern Daylight Time	07/30/2021 01:59:00 PM Eastern Daylight Time			08/04/2021 11:43:06 PM Eastern Daylight Time	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO)	01	01		1			H9335	001	0	2022	Select counties in MO		2	6055	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9335	003	0	1	01	01	H9335_003_0	4	1	2	1			0	07/18/2021	2022.01	07/18/2021 06:36:01 PM Eastern Daylight Time	08/04/2021 01:47:43 AM Eastern Daylight Time	07/30/2021 01:59:18 PM Eastern Daylight Time			08/04/2021 11:43:06 PM Eastern Daylight Time	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Access (HMO D-SNP)	01	01		1			H9335	003	0	2022	Select counties in MO		2	787	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9335	005	0	1	01	01	H9335_005_0	4	1					0	08/02/2021	2022.01	08/02/2021 04:16:18 PM Eastern Daylight Time	08/04/2021 01:48:12 AM Eastern Daylight Time	07/30/2021 01:59:38 PM Eastern Daylight Time			08/04/2021 11:43:06 PM Eastern Daylight Time	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Giveback (HMO)	01	01		1			H9335	005	0	2022	Select counties in MO		2	6246	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9335	006	0	1	01	01	H9335_006_0	4	1					0	05/31/2021	2022.01	05/31/2021 07:41:51 AM Pacific Daylight Time	08/04/2021 01:48:41 AM Eastern Daylight Time	07/30/2021 01:59:56 PM Eastern Daylight Time			08/04/2021 11:43:06 PM Eastern Daylight Time	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Assist (HMO)	01	01		1			H9335	006	0	2022	Select counties in MO		2	1146	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9357	001	0	1	04	01	H9357_001_0	3	1					0	08/02/2021	2022.01	08/02/2021 10:49:50 AM Central Daylight Time	08/04/2021 12:49:09 AM Central Daylight Time	07/30/2021 01:00:16 PM Central Daylight Time			08/04/2021 10:17:29 PM Central Daylight Time	CENTENE VENTURE INSURANCE COMPANY TEXAS	Ascension Complete	ascensioncomplete.com	Ascension Complete Seton Access Plus (PPO)	01	04		1			H9357	001	0	2022	Austin Area Counties		2	1204	2			2						ascensioncomplete.com/findadoctor	ascensioncomplete.com/formulary	ascensioncomplete.com/findadoctor	(833)705-1358		(833)705-1358		(866)277-6541		(866)277-6541		(833)705-1358		(833)705-1358		(866)277-6541		(866)277-6541		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9357	002	0	1	04	01	H9357_002_0	4	1					0	08/02/2021	2022.01	08/02/2021 10:51:06 AM Central Daylight Time	08/04/2021 12:49:37 AM Central Daylight Time	07/30/2021 01:00:36 PM Central Daylight Time			08/04/2021 10:17:29 PM Central Daylight Time	CENTENE VENTURE INSURANCE COMPANY TEXAS	Ascension Complete	ascensioncomplete.com	Ascension Complete Seton Access (PPO)	01	04		1			H9357	002	0	2022	Austin Area Counties		2	1204	2			2						ascensioncomplete.com/findadoctor	ascensioncomplete.com/formulary	ascensioncomplete.com/findadoctor	(833)705-1358		(833)705-1358		(866)277-6541		(866)277-6541		(833)705-1358		(833)705-1358		(866)277-6541		(866)277-6541		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9357	003	0	1	04	01	H9357_003_0	4	1					0	08/02/2021	2022.01	08/02/2021 10:52:01 AM Central Daylight Time	08/04/2021 12:50:05 AM Central Daylight Time	07/30/2021 01:00:54 PM Central Daylight Time			08/04/2021 10:17:29 PM Central Daylight Time	CENTENE VENTURE INSURANCE COMPANY TEXAS	Ascension Complete	ascensioncomplete.com	Ascension Complete Providence Access Plus (PPO)	01	04		1			H9357	003	0	2022	Waco Area Counties		2	421	2			2						ascensioncomplete.com/findadoctor	ascensioncomplete.com/formulary	ascensioncomplete.com/findadoctor	(833)705-1358		(833)705-1358		(866)277-6541		(866)277-6541		(833)705-1358		(833)705-1358		(866)277-6541		(866)277-6541		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9357	004	0	1	04	01	H9357_004_0	4	1					0	08/02/2021	2022.01	08/02/2021 10:53:33 AM Central Daylight Time	08/04/2021 12:50:30 AM Central Daylight Time	07/30/2021 01:01:30 PM Central Daylight Time			08/04/2021 10:17:29 PM Central Daylight Time	CENTENE VENTURE INSURANCE COMPANY TEXAS	Ascension Complete	ascensioncomplete.com	Ascension Complete Providence Access (PPO)	01	04		1			H9357	004	0	2022	Waco Area Counties		2	421	2			2						ascensioncomplete.com/findadoctor	ascensioncomplete.com/formulary	ascensioncomplete.com/findadoctor	(833)705-1358		(833)705-1358		(866)277-6541		(866)277-6541		(833)705-1358		(833)705-1358		(866)277-6541		(866)277-6541		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9364	001	0	1	01	01	H9364_001_0	5	1					0	08/03/2021	2022.01	08/03/2021 09:07:47 AM Eastern Daylight Time	08/04/2021 01:51:00 AM Eastern Daylight Time	07/30/2021 02:01:50 PM Eastern Daylight Time			08/04/2021 11:21:47 PM Eastern Daylight Time	WELLCARE OF MAINE, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO)	01	01		1			H9364	001	0	2022	All counties in ME		2	18471	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(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			0	06/02/2021	2022.01	06/02/2021 09:38:02 PM Eastern Daylight Time	08/04/2021 01:51:28 AM Eastern Daylight Time	07/30/2021 02:02:12 PM Eastern Daylight Time			08/04/2021 11:21:47 PM Eastern Daylight Time	WELLCARE OF MAINE, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Access (HMO D-SNP)	01	01		1			H9364	002	0	2022	All counties in ME		2	34669	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9364	003	0	1	01	01	H9364_003_0	5	1	2	1			0	06/03/2021	2022.01	06/03/2021 02:18:06 PM Eastern Daylight Time	08/04/2021 01:51:55 AM Eastern Daylight Time	07/30/2021 02:02:32 PM Eastern Daylight Time			08/04/2021 11:21:47 PM Eastern Daylight Time	WELLCARE OF MAINE, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Liberty (HMO D-SNP)	01	01		1			H9364	003	0	2022	All counties in ME		2	21084	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9364	004	0	1	01	01	H9364_004_0	5	1					0	08/03/2021	2022.01	08/03/2021 09:09:06 AM Eastern Daylight Time	08/04/2021 01:52:24 AM Eastern Daylight Time	07/30/2021 02:02:54 PM Eastern Daylight Time			08/04/2021 11:21:47 PM Eastern Daylight Time	WELLCARE OF MAINE, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Giveback (HMO)	01	01		1			H9364	004	0	2022	All counties in ME		2	6348	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9387	001	0	1	04	01	H9387_001_0	5	1					0	07/30/2021	2022.01	07/30/2021 02:31:51 PM Eastern Daylight Time	08/04/2021 01:52:52 AM Eastern Daylight Time	07/30/2021 02:03:12 PM Eastern Daylight Time			08/04/2021 09:45:33 PM Eastern Daylight Time	SUNFLOWER STATE HEALTH PLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellKS	Wellcare No Premium Open (PPO)	01	04		1			H9387	001	0	2022	Select counties in KS		2	4768	2			2						www.wellcare.com/allwellKS	www.wellcare.com/allwellKS	www.wellcare.com/allwellKS	(855)565-9519		(855)565-9519		(866)277-6583		(866)277-6583		(855)565-9519		(855)565-9519		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9387	002	0	1	04	01	H9387_002_0	4	1				0	0	07/18/2021	2022.01	07/18/2021 12:27:19 PM Eastern Daylight Time	06/04/2021 02:33:08 PM Eastern Daylight Time				07/19/2021 05:11:22 PM Eastern Daylight Time	SUNFLOWER STATE HEALTH PLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellKS	Wellcare Patriot Giveback Open (PPO)	01	04		1			H9387	002	0	2022	Select counties in KS		2	1281	2			2						www.wellcare.com/allwellKS	www.wellcare.com/allwellKS	www.wellcare.com/allwellKS	(855)565-9519		(855)565-9519		(866)277-6583		(866)277-6583										(711)-		(711)-		(711)-		(711)-										2					2						2			
H9387	003	0	1	04	01	H9387_003_0	5	1					0	07/30/2021	2022.01	07/30/2021 02:29:37 PM Eastern Daylight Time	08/04/2021 03:42:42 PM Eastern Daylight Time	07/30/2021 02:03:32 PM Eastern Daylight Time			08/04/2021 09:45:33 PM Eastern Daylight Time	SUNFLOWER STATE HEALTH PLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellKS	Wellcare Premium Hybrid Open (PPO)	01	04		1			H9387	003	0	2022	Select counties in KS		2	0	2			2						www.wellcare.com/allwellKS	www.wellcare.com/allwellKS	www.wellcare.com/allwellKS	(855)565-9519		(855)565-9519		(866)277-6583		(866)277-6583		(855)565-9519		(855)565-9519		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9403	001	0	1	01	01	H9403_001_0	5	1	2	1			0	08/05/2021	2022.01	08/05/2021 08:47:54 AM Central Daylight Time	08/05/2021 02:09:28 PM Central Daylight Time	08/05/2021 02:08:13 PM Central Daylight Time			08/05/2021 06:05:28 PM Central Daylight Time	EON HEALTH, INC. (SC)	Clear Spring Health	www.eonhealthplan.com	Clear Spring Health Deluxe Plan (HMO D-SNP)	01	01		1			H9403	001	0	2022	Select South Carolina Counties		2		2			1	3		1		1	https://www.eonhp.com/	https://www.eonhp.com/	www.eonhealthplan.com	(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9403	003	0	1	01	01	H9403_003_0	4	1		1			1	08/05/2021	2022.01	08/05/2021 08:53:58 AM Central Daylight Time	08/05/2021 02:09:29 PM Central Daylight Time	08/05/2021 02:08:36 PM Central Daylight Time			08/05/2021 06:05:28 PM Central Daylight Time	EON HEALTH, INC. (SC)	Clear Spring Health	www.eonhealthplan.com	Clear Spring Health Silver Plan (HMO C-SNP)	01	01		1			H9403	003	0	2022	Select South Carolina Counties		2		2			1	4			00000000000000000010		https://www.eonhp.com/	https://www.eonhp.com/	www.eonhealthplan.com	(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9403	004	0	1	01	01	H9403_004_0	5	1					1	08/05/2021	2022.01	08/05/2021 08:57:32 AM Central Daylight Time	08/05/2021 02:09:30 PM Central Daylight Time	08/05/2021 02:08:40 PM Central Daylight Time			08/05/2021 06:05:28 PM Central Daylight Time	EON HEALTH, INC. (SC)	Clear Spring Health	www.eonhealthplan.com	Clear Spring Health Select Plan (HMO)	01	01		1			H9403	004	0	2022	Select South Carolina Counties		2		2			2						https://www.eonhp.com/	https://www.eonhp.com/	www.eonhealthplan.com	(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9408	005	0	1	04	01	H9408_005_0	4	1					1	07/16/2021	2022.01	07/16/2021 12:03:39 PM Eastern Daylight Time	08/03/2021 04:22:56 PM Eastern Daylight Time	08/03/2021 04:09:56 PM Eastern Daylight Time			08/04/2021 04:29:02 PM Eastern Daylight Time	VIBRA HEALTH PLAN, INC.	Vibra Health Plan	www.vibrahealthplan.com	Vibra Health Plan Enhanced Complete (PPO)	01	04		1			H9408	005	0	2022	Southcentral and Northeast Pennsylvania		2		2			2						www.vibrahealthplan.com	www.vibrahealthplan.com	www.vibrahealthplan.com	(844)388-8268		(844)388-8268		(844)324-0691		(844)324-0691		(855)457-1352		(855)457-1352		(844)324-0691		(844)324-0691		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9408	006	1	1	04	01	H9408_006_1	4	1					1	08/03/2021	2022.01	08/03/2021 02:58:56 PM Eastern Daylight Time	08/03/2021 04:25:48 PM Eastern Daylight Time	08/03/2021 04:09:16 PM Eastern Daylight Time			08/04/2021 04:31:38 PM Eastern Daylight Time	VIBRA HEALTH PLAN, INC.	Vibra Health Plan	www.vibrahealthplan.com	Vibra Essential Advocate (PPO)	01	04		1			H9408	006	1	2022	Southcentral and Northeast Pennsylvania	Southcentral Pennsylvania	2		2			2						www.vibrahealthplan.com	www.vibrahealthplan.com	www.vibrahealthplan.com	(844)388-8268		(844)388-8268		(844)324-0691		(844)324-0691		(855)457-1352		(855)457-1352		(844)324-0691		(844)324-0691		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9408	006	2	1	04	01	H9408_006_2	4	1					1	08/03/2021	2022.01	08/03/2021 02:58:21 PM Eastern Daylight Time	08/03/2021 04:27:20 PM Eastern Daylight Time	08/03/2021 04:08:52 PM Eastern Daylight Time			08/04/2021 04:33:50 PM Eastern Daylight Time	VIBRA HEALTH PLAN, INC.	Vibra Health Plan	www.vibrahealthplan.com	Vibra Essential Advocate (PPO)	01	04		1			H9408	006	2	2022	Southcentral and Northeast Pennsylvania	Northeast Pennsylvania	2		2			2						www.vibrahealthplan.com	www.vibrahealthplan.com	www.vibrahealthplan.com	(844)388-8268		(844)388-8268		(844)324-0691		(844)324-0691		(855)457-1352		(855)457-1352		(844)324-0691		(844)324-0691		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9408	801	0	1	04	01	H9408_801_0	1	1						06/03/2021	2022.01	06/03/2021 01:13:38 PM Eastern Daylight Time					06/04/2021 12:08:32 PM Eastern Daylight Time	VIBRA HEALTH PLAN, INC.	Vibra Health Plan	www.vibrahealthplan.com	Vibra Group PPO Silver Rx (PPO)	01	04		1			H9408	801	0	2022	National		1	4584	2			2						www.vibrahealthplan.com	www.vibrahealthplan.com	www.vibrahealthplan.com	(844)388-8268		(844)388-8268		(844)324-0691		(844)324-0691		(855)457-1352		(855)457-1352		(844)324-0691		(844)324-0691		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7c;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;	2		1									
H9408	802	0	1	04	01	H9408_802_0	1	1						06/03/2021	2022.01	06/03/2021 01:15:02 PM Eastern Daylight Time					06/04/2021 12:08:32 PM Eastern Daylight Time	VIBRA HEALTH PLAN, INC.	Vibra Health Plan	www.vibrahealthplan.com	Vibra Group PPO Bronze Rx FY (PPO)	01	04		1			H9408	802	0	2022	National		1	24	2			2						www.vibrahealthplan.com	www.vibrahealthplan.com	www.vibrahealthplan.com	(844)388-8268		(844)388-8268		(844)324-0691		(844)324-0691		(855)457-1352		(855)457-1352		(844)324-0691		(844)324-0691		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7c;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;	2		1									
H9408	803	0	1	04	01	H9408_803_0	1	1				0	0	06/03/2021	2022.01	06/03/2021 01:16:23 PM Eastern Daylight Time					06/04/2021 12:08:32 PM Eastern Daylight Time	VIBRA HEALTH PLAN, INC.	Vibra Health Plan	www.vibrahealthplan.com	Vibra Group PPO Without Rx (PPO)	01	04		1			H9408	803	0	2022	National		1	396	2			2						https://www.vibrahealthplan.com/wps/portal/vhp/home/resources/drug-benefit	https://www.vibrahealthplan.com/wps/portal/vhp/home/resources/find-rx	www.vibrahealthplan.com	(844)388-8268		(844)388-8268		(844)324-0691		(844)324-0691										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7c;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;	2		1									
H9408	804	0	1	04	01	H9408_804_0	1	1				0	0	06/03/2021	2022.01	06/03/2021 01:17:43 PM Eastern Daylight Time					06/04/2021 12:08:32 PM Eastern Daylight Time	VIBRA HEALTH PLAN, INC.	Vibra Health Plan	www.vibrahealthplan.com	Vibra Group PPO Without Rx FY (PPO)	01	04		1			H9408	804	0	2022	National		1	24	2			2						https://www.vibrahealthplan.com/wps/portal/vhp/home/resources/drug-benefit	https://www.vibrahealthplan.com/wps/portal/vhp/home/resources/find-rx	www.vibrahealthplan.com	(844)388-8268		(844)388-8268		(844)324-0691		(844)324-0691										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7c;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;	2		1									
H9408	805	0	1	04	01	H9408_805_0	1	1						06/03/2021	2022.01	06/03/2021 01:18:58 PM Eastern Daylight Time					06/04/2021 12:08:32 PM Eastern Daylight Time	VIBRA HEALTH PLAN, INC.	Vibra Health Plan	www.vibrahealthplan.com	Vibra Group PPO Platinum Rx (PPO)	01	04		1			H9408	805	0	2022	National		1	24	2			2						www.vibrahealthplan.com	www.vibrahealthplan.com	www.vibrahealthplan.com	(844)388-8268		(844)388-8268		(844)324-0691		(844)324-0691		(855)457-1352		(855)457-1352		(844)324-0691		(844)324-0691		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7c;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;	2		1									
H9408	806	0	1	04	01	H9408_806_0	1	1						06/03/2021	2022.01	06/03/2021 01:20:18 PM Eastern Daylight Time					06/04/2021 12:11:48 PM Eastern Daylight Time	VIBRA HEALTH PLAN, INC.	Vibra Health Plan	www.vibrahealthplan.com	Vibra Group PPO Gold Rx (PPO)	01	04		1			H9408	806	0	2022	National		1	24	2			2						www.vibrahealthplan.com	www.vibrahealthplan.com	www.vibrahealthplan.com	(844)388-8268		(844)388-8268		(844)324-0691		(844)324-0691		(855)457-1352		(855)457-1352		(844)324-0691		(844)324-0691		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7c;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;	2		1									
H9408	807	0	1	04	01	H9408_807_0	1	1						06/03/2021	2022.01	06/03/2021 01:21:55 PM Eastern Daylight Time					06/04/2021 12:11:48 PM Eastern Daylight Time	VIBRA HEALTH PLAN, INC.	Vibra Health Plan	www.vibrahealthplan.com	Vibra Group PPO Bronze Rx (PPO)	01	04		1			H9408	807	0	2022	National		1	24	2			2						www.vibrahealthplan.com	www.vibrahealthplan.com	www.vibrahealthplan.com	(844)388-8268		(844)388-8268		(844)324-0691		(844)324-0691		(855)457-1352		(855)457-1352		(844)324-0691		(844)324-0691		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7c;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;	2		1									
H9408	808	0	1	04	01	H9408_808_0	1	1						06/03/2021	2022.01	06/03/2021 01:24:11 PM Eastern Daylight Time					06/04/2021 12:11:48 PM Eastern Daylight Time	VIBRA HEALTH PLAN, INC.	Vibra Health Plan	www.vibrahealthplan.com	Vibra Group PPO Platinum Rx FY (PPO)	01	04		1			H9408	808	0	2022	National		1	24	2			2						www.vibrahealthplan.com	www.vibrahealthplan.com	www.vibrahealthplan.com	(844)388-8268		(844)388-8268		(844)324-0691		(844)324-0691		(855)457-1352		(855)457-1352		(844)324-0691		(844)324-0691		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7c;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;	2		1									
H9408	809	0	1	04	01	H9408_809_0	1	1						06/03/2021	2022.01	06/03/2021 01:26:07 PM Eastern Daylight Time					06/04/2021 12:11:48 PM Eastern Daylight Time	VIBRA HEALTH PLAN, INC.	Vibra Health Plan	www.vibrahealthplan.com	Vibra Group PPO Gold Rx FY (PPO)	01	04		1			H9408	809	0	2022	National		1	24	2			2						www.vibrahealthplan.com	www.vibrahealthplan.com	www.vibrahealthplan.com	(844)388-8268		(844)388-8268		(844)324-0691		(844)324-0691		(855)457-1352		(855)457-1352		(844)324-0691		(844)324-0691		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7c;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;	2		1									
H9408	810	0	1	04	01	H9408_810_0	1	1						06/03/2021	2022.01	06/03/2021 01:27:24 PM Eastern Daylight Time					06/04/2021 12:11:48 PM Eastern Daylight Time	VIBRA HEALTH PLAN, INC.	Vibra Health Plan	www.vibrahealthplan.com	Vibra Group PPO Silver Rx FY (PPO)	01	04		1			H9408	810	0	2022	National		1	24	2			2						www.vibrahealthplan.com	www.vibrahealthplan.com	www.vibrahealthplan.com	(844)388-8268		(844)388-8268		(844)324-0691		(844)324-0691		(855)457-1352		(855)457-1352		(844)324-0691		(844)324-0691		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7c;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;	2		1									
H9412	803	0	1	04	01	H9412_803_0	3	1						05/24/2021	2022.01	05/24/2021 02:56:47 PM Eastern Daylight Time					06/04/2021 07:45:10 AM Eastern Daylight Time	GEISINGER QUALITY OPTIONS, INC.	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Preferred Rx  EGWP NJ (PPO)	01	04		1			H9412	803	0	2022	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			
H9414	001	0	1	04	01	H9414_001_0	11	1					1	08/10/2021	2022.01	08/10/2021 02:53:22 PM Eastern Daylight Time	08/05/2021 04:00:26 PM Eastern Daylight Time	08/05/2021 04:00:26 PM Eastern Daylight Time			08/10/2021 04:59:38 PM Eastern Daylight Time	CCA HMO COMPLETE, LLC	CCA HMO Complete	www.commonwealthcarealliance.org/become-a-member	CCA Medicare Preferred (PPO)	01	04		1			H9414	001	0	2022	BRI, ESS, FRA, HMD, HMP, MID, NOR, PLY, SUF, WOR		2		2			2						https://www.commonwealthcarealliance.org/members/pharmacy-program	https://www.commonwealthcarealliance.org/members/mapd-preferred/mapd-preferred-formulary	provider-directory.commonwealthcarealliance.org/	(866)610-2273		(866)610-2273		(866)275-1222		(866)275-1222		(866)610-2273		(866)610-2273		(866)275-1222		(866)275-1222		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9414	002	0	1	04	01	H9414_002_0	13	1					0	08/10/2021	2022.01	08/10/2021 04:58:49 PM Eastern Daylight Time	08/05/2021 04:00:26 PM Eastern Daylight Time	08/05/2021 04:00:26 PM Eastern Daylight Time			08/10/2021 04:59:38 PM Eastern Daylight Time	CCA HMO COMPLETE, LLC	CCA HMO Complete	www.commonwealthcarealliance.org/become-a-member	CCA Medicare Value (PPO)	01	04		1			H9414	002	0	2022	BRI, ESS, FRA, HMD, HMP, MID, NOR, PLY, SUF, WOR		2		2			2						https://www.commonwealthcarealliance.org/members/pharmacy-program	https://www.commonwealthcarealliance.org/members/mapd-value/mapd-value-formulary	provider-directory.commonwealthcarealliance.org/	(866)610-2273		(866)610-2273		(866)275-1222		(866)275-1222		(866)610-2273		(866)610-2273		(866)275-1222		(866)275-1222		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9428	001	0	1	04	01	H9428_001_0	5	1					0	07/30/2021	2022.01	07/30/2021 02:09:18 PM Eastern Daylight Time	08/04/2021 01:54:19 AM Eastern Daylight Time	07/30/2021 02:03:52 PM Eastern Daylight Time			08/04/2021 09:45:33 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium Open (PPO)	01	04		1			H9428	001	0	2022	Select counties in TN		2	5662	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9428	002	0	1	04	01	H9428_002_0	5	1					0	07/30/2021	2022.01	07/30/2021 01:31:48 PM Eastern Daylight Time	08/04/2021 01:54:47 AM Eastern Daylight Time	07/30/2021 02:04:14 PM Eastern Daylight Time			08/04/2021 09:45:33 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Giveback Open (PPO)	01	04		1			H9428	002	0	2022	Select counties in TN		2	7470	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9431	001	0	1	04	01	H9431_001_0	3	1					0	08/02/2021	2022.01	08/02/2021 03:30:59 PM Eastern Daylight Time	08/02/2021 03:35:47 PM Eastern Daylight Time	08/02/2021 09:58:14 AM Eastern Daylight Time			08/04/2021 02:44:24 PM 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	2022	Central New Mexico		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9431	002	0	1	04	01	H9431_002_0	3	1					0	06/02/2021	2022.01	06/02/2021 08:52:36 PM Eastern Daylight Time	08/02/2021 03:02:07 PM Eastern Daylight Time	08/02/2021 09:58:19 AM Eastern Daylight Time			08/04/2021 01:48:44 PM 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	2022	Kootenai County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9431	004	0	1	04	01	H9431_004_0	3	1					0	06/02/2021	2022.01	06/02/2021 05:04:51 PM Eastern Daylight Time	08/02/2021 03:03:25 PM Eastern Daylight Time	08/02/2021 09:58:23 AM Eastern Daylight Time			08/04/2021 01:48:44 PM 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	2022	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		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9431	005	0	1	04	01	H9431_005_0	3	1					0	06/02/2021	2022.01	06/02/2021 05:05:36 PM Eastern Daylight Time	08/02/2021 03:04:46 PM Eastern Daylight Time	08/02/2021 09:58:27 AM Eastern Daylight Time			08/04/2021 01:48:44 PM 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	2022	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		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9431	006	0	1	04	01	H9431_006_0	3	1					0	06/02/2021	2022.01	06/02/2021 08:54:58 PM Eastern Daylight Time	08/02/2021 03:06:18 PM Eastern Daylight Time	08/02/2021 09:58:31 AM Eastern Daylight Time			08/04/2021 01:48:44 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H9431	006	0	2022	Treasure Valley Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9431	009	0	1	04	01	H9431_009_0	3	1					0	08/02/2021	2022.01	08/02/2021 04:23:58 PM Eastern Daylight Time	08/03/2021 12:15:58 PM Eastern Daylight Time	08/02/2021 09:58:35 AM Eastern Daylight Time			08/04/2021 01:33:15 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Explorer Plan (PPO)	01	04		1			H9431	009	0	2022	Rhode Island		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9431	011	0	1	04	01	H9431_011_0	4	1					1	08/02/2021	2022.01	08/02/2021 03:14:19 PM Eastern Daylight Time	08/03/2021 12:16:54 PM Eastern Daylight Time	08/02/2021 09:58:39 AM Eastern Daylight Time			08/04/2021 01:33:15 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Explorer Plan (PPO)	01	04		1			H9431	011	0	2022	New Hampshire		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9431	013	0	1	04	01	H9431_013_0	3	1					0	08/05/2021	2022.01	08/05/2021 04:39:47 PM Central Daylight Time	08/03/2021 01:28:59 PM Central Daylight Time	08/02/2021 08:58:44 AM Central Daylight Time			08/05/2021 04:52:55 PM Central Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (PPO)	01	04		1			H9431	013	0	2022	Partial State of North Dakota		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9431	014	0	1	04	01	H9431_014_0	2	1					0	08/02/2021	2022.01	08/02/2021 03:20:29 PM Central Daylight Time	08/03/2021 01:29:55 PM Central Daylight Time	08/02/2021 08:58:48 AM Central Daylight Time			08/04/2021 01:00:17 PM Central Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite (PPO)	01	04		1			H9431	014	0	2022	Partial State of North Dakota		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9431	015	0	1	04	01	H9431_015_0	2	1				0	0	06/02/2021	2022.01	06/02/2021 08:47:52 PM Eastern Daylight Time	06/01/2021 07:34:00 PM Eastern Daylight Time				06/03/2021 01:58:25 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Eagle Plan (PPO)	01	04		1			H9431	015	0	2022	Oregon		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										2					2						2			
H9431	016	0	1	04	01	H9431_016_0	2	1				0	0	06/02/2021	2022.01	06/02/2021 08:48:30 PM Eastern Daylight Time	06/01/2021 07:34:44 PM Eastern Daylight Time				06/03/2021 01:58:25 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Eagle Plan (PPO)	01	04		1			H9431	016	0	2022	Idaho		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										2					2						2			
H9431	017	0	1	04	01	H9431_017_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 01:51:01 PM Eastern Daylight Time	06/02/2021 01:29:34 PM Eastern Daylight Time				06/03/2021 01:50:57 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Eagle Plan (PPO)	01	04		1			H9431	017	0	2022	New Mexico		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										2					2						2			
H9431	801	0	1	04	01	H9431_801_0	1	1				0	0	05/28/2021	2022.01	05/28/2021 02:26:23 PM Eastern Daylight Time					06/03/2021 02:01:28 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna First Health Medicare Plan (PPO)	01	04		1			H9431	801	0	2022	Multi-State		1	120	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H9431	802	0	1	04	01	H9431_802_0	1	1						05/28/2021	2022.01	05/28/2021 02:29:26 PM Eastern Daylight Time					06/03/2021 02:01:28 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna First Health Medicare Plan w/Rx (PPO)	01	04		1			H9431	802	0	2022	Multi-State		1	120	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(833)570-6670		(833)570-6670		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H9438	001	0	1	20	08	H9438_001_0	1	1						06/02/2021	2022.01	06/02/2021 09:49:04 AM Central Daylight Time		06/02/2021 09:38:42 AM Central Daylight Time			06/02/2021 09:52:50 AM Central Daylight Time	BLUESTEM PACE, INC.	Bluestem PACE	www.bluestempace.org	Bluestem PACE (PACE)	08	20		1			H9438	001	0	2022	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						06/02/2021	2022.01	06/02/2021 09:49:20 AM Central Daylight Time		06/02/2021 09:40:33 AM Central Daylight Time			06/02/2021 09:52:50 AM Central Daylight Time	BLUESTEM PACE, INC.	Bluestem PACE	www.bluestempace.org	Bluestem PACE (PACE)	08	20		1			H9438	002	0	2022	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	7	1	2	1			0	08/05/2021	2022.01	08/05/2021 01:15:15 PM Mountain Daylight Time	08/02/2021 08:40:24 PM Mountain Daylight Time	08/03/2021 01:46:26 PM Mountain Daylight Time			08/05/2021 01:25:21 PM Mountain Daylight Time	HEALTH CHOICE UTAH, INC.	Health Choice Generations Utah	https://www.healthchoicegenerations.com	Health Choice Generations Utah (HMO D-SNP)	01	01		1			H9455	001	0	2022	Counties: Salt Lake, Utah, Davis, Weber, Tooele		2		2			1	3		2		2	https://healthchoicegenerations.com	https://healthchoicegenerations.com/utah/members/prescription-drug-information/	https://healthchoicegenerations.com/utah/providers/provider-information/	(844)457-8943		(844)457-8943		(844)457-8943		(844)457-8943		(844)457-8943		(844)457-8943		(844)457-8943		(844)457-8943		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9460	001	0	1	01	01	H9460_001_0	3	1					0	08/02/2021	2022.01	08/02/2021 07:32:14 PM Central Daylight Time	08/03/2021 09:56:19 AM Central Daylight Time	07/30/2021 12:28:49 PM Central Daylight Time			08/04/2021 12:17:46 PM Central Daylight Time	CIGNA HEALTHCARE OF ST LOUIS, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H9460	001	0	2022	Kansas City Area		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(866)612-1391		(866)612-1391		(800)668-3813		(800)668-3813		(866)612-1391		(866)612-1391		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9460	002	0	1	01	01	H9460_002_0	2	1				0	0	05/22/2021	2022.01	05/22/2021 07:50:12 PM Central Daylight Time	05/31/2021 01:25:05 PM Central Daylight Time				06/02/2021 06:21:36 PM Central Daylight Time	CIGNA HEALTHCARE OF ST LOUIS, INC.	Cigna	www.cignamedicare.com	Cigna Fundamental Medicare (HMO)	01	01		1			H9460	002	0	2022	Kansas City Area		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(866)612-1391		(866)612-1391										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H9489	001	0	1	01	01	H9489_001_0	7	1					0	07/06/2021	2022.01	07/06/2021 02:56:55 PM Eastern Daylight Time	07/30/2021 03:16:06 PM Eastern Daylight Time	07/30/2021 03:15:40 PM Eastern Daylight Time			07/30/2021 03:40:17 PM Eastern Daylight Time	VERMONT BLUE ADVANTAGE, INC.	Vermont Blue Advantage	www.vermontblueadvantage.com	Vermont Blue Advantage Unity HMO (HMO)	01	01		1			H9489	001	0	2022	State of Vermont		2	8825	2			2						www.vermontblueadvantage.com/pharmacies	www.vermontblueadvantage.com/formularies	www.vermontblueadvantage.com/findadoctor	(844)839-5126		(844)839-5126		(844)510-2583		(844)510-2583		(877)779-2864		(877)779-2864		(844)510-2583		(844)510-2583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9489	801	0	1	01	01	H9489_801_0	5	1						04/19/2021	2022.01	04/19/2021 09:19:01 AM Eastern Daylight Time					06/07/2021 02:26:36 PM Eastern Daylight Time	VERMONT BLUE ADVANTAGE, INC.	Vermont Blue Advantage	www.vermontblueadvantage.com	Vermont Blue Advantage Group HMO (HMO)	01	01		1			H9489	801	0	2022	State of Vermont		1	0	2			2						www.vermontblueadvantage.com/pharmacies	www.vermontblueadvantage.com/formularies	www.vermontblueadvantage.com/findadoctor	(844)839-5126		(844)839-5126		(844)510-2583		(844)510-2583		(877)779-2864		(877)779-2864		(844)510-2583		(844)510-2583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;2;9a1;11a;15;	2		1					1				
H9489	802	0	1	02	01	H9489_802_0	5	1						04/19/2021	2022.01	04/19/2021 09:29:56 AM Eastern Daylight Time					06/07/2021 02:26:36 PM Eastern Daylight Time	VERMONT BLUE ADVANTAGE, INC.	Vermont Blue Advantage	www.vermontblueadvantage.com	Vermont Blue Advantage Group HMOPOS (HMO-POS)	01	02		1			H9489	802	0	2022	State of Vermont		1	0	2			2						www.vermontblueadvantage.com/pharmacies	www.vermontblueadvantage.com/formularies	www.vermontblueadvantage.com/findadoctor	(844)839-5126		(844)839-5126		(844)510-2583		(844)510-2583		(877)779-2864		(877)779-2864		(844)510-2583		(844)510-2583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;2;9a1;11a;15;	2		1	1	1a;2;9a1;11a;15;	2		1				
H9489	803	0	1	01	01	H9489_803_0	5	1						04/19/2021	2022.01	04/19/2021 09:30:42 AM Eastern Daylight Time					06/07/2021 02:26:36 PM Eastern Daylight Time	VERMONT BLUE ADVANTAGE, INC.	Vermont Blue Advantage	www.vermontblueadvantage.com	Vermont Blue Advantage Group HMO (HMO)	01	01		1			H9489	803	0	2022	State of Vermont		1	0	2			2						www.vermontblueadvantage.com/pharmacies	www.vermontblueadvantage.com/formularies	www.vermontblueadvantage.com/findadoctor	(844)839-5126		(844)839-5126		(844)510-2583		(844)510-2583		(877)779-2864		(877)779-2864		(844)510-2583		(844)510-2583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;2;9a1;11a;15;	2		1					1				
H9489	804	0	1	02	01	H9489_804_0	5	1						04/19/2021	2022.01	04/19/2021 09:33:57 AM Eastern Daylight Time					06/07/2021 02:26:36 PM Eastern Daylight Time	VERMONT BLUE ADVANTAGE, INC.	Vermont Blue Advantage	www.vermontblueadvantage.com	Vermont Blue Advantage Group HMOPOS (HMO-POS)	01	02		1			H9489	804	0	2022	State of Vermont		1	0	2			2						www.vermontblueadvantage.com/pharmacies	www.vermontblueadvantage.com/formularies	www.vermontblueadvantage.com/findadoctor	(844)839-5126		(844)839-5126		(844)510-2583		(844)510-2583		(877)779-2864		(877)779-2864		(844)510-2583		(844)510-2583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;2;9a1;11a;15;	2		1	1	1a;2;9a1;11a;15;	2		1				
H9489	805	0	1	01	01	H9489_805_0	5	1						04/19/2021	2022.01	04/19/2021 09:34:09 AM Eastern Daylight Time					06/07/2021 02:26:36 PM Eastern Daylight Time	VERMONT BLUE ADVANTAGE, INC.	Vermont Blue Advantage	www.vermontblueadvantage.com	Vermont Blue Advantage Group HMO (HMO)	01	01		1			H9489	805	0	2022	State of Vermont		1	0	2			2						www.vermontblueadvantage.com/pharmacies	www.vermontblueadvantage.com/formularies	www.vermontblueadvantage.com/findadoctor	(844)839-5126		(844)839-5126		(844)510-2583		(844)510-2583		(877)779-2864		(877)779-2864		(844)510-2583		(844)510-2583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;2;9a1;11a;15;	2		1					1				
H9489	806	0	1	02	01	H9489_806_0	5	1						04/19/2021	2022.01	04/19/2021 09:34:21 AM Eastern Daylight Time					06/07/2021 02:26:36 PM Eastern Daylight Time	VERMONT BLUE ADVANTAGE, INC.	Vermont Blue Advantage	www.vermontblueadvantage.com	Vermont Blue Advantage Group HMOPOS (HMO-POS)	01	02		1			H9489	806	0	2022	State of Vermont		1	0	2			2						www.vermontblueadvantage.com/pharmacies	www.vermontblueadvantage.com/formularies	www.vermontblueadvantage.com/findadoctor	(844)839-5126		(844)839-5126		(844)510-2583		(844)510-2583		(877)779-2864		(877)779-2864		(844)510-2583		(844)510-2583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;2;9a1;11a;15;	2		1	1	1a;2;9a1;11a;15;	2		1				
H9489	807	0	1	01	01	H9489_807_0	5	1				0	0	04/19/2021	2022.01	04/19/2021 09:34:32 AM Eastern Daylight Time					06/07/2021 02:26:36 PM Eastern Daylight Time	VERMONT BLUE ADVANTAGE, INC.	Vermont Blue Advantage	www.vermontblueadvantage.com	Vermont Blue Advantage Group HMO (HMO)	01	01		1			H9489	807	0	2022	State of Vermont		1	0	2			2						www.VermontBlueAdvantage.com/pharmacies	www.VermontBlueAdvantage.com/formularies	www.vermontblueadvantage.com/findadoctor	(844)839-5126		(844)839-5126		(844)510-2583		(844)510-2583										(711)-		(711)-		(711)-		(711)-										1	1	1a;2;9a1;11a;15;	2		1					1				
H9489	808	0	1	02	01	H9489_808_0	5	1				0	0	04/19/2021	2022.01	04/19/2021 09:34:43 AM Eastern Daylight Time					06/07/2021 02:26:36 PM Eastern Daylight Time	VERMONT BLUE ADVANTAGE, INC.	Vermont Blue Advantage	www.vermontblueadvantage.com	Vermont Blue Advantage Group HMOPOS (HMO-POS)	01	02		1			H9489	808	0	2022	State of Vermont		1	0	2			2						www.VermontBlueAdvantage.com/pharmacies	www.VermontBlueAdvantage.com/formularies	www.vermontblueadvantage.com/findadoctor	(844)839-5126		(844)839-5126		(844)510-2583		(844)510-2583										(711)-		(711)-		(711)-		(711)-										1	1	1a;2;9a1;11a;15;	2		1	1	1a;2;9a1;11a;15;	2		1				
H9525	003	0	1	01	01	H9525_003_0	7	1	2	1	1		0	07/28/2021	2022.01	07/28/2021 03:21:42 PM Eastern Daylight Time	08/03/2021 06:04:00 PM Eastern Daylight Time	08/03/2021 06:04:00 PM Eastern Daylight Time			08/04/2021 02:28:17 PM Eastern Daylight Time	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Anthem Blue Cross and Blue Shield	shop.anthem.com/medicare	Anthem MediBlue Dual Advantage (HMO D-SNP)	01	01		1			H9525	003	0	2022	Select Counties in Wisconsin		2		2			1	3		1		1	https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(866)242-0251		(866)242-0251		(855)793-1933		(855)793-1933		(833)344-1016		(833)344-1016		(855)523-0681		(855)523-0681		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9525	004	0	1	01	01	H9525_004_0	7	1			2		0	08/02/2021	2022.01	08/02/2021 02:30:11 PM Eastern Daylight Time	08/03/2021 06:04:00 PM Eastern Daylight Time	08/03/2021 06:04:00 PM Eastern Daylight Time			08/04/2021 02:28:17 PM Eastern Daylight Time	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Anthem Blue Cross and Blue Shield	shop.anthem.com/medicare	Anthem MediBlue Plus (HMO)	01	01		1			H9525	004	0	2022	Select Counties in Wisconsin		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(855)304-1774		(855)304-1774		(855)793-1934		(855)793-1934		(833)344-1014		(833)344-1014		(855)523-0683		(855)523-0683		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9525	006	0	1	01	01	H9525_006_0	7	1			2		0	08/02/2021	2022.01	08/02/2021 02:30:31 PM Eastern Daylight Time	08/03/2021 06:04:00 PM Eastern Daylight Time	08/03/2021 06:04:00 PM Eastern Daylight Time			08/04/2021 02:28:17 PM Eastern Daylight Time	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Anthem Blue Cross and Blue Shield	shop.anthem.com/medicare	Anthem MediBlue Plus (HMO)	01	01		1			H9525	006	0	2022	Select Counties in Wisconsin		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(855)304-1774		(855)304-1774		(855)793-1934		(855)793-1934		(833)344-1014		(833)344-1014		(855)523-0683		(855)523-0683		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9525	007	0	1	01	01	H9525_007_0	9	1	2	1	1		0	07/19/2021	2022.01	07/19/2021 02:48:58 PM Eastern Daylight Time	08/03/2021 06:03:59 PM Eastern Daylight Time	08/03/2021 06:03:59 PM Eastern Daylight Time			08/04/2021 02:00:52 PM Eastern Daylight Time	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Anthem Blue Cross and Blue Shield	shop.anthem.com/medicare	Anthem MediBlue Dual Advantage (HMO D-SNP)	01	01		1			H9525	007	0	2022	Kentucky		2		2			1	3		1		1	https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(844)879-3601		(844)879-3601		(855)793-1933		(855)793-1933		(833)344-1013		(833)344-1013		(855)523-0681		(855)523-0681		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9525	010	0	1	01	01	H9525_010_0	7	1	2	1	1		0	07/19/2021	2022.01	07/19/2021 02:49:22 PM Eastern Daylight Time	08/03/2021 06:03:59 PM Eastern Daylight Time	08/03/2021 06:03:59 PM Eastern Daylight Time			08/04/2021 02:00:52 PM Eastern Daylight Time	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Anthem Blue Cross and Blue Shield	shop.anthem.com/medicare	Anthem MediBlue + Kroger Dual Advantage (HMO D-SNP)	01	01		1			H9525	010	0	2022	Select counties in KY		2		2			1	3		1		1	https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(844)879-3601		(844)879-3601		(855)793-1933		(855)793-1933		(833)344-1013		(833)344-1013		(855)523-0681		(855)523-0681		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9525	011	0	1	01	01	H9525_011_0	9	1		1	2		0	07/19/2021	2022.01	07/19/2021 02:49:36 PM Eastern Daylight Time		08/03/2021 06:03:59 PM Eastern Daylight Time		08/03/2021 06:03:59 PM Eastern Daylight Time	08/04/2021 02:00:52 PM Eastern Daylight Time	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Anthem Blue Cross and Blue Shield	shop.anthem.com/medicare	Anthem MediBlue ESRD Care (HMO C-SNP)	01	01		1			H9525	011	0	2022	Kentucky		2		2			1	4			00000000100000000000		https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(844)879-3601		(844)879-3601		(855)793-1933		(855)793-1933		(833)344-1013		(833)344-1013		(855)523-0681		(855)523-0681		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9525	012	0	1	01	01	H9525_012_0	7	1	2	1	1		0	07/29/2021	2022.01	07/29/2021 11:57:41 AM Eastern Daylight Time	08/03/2021 06:04:00 PM Eastern Daylight Time	08/03/2021 06:04:00 PM Eastern Daylight Time			08/04/2021 02:28:17 PM Eastern Daylight Time	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Anthem Blue Cross and Blue Shield	shop.anthem.com/medicare	Anthem MediBlue Dual Connect (HMO D-SNP)	01	01		1			H9525	012	0	2022	Select counties in Wisconsin		2		2			1	3		2		2	https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(866)242-0251		(866)242-0251		(855)793-1933		(855)793-1933		(833)344-1016		(833)344-1016		(855)523-0681		(855)523-0681		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9525	013	1	1	01	01	H9525_013_1	7	1			2		0	08/02/2021	2022.01	08/02/2021 12:42:49 PM Eastern Daylight Time	08/03/2021 06:03:59 PM Eastern Daylight Time	08/03/2021 06:04:00 PM Eastern Daylight Time			08/04/2021 02:00:52 PM Eastern Daylight Time	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Anthem Blue Cross and Blue Shield	shop.anthem.com/medicare	Anthem MediBlue Plus (HMO)	01	01		1			H9525	013	1	2022	Select counties in KY	Rural KY	2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(844)879-3601		(844)879-3601		(855)793-1933		(855)793-1933		(833)344-1013		(833)344-1013		(855)523-0681		(855)523-0681		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9525	013	2	1	01	01	H9525_013_2	7	1			2		0	07/19/2021	2022.01	07/19/2021 02:49:57 PM Eastern Daylight Time	08/03/2021 06:04:00 PM Eastern Daylight Time	08/03/2021 06:04:00 PM Eastern Daylight Time			08/04/2021 02:00:52 PM Eastern Daylight Time	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Anthem Blue Cross and Blue Shield	shop.anthem.com/medicare	Anthem MediBlue Plus (HMO)	01	01		1			H9525	013	2	2022	Select counties in KY	Louisville KY	2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(844)879-3601		(844)879-3601		(855)793-1933		(855)793-1933		(833)344-1013		(833)344-1013		(855)523-0681		(855)523-0681		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9525	013	3	1	01	01	H9525_013_3	7	1			2		0	07/19/2021	2022.01	07/19/2021 02:50:09 PM Eastern Daylight Time	08/03/2021 06:04:00 PM Eastern Daylight Time	08/03/2021 06:04:00 PM Eastern Daylight Time			08/04/2021 02:00:52 PM Eastern Daylight Time	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Anthem Blue Cross and Blue Shield	shop.anthem.com/medicare	Anthem MediBlue Plus (HMO)	01	01		1			H9525	013	3	2022	Select counties in KY	Lexington KY	2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(844)879-3601		(844)879-3601		(855)793-1933		(855)793-1933		(833)344-1013		(833)344-1013		(855)523-0681		(855)523-0681		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9525	013	4	1	01	01	H9525_013_4	7	1			2		0	07/19/2021	2022.01	07/19/2021 02:50:20 PM Eastern Daylight Time	08/03/2021 06:04:00 PM Eastern Daylight Time	08/03/2021 06:04:00 PM Eastern Daylight Time			08/04/2021 02:00:52 PM Eastern Daylight Time	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Anthem Blue Cross and Blue Shield	shop.anthem.com/medicare	Anthem MediBlue Plus (HMO)	01	01		1			H9525	013	4	2022	Select counties in KY	Cincinnati KY	2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(844)879-3601		(844)879-3601		(855)793-1933		(855)793-1933		(833)344-1013		(833)344-1013		(855)523-0681		(855)523-0681		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9525	801	0	1	01	01	H9525_801_0	1	1						06/02/2021	2022.01	06/02/2021 04:02:28 PM Pacific Daylight Time					06/04/2021 10:45:06 AM 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	2022	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		(833)848-8729		(833)848-8729		(833)370-7462		(833)370-7462		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1					1				
H9525	802	0	1	01	01	H9525_802_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 04:02:40 PM Pacific Daylight Time					06/04/2021 10:45:06 AM 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	2022	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		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1					1				
H9525	803	0	2	01	01	H9525_803_0	1	1						06/02/2021	2022.01	06/02/2021 04:02:48 PM Pacific Daylight Time					06/04/2021 10:45:06 AM 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	2022	Wisconsin - Select Counties		1	600	2			2						www.anthem.com/wi/medicare	www.anthem.com/wi/medicare	www.anthem.com/wi/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)360-3669		(833)360-3669		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1					1				
H9525	804	0	1	01	01	H9525_804_0	1	1						06/02/2021	2022.01	06/02/2021 04:04:03 PM Pacific Daylight Time					06/04/2021 10:45:06 AM 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	2022	Kentucky - Select Counties		1	1296	2			2						www.anthem.com/ky/medicare	www.anthem.com/ky/medicare	www.anthem.com/ky/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)360-3669		(833)360-3669		(833)360-3669		(833)360-3669		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1					1				
H9525	805	0	1	01	01	H9525_805_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 04:04:16 PM Pacific Daylight Time					06/04/2021 10:45:06 AM 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	2022	Kentucky - Select Counties		1	600	2			2						www.anthem.com/ky/medicare	www.anthem.com/ky/medicare	www.anthem.com/ky/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1					1				
H9525	806	0	2	01	01	H9525_806_0	1	1						06/02/2021	2022.01	06/02/2021 04:04:35 PM Pacific Daylight Time					06/04/2021 10:45:06 AM 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	2022	Kentucky - Select Counties		1	600	2			2						www.anthem.com/ky/medicare	www.anthem.com/ky/medicare	www.anthem.com/ky/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)360-3669		(833)360-3669		(833)360-3669		(833)360-3669		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1					1				
H9525	807	0	2	01	01	H9525_807_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 04:03:03 PM Pacific Daylight Time					06/04/2021 10:45:06 AM 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	2022	Select Wisconsin Coutnies		1	600	2			2						www.anthem.com/wi/medicare	www.anthem.com/wi/medicare	www.anthem.com/wi/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1					1				
H9525	809	0	1	01	01	H9525_809_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 04:03:15 PM Pacific Daylight Time					06/04/2021 10:45:06 AM 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	2022	Select Wisconsin Counties		1	600	2			2						www.anthem.com/wi/medicare	www.anthem.com/wi/medicare	www.anthem.com/wi/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1					1				
H9525	811	0	2	01	01	H9525_811_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 04:04:44 PM Pacific Daylight Time					06/04/2021 10:45:06 AM 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	2022	Select Kentucky Counties		1	600	2			2						www.anthem.com/ky/medicare	www.anthem.com/ky/medicare	www.anthem.com/ky/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1					1				
H9525	813	0	1	01	01	H9525_813_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 04:04:57 PM Pacific Daylight Time					06/04/2021 10:45:06 AM 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	2022	Select Kentucky Counties		1	600	2			2						www.anthem.com/ky/medicare	www.anthem.com/ky/medicare	www.anthem.com/ky/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1					1				
H9525	815	0	2	01	01	H9525_815_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 04:03:32 PM Pacific Daylight Time					06/04/2021 10:45:06 AM 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	2022	Select Wisconsin Counties		1	600	2			2						www.anthem.com/wi/medicare	www.anthem.com/wi/medicare	www.anthem.com/wi/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1					1				
H9525	816	0	2	01	01	H9525_816_0	1	1				0	0	06/02/2021	2022.01	06/02/2021 04:05:13 PM Pacific Daylight Time					06/04/2021 10:45:06 AM 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	2022	Select  KY Counties		1	600	2			2						www.anthem.com/ky/medicare	www.anthem.com/ky/medicare	www.anthem.com/ky/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	2		1					1				
H9572	001	1	1	04	01	H9572_001_1	7	1					0	08/03/2021	2022.01	08/03/2021 01:02:01 PM Eastern Daylight Time	08/04/2021 04:31:00 PM Eastern Daylight Time	08/04/2021 04:30:49 PM Eastern Daylight Time			08/05/2021 08:16:02 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	2022	State of Michigan	Region 1	2	12689	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(877)241-2583		(877)241-2583		(855)425-7720		(855)425-7720		(877)241-2583		(877)241-2583		(855)425-7720		(855)425-7720		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9572	001	2	1	04	01	H9572_001_2	7	1					0	08/03/2021	2022.01	08/03/2021 01:29:26 PM Eastern Daylight Time	08/04/2021 04:30:42 PM Eastern Daylight Time	08/04/2021 04:30:33 PM Eastern Daylight Time			08/05/2021 08:16:02 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	2022	State of Michigan	Region 2	2	32513	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(877)241-2583		(877)241-2583		(855)425-7720		(855)425-7720		(877)241-2583		(877)241-2583		(855)425-7720		(855)425-7720		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9572	001	3	1	04	01	H9572_001_3	7	1					0	08/03/2021	2022.01	08/03/2021 01:02:27 PM Eastern Daylight Time	08/04/2021 04:30:26 PM Eastern Daylight Time	08/04/2021 04:30:13 PM Eastern Daylight Time			08/05/2021 08:16:02 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	2022	State of Michigan	Region 3	2	40497	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(877)241-2583		(877)241-2583		(855)425-7720		(855)425-7720		(877)241-2583		(877)241-2583		(855)425-7720		(855)425-7720		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9572	001	4	1	04	01	H9572_001_4	7	1					0	08/03/2021	2022.01	08/03/2021 01:29:15 PM Eastern Daylight Time	08/04/2021 04:29:53 PM Eastern Daylight Time	08/04/2021 04:29:31 PM Eastern Daylight Time			08/05/2021 08:16:02 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	2022	State of Michigan	Region 4	2	77228	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(877)241-2583		(877)241-2583		(855)425-7720		(855)425-7720		(877)241-2583		(877)241-2583		(855)425-7720		(855)425-7720		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9572	001	6	1	04	01	H9572_001_6	7	1					0	08/03/2021	2022.01	08/03/2021 01:05:10 PM Eastern Daylight Time	08/04/2021 04:29:19 PM Eastern Daylight Time	08/04/2021 04:29:10 PM Eastern Daylight Time			08/05/2021 08:16:02 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	2022	State of Michigan	Region 6	2	241093	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(877)241-2583		(877)241-2583		(855)425-7720		(855)425-7720		(877)241-2583		(877)241-2583		(855)425-7720		(855)425-7720		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9572	002	1	1	04	01	H9572_002_1	7	1					0	08/03/2021	2022.01	08/03/2021 01:29:42 PM Eastern Daylight Time	08/04/2021 04:29:02 PM Eastern Daylight Time	08/04/2021 04:28:49 PM Eastern Daylight Time			08/05/2021 08:16:02 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	2022	State of Michigan	Region 1	2	12220	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(877)241-2583		(877)241-2583		(855)425-7720		(855)425-7720		(877)241-2583		(877)241-2583		(855)425-7720		(855)425-7720		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9572	002	2	1	04	01	H9572_002_2	7	1					0	08/03/2021	2022.01	08/03/2021 01:00:36 PM Eastern Daylight Time	08/04/2021 04:28:42 PM Eastern Daylight Time	08/04/2021 04:28:34 PM Eastern Daylight Time			08/05/2021 08:16:02 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	2022	State of Michigan	Region 2	2	25674	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(877)241-2583		(877)241-2583		(855)425-7720		(855)425-7720		(877)241-2583		(877)241-2583		(855)425-7720		(855)425-7720		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9572	002	3	1	04	01	H9572_002_3	7	1					0	08/03/2021	2022.01	08/03/2021 01:30:24 PM Eastern Daylight Time	08/04/2021 04:28:27 PM Eastern Daylight Time	08/04/2021 04:28:14 PM Eastern Daylight Time			08/05/2021 08:16:02 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	2022	State of Michigan	Region 3	2	23647	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(877)241-2583		(877)241-2583		(855)425-7720		(855)425-7720		(877)241-2583		(877)241-2583		(855)425-7720		(855)425-7720		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9572	002	4	1	04	01	H9572_002_4	7	1					0	08/03/2021	2022.01	08/03/2021 01:05:38 PM Eastern Daylight Time	08/04/2021 04:28:07 PM Eastern Daylight Time	08/04/2021 04:27:59 PM Eastern Daylight Time			08/05/2021 08:16:02 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	2022	State of Michigan	Region 4	2	52082	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(877)241-2583		(877)241-2583		(855)425-7720		(855)425-7720		(877)241-2583		(877)241-2583		(855)425-7720		(855)425-7720		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9572	002	6	1	04	01	H9572_002_6	7	1					0	08/03/2021	2022.01	08/03/2021 01:30:14 PM Eastern Daylight Time	08/04/2021 04:27:48 PM Eastern Daylight Time	08/04/2021 04:27:40 PM Eastern Daylight Time			08/05/2021 08:16:02 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	2022	State of Michigan	Region 6	2	86764	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(877)241-2583		(877)241-2583		(855)425-7720		(855)425-7720		(877)241-2583		(877)241-2583		(855)425-7720		(855)425-7720		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9572	003	1	1	04	01	H9572_003_1	7	1					0	07/21/2021	2022.01	07/21/2021 12:18:23 PM Eastern Daylight Time	08/04/2021 04:27:33 PM Eastern Daylight Time	08/04/2021 04:27:20 PM Eastern Daylight Time			08/05/2021 08:16:02 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	2022	State of Michigan	Region 1	2	5649	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(877)241-2583		(877)241-2583		(855)425-7720		(855)425-7720		(877)241-2583		(877)241-2583		(855)425-7720		(855)425-7720		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9572	003	2	1	04	01	H9572_003_2	7	1					0	07/07/2021	2022.01	07/07/2021 02:20:38 PM Eastern Daylight Time	08/04/2021 04:27:13 PM Eastern Daylight Time	08/04/2021 04:27:05 PM Eastern Daylight Time			08/05/2021 08:16:02 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	2022	State of Michigan	Region 2	2	13019	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(877)241-2583		(877)241-2583		(855)425-7720		(855)425-7720		(877)241-2583		(877)241-2583		(855)425-7720		(855)425-7720		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9572	003	3	1	04	01	H9572_003_3	7	1					0	07/07/2021	2022.01	07/07/2021 02:20:44 PM Eastern Daylight Time	08/04/2021 04:26:58 PM Eastern Daylight Time	08/04/2021 04:26:45 PM Eastern Daylight Time			08/05/2021 08:16:02 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	2022	State of Michigan	Region 3	2	7337	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(877)241-2583		(877)241-2583		(855)425-7720		(855)425-7720		(877)241-2583		(877)241-2583		(855)425-7720		(855)425-7720		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9572	003	4	1	04	01	H9572_003_4	7	1					0	07/07/2021	2022.01	07/07/2021 02:02:30 PM Eastern Daylight Time	08/04/2021 04:26:37 PM Eastern Daylight Time	08/04/2021 04:26:29 PM Eastern Daylight Time			08/05/2021 08:16:02 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	2022	State of Michigan	Region 4	2	22798	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(877)241-2583		(877)241-2583		(855)425-7720		(855)425-7720		(877)241-2583		(877)241-2583		(855)425-7720		(855)425-7720		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9572	003	6	1	04	01	H9572_003_6	7	1					0	07/07/2021	2022.01	07/07/2021 02:03:52 PM Eastern Daylight Time	08/04/2021 04:26:20 PM Eastern Daylight Time	08/04/2021 04:26:11 PM Eastern Daylight Time			08/05/2021 08:16:02 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	2022	State of Michigan	Region 6	2	40845	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(877)241-2583		(877)241-2583		(855)425-7720		(855)425-7720		(877)241-2583		(877)241-2583		(855)425-7720		(855)425-7720		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9572	004	1	1	04	01	H9572_004_1	8	1					0	07/07/2021	2022.01	07/07/2021 02:05:51 PM Eastern Daylight Time	08/04/2021 04:26:04 PM Eastern Daylight Time	08/04/2021 04:25:56 PM Eastern Daylight Time			08/05/2021 08:16:02 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	2022	State of Michigan	Region 1	2	16378	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(877)241-2583		(877)241-2583		(855)425-7720		(855)425-7720		(877)241-2583		(877)241-2583		(855)425-7720		(855)425-7720		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9572	004	2	1	04	01	H9572_004_2	8	1					0	07/07/2021	2022.01	07/07/2021 02:20:52 PM Eastern Daylight Time	08/04/2021 04:25:46 PM Eastern Daylight Time	08/04/2021 04:25:37 PM Eastern Daylight Time			08/05/2021 08:16:02 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	2022	State of Michigan	Region 2	2	60169	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(877)241-2583		(877)241-2583		(855)425-7720		(855)425-7720		(877)241-2583		(877)241-2583		(855)425-7720		(855)425-7720		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9572	004	3	1	04	01	H9572_004_3	8	1					0	07/07/2021	2022.01	07/07/2021 02:20:58 PM Eastern Daylight Time	08/04/2021 04:25:31 PM Eastern Daylight Time	08/04/2021 04:25:18 PM Eastern Daylight Time			08/05/2021 08:16:02 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	2022	State of Michigan	Region 3	2	76269	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(877)241-2583		(877)241-2583		(855)425-7720		(855)425-7720		(877)241-2583		(877)241-2583		(855)425-7720		(855)425-7720		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9572	004	4	1	04	01	H9572_004_4	8	1					0	07/07/2021	2022.01	07/07/2021 02:13:10 PM Eastern Daylight Time	08/04/2021 04:25:11 PM Eastern Daylight Time	08/04/2021 04:25:02 PM Eastern Daylight Time			08/05/2021 08:16:02 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	2022	State of Michigan	Region 4	2	167697	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(877)241-2583		(877)241-2583		(855)425-7720		(855)425-7720		(877)241-2583		(877)241-2583		(855)425-7720		(855)425-7720		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9572	004	6	1	04	01	H9572_004_6	8	1					0	07/07/2021	2022.01	07/07/2021 02:12:54 PM Eastern Daylight Time	08/04/2021 04:24:55 PM Eastern Daylight Time	08/04/2021 04:24:43 PM Eastern Daylight Time			08/05/2021 08:16:02 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	2022	State of Michigan	Region 6	2	264574	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(877)241-2583		(877)241-2583		(855)425-7720		(855)425-7720		(877)241-2583		(877)241-2583		(855)425-7720		(855)425-7720		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9572	801	0	1	04	01	H9572_801_0	4	1						05/23/2021	2022.01	05/23/2021 08:03:20 AM Eastern Daylight Time					06/07/2021 01:05:03 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	2022	State of Michigan		1	356280	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;3-4;5;6;7b;7c;7e;7f;7h;7i;7k;8a;8b1;8b2;9a1;9b;9c;10a;11a;11b;11c;12;15;	2		1									
H9572	802	0	1	04	01	H9572_802_0	5	1				0	0	06/23/2021	2022.01	06/23/2021 03:42:15 PM Eastern Daylight Time					06/23/2021 04:40:36 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 (PPO)	01	04		1			H9572	802	0	2022	State of Michigan		1	4593108	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;3-4;5;6;7b;7c;7e;7f;7h;7i;7k;8a;8b1;8b2;9a1;9b;9c;10a;11a;11b;11c;12;15;	2		1									
H9572	803	0	1	04	01	H9572_803_0	4	1						05/23/2021	2022.01	05/23/2021 08:04:05 AM Eastern Daylight Time					06/07/2021 01:05:03 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 non-CY (PPO)	01	04		1			H9572	803	0	2022	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;3-4;5;6;7b;7c;7e;7f;7h;7i;7k;8a;8b1;8b2;9a1;9b;9c;10a;11a;11b;11c;12;15;	2		1									
H9572	804	0	1	04	01	H9572_804_0	4	1				0	0	05/06/2021	2022.01	05/06/2021 09:39:40 PM Eastern Daylight Time					06/07/2021 01:05:03 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 non-CY (PPO)	01	04		1			H9572	804	0	2022	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;3-4;5;6;7b;7c;7e;7f;7h;7i;7k;8a;8b1;8b2;9a1;9b;9c;10a;11a;11b;11c;12;15;	2		1									
H9572	805	0	1	04	01	H9572_805_0	4	1				0	0	05/19/2021	2022.01	05/19/2021 11:28:18 AM Eastern Daylight Time					06/07/2021 01:05:03 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 ASC (PPO)	01	04		1			H9572	805	0	2022	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;3-4;5;6;7b;7c;7e;7f;7h;7i;7k;8a;8b1;8b2;9a1;9b;9c;10a;11a;11b;11c;12;15;	2		1									
H9576	001	0	1	48	05	H9576_001_0	2	1						06/28/2021	2022.01	06/28/2021 01:21:42 PM Eastern Daylight Time					06/28/2021 01:22:21 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	2022	State of Rhode Island		2	155887	2			2						https://www.nhpri.org/medicare-medicaid/find-a-provider-or-pharmacy/	https://www.nhpri.org/medicare-medicaid/member-materials/	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	8	1	2	1			0	08/04/2021	2022.01	08/04/2021 03:45:53 PM Eastern Daylight Time	08/04/2021 03:44:31 PM Eastern Daylight Time	08/04/2021 03:44:31 PM Eastern Daylight Time			08/04/2021 06:21:29 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 D-SNP)	01	01		1			H9585	001	0	2022	Barnstable, Bristol, Hampden, Plymouth, Suffolk		2	21793	2			1	3		1		1	www.SeniorsGetMore.org/pharmacy	www.SeniorsGetMore.org/pharmacy	www.SeniorsGetMore.org	(855)833-8125		(855)833-8125		(855)833-8124		(855)833-8124		(855)833-8125		(855)833-8125		(855)833-8124		(855)833-8124		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9589	003	0	1	04	01	H9589_003_0	8	1					1	08/09/2021	2022.01	08/09/2021 03:53:00 PM Central Daylight Time	08/11/2021 01:34:34 PM Central Daylight Time	08/05/2021 02:08:44 PM Central Daylight Time			08/11/2021 07:24:20 PM Central Daylight Time	EON HEALTH, INC. (GA)	Clear Spring Health	www.eonhealthplan.com	Clear Spring Health Choice Plan (PPO)	01	04		1			H9589	003	0	2022	Select Georgia Counties		2		2			2						https://www.eonhp.com/	https://www.eonhp.com/	www.eonhealthplan.com	(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(877)364-4566		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9590	001	0	1	01	01	H9590_001_0	4	1		1			0	08/03/2021	2022.01	08/03/2021 07:02:57 PM Central Daylight Time	08/03/2021 09:12:31 PM Central Daylight Time	08/04/2021 12:06:58 AM Central Daylight Time			08/05/2021 10:08:57 AM Central Daylight Time	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Longevity Health	www.longevityhealthplan.com	Longevity Health Plan (HMO I-SNP)	01	01		1			H9590	001	0	2022	Illinois (partial)		2	2041	2			1	1	1				www.longevityhealthplan.com	www.longevityhealthplan.com	www.longevityhealthplan.com	(888)886-9770		(888)886-9770		(888)886-9770		(888)886-9770		(888)886-9770		(888)886-9770		(888)886-9770		(888)886-9770		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9592	001	0	1	20	08	H9592_001_0	1	1						06/02/2021	2022.01	06/02/2021 10:25:33 AM Pacific Daylight Time		06/02/2021 10:05:35 AM Pacific Daylight Time			06/02/2021 10:28:34 AM Pacific Daylight Time	INNOVATIVE INTEGRATED HEALTH, INC.	Innovative Integrated Health Inc.	www.fresnopace.org	Innovative Integrated Health (PACE)	08	20		1			H9592	001	0	2022	Fresno, Kern, Madera, Tulare Counties		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	1	1						06/02/2021	2022.01	06/02/2021 10:25:51 AM Pacific Daylight Time		06/02/2021 10:05:42 AM Pacific Daylight Time			06/02/2021 10:28:34 AM Pacific Daylight Time	INNOVATIVE INTEGRATED HEALTH, INC.	Innovative Integrated Health Inc.	https://www.fresnopace.org/	Innovative Integrated Health (PACE)	08	20		1			H9592	002	0	2022	Fresno, Kern, Madera, Tulare Counties		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																
H9614	001	0	1	04	01	H9614_001_0	6	1					0	08/04/2021	2022.01	08/04/2021 12:34:58 PM Pacific Daylight Time	08/02/2021 09:11:00 PM Pacific Daylight Time	07/30/2021 10:40:12 AM Pacific Daylight Time			08/04/2021 12:36:10 PM Pacific Daylight Time	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Alignment Health Plan	www.alignmenthealthplan.com	AVA (PPO)	01	04		1			H9614	001	0	2022	Maricopa, Pima		2	2760	2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247	1	(323)728-7232	6	(844)227-7616		(844)227-7616		(888)979-2247	1	(323)728-7232	6	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9614	801	0	1	04	01	H9614_801_0	3	1						07/13/2021	2022.01	07/13/2021 11:03:30 AM Pacific Daylight Time					07/13/2021 12:24:55 PM Pacific Daylight Time	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan Retiree Options (PPO)	01	04		1			H9614	801	0	2022	Maricopa, Pima		1	6000	2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247	1	(323)728-7232	6	(844)227-7616		(844)227-7616		(888)979-2247	1	(323)728-7232	6	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9614	802	0	1	04	01	H9614_802_0	3	1						07/13/2021	2022.01	07/13/2021 11:05:11 AM Pacific Daylight Time					07/13/2021 12:24:55 PM Pacific Daylight Time	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan Retiree Options (PPO)	01	04		1			H9614	802	0	2022	Maricopa, Pima		1	6000	2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247	1	(323)728-7232	6	(844)227-7616		(844)227-7616		(888)979-2247	1	(323)728-7232	6	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9614	803	0	1	04	01	H9614_803_0	3	1				0	0	07/13/2021	2022.01	07/13/2021 11:07:19 AM Pacific Daylight Time					07/13/2021 12:24:55 PM Pacific Daylight Time	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan Retiree Options (PPO)	01	04		1			H9614	803	0	2022	Maricopa, Pima		1	6000	2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247	1	(323)728-7232	6									(711)-		(711)-		(711)-		(711)-										2					2						2			
H9614	804	0	1	04	01	H9614_804_0	3	1				0	0	07/13/2021	2022.01	07/13/2021 11:09:34 AM Pacific Daylight Time					07/13/2021 12:24:55 PM Pacific Daylight Time	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan Retiree Options (PPO)	01	04		1			H9614	804	0	2022	Maricopa, Pima		1	6000	2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247	1	(323)728-7232	6									(711)-		(711)-		(711)-		(711)-										2					2						2			
H9615	007	0	1	04	01	H9615_007_0	6	1					0	07/13/2021	2022.01	07/13/2021 04:17:21 PM Eastern Daylight Time	08/05/2021 12:00:22 AM Eastern Daylight Time	08/05/2021 12:05:41 AM Eastern Daylight Time			08/05/2021 01:34:17 PM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP HEALTH CARE	www.joinMVPmedicare.com	MVP Medicare WellSelect Plus with Part D (PPO)	01	04		1			H9615	007	0	2022	S.Tier NY, Central NY, Eastern NY		2	12366	2			2						https://www.mvphealthcare.com/partD	https://www.mvphealthcare.com/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	6	1					0	07/13/2021	2022.01	07/13/2021 05:02:32 PM Eastern Daylight Time	08/05/2021 12:00:27 AM Eastern Daylight Time	08/05/2021 12:05:45 AM Eastern Daylight Time			08/05/2021 01:34:17 PM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP HEALTH CARE	www.joinMVPmedicare.com	MVP Medicare WellSelect with Part D (PPO)	01	04		1			H9615	008	0	2022	S.Tier NY, Central NY, Eastern NY, Vermont		2	111447	2			2						https://www.mvphealthcare.com/partD	https://www.mvphealthcare.com/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	6	1					0	07/13/2021	2022.01	07/13/2021 04:19:27 PM Eastern Daylight Time	08/05/2021 12:00:33 AM Eastern Daylight Time	08/05/2021 12:05:50 AM Eastern Daylight Time			08/05/2021 01:34:17 PM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP HEALTH CARE	www.joinMVPmedicare.com	MVP Medicare WellSelect Plus with Part D (PPO)	01	04		1			H9615	009	0	2022	Hudson Valley NY		2	6697	2			2						https://www.mvphealthcare.com/partD	https://www.mvphealthcare.com/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	6	1					0	07/13/2021	2022.01	07/13/2021 04:20:13 PM Eastern Daylight Time	08/05/2021 12:00:38 AM Eastern Daylight Time	08/05/2021 12:05:54 AM Eastern Daylight Time			08/05/2021 01:34:17 PM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP HEALTH CARE	www.joinMVPmedicare.com	MVP Medicare WellSelect with Part D (PPO)	01	04		1			H9615	010	0	2022	Hudson Valley NY		2	81128	2			2						https://www.mvphealthcare.com/partD	https://www.mvphealthcare.com/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					0	07/13/2021	2022.01	07/13/2021 04:21:51 PM Eastern Daylight Time	08/05/2021 12:00:43 AM Eastern Daylight Time	08/05/2021 12:05:59 AM Eastern Daylight Time			08/05/2021 01:34:17 PM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP HEALTH CARE	www.joinmvpmedicare.com	MVP Medicare WellSelect with Part D (PPO)	01	04		1			H9615	012	0	2022	Western NY (Rochester/Buffalo)		2	43530	2			2						https://www.mvphealthcare.com/partD	https://www.mvphealthcare.com/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	014	0	1	04	01	H9615_014_0	6	1					0	07/13/2021	2022.01	07/13/2021 04:22:42 PM Eastern Daylight Time	08/05/2021 12:00:48 AM Eastern Daylight Time	08/05/2021 12:06:03 AM Eastern Daylight Time			08/05/2021 01:34:17 PM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP HEALTH CARE	www.joinmvpmedicare.com	MVP Medicare Patriot Plan with Part D (PPO)	01	04		1			H9615	014	0	2022	Buffalo, Rochester, S. Tier, CNY, Capital, Hudson		2		2			2						https://www.mvphealthcare.com/partD	https://www.mvphealthcare.com/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	015	0	1	04	01	H9615_015_0	7	1					0	07/13/2021	2022.01	07/13/2021 04:24:16 PM Eastern Daylight Time	08/05/2021 12:00:53 AM Eastern Daylight Time	08/05/2021 12:06:08 AM Eastern Daylight Time			08/05/2021 01:34:17 PM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP HEALTH CARE	www.joinmvpmedicare.com	UVM Health Advantage Select (PPO)	01	04		1			H9615	015	0	2022	Vermont, Northern NY		2		2			2						https://www.mvphealthcare.com/partD	https://www.mvphealthcare.com/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	016	0	1	04	01	H9615_016_0	7	1					0	07/13/2021	2022.01	07/13/2021 04:25:11 PM Eastern Daylight Time	08/05/2021 12:00:58 AM Eastern Daylight Time	08/05/2021 12:06:12 AM Eastern Daylight Time			08/05/2021 01:34:17 PM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP HEALTH CARE	www.joinmvpmedicare.com	UVM Health Advantage Secure (PPO)	01	04		1			H9615	016	0	2022	Vermont, Northern NY		2		2			2						https://www.mvphealthcare.com/partD	https://www.mvphealthcare.com/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	017	0	1	04	01	H9615_017_0	6	1					0	07/13/2021	2022.01	07/13/2021 04:26:43 PM Eastern Daylight Time	08/05/2021 12:01:03 AM Eastern Daylight Time	08/05/2021 12:06:17 AM Eastern Daylight Time			08/05/2021 01:34:17 PM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP HEALTH CARE	www.joinmvpmedicare.com	UVM Health Advantage Preferred (PPO)	01	04		1			H9615	017	0	2022	Vermont, Northern NY		2		2			2						https://www.mvphealthcare.com/partD	https://www.mvphealthcare.com/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						05/25/2021	2022.01	05/25/2021 01:39:59 PM Eastern Daylight Time					06/05/2021 06:23:18 PM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP HEALTH CARE	www.mvphealthcare.com	MVP GoldAnywhere Rx - Employer Group (PPO)	01	04		1			H9615	802	0	2022	Employer Group East/West NY, Vermont		1	109104	2			2						https://www.mvphealthcare.com/partD	https://www.mvphealthcare.com/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	807	0	1	04	01	H9615_807_0	1	1						05/25/2021	2022.01	05/25/2021 02:43:05 PM Eastern Daylight Time					06/05/2021 06:23:18 PM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP HEALTH CARE	www.mvphealthcare.com	MVP USA Care Rx - Employer Group (PPO)	01	04		1			H9615	807	0	2022	United States and Puerto Rico		1	21738	2			2						https://www.mvphealthcare.com/partD	https://www.mvphealthcare.com/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	810	0	1	04	01	H9615_810_0	1	1				0	0	05/25/2021	2022.01	05/25/2021 02:57:26 PM Eastern Daylight Time					06/05/2021 06:23:18 PM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP HEALTH CARE	www.mvphealthcare.com	MVP GoldAnywhere - Employer Group (PPO)	01	04		1			H9615	810	0	2022	Employer Group East/West NY, Vermont		1	0	2			2						https://www.mvphealthcare.com/partD	https://www.mvphealthcare.com/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			
H9615	811	0	1	04	01	H9615_811_0	1	1				0	0	05/25/2021	2022.01	05/25/2021 03:24:08 PM Eastern Daylight Time					06/05/2021 06:23:18 PM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP HEALTH CARE	www.mvphealthcare.com	MVP USA Care without Part D - Employer Group (PPO)	01	04		1			H9615	811	0	2022	United States and Puerto Rico		1	0	2			2						https://www.mvphealthcare.com/partD	https://www.mvphealthcare.com/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			
H9616	001	0	1	20	08	H9616_001_0	1	1						05/28/2021	2022.01	05/28/2021 02:52:43 PM Pacific Daylight Time		05/28/2021 02:44:47 PM Pacific Daylight Time			05/28/2021 02:54:33 PM Pacific Daylight Time	CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO	San Diego PACE	http://www.syhealth.org/sdpace/	San Diego PACE (Duals) (PACE)	08	20		1			H9616	001	0	2022	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						05/28/2021	2022.01	05/28/2021 02:53:05 PM Pacific Daylight Time		05/28/2021 02:45:12 PM Pacific Daylight Time			05/28/2021 02:54:33 PM Pacific Daylight Time	CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO	San Diego PACE	http://www.syhealth.org/sdpace/	San Diego PACE (Medicare Only) (PACE)	08	20		1			H9616	002	0	2022	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	5	1					0	08/01/2021	2022.01	08/01/2021 02:44:50 PM Eastern Daylight Time	08/04/2021 01:55:15 AM Eastern Daylight Time	07/30/2021 02:04:34 PM Eastern Daylight Time			08/04/2021 08:53:46 PM Eastern Daylight Time	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Wellcare by Allwell	www.wellcare.com/allwellAR	Wellcare No Premium Medicare (HMO)	01	01		1			H9630	001	0	2022	Select counties in AR		2	82639	2			2						www.wellcare.com/allwellAR	www.wellcare.com/allwellAR	www.wellcare.com/allwellAR	(855)565-9518		(855)565-9518		(866)277-6583		(866)277-6583		(855)565-9518		(855)565-9518		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9630	002	0	1	01	01	H9630_002_0	5	1					0	08/01/2021	2022.01	08/01/2021 02:47:23 PM Eastern Daylight Time	08/04/2021 01:55:43 AM Eastern Daylight Time	07/30/2021 02:04:54 PM Eastern Daylight Time			08/04/2021 08:53:46 PM Eastern Daylight Time	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Wellcare by Allwell	www.wellcare.com/allwellAR	Wellcare No Premium (HMO)	01	01		1			H9630	002	0	2022	Select counties in AR		2	167123	2			2						www.wellcare.com/allwellAR	www.wellcare.com/allwellAR	www.wellcare.com/allwellAR	(855)565-9518		(855)565-9518		(866)277-6583		(866)277-6583		(855)565-9518		(855)565-9518		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9630	003	0	1	01	01	H9630_003_0	5	1					0	08/01/2021	2022.01	08/01/2021 02:48:49 PM Eastern Daylight Time	08/04/2021 01:56:09 AM Eastern Daylight Time	07/30/2021 02:05:14 PM Eastern Daylight Time			08/04/2021 08:53:46 PM Eastern Daylight Time	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Wellcare by Allwell	www.wellcare.com/allwellAR	Wellcare No Premium Select (HMO)	01	01		1			H9630	003	0	2022	Select counties in AR		2	18771	2			2						www.wellcare.com/allwellAR	www.wellcare.com/allwellAR	www.wellcare.com/allwellAR	(855)565-9518		(855)565-9518		(866)277-6583		(866)277-6583		(855)565-9518		(855)565-9518		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9630	004	0	1	01	01	H9630_004_0	5	1					0	08/01/2021	2022.01	08/01/2021 02:52:38 PM Eastern Daylight Time	08/04/2021 01:56:37 AM Eastern Daylight Time	07/30/2021 02:05:46 PM Eastern Daylight Time			08/04/2021 08:53:46 PM Eastern Daylight Time	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Wellcare by Allwell	www.wellcare.com/allwellAR	Wellcare No Premium Medicare (HMO)	01	01		1			H9630	004	0	2022	Select counties in AR		2	32980	2			2						www.wellcare.com/allwellAR	www.wellcare.com/allwellAR	www.wellcare.com/allwellAR	(855)565-9518		(855)565-9518		(866)277-6583		(866)277-6583		(855)565-9518		(855)565-9518		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9630	005	0	1	01	01	H9630_005_0	5	1					0	05/30/2021	2022.01	05/30/2021 10:44:44 AM Eastern Daylight Time	08/04/2021 01:57:06 AM Eastern Daylight Time	07/30/2021 02:06:28 PM Eastern Daylight Time			08/04/2021 08:53:46 PM Eastern Daylight Time	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Wellcare by Allwell	www.wellcare.com/allwellAR	Wellcare Assist (HMO)	01	01		1			H9630	005	0	2022	Select counties in AR		2	13873	2			2						www.wellcare.com/allwellAR	www.wellcare.com/allwellAR	www.wellcare.com/allwellAR	(855)565-9518		(855)565-9518		(866)277-6583		(866)277-6583		(855)565-9518		(855)565-9518		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9630	006	0	1	01	01	H9630_006_0	5	1					0	05/30/2021	2022.01	05/30/2021 10:46:13 AM Eastern Daylight Time	08/04/2021 01:57:35 AM Eastern Daylight Time	07/30/2021 02:07:08 PM Eastern Daylight Time			08/04/2021 08:53:46 PM Eastern Daylight Time	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Wellcare by Allwell	www.wellcare.com/allwellAR	Wellcare Assist (HMO)	01	01		1			H9630	006	0	2022	Select counties in AR		2	48318	2			2						www.wellcare.com/allwellAR	www.wellcare.com/allwellAR	www.wellcare.com/allwellAR	(855)565-9518		(855)565-9518		(866)277-6583		(866)277-6583		(855)565-9518		(855)565-9518		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9630	008	0	1	01	01	H9630_008_0	5	1					0	08/01/2021	2022.01	08/01/2021 02:56:58 PM Eastern Daylight Time	08/04/2021 01:58:02 AM Eastern Daylight Time	07/30/2021 02:07:38 PM Eastern Daylight Time			08/04/2021 08:53:46 PM Eastern Daylight Time	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Wellcare by Allwell	www.wellcare.com/allwellAR	Wellcare Giveback (HMO)	01	01		1			H9630	008	0	2022	Select counties in AR		2	29651	2			2						www.wellcare.com/allwellAR	www.wellcare.com/allwellAR	www.wellcare.com/allwellAR	(855)565-9518		(855)565-9518		(866)277-6583		(866)277-6583		(855)565-9518		(855)565-9518		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9630	009	0	1	01	01	H9630_009_0	4	1				0	0	05/30/2021	2022.01	05/30/2021 10:48:48 AM Eastern Daylight Time	06/04/2021 07:54:21 PM Eastern Daylight Time				07/19/2021 04:34:39 PM Eastern Daylight Time	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Wellcare by Allwell	www.wellcare.com/allwellAR	Wellcare Patriot No Premium (HMO)	01	01		1			H9630	009	0	2022	Select counties in AR		2	3058	2			2						www.wellcare.com/allwellAR	www.wellcare.com/allwellAR	www.wellcare.com/allwellAR	(855)565-9518		(855)565-9518		(866)277-6583		(866)277-6583										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H9630	010	0	1	01	01	H9630_010_0	5	1	2	1			0	06/04/2021	2022.01	06/04/2021 02:25:45 PM Eastern Daylight Time	08/04/2021 01:58:59 AM Eastern Daylight Time	07/30/2021 02:08:00 PM Eastern Daylight Time			08/04/2021 08:53:46 PM Eastern Daylight Time	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Wellcare by Allwell	www.wellcare.com/allwellAR	Wellcare Dual Access (HMO D-SNP)	01	01		1			H9630	010	0	2022	Select counties in AR		2	8356	2			1	3		1		1	www.wellcare.com/allwellAR	www.wellcare.com/allwellAR	www.wellcare.com/allwellAR	(855)565-9518		(855)565-9518		(866)277-6583		(866)277-6583		(855)565-9518		(855)565-9518		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9630	011	0	1	01	01	H9630_011_0	5	1	2	1			0	06/04/2021	2022.01	06/04/2021 02:13:42 PM Eastern Daylight Time	08/04/2021 01:59:28 AM Eastern Daylight Time	07/30/2021 02:08:32 PM Eastern Daylight Time			08/04/2021 08:53:46 PM Eastern Daylight Time	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Wellcare by Allwell	www.wellcare.com/allwellAR	Wellcare Dual Liberty (HMO D-SNP)	01	01		1			H9630	011	0	2022	Select counties in AR		2	10173	2			1	3		1		1	www.wellcare.com/allwellAR	www.wellcare.com/allwellAR	www.wellcare.com/allwellAR	(855)565-9518		(855)565-9518		(866)277-6583		(866)277-6583		(855)565-9518		(855)565-9518		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9630	801	0	1	01	01	H9630_801_0	2	1						05/03/2021	2022.01	05/03/2021 02:13:02 PM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Wellcare by Allwell	allwell.arhealthwellness.com	Allwell Group (HMO)	01	01		1			H9630	801	0	2022	Arkansas		1	100	2			2						allwell.arhealthwellness.com/findadoctor	allwell.arhealthwellness.com/formulary	allwell.arhealthwellness.com/findadoctor	(855)565-9518		(855)565-9518		(844)942-0039		(844)942-0039		(855)565-9518		(855)565-9518		(844)942-0039		(844)942-0039		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H9630	802	0	1	01	01	H9630_802_0	2	1				0	0	05/03/2021	2022.01	05/03/2021 02:13:08 PM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Wellcare by Allwell	allwell.arhealthwellness.com	Allwell Group (HMO)	01	01		1			H9630	802	0	2022	Arkansas		1	100	2			2						allwell.arhealthwellness.com/findadoctor	allwell.arhealthwellness.com/formulary	allwell.arhealthwellness.com/findadoctor	(855)565-9518		(855)565-9518		(844)942-0039		(844)942-0039										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H9630	803	0	1	01	01	H9630_803_0	2	1						05/03/2021	2022.01	05/03/2021 02:13:14 PM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Wellcare by Allwell	allwell.arhealthwellness.com	Allwell Group (HMO)	01	01		1			H9630	803	0	2022	Arkansas		1	100	2			2						allwell.arhealthwellness.com/findadoctor	allwell.arhealthwellness.com/formulary	allwell.arhealthwellness.com/findadoctor	(855)565-9518		(855)565-9518		(844)942-0039		(844)942-0039		(855)565-9518		(855)565-9518		(844)942-0039		(844)942-0039		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H9649	001	0	1	20	08	H9649_001_0	1	1						09/14/2021	2022.01	09/14/2021 12:29:01 PM Mountain Daylight Time		09/14/2021 09:56:44 AM Mountain Daylight Time			09/14/2021 12:32:31 PM Mountain Daylight Time	HOPEWEST	HopeWest PACE	https://www.hopewestco.org/	Hope West PACE - Dual Eligible (PACE)	08	20		1			H9649	001	0	2022	Mesa County		2		2			2						https://www.hopewestco.org/	NA										(866)310-8900		(970)255-7223				(970)255-7223										(800)659-2656		(800)659-2656				(800)659-2656																
H9649	002	0	1	20	08	H9649_002_0	1	1						09/14/2021	2022.01	09/14/2021 12:29:19 PM Mountain Daylight Time		09/14/2021 09:56:45 AM Mountain Daylight Time			09/14/2021 12:32:31 PM Mountain Daylight Time	HOPEWEST	HopeWest PACE	https://www.hopewestco.org/	Hope West Pace - Medicare Only (PACE)	08	20		1			H9649	002	0	2022	Mesa County		2		2			2						https://www.hopewestco.org/	NA										(866)310-8900		(970)255-7223				(970)255-7223										(800)659-2656		(800)659-2656				(800)659-2656																
H9662	801	0	1	01	01	H9662_801_0	2	1						05/10/2021	2022.01	05/10/2021 10:47:43 AM Central Daylight Time					06/02/2021 06:21:36 PM Central Daylight Time	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H9662	801	0	2022	Southern CA		1	600	2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.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)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H9662	802	0	1	01	01	H9662_802_0	2	1						05/10/2021	2022.01	05/10/2021 10:48:00 AM Central Daylight Time					06/02/2021 06:21:36 PM Central Daylight Time	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare FY (HMO)	01	01		1			H9662	802	0	2022	Southern CA		1	600	2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.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)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H9686	001	0	1	01	01	H9686_001_0	5	1					0	08/03/2021	2022.01	08/03/2021 09:50:24 PM Pacific Daylight Time	08/02/2021 11:25:54 PM Pacific Daylight Time	07/30/2021 11:33:10 AM Pacific Daylight Time			08/03/2021 10:17:01 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan Platinum (HMO)	01	01		1			H9686	001	0	2022	Clark, Washoe & Nye		2	30176	2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(866)634-2247		(888)979-2247		(888)979-2247		(844)227-7616		(844)227-7616		(888)979-2247		(888)979-2247		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9686	003	0	1	01	01	H9686_003_0	7	1					0	08/03/2021	2022.01	08/03/2021 09:50:32 PM Pacific Daylight Time	08/02/2021 11:27:22 PM Pacific Daylight Time	07/30/2021 11:35:40 AM Pacific Daylight Time			08/03/2021 10:17:01 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Alignment Health Plan	www.alignmenthealthplan.com	AVA (HMO)	01	01		1			H9686	003	0	2022	Clark, Washoe & Nye		2	4836	2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(866)634-2247		(888)979-2247		(888)979-2247		(844)227-7616		(844)227-7616		(888)979-2247		(888)979-2247		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9686	004	0	1	01	01	H9686_004_0	6	1		1			0	08/03/2021	2022.01	08/03/2021 09:50:42 PM Pacific Daylight Time	08/03/2021 11:32:34 AM Pacific Daylight Time	07/30/2021 11:36:32 AM Pacific Daylight Time			08/03/2021 10:17:01 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan Heart & Diabetes (HMO C-SNP)	01	01		1			H9686	004	0	2022	Clark, Washoe & Nye		2	2382	2			1	4			00000000000000000010		www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247	1	(323)728-7232	6	(844)227-7616		(844)227-7616		(888)979-2247	1	(323)728-7232	6	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9686	005	0	1	01	01	H9686_005_0	5	1	2	1			0	07/13/2021	2022.01	07/13/2021 11:47:31 AM Pacific Daylight Time	08/03/2021 10:51:36 AM Pacific Daylight Time	07/30/2021 11:37:26 AM Pacific Daylight Time			08/03/2021 10:17:01 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan the ONE (HMO D-SNP)	01	01		1			H9686	005	0	2022	Clark, Washoe & Nye		2	3126	2			1	3		1		1	www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247	1	(323)728-7232	6	(844)227-7616		(844)227-7616		(888)979-2247	1	(323)728-7232	6	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9686	801	0	1	01	01	H9686_801_0	4	1						07/16/2021	2022.01	07/16/2021 09:45:37 AM Pacific Daylight Time					07/16/2021 09:55:29 AM Pacific Daylight Time	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan Retiree Options (HMO)	01	01		1			H9686	801	0	2022	Clark, Washoe & Nye		1	6000	2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(866)634-2247	5550	(888)979-2247	1	(888)979-2247	6	(844)227-7616		(844)227-7616		(888)979-2247	1	(888)979-2247	6	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9686	802	0	1	01	01	H9686_802_0	4	1						07/16/2021	2022.01	07/16/2021 09:45:52 AM Pacific Daylight Time					07/16/2021 09:55:29 AM Pacific Daylight Time	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan Retiree Options (HMO)	01	01		1			H9686	802	0	2022	Clark, Washoe & Nye		1	6000	2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(866)634-2247	5550	(888)979-2247	1	(888)979-2247	6	(844)227-7616		(844)227-7616		(888)979-2247	1	(888)979-2247	6	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9686	803	0	1	01	01	H9686_803_0	4	1				0	0	07/16/2021	2022.01	07/16/2021 09:46:04 AM Pacific Daylight Time					07/16/2021 09:55:29 AM Pacific Daylight Time	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan Retiree Options (HMO)	01	01		1			H9686	803	0	2022	Clark, Washoe & Nye		1	6000	2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(866)634-2247	5550	(888)979-2247	1	(888)979-2247	6									(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H9686	804	0	1	01	01	H9686_804_0	4	1				0	0	07/16/2021	2022.01	07/16/2021 09:46:15 AM Pacific Daylight Time					07/16/2021 09:55:29 AM Pacific Daylight Time	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan Retiree Options (HMO)	01	01		1			H9686	804	0	2022	Clark, Washoe & Nye		1	6000	2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(866)634-2247	5550	(888)979-2247	1	(888)979-2247	6									(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H9699	004	1	1	01	01	H9699_004_1	5	1					0	08/04/2021	2022.01	08/04/2021 04:53:36 PM Central Daylight Time	08/04/2021 05:13:32 PM Central Daylight Time	08/04/2021 05:18:39 PM Central Daylight Time			08/04/2021 05:33:00 PM Central Daylight Time	HMO PARTNERS, INC.	Health Advantage	www.arkansasbluecross.com/medicare	Health Advantage Blue Classic (HMO)	01	01		1			H9699	004	1	2022	State of Arkansas	Northwest and West Central AR counties	2	24974	2			2						http://www.arkansasbluecross.com	www.arkansasbluecross.com/medicare	www.arkansasbluecross.com	(877)349-9335		(877)349-9335		(888)605-0322		(888)605-0322		(877)349-9335		(877)349-9335		(888)605-0322		(888)605-0322		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9699	004	2	1	01	01	H9699_004_2	5	1					0	08/04/2021	2022.01	08/04/2021 04:55:07 PM Central Daylight Time	08/04/2021 05:13:37 PM Central Daylight Time	08/04/2021 05:18:43 PM Central Daylight Time			08/04/2021 05:33:00 PM Central Daylight Time	HMO PARTNERS, INC.	Health Advantage	www.arkansasbluecross.com/medicare	Health Advantage Blue Classic (HMO)	01	01		1			H9699	004	2	2022	State of Arkansas	East Central AR counties	2	15779	2			2						http://www.arkansasbluecross.com	www.arkansasbluecross.com/medicare	www.arkansasbluecross.com	(877)349-9335		(877)349-9335		(888)605-0322		(888)605-0322		(877)349-9335		(877)349-9335		(888)605-0322		(888)605-0322		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9699	004	3	1	01	01	H9699_004_3	5	1					0	08/04/2021	2022.01	08/04/2021 04:55:55 PM Central Daylight Time	08/04/2021 05:13:41 PM Central Daylight Time	08/04/2021 05:18:47 PM Central Daylight Time			08/04/2021 05:33:00 PM Central Daylight Time	HMO PARTNERS, INC.	Health Advantage	www.arkansasbluecross.com/medicare	Health Advantage Blue Classic (HMO)	01	01		1			H9699	004	3	2022	State of Arkansas	Central AR counties	2	2879	2			2						http://www.arkansasbluecross.com	www.arkansasbluecross.com/medicare	www.arkansasbluecross.com	(877)349-9335		(877)349-9335		(888)605-0322		(888)605-0322		(877)349-9335		(877)349-9335		(888)605-0322		(888)605-0322		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9699	006	0	1	01	01	H9699_006_0	5	1					1	08/04/2021	2022.01	08/04/2021 04:56:43 PM Central Daylight Time	08/04/2021 05:13:46 PM Central Daylight Time	08/04/2021 05:18:51 PM Central Daylight Time			08/04/2021 05:33:00 PM Central Daylight Time	HMO PARTNERS, INC.	Health Advantage	www.arkansasbluecross.com/medicare	Health Advantage Blue Premier (HMO)	01	01		1			H9699	006	0	2022	Select Counties in West and Central AR		2	11535	2			2						www.arkansasbluecross.com/medicare	www.arkansasbluecross.com/medicare	www.arkansasbluecross.com	(877)349-9335		(877)349-9335		(888)605-0322		(888)605-0322		(877)349-9335		(877)349-9335		(888)605-0322		(888)605-0322		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9706	001	0	1	01	01	H9706_001_0	3	1					0	06/03/2021	2022.01	06/03/2021 01:39:18 PM Central Daylight Time	08/03/2021 10:51:42 AM Central Daylight Time	08/04/2021 05:14:22 PM Central Daylight Time			08/05/2021 05:38:13 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of Texas	www.getbluetx.com/mapd	Blue Cross Medicare Advantage Value (HMO)	01	01		1			H9706	001	0	2022	Collin, Dallas, Denton, Tarrant		2	16994	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			
H9706	002	0	1	01	01	H9706_002_0	5	1	2	1			0	07/08/2021	2022.01	07/08/2021 10:03:08 AM Central Daylight Time	08/03/2021 10:52:12 AM Central Daylight Time	08/04/2021 05:14:42 PM Central Daylight Time			08/09/2021 11:08:27 AM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of Texas	www.getbluetx.com/dsnp	Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP)	01	01		1			H9706	002	0	2022	State of Texas		2	1998	2			1	3		1		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			
H9706	003	0	1	01	01	H9706_003_0	3	1					0	06/03/2021	2022.01	06/03/2021 01:40:28 PM Central Daylight Time	08/03/2021 10:52:36 AM Central Daylight Time	08/04/2021 05:15:00 PM Central Daylight Time			08/05/2021 05:38:13 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of Texas	www.getbluetx.com/mapd	Blue Cross Medicare Advantage Value (HMO)	01	01		1			H9706	003	0	2022	Austin Metro		2	6701	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			
H9706	005	0	1	01	01	H9706_005_0	3	1					0	06/03/2021	2022.01	06/03/2021 01:40:59 PM Central Daylight Time	08/03/2021 10:53:02 AM Central Daylight Time	08/04/2021 05:15:18 PM Central Daylight Time			08/05/2021 05:38:13 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of Texas	www.getbluetx.com/mapd	Blue Cross Medicare Advantage Value (HMO)	01	01		1			H9706	005	0	2022	Southeast Texas Market HMO		2	1724	2			2						www.getbluetx.com/mapd	www.getbluetx.com/mapd	www.getbluetx.com/mapd	(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			
H9706	801	0	1	01	01	H9706_801_0	1	1						05/27/2021	2022.01	05/27/2021 11:24:30 AM Central Daylight Time					05/28/2021 11:36:07 AM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of Texas	www.getbluetx.com/mapd	Blue Cross Group Medicare Advantage (HMO)	01	01		1			H9706	801	0	2022	Statewide in 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)-		2					2					2	2			
H9706	802	0	1	01	01	H9706_802_0	1	1						05/27/2021	2022.01	05/27/2021 11:24:37 AM Central Daylight Time					05/28/2021 11:36:07 AM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of Texas	www.getbluetx.com/mapd	Blue Cross Group Medicare Advantage (HMO)	01	01		1			H9706	802	0	2022	Statewide in 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)-		2					2					2	2			
H9706	803	0	1	01	01	H9706_803_0	1	1				0	0	05/27/2021	2022.01	05/27/2021 11:24:43 AM Central Daylight Time					05/28/2021 11:36:07 AM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of Texas	www.getbluetx.com/mapd	Blue Cross Group Medicare Advantage (HMO)	01	01		1			H9706	803	0	2022	Statewide in 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)-										2					2					2	2			
H9712	001	0	1	48	05	H9712_001_0	4	1						06/03/2021	2022.01	06/03/2021 12:17:02 PM Eastern Daylight Time					06/05/2021 02:58:06 PM Eastern Daylight Time	HAP EMPOWERED HEALTH PLAN, INC.	HAP Empowered MI Health Link	www.hap.org/mihealthlink	HAP Empowered MI Health Link (Medicare-Medicaid Plan)	05	48		1			H9712	001	0	2022	Macomb and Wayne Counties		2		1	1		2						www.hap.org/mihealthlink	www.hap.org/mihealthlink	www.hap.org/mihealthlink	(888)654-0706		(248)663-3800		(833)923-1630		(833)923-1630		(877)797-9698		(877)797-9698		(833)923-1630		(833)923-1630		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H9725	001	0	1	01	01	H9725_001_0	4	1			2		0	08/02/2021	2022.01	08/02/2021 03:30:37 PM Central Daylight Time	08/02/2021 06:09:54 PM Central Daylight Time	07/30/2021 12:29:15 PM Central Daylight Time			08/04/2021 12:17:46 PM Central Daylight Time	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H9725	001	0	2022	North Carolina		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)980-3049		(855)980-3049		(800)668-3813		(800)668-3813		(855)980-3049		(855)980-3049		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9725	003	0	1	01	01	H9725_003_0	5	1	2	1	1		0	07/09/2021	2022.01	07/09/2021 12:06:59 PM Central Daylight Time	08/02/2021 06:11:00 PM Central Daylight Time	07/30/2021 12:29:41 PM Central Daylight Time			08/04/2021 12:17:46 PM Central Daylight Time	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Cigna	www.cignamedicare.com	Cigna TotalCare (HMO D-SNP)	01	01		1			H9725	003	0	2022	North Carolina		2		2			1	3		2		2	www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)980-3049		(855)980-3049		(800)668-3813		(800)668-3813		(855)980-3049		(855)980-3049		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9725	005	0	1	01	01	H9725_005_0	3	1			2	0	0	07/09/2021	2022.01	07/09/2021 12:07:27 PM Central Daylight Time	05/28/2021 10:21:18 AM Central Daylight Time				07/19/2021 04:08:28 PM Central Daylight Time	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Cigna	www.cignamedicare.com	Cigna Fundamental Medicare (HMO)	01	01		1			H9725	005	0	2022	North Carolina		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)980-3049		(855)980-3049										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H9725	006	0	1	01	01	H9725_006_0	4	1			2		0	08/02/2021	2022.01	08/02/2021 03:31:23 PM Central Daylight Time	08/02/2021 06:12:04 PM Central Daylight Time	07/30/2021 12:30:05 PM Central Daylight Time			08/04/2021 12:17:46 PM Central Daylight Time	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Plus Medicare (HMO)	01	01		1			H9725	006	0	2022	North Carolina		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)980-3049		(855)980-3049		(800)668-3813		(800)668-3813		(855)980-3049		(855)980-3049		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9725	007	0	1	01	01	H9725_007_0	4	1			2		0	08/02/2021	2022.01	08/02/2021 03:32:51 PM Central Daylight Time	08/02/2021 06:13:03 PM Central Daylight Time	07/30/2021 12:30:32 PM Central Daylight Time			08/04/2021 12:17:46 PM Central Daylight Time	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H9725	007	0	2022	North Carolina		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)982-6174		(855)982-6174		(800)668-3813		(800)668-3813		(855)982-6174		(855)982-6174		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9725	008	0	1	01	01	H9725_008_0	4	1			2		0	08/02/2021	2022.01	08/02/2021 05:07:23 PM Central Daylight Time	08/02/2021 06:14:09 PM Central Daylight Time	07/30/2021 12:30:57 PM Central Daylight Time			08/04/2021 12:17:46 PM Central Daylight Time	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H9725	008	0	2022	Tri Cities		2		2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(800)668-3813		(800)668-3813		(855)980-3049		(855)980-3049		(800)668-3813		(800)668-3813		(855)980-3049		(855)980-3049		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9725	801	0	1	01	01	H9725_801_0	2	1						05/10/2021	2022.01	05/10/2021 10:49:11 AM Central Daylight Time					06/02/2021 06:21:36 PM Central Daylight Time	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Cigna	www.cignamedicare.com	Cigna Preferred Medicare (HMO)	01	01		1			H9725	801	0	2022	Statewide NC		1	600	2			2						www.cigna.com/medicare	www.cignamedicare.com	www.cignamedicare.com	(888)281-7867		(888)281-7867		(888)281-7867		(888)281-7867		(888)281-7867		(888)281-7867		(888)281-7867		(888)281-7867		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H9730	003	0	1	01	01	H9730_003_0	5	1	2	1			0	07/19/2021	2022.01	07/19/2021 09:26:32 AM Eastern Daylight Time	08/04/2021 01:59:55 AM Eastern Daylight Time	07/30/2021 02:08:58 PM Eastern Daylight Time			08/04/2021 10:34:28 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Wellcare	www.wellcare.com/medicare	Wellcare Dual Access (HMO D-SNP)	01	01		1			H9730	003	0	2022	All counties in KY		2	75682	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9730	004	0	1	01	01	H9730_004_0	6	1	2	1			0	07/19/2021	2022.01	07/19/2021 09:30:13 AM Eastern Daylight Time	08/04/2021 02:00:25 AM Eastern Daylight Time	07/30/2021 02:09:20 PM Eastern Daylight Time			08/04/2021 10:34:28 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Wellcare	www.wellcare.com/medicare	Wellcare Dual Liberty (HMO D-SNP)	01	01		1			H9730	004	0	2022	All counties in KY		2	92906	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(833)444-9089		(833)444-9089		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9730	005	0	1	02	01	H9730_005_0	5	1					0	08/03/2021	2022.01	08/03/2021 10:46:24 AM Eastern Daylight Time	08/04/2021 02:00:55 AM Eastern Daylight Time	07/30/2021 02:09:44 PM Eastern Daylight Time			08/04/2021 10:34:28 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Wellcare	www.wellcare.com/medicare	Wellcare No Premium Essential (HMO-POS)	01	02		1			H9730	005	0	2022	All counties in KY		2	45841	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9730	007	0	1	01	01	H9730_007_0	5	1					0	07/19/2021	2022.01	07/19/2021 09:34:19 AM Eastern Daylight Time	08/04/2021 02:01:24 AM Eastern Daylight Time	07/30/2021 02:10:14 PM Eastern Daylight Time			08/04/2021 10:34:28 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Wellcare	www.wellcare.com/medicare	Wellcare Giveback (HMO)	01	01		1			H9730	007	0	2022	All counties in KY		2	125056	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9730	009	0	1	01	01	H9730_009_0	5	1					0	08/03/2021	2022.01	08/03/2021 11:11:51 AM Eastern Daylight Time	08/04/2021 02:01:52 AM Eastern Daylight Time	07/30/2021 02:10:40 PM Eastern Daylight Time			08/04/2021 10:34:28 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO)	01	01		1			H9730	009	0	2022	All counties in KY		2	210049	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9730	010	0	1	01	01	H9730_010_0	5	1					0	06/04/2021	2022.01	06/04/2021 01:16:03 PM Eastern Daylight Time	08/04/2021 03:43:06 PM Eastern Daylight Time	07/30/2021 02:11:20 PM Eastern Daylight Time			08/04/2021 10:34:28 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Wellcare	www.wellcare.com/medicare	Wellcare Assist (HMO)	01	01		1			H9730	010	0	2022	All counties in KY		2	21393	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9761	001	0	1	04	01	H9761_001_0	5	1					0	08/03/2021	2022.01	08/03/2021 10:07:41 AM Eastern Daylight Time	08/04/2021 02:02:50 AM Eastern Daylight Time	07/30/2021 02:11:52 PM Eastern Daylight Time			08/04/2021 11:21:47 PM Eastern Daylight Time	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium Open (PPO)	01	04		1			H9761	001	0	2022	Select counties in MA		2	4446	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9761	002	0	1	04	01	H9761_002_0	5	1					0	08/03/2021	2022.01	08/03/2021 10:11:41 AM Eastern Daylight Time	08/04/2021 02:03:20 AM Eastern Daylight Time	07/30/2021 02:12:32 PM Eastern Daylight Time			08/04/2021 11:21:47 PM Eastern Daylight Time	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Giveback Open (PPO)	01	04		1			H9761	002	0	2022	Select counties in MA		2	4004	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9761	003	0	1	04	01	H9761_003_0	6	1					0	06/06/2021	2022.01	06/06/2021 11:21:03 PM Eastern Daylight Time	08/04/2021 02:03:51 AM Eastern Daylight Time	07/30/2021 02:13:12 PM Eastern Daylight Time			08/04/2021 11:21:47 PM Eastern Daylight Time	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Assist Open (PPO)	01	04		1			H9761	003	0	2022	Select counties in MA		2	1105	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9761	004	0	1	04	01	H9761_004_0	5	1					0	08/03/2021	2022.01	08/03/2021 10:09:39 AM Eastern Daylight Time	08/04/2021 02:04:20 AM Eastern Daylight Time	07/30/2021 02:13:46 PM Eastern Daylight Time			08/04/2021 11:21:47 PM Eastern Daylight Time	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Premium Enhanced Open (PPO)	01	04		1			H9761	004	0	2022	Select counties in MA		2	871	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(833)444-9088		(833)444-9088		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9763	001	0	1	01	01	H9763_001_0	4	1					1	08/04/2021	2022.01	08/04/2021 03:20:13 PM Central Daylight Time	08/03/2021 03:43:21 PM Central Daylight Time	08/03/2021 03:29:01 PM Central Daylight Time			08/04/2021 09:39:12 PM Central Daylight Time	OCHSNER HEALTH PLAN, INC.	Ochsner Health Plan	www.ochsnerhealthplan.com	Ochsner Health Plan Premier (HMO)	01	01		1			H9763	001	0	2022	Baton Rouge and New Orleans Metro Area		2		2			2						www.ochsnerhealthplan.com	www.ochsnerhealthplan.com	www.ochsnerhealthplan.com	(885)668-3574		(504)354-3655		(885)668-3592		(504)354-3655		(885)668-3574		(504)354-3655		(885)668-3592		(504)354-3655		(800)833-5833		(711)-		(800)833-5833		(711)-		(800)833-5833		(711)-		(800)833-5833		(711)-		2					2					2	2			
H9763	002	0	1	02	01	H9763_002_0	5	1					1	08/04/2021	2022.01	08/04/2021 03:20:59 PM Central Daylight Time	08/03/2021 04:17:53 PM Central Daylight Time	08/03/2021 03:29:38 PM Central Daylight Time			08/04/2021 09:39:12 PM Central Daylight Time	OCHSNER HEALTH PLAN, INC.	Ochsner Health Plan	www.ochsnerhealthplan.com	Ochsner Health Plan Freedom (HMO-POS)	01	02		1			H9763	002	0	2022	Baton Rouge and New Orleans Metro Area		2		2			2						www.ochsnerhealthplan.com	www.ochsnerhealthplan.com	www.ochsnerhealthplan.com	(885)668-3574		(504)354-3655		(885)668-3592		(504)354-3655		(885)668-3574		(504)354-3655		(885)668-3592		(504)354-3655		(800)833-5833		(711)-		(800)833-5833		(711)-		(800)833-5833		(711)-		(800)833-5833		(711)-		2					2					2	2			
H9808	004	0	1	04	01	H9808_004_0	11	1					0	08/04/2021	2022.01	08/04/2021 06:29:16 PM India Standard Time	08/03/2021 03:30:25 PM Central Daylight Time	07/29/2021 06:35:20 PM Central Daylight Time			08/04/2021 03:50:46 PM Central Daylight Time	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	www.healthteamadvantage.com	HealthTeam Advantage Plan I (PPO)	01	04		1			H9808	004	0	2022	AL GL RA RO FOR DV DVS		2	171477	2			2						www.healthteamadvantage.com	www.healthteamadvantage.com	www.healthteamadvantage.com	(888)965-1965		(888)965-1965		(877)905-9216		(877)905-9216		(888)965-1965		(888)965-1965		(877)905-9216		(877)905-9216		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9808	005	0	1	04	01	H9808_005_0	11	1					0	08/04/2021	2022.01	08/04/2021 07:39:18 PM India Standard Time	08/03/2021 03:28:12 PM Central Daylight Time	07/29/2021 06:37:38 PM Central Daylight Time			08/04/2021 03:50:46 PM Central Daylight Time	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	www.healthteamadvantage.com	HealthTeam Advantage Plan II (PPO)	01	04		1			H9808	005	0	2022	AL GL RA RO FOR DV DVS		2	14788	2			2						www.healthteamadvantage.com	www.healthteamadvantage.com	www.healthteamadvantage.com	(888)965-1965		(888)965-1965		(877)905-9216		(877)905-9216		(888)965-1965		(888)965-1965		(877)905-9216		(877)905-9216		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9808	807	0	1	04	01	H9808_807_0	8	1					0	07/07/2021	2022.01	07/07/2021 01:19:15 AM India Standard Time					07/06/2021 03:38:51 PM Central Daylight Time	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	www.healthteamadvantage.com	HealthTeam Advantage Plan I EGWP (PPO)	01	04		1			H9808	807	0	2022	Piedmont Triad		1	1200	2			2						www.healthteamadvantage.com	www.healthteamadvantage.com	www.healthteamadvantage.com	(888)965-1965		(888)965-1965		(877)905-9216		(877)905-9216		(888)965-1965		(888)965-1965		(877)905-9216		(877)905-9216		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9808	808	0	1	04	01	H9808_808_0	8	1					0	07/07/2021	2022.01	07/07/2021 01:20:28 AM India Standard Time					07/06/2021 03:38:51 PM Central Daylight Time	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	www.healthteamadvantage.com	HealthTeam Advantage Plan II EGWP (PPO)	01	04		1			H9808	808	0	2022	Piedmont Triad		1	1200	2			2						www.healthteamadvantage.com	www.healthteamadvantage.com	www.healthteamadvantage.com	(888)965-1965		(888)965-1965		(877)905-9216		(877)905-9216		(888)965-1965		(888)965-1965		(877)905-9216		(877)905-9216		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9811	001	0	1	01	01	H9811_001_0	5	1					0	08/01/2021	2022.01	08/01/2021 03:30:26 PM Eastern Daylight Time	08/04/2021 08:29:05 AM Eastern Daylight Time	07/30/2021 02:14:06 PM Eastern Daylight Time			08/04/2021 08:53:46 PM Eastern Daylight Time	MAGNOLIA HEALTH PLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellMS	Wellcare No Premium Medicare (HMO)	01	01		1			H9811	001	0	2022	Select counties in MS		2	18062	2			2						www.wellcare.com/allwellMS	www.wellcare.com/allwellMS	www.wellcare.com/allwellMS	(844)786-7711		(844)786-7711		(866)277-6583		(866)277-6583		(844)786-7711		(844)786-7711		(866)277-6583		(866)277-6583		(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			0	07/06/2021	2022.01	07/06/2021 12:47:12 PM Eastern Daylight Time	08/04/2021 08:12:17 AM Eastern Daylight Time	07/30/2021 02:14:40 PM Eastern Daylight Time			08/04/2021 08:53:46 PM Eastern Daylight Time	MAGNOLIA HEALTH PLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellMS	Wellcare Dual Access Medicare (HMO D-SNP)	01	01		1			H9811	006	0	2022	Select counties in MS		2	1930	2			1	3		1		1	www.wellcare.com/allwellMS	www.wellcare.com/allwellMS	www.wellcare.com/allwellMS	(833)260-4124		(833)260-4124		(866)277-6583		(866)277-6583		(833)260-4124		(833)260-4124		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9811	008	0	1	01	01	H9811_008_0	5	1					0	08/01/2021	2022.01	08/01/2021 03:31:28 PM Eastern Daylight Time	08/04/2021 08:06:31 AM Eastern Daylight Time	07/30/2021 02:15:12 PM Eastern Daylight Time			08/04/2021 08:53:46 PM Eastern Daylight Time	MAGNOLIA HEALTH PLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellMS	Wellcare Giveback Boost (HMO)	01	01		1			H9811	008	0	2022	Select counties in MS		2	1321	2			2						www.wellcare.com/allwellMS	www.wellcare.com/allwellMS	www.wellcare.com/allwellMS	(844)786-7711		(844)786-7711		(866)277-6583		(866)277-6583		(844)786-7711		(844)786-7711		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9811	009	0	1	01	01	H9811_009_0	5	1					0	05/30/2021	2022.01	05/30/2021 10:21:03 AM Eastern Daylight Time	08/04/2021 08:14:50 AM Eastern Daylight Time	07/30/2021 02:15:42 PM Eastern Daylight Time			08/04/2021 08:53:46 PM Eastern Daylight Time	MAGNOLIA HEALTH PLAN, INC.	Wellcare by Allwell	www.wellcare.com/allwellMS	Wellcare Assist Complement (HMO)	01	01		1			H9811	009	0	2022	Select counties in MS		2	1757	2			2						www.wellcare.com/allwellMS	www.wellcare.com/allwellMS	www.wellcare.com/allwellMS	(844)786-7711		(844)786-7711		(866)277-6583		(866)277-6583		(844)786-7711		(844)786-7711		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9811	801	0	1	01	01	H9811_801_0	2	1						05/03/2021	2022.01	05/03/2021 02:13:24 PM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	MAGNOLIA HEALTH PLAN, INC.	Wellcare by Allwell	allwell.magnoliahealthplan.com	Allwell Group (HMO)	01	01		1			H9811	801	0	2022	Statewide		1	100	2			2						allwell.magnoliahealthplan.com/findadoctor	allwell.magnoliahealthplan.com/formulary	allwell.magnoliahealthplan.com/findadoctor	(844)786-7711		(844)786-7711		(844)942-0039		(844)942-0039		(844)786-7711		(844)786-7711		(844)942-0039		(844)942-0039		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H9811	802	0	1	01	01	H9811_802_0	2	1				0	0	05/03/2021	2022.01	05/03/2021 02:13:31 PM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	MAGNOLIA HEALTH PLAN, INC.	Wellcare by Allwell	allwell.magnoliahealthplan.com	Allwell Group (HMO)	01	01		1			H9811	802	0	2022	Statewide		1	100	2			2						allwell.magnoliahealthplan.com/findadoctor	allwell.magnoliahealthplan.com/formulary	allwell.magnoliahealthplan.com/findadoctor	(844)786-7711		(844)786-7711		(844)942-0039		(844)942-0039										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H9811	803	0	1	01	01	H9811_803_0	2	1						05/03/2021	2022.01	05/03/2021 02:13:39 PM Eastern Daylight Time					06/04/2021 08:18:13 PM Eastern Daylight Time	MAGNOLIA HEALTH PLAN, INC.	Wellcare by Allwell	allwell.magnoliahealthplan.com	Allwell Group (HMO)	01	01		1			H9811	803	0	2022	Statewide		1	100	2			2						allwell.magnoliahealthplan.com/findadoctor	allwell.magnoliahealthplan.com/formulary	allwell.magnoliahealthplan.com/findadoctor	(844)786-7711		(844)786-7711		(844)942-0039		(844)942-0039		(844)786-7711		(844)786-7711		(844)942-0039		(844)942-0039		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1					1				
H9826	001	0	1	01	01	H9826_001_0	7	1	2	1			0	08/03/2021	2022.01	08/03/2021 03:58:24 PM Central Daylight Time	07/31/2021 02:39:45 PM Central Daylight Time	08/04/2021 12:01:56 PM Central Daylight Time			08/04/2021 12:41:25 PM Central Daylight Time	COMMUNITY HEALTH CHOICE TEXAS, INC.	Community Health Choice	www.communityhealthchoice.org/medicare	Community Health Choice (HMO D-SNP)	01	01		1			H9826	001	0	2022	Southeast Texas		2		2			1	3		1		1	www.communityhealthchoice.org/medicare	www.communityhealthchoice.org/medicare	www.communityhealthchoice.org/medicare	(833)276-8306		(713)295-5007		(833)276-8306		(713)295-5007		(833)276-8306		(713)295-5007		(833)276-8306		(713)295-5007		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9827	001	0	1	01	01	H9827_001_0	5	1					1	08/04/2021	2022.01	08/04/2021 08:52:57 AM Eastern Daylight Time	08/05/2021 07:04:36 AM Eastern Daylight Time	08/05/2021 07:04:37 AM Eastern Daylight Time			08/05/2021 07:34:42 AM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	MediGold	www.MediGold.com	MediGold Essential Care (HMO)	01	01		1			H9827	001	0	2022	Select Counties in New York		2		2			2						www.MediGold.com	www.MediGold.com	www.MediGold.com	(800)240-3851		(800)240-3851		(800)964-4525		(800)964-4525		(800)240-3851		(800)240-3851		(800)964-4525		(800)964-4525		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9827	002	0	1	01	01	H9827_002_0	5	1					1	08/04/2021	2022.01	08/04/2021 08:55:29 AM Eastern Daylight Time	08/05/2021 07:04:41 AM Eastern Daylight Time	08/05/2021 07:04:46 AM Eastern Daylight Time			08/05/2021 07:34:42 AM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	MediGold	www.MediGold.com	MediGold True Advantage (HMO)	01	01		1			H9827	002	0	2022	Select Counties in New York		2		2			2						www.MediGold.com	www.MediGold.com	www.MediGold.com	(800)240-3851		(800)240-3851		(800)964-4525		(800)964-4525		(800)240-3851		(800)240-3851		(800)964-4525		(800)964-4525		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9827	003	0	1	01	01	H9827_003_0	5	1				0	0	07/17/2021	2022.01	07/17/2021 08:37:27 AM Eastern Daylight Time	07/19/2021 06:58:06 AM Eastern Daylight Time				07/19/2021 07:48:08 AM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	MediGold	www.MediGold.com	MediGold Medical Only (HMO)	01	01		1			H9827	003	0	2022	Select Counties in New York		2		2			2						www.MediGold.com	www.MediGold.com	www.MediGold.com	(800)240-3851		(800)240-3851		(800)964-4525		(800)964-4525										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H9828	001	0	1	01	01	H9828_001_0	7	1					0	08/04/2021	2022.01	08/04/2021 12:12:34 PM Eastern Daylight Time	08/04/2021 03:53:18 PM Eastern Daylight Time	08/04/2021 03:53:18 PM Eastern Daylight Time			08/04/2021 04:44:18 PM Eastern Daylight Time	APEX HEALTH, INC.	ApexHealth	www.apexhealth.com	ApexBold (HMO)	01	01		1			H9828	001	0	2022	Greater Charlotte Area, Stanly and Yadkin Counties		2		2			2						www.apexhealth.com	www.apexhealth.com	www.apexhealth.com	(844)279-0508		(844)279-0508		(844)279-0508		(844)279-0508		(844)279-0508		(844)279-0508		(844)279-0508		(844)279-0508		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9828	002	0	1	01	01	H9828_002_0	7	1					0	07/09/2021	2022.01	07/09/2021 02:28:44 PM Eastern Daylight Time	08/04/2021 03:53:18 PM Eastern Daylight Time	08/04/2021 03:53:18 PM Eastern Daylight Time			08/04/2021 04:44:18 PM Eastern Daylight Time	APEX HEALTH, INC.	ApexHealth	www.apexhealth.com	ApexEnrich (HMO)	01	01		1			H9828	002	0	2022	Greater Charlotte Area, Stanly and Yadkin Counties		2		2			2						www.apexhealth.com	www.apexhealth.com	www.apexhealth.com	(844)279-0508		(844)279-0508		(844)279-0508		(844)279-0508		(844)279-0508		(844)279-0508		(844)279-0508		(844)279-0508		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9828	003	0	1	01	01	H9828_003_0	7	1					0	08/04/2021	2022.01	08/04/2021 12:14:00 PM Eastern Daylight Time	08/04/2021 03:53:18 PM Eastern Daylight Time	08/04/2021 03:53:18 PM Eastern Daylight Time			08/04/2021 04:44:18 PM Eastern Daylight Time	APEX HEALTH, INC.	ApexHealth	www.apexhealth.com	ApexBold (HMO)	01	01		1			H9828	003	0	2022	Central NC, Winston-Salem Area, SC Border Counties		2		2			2						www.apexhealth.com	www.apexhealth.com	www.apexhealth.com	(844)279-0508		(844)279-0508		(844)279-0508		(844)279-0508		(844)279-0508		(844)279-0508		(844)279-0508		(844)279-0508		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9830	001	0	1	20	08	H9830_001_0	1	1						05/27/2021	2022.01	05/27/2021 09:20:36 AM Mountain Daylight Time		05/27/2021 08:41:41 AM Mountain Daylight Time			05/27/2021 09:22:18 AM Mountain Daylight Time	INNOVAGE PENNSYLVANIA LIFE, LLC	InnovAge Pennsylvania LIFE	www.MyInnovAge.com	InnovAge Pennsylvania LIFE, LLC  - Dual (PACE)	08	20		1			H9830	001	0	2022	InnovAge PA LIFE - North, NW, NE Phila Svc Area		2		2			2						https://www.granerx.com/	N/A										(844)704-9613	711	(844)704-9613		(844)704-9613		(844)704-9613										(844)704-9613	711	(844)704-9613	711	(844)704-9613		(844)704-9613																
H9830	002	0	1	20	08	H9830_002_0	1	1						05/27/2021	2022.01	05/27/2021 09:20:54 AM Mountain Daylight Time		05/27/2021 08:41:41 AM Mountain Daylight Time			05/27/2021 09:22:18 AM Mountain Daylight Time	INNOVAGE PENNSYLVANIA LIFE, LLC	InnovAge Pennsylvania LIFE	www.MyInnovAge.com	InnovAge Pennsylvania LIFE, LLC - Medicare Only (PACE)	08	20		1			H9830	002	0	2022	InnovAge PA LIFE - North, NW, NE Phila Svc Area		2		2			2						https://www.granerx.com/	N/A										(844)704-9613	711	(844)704-9613		(844)704-9613		(844)704-9613										(844)704-9613	711	(844)704-9613	711	(844)704-9613		(844)704-9613																
H9834	001	0	1	01	01	H9834_001_0	4	1					1	07/07/2021	2022.01	07/07/2021 10:03:06 AM Central Daylight Time	08/05/2021 12:00:48 PM Central Daylight Time	08/05/2021 12:00:52 PM Central Daylight Time			08/05/2021 01:21:37 PM Central Daylight Time	QUARTZ HEALTH PLAN MN CORPORATION	Quartz Medicare Advantage	quartzbenefits.com/medicareadvantage	Gundersen MN Quartz Med Advantage Elite D (w/Rx) (HMO)	01	01		1			H9834	001	0	2022	Counties: Fillmore, Houston, Wabasha, Winona		2		2			2						quartzbenefits.com/MAFindaPharmacy	quartzbenefits.com/MAFormulary	quartzbenefits.com/MAFindaDoctor	(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	4	1					1	07/07/2021	2022.01	07/07/2021 10:02:39 AM Central Daylight Time	08/05/2021 12:00:49 PM Central Daylight Time	08/05/2021 12:00:52 PM Central Daylight Time			08/05/2021 01:21:37 PM Central Daylight Time	QUARTZ HEALTH PLAN MN CORPORATION	Quartz Medicare Advantage	quartzbenefits.com/medicareadvantage	Gundersen MN Quartz Med Advantage Value D (w/Rx) (HMO)	01	01		1			H9834	003	0	2022	Counties: Fillmore, Houston, Wabasha, Winona		2		2			2						quartzbenefits.com/MAFindaPharmacy	quartzbenefits.com/MAFormulary	quartzbenefits.com/MAFindaDoctor	(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				0	0	07/07/2021	2022.01	07/07/2021 10:02:20 AM Central Daylight Time	07/16/2021 09:00:23 AM Central Daylight Time				07/16/2021 09:22:13 AM Central Daylight Time	QUARTZ HEALTH PLAN MN CORPORATION	Quartz Medicare Advantage	quartzbenefits.com/medicareadvantage	Gundersen MN Quartz Med Advantage Value (HMO)	01	01		1			H9834	004	0	2022	Counties: Fillmore, Houston, Wabasha, Winona		2		2			2						quartzbenefits.com/MAFindaPharmacy	quartzbenefits.com/MAFormulary	quartzbenefits.com/MAFindaDoctor	(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				0	0	07/07/2021	2022.01	07/07/2021 10:02:03 AM Central Daylight Time	07/16/2021 09:00:23 AM Central Daylight Time				07/16/2021 09:22:13 AM Central Daylight Time	QUARTZ HEALTH PLAN MN CORPORATION	Quartz Medicare Advantage	quartzbenefits.com/medicareadvantage	Gundersen MN Quartz Med Advantage Elite (HMO)	01	01		1			H9834	005	0	2022	Counties: Fillmore, Houston, Wabasha, Winona		2		2			2						quartzbenefits.com/MAFindaPharmacy	quartzbenefits.com/MAFormulary	quartzbenefits.com/MAFindaDoctor	(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	006	0	1	01	01	H9834_006_0	4	1					1	08/05/2021	2022.01	08/05/2021 09:29:01 AM Central Daylight Time	08/05/2021 12:00:49 PM Central Daylight Time	08/05/2021 12:00:52 PM Central Daylight Time			08/05/2021 01:21:37 PM Central Daylight Time	QUARTZ HEALTH PLAN MN CORPORATION	Quartz Medicare Advantage	quartzbenefits.com/medicareadvantage	Gundersen MN Quartz Med Advantage Core D (w/Rx) (HMO)	01	01		1			H9834	006	0	2022	Counties: Fillmore, Houston, Wabasha, Winona		2		2			2						quartzbenefits.com/MAFindaPharmacy	quartzbenefits.com/MAFormulary	quartzbenefits.com/MAFindaDoctor	(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			
H9842	001	0	1	20	08	H9842_001_0	1	1						06/07/2021	2022.01	06/07/2021 10:37:53 AM Eastern Daylight Time		06/07/2021 10:09:30 AM Eastern Daylight Time			06/07/2021 10:41:47 AM Eastern Daylight Time	SAINT JOSEPH PACE	Saint Joseph PACE	trinityhealthpace.org	Saint Joseph PACE (PACE)	08	20		1			H9842	001	0	2022	Partial Saint Joseph, Marshall & Elkhart counties		2		2			2						pharmastar.com	TBD												(574)247-8700				(574)247-8700												(574)247-8701				(574)247-8701																
H9842	002	0	1	20	08	H9842_002_0	1	1						06/07/2021	2022.01	06/07/2021 10:38:08 AM Eastern Daylight Time		06/07/2021 10:09:30 AM Eastern Daylight Time			06/07/2021 10:41:47 AM Eastern Daylight Time	SAINT JOSEPH PACE	Saint Joseph PACE	trinityhealthpace.org	Saint Joseph PACE - Medicare Only (PACE)	08	20		1			H9842	002	0	2022	Partial St. Joseph, Marshall & Elkhart Counties		2		2			2						pharmastar.com	TBD												(574)247-8700				(574)247-8700												(574)247-8701				(574)247-8701																
H9861	001	0	1	01	01	H9861_001_0	8	1			2		1	08/04/2021	2022.01	08/04/2021 03:34:37 PM Eastern Daylight Time	08/04/2021 04:04:21 PM Eastern Daylight Time	08/04/2021 04:04:21 PM Eastern Daylight Time			08/04/2021 04:06:01 PM Eastern Daylight Time	RELIANCE HMO, INC.	Reliance Medicare Advantage	RelianceMedicareAdvantage.org	Reliance Principle Plan (HMO)	01	01		1			H9861	001	0	2022	Wayne, Oakland, Macomb, Genesee, St. Clair, Monroe		2		2			2						RelianceMedicareAdvantage.org	RelianceMedicareAdvantage.org	RelianceMedicareAdvantage.org	(855)959-5855		(855)959-5855		(833)653-2041		(833)653-2041		(844)705-7498		(844)705-7498		(833)653-2041		(833)653-2041		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	8b1;8b3;	
H9861	002	0	1	01	01	H9861_002_0	8	1			2		1	08/04/2021	2022.01	08/04/2021 03:34:57 PM Eastern Daylight Time	08/04/2021 04:04:21 PM Eastern Daylight Time	08/04/2021 04:04:21 PM Eastern Daylight Time			08/04/2021 04:06:01 PM Eastern Daylight Time	RELIANCE HMO, INC.	Reliance Medicare Advantage	RelianceMedicareAdvantage.org	Reliance Cardinal Plan (HMO)	01	01		1			H9861	002	0	2022	Wayne, Oakland, Macomb, Genesee, St. Clair, Monroe		2		2			2						RelianceMedicareAdvantage.org	RelianceMedicareAdvantage.org	RelianceMedicareAdvantage.org	(855)959-5855		(855)959-5855		(833)653-2041		(833)653-2041		(844)705-7498		(844)705-7498		(833)653-2041		(833)653-2041		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	8b1;8b3;	
H9861	003	0	1	01	01	H9861_003_0	11	1	2	1	1		0	07/22/2021	2022.01	07/22/2021 01:34:52 PM Eastern Daylight Time	08/04/2021 04:04:21 PM Eastern Daylight Time	08/04/2021 04:04:21 PM Eastern Daylight Time			08/04/2021 04:06:01 PM Eastern Daylight Time	RELIANCE HMO, INC.	Reliance Medicare Advantage	RelianceMedicareAdvantage.org	Reliance Dual Care Plus (HMO D-SNP)	01	01		1			H9861	003	0	2022	Wayne, Oakland, Macomb, Genesee, St. Clair		2	6000	2			1	3		1		1	RelianceMedicareAdvantage.org	RelianceMedicareAdvantage.org	RelianceMedicareAdvantage.org	(855)959-5855		(855)959-5855		(833)653-2041		(833)653-2041		(844)705-7498		(844)705-7498		(833)653-2041		(833)653-2041		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9869	001	0	1	48	05	H9869_001_0	1	1						05/19/2021	2022.01	05/19/2021 09:27:48 AM Central Daylight Time					05/19/2021 08:13:00 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	2022	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		(888)648-6759		(888)648-6759		(855)747-5483		(855)747-5483		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H9876	001	0	1	04	01	H9876_001_0	10	1					1	08/10/2021	2022.01	08/10/2021 02:55:29 PM Eastern Daylight Time	08/05/2021 04:00:26 PM Eastern Daylight Time	08/05/2021 04:00:26 PM Eastern Daylight Time			08/10/2021 05:00:50 PM Eastern Daylight Time	CCA HMO COMPLETE RHODE ISLAND LLC	CCA HMO Complete Rhode Island	commonwealthcarealliance.org/ri/become-a-member	CCA Medicare Preferred (PPO)	01	04		1			H9876	001	0	2022	Rhode Island		2		2			2						https://www.commonwealthcarealliance.org/members/pharmacy-program	https://www.commonwealthcarealliance.org/ri/members/mapd-preferred/mapd-preferred-formulary	provider-directory.commonwealthcarealliance.org/	(866)655-3117		(866)655-3117		(866)275-1222		(866)275-1222		(866)655-3117		(866)655-3117		(866)275-1222		(866)275-1222		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9876	002	0	1	04	01	H9876_002_0	10	1					0	08/10/2021	2022.01	08/10/2021 02:56:13 PM Eastern Daylight Time	08/05/2021 04:00:26 PM Eastern Daylight Time	08/05/2021 04:00:26 PM Eastern Daylight Time			08/10/2021 05:00:50 PM Eastern Daylight Time	CCA HMO COMPLETE RHODE ISLAND LLC	CCA HMO Complete Rhode Island	commonwealthcarealliance.org/ri/become-a-member	CCA Medicare Value (PPO)	01	04		1			H9876	002	0	2022	Rhode Island		2		2			2						https://www.commonwealthcarealliance.org/members/pharmacy-program	https://www.commonwealthcarealliance.org/ri/members/mapd-value/mapd-value-formulary	provider-directory.commonwealthcarealliance.org/	(866)655-3117		(866)655-3117		(866)275-1222		(866)275-1222		(866)655-3117		(866)655-3117		(866)275-1222		(866)275-1222		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9877	001	0	1	01	01	H9877_001_0	10	1	2	1	1		0	07/16/2021	2022.01	07/16/2021 08:29:16 PM Eastern Daylight Time	08/05/2021 09:20:12 AM Eastern Daylight Time	08/05/2021 09:20:12 AM Eastern Daylight Time			08/05/2021 12:25:26 PM Eastern Daylight Time	VIRGINIA PREMIER HEALTH PLAN, INC.	Virginia Premier	www.virginiapremier.com	Virginia Premier Advantage Elite (HMO D-SNP)	01	01		1			H9877	001	0	2022	Virginia		2	122834	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			
H9884	001	0	1	04	01	H9884_001_0	10	1					1	08/03/2021	2022.01	08/03/2021 01:13:58 PM US Eastern Daylight Time	08/04/2021 03:43:42 PM Eastern Daylight Time	07/30/2021 10:28:02 AM Eastern Daylight Time			08/05/2021 09:29:00 AM Eastern Daylight Time	DEVOTED HEALTH INSURANCE COMPANY	Devoted Health	www.Devoted.com	Devoted Health Latitude South Florida (PPO)	01	04		1			H9884	001	0	2022	Broward & Palm Beach Counties		2		2			2						www.Devoted.com	www.Devoted.com	www.Devoted.com	(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9884	003	0	1	04	01	H9884_003_0	10	1					1	08/03/2021	2022.01	08/03/2021 01:16:19 PM US Eastern Daylight Time	08/04/2021 03:44:10 PM Eastern Daylight Time	07/30/2021 10:28:22 AM Eastern Daylight Time			08/05/2021 09:29:00 AM Eastern Daylight Time	DEVOTED HEALTH INSURANCE COMPANY	Devoted Health	www.Devoted.com	Devoted Health Latitude Greater Orlando (PPO)	01	04		1			H9884	003	0	2022	Osceola, Seminole, and Orange Counties		2		2			2						www.Devoted.com	www.Devoted.com	www.Devoted.com	(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9884	004	0	1	04	01	H9884_004_0	10	1					1	08/03/2021	2022.01	08/03/2021 01:18:09 PM US Eastern Daylight Time	08/04/2021 03:44:37 PM Eastern Daylight Time	07/30/2021 10:28:41 AM Eastern Daylight Time			08/05/2021 09:29:00 AM Eastern Daylight Time	DEVOTED HEALTH INSURANCE COMPANY	Devoted Health	www.Devoted.com	Devoted Health Latitude Greater Jacksonville (PPO)	01	04		1			H9884	004	0	2022	Clay, Duval, and Nassau Counties		2		2			2						www.Devoted.com	www.Devoted.com	www.Devoted.com	(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9884	005	0	1	04	01	H9884_005_0	10	1					1	08/03/2021	2022.01	08/03/2021 01:21:43 PM US Eastern Daylight Time	08/04/2021 03:45:07 PM Eastern Daylight Time	07/30/2021 10:29:01 AM Eastern Daylight Time			08/05/2021 09:29:00 AM Eastern Daylight Time	DEVOTED HEALTH INSURANCE COMPANY	Devoted Health	www.Devoted.com	Devoted Health Latitude Greater Tampa Bay (PPO)	01	04		1			H9884	005	0	2022	Hillsborough, Pinellas, Hernando, & Pasco Counties		2		2			2						www.Devoted.com	www.Devoted.com	www.Devoted.com	(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9884	006	0	1	04	01	H9884_006_0	10	1					1	08/03/2021	2022.01	08/03/2021 01:23:12 PM US Eastern Daylight Time	08/04/2021 03:45:34 PM Eastern Daylight Time	07/30/2021 10:29:20 AM Eastern Daylight Time			08/05/2021 09:29:00 AM Eastern Daylight Time	DEVOTED HEALTH INSURANCE COMPANY	Devoted Health	www.Devoted.com	Devoted Health Latitude Polk (PPO)	01	04		1			H9884	006	0	2022	Polk County		2		2			2						www.Devoted.com	www.Devoted.com	www.Devoted.com	(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9884	007	0	1	04	01	H9884_007_0	10	1					1	08/03/2021	2022.01	08/03/2021 01:25:37 PM US Eastern Daylight Time	08/04/2021 03:46:03 PM Eastern Daylight Time	07/30/2021 10:29:40 AM Eastern Daylight Time			08/05/2021 09:29:00 AM Eastern Daylight Time	DEVOTED HEALTH INSURANCE COMPANY	Devoted Health	www.Devoted.com	Devoted Health Latitude Manatee (PPO)	01	04		1			H9884	007	0	2022	Manatee County		2		2			2						www.Devoted.com	www.Devoted.com	www.Devoted.com	(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(800)338-6833		(800)338-6833		(800)376-5889		(800)376-5889		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9900	001	0	1	01	01	H9900_001_0	5	1					0	08/01/2021	2022.01	08/01/2021 03:12:41 PM Eastern Daylight Time	08/04/2021 02:05:50 AM Eastern Daylight Time	07/30/2021 02:16:02 PM Eastern Daylight Time			08/04/2021 08:53:46 PM Eastern Daylight Time	WELLCARE OF OKLAHOMA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Giveback (HMO)	01	01		1			H9900	001	0	2022	Select counties in OK		2	808	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)853-0865		(833)853-0865		(844)917-0175		(844)917-0175		(833)853-0865		(833)853-0865		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9900	002	0	1	01	01	H9900_002_0	5	1	2	1			0	06/02/2021	2022.01	06/02/2021 02:12:27 PM Eastern Daylight Time	08/04/2021 02:06:18 AM Eastern Daylight Time	07/30/2021 02:16:22 PM Eastern Daylight Time			08/04/2021 08:53:46 PM Eastern Daylight Time	WELLCARE OF OKLAHOMA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Access (HMO D-SNP)	01	01		1			H9900	002	0	2022	Select counties in OK		2	1240	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)853-0866		(833)853-0866		(844)917-0175		(844)917-0175		(833)853-0866		(833)853-0866		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9900	003	0	1	01	01	H9900_003_0	5	1	2	1			0	06/02/2021	2022.01	06/02/2021 02:14:29 PM Eastern Daylight Time	08/04/2021 02:06:44 AM Eastern Daylight Time	07/30/2021 02:16:54 PM Eastern Daylight Time			08/04/2021 08:53:46 PM Eastern Daylight Time	WELLCARE OF OKLAHOMA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Dual Liberty (HMO D-SNP)	01	01		1			H9900	003	0	2022	Select counties in OK		2	1240	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)853-0866		(833)853-0866		(844)917-0175		(844)917-0175		(833)853-0866		(833)853-0866		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9900	004	0	1	01	01	H9900_004_0	5	1					0	08/01/2021	2022.01	08/01/2021 03:13:45 PM Eastern Daylight Time	08/04/2021 02:07:11 AM Eastern Daylight Time	07/30/2021 02:17:16 PM Eastern Daylight Time			08/04/2021 08:53:46 PM Eastern Daylight Time	WELLCARE OF OKLAHOMA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO)	01	01		1			H9900	004	0	2022	Select counties in OK		2	808	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)853-0865		(833)853-0865		(844)917-0175		(844)917-0175		(833)853-0865		(833)853-0865		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9900	005	0	1	01	01	H9900_005_0	5	1					0	08/01/2021	2022.01	08/01/2021 03:14:54 PM Eastern Daylight Time	08/04/2021 02:07:39 AM Eastern Daylight Time	07/30/2021 02:17:36 PM Eastern Daylight Time			08/04/2021 08:53:46 PM Eastern Daylight Time	WELLCARE OF OKLAHOMA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare No Premium (HMO)	01	01		1			H9900	005	0	2022	Select counties in OK		2	808	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)853-0865		(833)853-0865		(844)917-0175		(844)917-0175		(833)853-0865		(833)853-0865		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9900	006	0	1	01	01	H9900_006_0	5	1					0	05/30/2021	2022.01	05/30/2021 10:56:28 AM Eastern Daylight Time	08/04/2021 02:08:07 AM Eastern Daylight Time	07/30/2021 02:17:56 PM Eastern Daylight Time			08/04/2021 08:53:46 PM Eastern Daylight Time	WELLCARE OF OKLAHOMA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Assist (HMO)	01	01		1			H9900	006	0	2022	Select counties in OK		2	808	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)853-0865		(833)853-0865		(844)917-0175		(844)917-0175		(833)853-0865		(833)853-0865		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9900	007	0	1	01	01	H9900_007_0	5	1					0	05/30/2021	2022.01	05/30/2021 10:54:53 AM Eastern Daylight Time	08/04/2021 02:08:35 AM Eastern Daylight Time	07/30/2021 02:18:18 PM Eastern Daylight Time			08/04/2021 08:53:46 PM Eastern Daylight Time	WELLCARE OF OKLAHOMA, INC.	Wellcare	www.wellcare.com/medicare	Wellcare Assist (HMO)	01	01		1			H9900	007	0	2022	Select counties in OK		2	808	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)853-0865		(833)853-0865		(844)917-0175		(844)917-0175		(833)853-0865		(833)853-0865		(844)917-0175		(844)917-0175		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9904	001	0	1	04	01	H9904_001_0	13	1					0	08/04/2021	2022.01	08/04/2021 02:26:26 PM Eastern Daylight Time	08/04/2021 02:24:06 PM Eastern Daylight Time	08/04/2021 12:20:51 PM Eastern Daylight Time			08/04/2021 03:29:32 PM Eastern Daylight Time	CENTRAL MASS HEALTH, LLC	Central Mass Health	https://www.massadvantage.com	Mass Advantage Premiere (PPO)	01	04		1			H9904	001	0	2022	Massachusetts (Partial)		2		2			2						https://www.massadvantage.com	https://www.massadvantage.com	https://www.massadvantage.com	(844)915-0234		(844)915-0234		(844)915-0234		(844)915-0234		(844)915-0234		(844)915-0234		(844)915-0234		(844)915-0234		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9909	001	0	1	01	01	H9909_001_0	2	1		1			0	08/03/2021	2022.01	08/03/2021 03:05:36 PM Central Daylight Time	08/05/2021 08:08:04 AM Central Daylight Time	08/05/2021 08:08:22 AM Central Daylight Time			08/05/2021 08:50:53 AM Central Daylight Time	AMERICAN HEALTH PLAN OF MS, INC.	American Health Advantage of MS	ms.AmHealthPlans.com	American Health Advantage of Mississippi (HMO I-SNP)	01	01		1			H9909	001	0	2022	Mississippi		2		2			1	1	3				ms.AmHealthPlans.com	ms.AmHealthPlans.com	ms.AmHealthPlans.com	(844)917-0642		(844)917-0642		(844)917-0642		(844)917-0642		(844)917-0642		(844)917-0642		(844)917-0642		(844)917-0642		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9917	001	0	1	01	01	H9917_001_0	6	1		1			0	07/07/2021	2022.01	07/07/2021 12:41:11 PM Eastern Daylight Time	08/05/2021 01:19:20 PM Eastern Daylight Time	08/02/2021 03:18:51 PM Eastern Daylight Time			08/05/2021 04:38:50 PM Eastern Daylight Time	ALIGN SENIOR CARE FLORIDA, INC.	Align Senior Care	www.alignseniorcare.com	Align Thrive (HMO I-SNP)	01	01		1			H9917	001	0	2022	Florida (partial)		2	9809	2			1	1	3				www.alignseniorcare.com	www.alignseniorcare.com	www.alignseniorcare.com	(844)788-8935		(844)788-8935		(844)788-8935		(844)788-8935		(844)788-8935		(844)788-8935		(844)788-8935		(844)788-8935		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9917	002	0	1	01	01	H9917_002_0	6	1		1			0	07/07/2021	2022.01	07/07/2021 12:43:05 PM Eastern Daylight Time	08/05/2021 01:19:56 PM Eastern Daylight Time	08/02/2021 03:19:19 PM Eastern Daylight Time			08/05/2021 04:38:50 PM Eastern Daylight Time	ALIGN SENIOR CARE FLORIDA, INC.	Align Senior Care	www.alignseniorcare.com	Align Connect (HMO C-SNP)	01	01		1			H9917	002	0	2022	Florida (partial)		2	3635	2			1	4			00000100000000000000		www.alignseniorcare.com	www.alignseniorcare.com	www.alignseniorcare.com	(844)788-8935		(844)788-8935		(844)788-8935		(844)788-8935		(844)788-8935		(844)788-8935		(844)788-8935		(844)788-8935		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9942	001	0	1	04	01	H9942_001_0	5	1		1			0	08/03/2021	2022.01	08/03/2021 07:03:31 PM Central Daylight Time	08/03/2021 03:34:06 PM Central Daylight Time	08/04/2021 12:08:33 AM Central Daylight Time			08/05/2021 10:08:57 AM Central Daylight Time	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Longevity Health Plan	www.longevityhealthplan.com	Longevity Health Plan (PPO I-SNP)	01	04		1			H9942	001	0	2022	New Jersey (partial)		2		2			1	1	1				www.longevityhealthplan.com	www.longevityhealthplan.com	www.longevityhealthplan.com	(888)899-8490		(888)899-8490		(888)899-8490		(888)899-8490		(888)899-8490		(888)899-8490		(888)899-8490		(888)899-8490		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9952	001	0	1	01	01	H9952_001_0	7	1	2	1			0	08/05/2021	2022.01	08/05/2021 08:28:24 AM Central Daylight Time	08/05/2021 12:29:37 PM Central Daylight Time	08/05/2021 12:28:48 PM Central Daylight Time			08/05/2021 01:20:46 PM Central Daylight Time	MEDICA HEALTH PLANS	Medica	medica.com	Medica AccessAbility Solution Enhanced (HMO D-SNP)	01	01		1			H9952	001	0	2022	Greater Minneapolis/St. Paul Metro Area		2	17032	2			1	3		1		1	medica.com/ASE	medica.com/ASE	medica.com/ASE	(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			
H9955	001	0	1	01	01	H9955_001_0	7	1	2	1			0	08/05/2021	2022.01	08/05/2021 02:31:25 PM Pacific Daylight Time	08/04/2021 06:00:44 PM Pacific Daylight Time	08/12/2021 01:02:25 PM Pacific Daylight Time			08/12/2021 01:06:10 PM Pacific Daylight Time	MOLINA HEALTHCARE OF OHIO, INC.	Molina Healthcare of Ohio	www.molinahealthcare.com/medicare	Molina Medicare Complete Care (HMO D-SNP)	01	01		1			H9955	001	0	2022	Select Counties In Ohio		2		2			1	3		2		2	www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	(866)472-4584		(866)472-4584		(866)403-8293		(866)403-8293		(866)472-4584		(866)472-4584		(866)403-8293		(866)403-8293		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9955	002	0	1	01	01	H9955_002_0	5	1					1	08/05/2021	2022.01	08/05/2021 02:31:57 PM Pacific Daylight Time	08/04/2021 06:01:34 PM Pacific Daylight Time	08/04/2021 04:51:52 PM Pacific Daylight Time			08/05/2021 03:02:36 PM Pacific Daylight Time	MOLINA HEALTHCARE OF OHIO, INC.	Molina Healthcare of Ohio	www.molinahealthcare.com/medicare	Molina Medicare Choice Care (HMO)	01	01		1			H9955	002	0	2022	Select Counties in Ohio		2		2			2						www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	(866)472-4584		(866)472-4584		(866)403-8293		(866)403-8293		(866)472-4584		(866)472-4584		(866)403-8293		(866)403-8293		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9976	001	0	1	04	01	H9976_001_0	4	1					0	07/18/2021	2022.01	07/18/2021 05:42:03 PM Eastern Daylight Time	08/04/2021 02:09:04 AM Eastern Daylight Time	07/30/2021 02:18:50 PM Eastern Daylight Time			08/04/2021 11:54:32 PM Eastern Daylight Time	WESTERN SKY COMMUNITY CARE, INC.	Wellcare by Allwell	www.wellcare.com/allwellNM	Wellcare Assist Open (PPO)	01	04		1			H9976	001	0	2022	Select counties in NM		2	758	2			2						www.wellcare.com/allwellNM	www.wellcare.com/allwellNM	www.wellcare.com/allwellNM	(833)543-0246		(833)543-0246		(866)277-6583		(866)277-6583		(833)543-0246		(833)543-0246		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9976	002	0	1	04	01	H9976_002_0	5	1					0	08/02/2021	2022.01	08/02/2021 03:49:39 PM Eastern Daylight Time	08/04/2021 02:09:32 AM Eastern Daylight Time	07/30/2021 02:19:12 PM Eastern Daylight Time			08/04/2021 11:54:32 PM Eastern Daylight Time	WESTERN SKY COMMUNITY CARE, INC.	Wellcare by Allwell	www.wellcare.com/allwellNM	Wellcare No Premium Open (PPO)	01	04		1			H9976	002	0	2022	Select counties in NM		2	758	2			2						www.wellcare.com/allwellNM	www.wellcare.com/allwellNM	www.wellcare.com/allwellNM	(833)543-0246		(833)543-0246		(866)277-6583		(866)277-6583		(833)543-0246		(833)543-0246		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9976	003	0	1	04	01	H9976_003_0	4	1					0	08/02/2021	2022.01	08/02/2021 03:52:43 PM Eastern Daylight Time	08/04/2021 02:10:00 AM Eastern Daylight Time	07/30/2021 02:19:32 PM Eastern Daylight Time			08/04/2021 11:54:32 PM Eastern Daylight Time	WESTERN SKY COMMUNITY CARE, INC.	Wellcare by Allwell	www.wellcare.com/allwellNM	Wellcare Low Premium Open (PPO)	01	04		1			H9976	003	0	2022	Select counties in NM		2	2602	2			2						www.wellcare.com/allwellNM	www.wellcare.com/allwellNM	www.wellcare.com/allwellNM	(833)543-0246		(833)543-0246		(866)277-6583		(866)277-6583		(833)543-0246		(833)543-0246		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9976	004	0	1	04	01	H9976_004_0	4	1					0	08/02/2021	2022.01	08/02/2021 03:55:01 PM Eastern Daylight Time	08/04/2021 02:10:30 AM Eastern Daylight Time	07/30/2021 02:19:50 PM Eastern Daylight Time			08/04/2021 11:54:32 PM Eastern Daylight Time	WESTERN SKY COMMUNITY CARE, INC.	Wellcare by Allwell	www.wellcare.com/allwellNM	Wellcare Giveback Open (PPO)	01	04		1			H9976	004	0	2022	Select counties in NM		2	2602	2			2						www.wellcare.com/allwellNM	www.wellcare.com/allwellNM	www.wellcare.com/allwellNM	(833)543-0246		(833)543-0246		(866)277-6583		(866)277-6583		(833)543-0246		(833)543-0246		(866)277-6583		(866)277-6583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9986	001	0	1	01	01	H9986_001_0	6	1		1			0	09/23/2021	2022.01	09/23/2021 09:26:51 PM Central Daylight Time	08/02/2021 11:30:24 AM Central Daylight Time	08/02/2021 10:15:03 AM Central Daylight Time			09/23/2021 09:27:56 PM Central Daylight Time	HPMP OF FLORIDA, INC.	Florida Complete Care	fc2healthplan.com	Florida Complete Care (HMO I-SNP)	01	01		1			H9986	001	0	2022	Florida		2		2			1	1	3				www.fc2healthplan.com	fc2healthplan.com	fc2healthplan.com	(833)322-7526		(833)322-7526		(833)322-7526		(833)322-7526		(833)322-7526		(833)322-7526		(833)322-7526		(833)322-7526		(833)322-7526		(833)322-7526		(833)322-7526		(833)322-7526		(833)322-7526		(833)322-7526		(833)322-7526		(833)322-7526		2					2					2	2			
H9986	002	0	1	01	01	H9986_002_0	6	1		1			0	09/23/2021	2022.01	09/23/2021 09:14:55 PM Central Daylight Time	08/02/2021 11:34:06 AM Central Daylight Time	08/02/2021 10:17:01 AM Central Daylight Time			09/23/2021 09:27:56 PM Central Daylight Time	HPMP OF FLORIDA, INC.	Florida Complete Care	fc2healthplan.com	Florida Complete Care- In The Community (HMO I-SNP)	01	01		1			H9986	002	0	2022	Florida		2		2			1	1	3				www.fc2healthplan.com	www.fc2healthplan.com	www.fc2healthplan.com	(833)322-7526		(833)322-7526		(833)322-7526		(833)322-7526		(833)322-7526		(833)322-7526		(833)322-7526		(833)322-7526		(833)322-7526		(833)322-7526		(833)322-7526		(833)322-7526		(833)322-7526		(833)322-7526		(833)322-7526		(833)322-7526		2					2					2	2			
H9998	001	0	1	20	08	H9998_001_0	1	1						05/27/2021	2022.01	05/27/2021 08:52:52 AM Central Daylight Time		05/27/2021 08:24:57 AM Central Daylight Time			05/27/2021 08:54:54 AM Central Daylight Time	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	Silver Star	www.silverstar.org	Silver Star - Dual (PACE)	08	20		1			H9998	001	0	2022	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						05/27/2021	2022.01	05/27/2021 08:53:34 AM Central Daylight Time		05/27/2021 08:24:38 AM Central Daylight Time			05/27/2021 08:54:54 AM Central Daylight Time	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	Silver Star	www.silverstar.org	Silver Star - Medicare only (PACE)	08	20		1			H9998	002	0	2022	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	4	1				0	0	06/03/2021	2022.01	06/03/2021 03:19:59 PM Eastern Daylight Time	08/03/2021 06:09:54 PM Eastern Daylight Time				08/04/2021 03:07:30 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R0110-001 (Regional PPO)	11	31		1			R0110	001	0	2022	States of Louisiana and Mississippi		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_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	003	0	1	31	11	R0110_003_0	5	1					1	07/15/2021	2022.01	07/15/2021 05:23:03 PM Eastern Daylight Time	08/03/2021 06:08:03 PM Eastern Daylight Time	07/30/2021 12:10:16 PM Eastern Daylight Time			08/04/2021 03:07:30 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R0110-003 (Regional PPO)	11	31		1			R0110	003	0	2022	States of Louisiana and Mississippi		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1						05/27/2021	2022.01	05/27/2021 09:59:13 AM Eastern Daylight Time					06/01/2021 02:13:18 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R0110	801	0	2022	States of Louisiana and Mississippi		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242		(866)396-8810		(866)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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
R0110	802	0	1	31	11	R0110_802_0	2	1				0	0	05/25/2021	2022.01	05/25/2021 09:09:04 AM Eastern Daylight Time					06/01/2021 02:13:18 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R0110	802	0	2022	States of Louisiana and Mississippi		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
R0759	001	0	1	31	11	R0759_001_0	4	1			2		1	08/04/2021	2022.01	08/04/2021 12:42:22 PM Central Daylight Time	08/03/2021 11:50:34 AM Central Daylight Time	07/29/2021 09:27:49 PM Central Daylight Time			08/04/2021 07:39:56 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 2 (Regional PPO)	11	31		1			R0759	001	0	2022	Entire 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			
R0759	002	0	1	31	11	R0759_002_0	3	1			2	0	0	08/04/2021	2022.01	08/04/2021 12:42:34 PM Central Daylight Time	08/03/2021 11:51:03 AM Central Daylight Time				08/04/2021 07:39:56 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Patriot (Regional PPO)	11	31		1			R0759	002	0	2022	Entire 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			
R0759	003	0	1	31	11	R0759_003_0	3	1	2	1	2		0	08/04/2021	2022.01	08/04/2021 12:42:45 PM Central Daylight Time	08/03/2021 11:51:30 AM Central Daylight Time	07/29/2021 09:28:05 PM Central Daylight Time			08/04/2021 07:39:56 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete RP (Regional PPO D-SNP)	11	31		1			R0759	003	0	2022	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			
R0802	001	0	1	31	11	R0802_001_0	7	1					1	08/03/2021	2022.01	08/03/2021 10:45:32 AM Eastern Daylight Time	08/05/2021 12:41:04 PM Eastern Daylight Time	08/05/2021 04:20:31 PM Eastern Daylight Time			08/05/2021 04:31:16 PM Eastern Daylight Time	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Martin's Point Generations Advantage	MartinsPoint.org/Advantage	Martin's Point Generations Advantage Flex (Regional PPO)	11	31		1			R0802	001	0	2022	Northern New England (New Hampshire and Maine)		2		2			2						MartinsPoint.org/Advantage	MartinsPoint.org/Advantage	MartinsPoint.org/Advantage	(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			2	0	0	08/02/2021	2022.01	08/02/2021 09:53:21 AM Eastern Daylight Time	08/03/2021 05:23:37 PM Eastern Daylight Time				08/04/2021 01:59:57 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R0865-001 (Regional PPO)	11	31		1			R0865	001	0	2022	States of Indiana and Kentucky		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_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	5	1			1		1	08/04/2021	2022.01	08/04/2021 01:45:07 PM Eastern Daylight Time	08/03/2021 06:05:16 PM Eastern Daylight Time	07/30/2021 12:10:28 PM Eastern Daylight Time			08/04/2021 01:59:57 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R0865-003 (Regional PPO)	11	31		1			R0865	003	0	2022	States of Indiana and Kentucky		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	2	1						05/25/2021	2022.01	05/25/2021 09:09:49 AM Eastern Daylight Time					06/01/2021 02:13:18 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R0865	801	0	2022	States of Indiana and Kentucky		1	4120	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242		(866)396-8810		(866)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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
R0865	802	0	1	31	11	R0865_802_0	2	1				0	0	05/25/2021	2022.01	05/25/2021 09:09:41 AM Eastern Daylight Time					06/01/2021 02:13:18 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R0865	802	0	2022	States of Indiana and Kentucky		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
R0923	001	0	1	31	11	R0923_001_0	4	1			2	0	0	07/21/2021	2022.01	07/21/2021 01:11:52 PM Eastern Daylight Time	08/03/2021 05:22:59 PM Eastern Daylight Time				08/04/2021 02:16:11 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R0923-001 (Regional PPO)	11	31		1			R0923	001	0	2022	States of Pennsylvania and West Virginia		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_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			1		1	07/08/2021	2022.01	07/08/2021 03:58:15 PM Eastern Daylight Time	08/03/2021 05:51:29 PM Eastern Daylight Time	07/30/2021 12:10:40 PM Eastern Daylight Time			08/04/2021 02:16:11 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R0923-002 (Regional PPO)	11	31		1			R0923	002	0	2022	States of Pennsylvania and West Virginia		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	2	1						05/25/2021	2022.01	05/25/2021 09:25:18 AM Eastern Daylight Time					06/01/2021 02:13:18 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R0923	801	0	2022	States of Pennsylvania and West Verginia		1	1771	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242		(866)396-8810		(866)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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
R0923	802	0	1	31	11	R0923_802_0	2	1				0	0	05/25/2021	2022.01	05/25/2021 09:33:27 AM Eastern Daylight Time					06/01/2021 02:13:18 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R0923	802	0	2022	States of Pennsylvania and West Verginia		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
R1390	001	0	1	31	11	R1390_001_0	4	1				0	0	08/04/2021	2022.01	08/04/2021 10:34:11 AM Eastern Daylight Time	08/04/2021 11:41:25 AM Eastern Daylight Time				08/04/2021 02:22:44 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R1390-001 (Regional PPO)	11	31		1			R1390	001	0	2022	States of North Carolina and Virginia		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_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	3	1					1	08/04/2021	2022.01	08/04/2021 09:22:15 AM Eastern Daylight Time	08/04/2021 11:41:49 AM Eastern Daylight Time	08/03/2021 02:20:00 PM Eastern Daylight Time			08/04/2021 02:22:44 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R1390-002 (Regional PPO)	11	31		1			R1390	002	0	2022	States of North Carolina and Virginia		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R1390	003	0	1	31	11	R1390_003_0	3	1				0	0	08/03/2021	2022.01	08/03/2021 10:54:38 AM Eastern Daylight Time	08/04/2021 11:42:13 AM Eastern Daylight Time				08/04/2021 02:22:44 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Honor R1390-003 (Regional PPO)	11	31		1			R1390	003	0	2022	States of North Carolina and Virginia		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_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	801	0	1	31	11	R1390_801_0	2	1						05/27/2021	2022.01	05/27/2021 10:12:21 AM Eastern Daylight Time					06/01/2021 02:13:18 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R1390	801	0	2022	States of North Carolina and Virginia		1	1765	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242		(866)396-8810		(866)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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
R1390	802	0	1	31	11	R1390_802_0	2	1				0	0	05/25/2021	2022.01	05/25/2021 09:55:43 AM Eastern Daylight Time					06/01/2021 02:13:18 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R1390	802	0	2022	States of North Carolina and Virginia		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
R1532	001	0	1	31	11	R1532_001_0	3	1				0	0	06/03/2021	2022.01	06/03/2021 03:42:39 PM Eastern Daylight Time	08/03/2021 05:29:05 PM Eastern Daylight Time				08/04/2021 02:23:59 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R1532-001 (Regional PPO)	11	31		1			R1532	001	0	2022	States of Arkansas and Missouri		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription-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					0	06/04/2021	2022.01	06/04/2021 01:00:13 PM Eastern Daylight Time	08/07/2021 01:05:09 AM Eastern Daylight Time	07/30/2021 12:11:04 PM Eastern Daylight Time			08/09/2021 01:15:55 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R1532-002 (Regional PPO)	11	31		1			R1532	002	0	2022	States of Arkansas and Missouri		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription-drugs/medicare_drug_tools/medicare_drug_list	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	2	1						05/25/2021	2022.01	05/25/2021 10:05:54 AM Eastern Daylight Time					06/01/2021 02:13:18 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R1532	801	0	2022	States of Arkansas and Missouri		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription-drugs/medicare_drug_tools/medicare_drug_list	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242		(866)396-8810		(866)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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
R1532	802	0	1	31	11	R1532_802_0	2	1				0	0	05/25/2021	2022.01	05/25/2021 10:12:16 AM Eastern Daylight Time					06/01/2021 02:13:18 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R1532	802	0	2022	States of Arkansas and Missouri		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription-drugs/medicare_drug_tools/medicare_drug_list	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
R1548	001	0	1	31	11	R1548_001_0	4	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 11:17:08 AM Central Daylight Time	08/03/2021 11:51:58 AM Central Daylight Time	07/29/2021 09:28:22 PM Central Daylight Time			08/04/2021 04:59:49 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE CO. OF THE RIVER VALLEY	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete RP (Regional PPO D-SNP)	11	31		1			R1548	001	0	2022	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			
R2604	001	0	1	31	11	R2604_001_0	2	1					1	08/04/2021	2022.01	08/04/2021 09:59:06 AM Central Daylight Time	08/03/2021 07:49:58 PM Central Daylight Time	07/29/2021 09:28:37 PM Central Daylight Time			08/04/2021 02:05:05 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Choice (Regional PPO)	11	31		1			R2604	001	0	2022	Georgia and 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			
R2604	002	0	1	31	11	R2604_002_0	3	1		1			0	08/04/2021	2022.01	08/04/2021 09:57:34 AM Central Daylight Time	08/03/2021 07:50:31 PM Central Daylight Time	07/29/2021 09:28:54 PM Central Daylight Time			08/04/2021 02:05:05 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Silver (Regional PPO C-SNP)	11	31		1			R2604	002	0	2022	Georgia and South Carolina		2		2			1	4			00000000000000000010		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			
R2604	003	0	1	31	11	R2604_003_0	3	1		1			1	08/04/2021	2022.01	08/04/2021 09:55:31 AM Central Daylight Time	08/03/2021 07:51:02 PM Central Daylight Time	07/29/2021 09:29:10 PM Central Daylight Time			08/04/2021 02:05:05 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Gold (Regional PPO C-SNP)	11	31		1			R2604	003	0	2022	Georgia and South Carolina		2		2			1	4			00000000000000000010		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			
R2604	005	0	1	31	11	R2604_005_0	3	1				0	0	08/04/2021	2022.01	08/04/2021 09:54:02 AM Central Daylight Time	08/03/2021 07:51:35 PM Central Daylight Time				08/04/2021 02:05:05 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Patriot (Regional PPO)	11	31		1			R2604	005	0	2022	Georgia and 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										(711)-		(711)-		(711)-		(711)-										2					2						2			
R3175	003	0	1	31	11	R3175_003_0	5	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 03:19:38 PM Central Daylight Time	08/03/2021 12:51:57 PM Central Daylight Time	07/29/2021 09:29:26 PM Central Daylight Time			08/04/2021 03:26:24 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete RP (Regional PPO D-SNP)	11	31		1			R3175	003	0	2022	State of Hawaii		2		2			1	3		1		1	www.UHCCommunityPlan.com	www.UHCCommunityPlan.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						05/24/2021	2022.01	05/24/2021 05:01:06 PM Eastern Daylight Time					06/02/2021 10:31:02 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (Regional PPO)	11	31		1			R3175	801	0	2022	State of Hawaii		1	0	2			2						www.UHCCommunityPlan.com	www.UHCCommunityPlan.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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
R3175	802	0	1	31	11	R3175_802_0	1	1				0	0	05/24/2021	2022.01	05/24/2021 05:01:37 PM Eastern Daylight Time					06/02/2021 10:31:02 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (Regional PPO)	11	31		1			R3175	802	0	2022	State of Hawaii		1	0	2			2						www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
R3332	001	0	1	31	11	R3332_001_0	5	1					1	06/03/2021	2022.01	06/03/2021 09:25:11 PM Eastern Daylight Time	08/05/2021 12:40:46 PM Eastern Daylight Time	08/02/2021 03:11:19 PM Eastern Daylight Time			08/05/2021 02:37:03 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	2022	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	6	1				0	0	08/05/2021	2022.01	08/05/2021 02:04:04 PM Eastern Daylight Time	08/03/2021 05:28:32 PM Eastern Daylight Time				08/05/2021 02:18:10 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R3392-001 (Regional PPO)	11	31		1			R3392	001	0	2022	States of Georgia and South Carolina		2		2			2						https://www.humana.com/pharmacy/	http:www.humana.com/medicare/medicare_prescription_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					0	07/15/2021	2022.01	07/15/2021 02:46:41 PM Eastern Daylight Time	08/03/2021 05:29:10 PM Eastern Daylight Time	07/30/2021 12:11:16 PM Eastern Daylight Time			08/04/2021 01:54:37 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R3392-002 (Regional PPO)	11	31		1			R3392	002	0	2022	States of Georgia and South Carolina		2		2			2						https://www.humana.com/pharmacy/	http:www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	2	1						05/25/2021	2022.01	05/25/2021 10:23:04 AM Eastern Daylight Time					06/01/2021 02:13:18 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R3392	801	0	2022	States of Georgia and South Carolina		1	2722	2			2						https://www.humana.com/pharmacy/	http:www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242		(866)396-8810		(866)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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
R3392	802	0	1	31	11	R3392_802_0	2	1				0	0	05/25/2021	2022.01	05/25/2021 10:28:48 AM Eastern Daylight Time					06/01/2021 02:13:18 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R3392	802	0	2022	States of Georgia and South Carolina		1	1200	2			2						https://www.humana.com/pharmacy/	http:www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
R3444	008	0	1	31	11	R3444_008_0	3	1		1			0	08/04/2021	2022.01	08/04/2021 11:56:31 AM Central Daylight Time	08/03/2021 01:16:10 PM Central Daylight Time	07/29/2021 09:29:43 PM Central Daylight Time			08/05/2021 01:50:49 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Silver (Regional PPO C-SNP)	11	31		1			R3444	008	0	2022	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	009	0	1	31	11	R3444_009_0	3	1		1			1	08/04/2021	2022.01	08/04/2021 11:58:30 AM Central Daylight Time	08/03/2021 01:16:42 PM Central Daylight Time	07/29/2021 09:29:59 PM Central Daylight Time			08/05/2021 01:50:49 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Gold (Regional PPO C-SNP)	11	31		1			R3444	009	0	2022	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	012	0	1	31	11	R3444_012_0	2	1					1	08/04/2021	2022.01	08/04/2021 12:00:57 PM Central Daylight Time	08/03/2021 01:17:15 PM Central Daylight Time	07/29/2021 09:30:15 PM Central Daylight Time			08/05/2021 01:50:49 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Choice Plan 2 (Regional PPO)	11	31		1			R3444	012	0	2022	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			
R3444	023	0	1	31	11	R3444_023_0	2	1					1	08/04/2021	2022.01	08/04/2021 12:02:18 PM Central Daylight Time	08/03/2021 01:17:46 PM Central Daylight Time	07/29/2021 09:30:30 PM Central Daylight Time			08/05/2021 01:50:49 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO)	11	31		1			R3444	023	0	2022	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	5	1			2	0	0	07/15/2021	2022.01	07/15/2021 04:37:01 PM Eastern Daylight Time	08/03/2021 05:48:55 PM Eastern Daylight Time				08/04/2021 01:54:36 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R3887-001 (Regional PPO)	11	31		1			R3887	001	0	2022	State of Michigan		2		2			2						https://www.humana.com/pharmacy/	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	4	1			2		0	07/15/2021	2022.01	07/15/2021 04:37:43 PM Eastern Daylight Time	08/03/2021 05:42:51 PM Eastern Daylight Time	07/30/2021 12:11:28 PM Eastern Daylight Time			08/04/2021 01:54:36 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R3887-002 (Regional PPO)	11	31		1			R3887	002	0	2022	State of Michigan		2		2			2						https://www.humana.com/pharmacy/	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	2	1						05/25/2021	2022.01	05/25/2021 10:45:56 AM Eastern Daylight Time					06/01/2021 02:13:18 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R3887	801	0	2022	State of Michigan		1	3010	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tool/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242		(866)396-8810		(866)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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
R3887	802	0	1	31	11	R3887_802_0	2	1				0	0	05/25/2021	2022.01	05/25/2021 10:53:28 AM Eastern Daylight Time					06/01/2021 02:13:18 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R3887	802	0	2022	State of Michigan		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tool/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
R4182	001	0	1	31	11	R4182_001_0	4	1				0	0	08/04/2021	2022.01	08/04/2021 10:31:01 AM Eastern Daylight Time	08/03/2021 05:54:59 PM Eastern Daylight Time				08/04/2021 03:07:30 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R4182-001 (Regional PPO)	11	31		1			R4182	001	0	2022	State of Texas		2		2			2						https://www.humana.com/pharmacy/	http:www.humana.com/medicare/medicare_prescription_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	3	1					0	06/03/2021	2022.01	06/03/2021 04:49:11 PM Eastern Daylight Time	08/03/2021 06:13:28 PM Eastern Daylight Time	07/30/2021 12:11:40 PM Eastern Daylight Time			08/04/2021 02:34:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R4182-003 (Regional PPO)	11	31		1			R4182	003	0	2022	State of Texas		2		2			2						https://www.humana.com/pharmacy/	http:www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	1					0	06/03/2021	2022.01	06/03/2021 02:08:50 PM Eastern Daylight Time	08/03/2021 05:55:33 PM Eastern Daylight Time	07/30/2021 12:11:54 PM Eastern Daylight Time			08/04/2021 02:34:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R4182-004 (Regional PPO)	11	31		1			R4182	004	0	2022	State of Texas		2		2			2						https://www.humana.com/pharmacy/	http:www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	2	1						05/25/2021	2022.01	05/25/2021 11:01:47 AM Eastern Daylight Time					06/01/2021 02:13:18 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R4182	801	0	2022	State of Texas		1	2731	2			2						https://www.humana.com/pharmacy/	http:www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242		(866)396-8810		(866)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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
R4182	802	0	1	31	11	R4182_802_0	2	1				0	0	05/25/2021	2022.01	05/25/2021 12:21:04 PM Eastern Daylight Time					06/01/2021 02:13:18 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R4182	802	0	2022	State of Texas		1	1200	2			2						https://www.humana.com/pharmacy/	http:www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
R4487	001	0	1	31	11	R4487_001_0	10	1					0	07/14/2021	2022.01	07/14/2021 05:26:38 PM Eastern Daylight Time	08/03/2021 06:04:00 PM Eastern Daylight Time	08/03/2021 06:04:00 PM Eastern Daylight Time			08/04/2021 02:28:17 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	shop.anthem.com/medicare	Anthem MediBlue Access Basic (Regional PPO)	11	31		1			R4487	001	0	2022	Indiana and Kentucky		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(800)467-1199		(800)467-1199		(855)793-1935		(855)793-1935		(833)344-1017		(833)344-1017		(855)523-0684		(855)523-0684		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R4845	001	0	1	31	11	R4845_001_0	3	1				0	0	06/04/2021	2022.01	06/04/2021 10:35:20 AM Eastern Daylight Time	08/03/2021 05:30:24 PM Eastern Daylight Time				08/04/2021 01:53:51 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R4845-001 (Regional PPO)	11	31		1			R4845	001	0	2022	States of Kansas and Oklahoma		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_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					0	05/31/2021	2022.01	05/31/2021 11:16:38 AM Eastern Daylight Time	08/03/2021 06:21:28 PM Eastern Daylight Time	07/30/2021 12:12:06 PM Eastern Daylight Time			08/04/2021 01:53:51 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R4845-002 (Regional PPO)	11	31		1			R4845	002	0	2022	States of Kansas and Oklahoma		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	2	1						05/25/2021	2022.01	05/25/2021 12:28:25 PM Eastern Daylight Time					06/01/2021 02:13:18 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R4845	801	0	2022	States of Kansas and Oklahoma		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242		(866)396-8810		(866)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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
R4845	802	0	1	31	11	R4845_802_0	2	1				0	0	05/25/2021	2022.01	05/25/2021 12:35:15 PM Eastern Daylight Time					06/01/2021 02:13:18 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R4845	802	0	2022	States of Kansas and Oklahoma		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
R5329	001	0	1	31	11	R5329_001_0	3	1					1	08/04/2021	2022.01	08/04/2021 03:57:08 PM Central Daylight Time	08/03/2021 01:34:19 PM Central Daylight Time	07/29/2021 09:30:46 PM Central Daylight Time			08/05/2021 04:48:13 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (Regional PPO)	11	31		1			R5329	001	0	2022	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	3	1					1	08/04/2021	2022.01	08/04/2021 10:41:36 AM Central Daylight Time	08/03/2021 01:15:12 PM Central Daylight Time	07/29/2021 09:31:02 PM Central Daylight Time			08/05/2021 02:43:57 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Choice Plan 1 (Regional PPO)	11	31		1			R5342	001	0	2022	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	3	1				0	0	08/05/2021	2022.01	08/05/2021 10:24:13 AM Central Daylight Time	08/03/2021 01:15:47 PM Central Daylight Time				08/05/2021 02:43:57 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Patriot (Regional PPO)	11	31		1			R5342	002	0	2022	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	3	1					1	08/04/2021	2022.01	08/04/2021 10:43:48 AM Central Daylight Time	08/03/2021 01:16:22 PM Central Daylight Time	07/29/2021 09:31:18 PM Central Daylight Time			08/05/2021 02:43:57 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO)	11	31		1			R5342	005	0	2022	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	3	1					1	08/04/2021	2022.01	08/04/2021 10:46:01 AM Central Daylight Time	08/03/2021 01:16:57 PM Central Daylight Time	07/29/2021 09:31:34 PM Central Daylight Time			08/05/2021 02:43:57 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Choice Plan 4 (Regional PPO)	11	31		1			R5342	006	0	2022	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	3	1						06/02/2021	2022.01	06/02/2021 11:34:42 AM Eastern Daylight Time					06/02/2021 11:49:49 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (Regional PPO)	11	31		1			R5342	801	0	2022	State of New York		1	180	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
R5342	802	0	1	31	11	R5342_802_0	3	1				0	0	06/02/2021	2022.01	06/02/2021 11:34:50 AM Eastern Daylight Time					06/02/2021 11:49:49 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (Regional PPO)	11	31		1			R5342	802	0	2022	State of 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										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
R5342	803	0	1	31	11	R5342_803_0	3	1						06/02/2021	2022.01	06/02/2021 11:34:57 AM Eastern Daylight Time					06/02/2021 11:49:49 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (Regional PPO)	11	31		1			R5342	803	0	2022	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	1	1a;1b;2;3-1;3-2;3-3;3-4;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;18a;	2		1									
R5361	001	0	1	31	11	R5361_001_0	4	1				0	0	06/05/2021	2022.01	06/05/2021 11:49:46 AM Eastern Daylight Time	08/03/2021 07:43:18 PM Eastern Daylight Time				08/05/2021 09:32:14 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R5361-001 (Regional PPO)	11	31		1			R5361	001	0	2022	States of Illinois and Wisconsin		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_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	3	1					0	08/03/2021	2022.01	08/03/2021 11:09:47 AM Eastern Daylight Time	08/03/2021 08:04:25 PM Eastern Daylight Time	07/30/2021 12:12:18 PM Eastern Daylight Time			08/04/2021 06:08:57 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R5361-002 (Regional PPO)	11	31		1			R5361	002	0	2022	States of Illinois and Wisconsin		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	2	1						05/25/2021	2022.01	05/25/2021 12:50:32 PM Eastern Daylight Time					06/01/2021 02:13:18 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R5361	801	0	2022	States of Illinois and Wisconsin		1	7063	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242		(866)396-8810		(866)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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
R5361	802	0	1	31	11	R5361_802_0	2	1				0	0	05/25/2021	2022.01	05/25/2021 12:58:44 PM Eastern Daylight Time					06/01/2021 02:13:18 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R5361	802	0	2022	States of Illnois and Wisconsin		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
R5495	001	0	1	31	11	R5495_001_0	4	1			2	0	0	08/01/2021	2022.01	08/01/2021 01:30:02 PM Eastern Daylight Time	08/03/2021 05:45:21 PM Eastern Daylight Time				08/04/2021 01:54:36 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R5495-001 (Regional PPO)	11	31		1			R5495	001	0	2022	State of Ohio		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_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			2		0	06/03/2021	2022.01	06/03/2021 05:15:54 PM Eastern Daylight Time	08/03/2021 05:44:14 PM Eastern Daylight Time	07/30/2021 12:12:30 PM Eastern Daylight Time			08/04/2021 01:54:36 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R5495-002 (Regional PPO)	11	31		1			R5495	002	0	2022	State of Ohio		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	2	1						05/25/2021	2022.01	05/25/2021 01:06:34 PM Eastern Daylight Time					06/01/2021 02:13:18 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R5495	801	0	2022	State of Ohio		1	2632	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242		(866)396-8810		(866)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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
R5495	802	0	1	31	11	R5495_802_0	2	1				0	0	05/25/2021	2022.01	05/25/2021 01:14:22 PM Eastern Daylight Time					06/01/2021 02:13:18 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R5495	802	0	2022	State of Ohio		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
R5826	005	0	1	31	11	R5826_005_0	4	1					1	06/03/2021	2022.01	06/03/2021 02:15:53 PM Eastern Daylight Time	08/03/2021 05:26:13 PM Eastern Daylight Time	07/30/2021 12:12:44 PM Eastern Daylight Time			08/04/2021 01:39:21 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R5826-005 (Regional PPO)	11	31		1			R5826	005	0	2022	State of Florida		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4	1				0	0	08/02/2021	2022.01	08/02/2021 10:38:06 AM Eastern Daylight Time	08/03/2021 05:27:29 PM Eastern Daylight Time				08/04/2021 01:39:21 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R5826-018 (Regional PPO)	11	31		1			R5826	018	0	2022	State of Florida		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_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	3	1					0	05/31/2021	2022.01	05/31/2021 10:31:25 AM Eastern Daylight Time	08/03/2021 05:29:35 PM Eastern Daylight Time	07/30/2021 12:12:56 PM Eastern Daylight Time			08/04/2021 01:39:21 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R5826-074 (Regional PPO)	11	31		1			R5826	074	0	2022	State of Florida		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	2	1						05/27/2021	2022.01	05/27/2021 10:33:47 AM Eastern Daylight Time					06/01/2021 02:13:18 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R5826	805	0	2022	State of Florida		1	6400	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242		(866)396-8810		(866)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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
R5826	819	0	1	31	11	R5826_819_0	2	1				0	0	05/25/2021	2022.01	05/25/2021 01:44:03 PM Eastern Daylight Time					06/01/2021 02:13:18 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R5826	819	0	2022	State of Florida		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
R5941	013	0	1	31	11	R5941_013_0	8	1				0	0	08/02/2021	2022.01	08/02/2021 12:43:15 PM Eastern Daylight Time	08/03/2021 06:04:00 PM Eastern Daylight Time				08/04/2021 02:00:52 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	2022	Ohio		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(800)467-1199		(800)467-1199		(855)793-1936		(855)793-1936										(711)-		(711)-		(711)-		(711)-										2					2						2			
R5941	014	0	1	31	11	R5941_014_0	8	1					0	07/14/2021	2022.01	07/14/2021 01:31:07 PM Eastern Daylight Time	08/03/2021 06:04:00 PM Eastern Daylight Time	08/03/2021 06:04:00 PM Eastern Daylight Time			08/04/2021 02:00:52 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	2022	Ohio		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(800)467-1199		(800)467-1199		(855)793-1936		(855)793-1936		(833)348-5279		(833)348-5279		(855)523-0685		(855)523-0685		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R6694	003	0	1	31	11	R6694_003_0	2	1					0	05/27/2021	2022.01	05/27/2021 04:30:06 PM Eastern Daylight Time	08/03/2021 01:08:11 PM Eastern Daylight Time	08/02/2021 09:58:52 AM Eastern Daylight Time			08/04/2021 01:24:40 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plus 1 (Regional PPO)	11	31		1			R6694	003	0	2022	Ohio		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R6694	005	0	1	31	11	R6694_005_0	3	1					0	06/01/2021	2022.01	06/01/2021 11:56:50 AM Eastern Daylight Time	08/03/2021 01:09:41 PM Eastern Daylight Time	08/02/2021 09:58:56 AM Eastern Daylight Time			08/04/2021 01:24:40 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plus 2 (Regional PPO)	11	31		1			R6694	005	0	2022	Ohio		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(888)268-9800		(888)268-9800		(833)859-6031		(833)859-6031		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R6694	006	0	1	31	11	R6694_006_0	3	1					0	05/26/2021	2022.01	05/26/2021 02:05:38 PM Eastern Daylight Time	08/06/2021 02:18:39 PM Eastern Daylight Time	08/02/2021 09:59:00 AM Eastern Daylight Time			08/09/2021 12:20:18 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (Regional PPO)	11	31		1			R6694	006	0	2022	New Jersey Counties: All		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-8764		(833)570-6671		(833)206-8764		(833)206-8764		(833)570-8764		(833)570-6671		(833)570-8764		(833)570-6671		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R6801	008	0	1	31	11	R6801_008_0	3	1		1	2		0	08/04/2021	2022.01	08/04/2021 10:54:15 AM Central Daylight Time	08/03/2021 01:01:25 PM Central Daylight Time	07/29/2021 09:31:50 PM Central Daylight Time			08/04/2021 04:09:25 PM Central Daylight Time	CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Silver (Regional PPO C-SNP)	11	31		1			R6801	008	0	2022	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	009	0	1	31	11	R6801_009_0	3	1		1	2		1	08/04/2021	2022.01	08/04/2021 10:55:30 AM Central Daylight Time	08/03/2021 01:02:00 PM Central Daylight Time	07/29/2021 09:32:06 PM Central Daylight Time			08/04/2021 04:09:25 PM Central Daylight Time	CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Gold (Regional PPO C-SNP)	11	31		1			R6801	009	0	2022	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	4	1	2	1	1		0	08/04/2021	2022.01	08/04/2021 10:57:04 AM Central Daylight Time	08/03/2021 01:02:35 PM Central Daylight Time	07/29/2021 09:32:23 PM Central Daylight Time			08/04/2021 04:09:25 PM Central Daylight Time	CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANY	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Choice (Regional PPO D-SNP)	11	31		1			R6801	011	0	2022	Texas		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			
R6801	012	0	1	31	11	R6801_012_0	4	1			2		1	08/04/2021	2022.01	08/04/2021 10:58:10 AM Central Daylight Time	08/03/2021 01:03:11 PM Central Daylight Time	07/29/2021 09:32:38 PM Central Daylight Time			08/04/2021 04:09:25 PM Central Daylight Time	CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Choice (Regional PPO)	11	31		1			R6801	012	0	2022	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	4	1				0	0	06/02/2021	2022.01	06/02/2021 10:13:03 AM Eastern Daylight Time	08/03/2021 07:27:14 PM Eastern Daylight Time				08/04/2021 01:36:12 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R7220-001 (Regional PPO)	11	31		1			R7220	001	0	2022	State of Arizona		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_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	3	1					0	06/02/2021	2022.01	06/02/2021 10:14:06 AM Eastern Daylight Time	08/03/2021 07:28:14 PM Eastern Daylight Time	07/30/2021 12:13:08 PM Eastern Daylight Time			08/04/2021 01:36:12 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R7220-002 (Regional PPO)	11	31		1			R7220	002	0	2022	State of Arizona		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	2	1						05/27/2021	2022.01	05/27/2021 10:36:44 AM Eastern Daylight Time					06/01/2021 02:13:18 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R7220	801	0	2022	State of Arizona		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242		(866)396-8810		(866)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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
R7220	802	0	1	31	11	R7220_802_0	2	1				0	0	05/27/2021	2022.01	05/27/2021 10:40:27 AM Eastern Daylight Time					06/01/2021 02:13:18 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R7220	802	0	2022	State of Arizona		1	1220	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
R7315	001	0	1	31	11	R7315_001_0	3	1			2	0	0	06/03/2021	2022.01	06/03/2021 02:03:48 PM Eastern Daylight Time	08/03/2021 06:38:38 PM Eastern Daylight Time				08/04/2021 01:47:16 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R7315-001 (Regional PPO)	11	31		1			R7315	001	0	2022	States of Alabama and Tennessee		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_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			1		0	07/08/2021	2022.01	07/08/2021 03:52:17 PM Eastern Daylight Time	08/03/2021 06:58:34 PM Eastern Daylight Time	07/30/2021 12:13:20 PM Eastern Daylight Time			08/04/2021 01:47:16 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R7315-002 (Regional PPO)	11	31		1			R7315	002	0	2022	States of Alabama and Tennessee		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	2	1						05/25/2021	2022.01	05/25/2021 02:06:30 PM Eastern Daylight Time					06/01/2021 02:13:18 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R7315	801	0	2022	States of Alabama and Tennessee		1	1915	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242		(866)396-8810		(866)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;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
R7315	802	0	1	31	11	R7315_802_0	2	1				0	0	05/27/2021	2022.01	05/27/2021 10:41:11 AM Eastern Daylight Time					06/01/2021 02:13:18 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R7315	802	0	2022	States of Alabama and Tennessee		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;17b;18a;	1									
R7444	001	0	1	31	11	R7444_001_0	2	1					1	08/04/2021	2022.01	08/04/2021 03:58:50 PM Central Daylight Time	08/03/2021 01:35:35 PM Central Daylight Time	07/29/2021 09:32:54 PM Central Daylight Time			08/05/2021 04:59:14 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (Regional PPO)	11	31		1			R7444	001	0	2022	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			
S0586	801	0		29	10	S0586_801_0	1	1						05/28/2021	2022.01	05/28/2021 04:15:19 PM Eastern Daylight Time					06/05/2021 06:23:18 PM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP Health Care	www.mvphealthcare.com	MVP RxCare - Employer Group (PDP)	10	29					S0586	801	0	2022	United States and Puerto Rico		1					2						https://www.mvphealthcare.com/partD	https://www.mvphealthcare.com/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						04/30/2021	2022.01	04/30/2021 05:14:14 PM Eastern Daylight Time					06/07/2021 02:08:35 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	2022	Massachusetts and Nationwide		1					2						www.tuftsmedicarepreferred.org/doctor-search	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						04/30/2021	2022.01	04/30/2021 05:14:43 PM Eastern Daylight Time					06/07/2021 02:08:35 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	2022	Massachusetts and Nationwide		1					2						www.tuftsmedicarepreferred.org/doctor-search	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	1	1					0	06/07/2021	2022.01	06/07/2021 10:38:23 AM Central Daylight Time		06/03/2021 05:02:10 PM Central Daylight Time			06/07/2021 11:00:29 AM Central Daylight Time	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	BlueRx (PDP)	www.bluerxalatenn.com	BlueRx Enhanced Plus (PDP)	10	29					S1030	001	0	2022	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	1	1					0	06/07/2021	2022.01	06/07/2021 08:43:13 AM Central Daylight Time		06/03/2021 05:02:52 PM Central Daylight Time			06/07/2021 09:29:53 AM Central Daylight Time	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	BlueRx (PDP)	www.bluerxalatenn.com	BlueRx Essential (PDP)	10	29					S1030	006	0	2022	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	1	1					0	06/06/2021	2022.01	06/06/2021 09:59:47 AM Central Daylight Time		06/03/2021 05:03:34 PM Central Daylight Time			06/07/2021 09:29:53 AM Central Daylight Time	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	BlueRx (PDP)	www.bluerxalatenn.com	BlueRx Enhanced (PDP)	10	29					S1030	010	0	2022	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	801	0		29	10	S1030_801_0	1	1						05/03/2021	2022.01	05/03/2021 03:29:51 PM Central Daylight Time					06/05/2021 12:12:34 PM 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	2022	State of Alabama, State of Tennessee		1					2						www.bluerxalatenn.com	www.bluerxalatenn.com										(800)377-3998		(800)377-3998		(877)233-3555		(877)233-3555										(711)-		(711)-		(711)-		(711)-																
S1030	802	0		29	10	S1030_802_0	1	1						05/17/2021	2022.01	05/17/2021 12:39:08 PM Central Daylight Time					06/07/2021 11:00:29 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	2022	State of Alabama, State of Tennessee		1					2						www.bluerxalatenn.com	www.bluerxalatenn.com										(800)377-3998		(800)377-3998		(877)233-3555		(877)233-3555										(711)-		(711)-		(711)-		(711)-																
S1030	803	0		29	10	S1030_803_0	1	1						05/03/2021	2022.01	05/03/2021 03:30:03 PM Central Daylight Time					06/05/2021 12:12:34 PM 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	2022	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						05/17/2021	2022.01	05/17/2021 12:39:12 PM Central Daylight Time					06/07/2021 11:00:29 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	2022	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	805	0		29	10	S1030_805_0	1	1						05/03/2021	2022.01	05/03/2021 03:30:14 PM Central Daylight Time					06/05/2021 12:12:34 PM Central Daylight Time	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	BlueRx (PDP)	www.bluerxalatenn.com	BlueRx Employer Group Plan 805 (PDP)	10	29					S1030	805	0	2022	State of Alabama, State of Tennessee		1					2						www.bluerxalatenn.com	www.bluerxalatenn.com										(855)453-5185		(855)453-5185		(855)453-5185		(855)453-5185										(711)-		(711)-		(711)-		(711)-																
S1140	801	0		29	10	S1140_801_0	1	1						06/04/2021	2022.01	06/04/2021 03:05:49 PM Eastern Daylight Time					06/07/2021 02:13:33 PM Eastern Daylight Time	Highmark Western and Northeastern New York Inc.	BlueCross BlueShield of WNY and BlueShield of NENY	www.nymedicare.com	Group PDP (PDP)	10	29					S1140	801	0	2022	New York State		1					2						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	1	1						06/04/2021	2022.01	06/04/2021 03:05:55 PM Eastern Daylight Time					06/07/2021 02:13:33 PM Eastern Daylight Time	Highmark Western and Northeastern New York Inc.	BlueCross BlueShield of WNY and BlueShield of NENY	www.nymedicare.com	Group PDP Enhanced (PDP)	10	29					S1140	802	0	2022	New York State		1					2						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						06/04/2021	2022.01	06/04/2021 08:44:51 AM Central Daylight Time					06/04/2021 08:47:50 AM Central Daylight Time	HEALTHPARTNERS, INC.	HealthPartners	healthpartners.com/medicare	HealthPartners Group PDP CY (PDP)	10	29					S1822	801	0	2022	Nationwide		1					2						healthpartners.com/partdpharmacy	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						05/28/2021	2022.01	05/28/2021 10:29:41 AM Central Daylight Time					06/04/2021 08:47:50 AM Central Daylight Time	HEALTHPARTNERS, INC.	HealthPartners	healthpartners.com/medicare	HealthPartners Group PDP NCY (PDP)	10	29					S1822	802	0	2022	Nationwide		1					2						healthpartners.com/partdpharmacy	healthpartners.com/medicarerx										(877)816-9539		(952)883-7373		(866)993-7428		(952)883-7428										(711)-		(711)-		(711)-		(711)-																
S2465	801	0		29	10	S2465_801_0	3	1						06/04/2021	2022.01	06/04/2021 10:57:08 AM Eastern Daylight Time					06/04/2021 07:35:25 PM Eastern Daylight Time	OPTIMA HEALTH PLAN	Optima Medicare	www.optimahealth.com/medicare	Optima Medicare - Calendar Year (PDP)	10	29					S2465	801	0	2022	Nationwide		1					2						www.optimahealth.com/medicare	www.optimahealth.com/medicare										(800)927-6048		(800)927-6048		(844)563-4201		(844)563-4201										(800)828-1140		(711)-		(800)828-1140		(711)-																
S2465	802	0		29	10	S2465_802_0	3	1						06/04/2021	2022.01	06/04/2021 10:57:25 AM Eastern Daylight Time					06/04/2021 07:35:25 PM Eastern Daylight Time	OPTIMA HEALTH PLAN	Optima Medicare	www.optimahealth.com/medicare	Optima Medicare Non-Calendar Year (PDP)	10	29					S2465	802	0	2022	Nationwide		1					2						www.optimahealth.com/medicare	www.optimahealth.com/medicare										(800)927-6048		(800)927-6048		(844)563-4201		(844)563-4201										(800)828-1140		(711)-		(800)828-1140		(711)-																
S2468	003	0		29	10	S2468_003_0	3	1					0	06/02/2021	2022.01	06/02/2021 03:05:29 PM Pacific Daylight Time		05/27/2021 03:12:02 PM Pacific Daylight Time			06/05/2021 08:52:11 AM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	blueshieldca.com/medicare	Blue Shield Rx Plus (PDP)	10	29					S2468	003	0	2022	State of California		2					2						blueshieldca.com/medpharmacy2022	blueshieldca.com/medformulary2022										(888)239-6469		(888)239-6469		(888)292-7591		(888)292-7591										(711)-		(711)-		(711)-		(711)-																
S2468	004	0		29	10	S2468_004_0	3	1					0	06/02/2021	2022.01	06/02/2021 03:07:30 PM Pacific Daylight Time		05/27/2021 03:14:19 PM Pacific Daylight Time			06/05/2021 08:52:11 AM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	blueshieldca.com/medicare	Blue Shield Rx Enhanced (PDP)	10	29					S2468	004	0	2022	State of California		2					2						blueshieldca.com/medpharmacy2022	blueshieldca.com/medformulary2022										(888)239-6469		(888)239-6469		(888)292-7591		(888)292-7591										(711)-		(711)-		(711)-		(711)-																
S2468	801	0		29	10	S2468_801_0	3	1						05/08/2021	2022.01	05/08/2021 02:16:23 PM Pacific Daylight Time					06/05/2021 08:52:11 AM 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	2022	PDP Employer Group Plan		1					2						blueshieldca.com/medpharmacy2022	blueshieldca.com/medformulary2022										(888)239-6469		(888)239-6469		(888)239-6469		(888)239-6469										(711)-		(711)-		(711)-		(711)-																
S2468	802	0		29	10	S2468_802_0	3	1						04/15/2021	2022.01	04/15/2021 01:44:37 PM Pacific Daylight Time					06/05/2021 08:52:11 AM 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	2022	PDP Employer Group Plan		1					2						blueshieldca.com/medpharmacy2022	blueshieldca.com/medformulary2022										(888)239-6469		(888)239-6469		(888)239-6469		(888)239-6469										(711)-		(711)-		(711)-		(711)-																
S2668	005	0		29	10	S2668_005_0	2	1					0	06/04/2021	2022.01	06/04/2021 12:33:52 PM Central Daylight Time		06/07/2021 12:49:12 PM Central Daylight Time			06/07/2021 01:25:11 PM Central Daylight Time	MEMBERS HEALTH INSURANCE COMPANY	Farm Bureau Health Plans	www.fbhp.com/part-d	Farm Bureau Essential Rx (PDP)	10	29					S2668	005	0	2022	Alabama and Tennessee		2					2						fbhealthplans.com placeholder	www.fbhp.com/part-d/essentialrx										(866)643-6924		(866)643-6924		(844)368-8738		(844)368-8738										(711)-		(711)-		(711)-		(711)-																
S2668	006	0		29	10	S2668_006_0	2	1					1	06/04/2021	2022.01	06/04/2021 12:35:38 PM Central Daylight Time		06/07/2021 12:50:14 PM Central Daylight Time			06/07/2021 01:25:11 PM Central Daylight Time	MEMBERS HEALTH INSURANCE COMPANY	Farm Bureau Health Plans	www.fbhp.com/part-d	Farm Bureau Select Rx (PDP)	10	29					S2668	006	0	2022	Alabama and Tennessee		2					2						fbhealthplans.com placeholder	www.fbhp.com/part-d/selectrx										(866)643-6924		(866)643-6924		(844)368-8738		(844)368-8738										(711)-		(711)-		(711)-		(711)-																
S2874	001	0		29	10	S2874_001_0	5	1					1	07/01/2021	2022.01	07/01/2021 11:49:49 AM Eastern Daylight Time		06/02/2021 08:17:00 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE OF PUERTO RICO, INC.	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S2874	001	0	2022	Puerto Rico - Island Wide		2					2						https://www.humana.com/pharmacy/	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	4	1					0	07/01/2021	2022.01	07/01/2021 11:50:17 AM Eastern Daylight Time		06/02/2021 08:17:18 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE OF PUERTO RICO, INC.	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S2874	004	0	2022	Puerto Rico - Island Wide		2					2						https://www.humana.com/pharmacy/	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	3	1						05/27/2021	2022.01	05/27/2021 10:43:27 AM Eastern Daylight Time					06/01/2021 02:13:18 PM Eastern Daylight Time	HUMANA INSURANCE OF PUERTO RICO, INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (PDP)	10	29					S2874	801	0	2022	Puerto Rico - Island Wide		1					2						https://www.humana.com/pharmacy/	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	2	1					0	05/21/2021	2022.01	05/21/2021 02:40:10 PM Eastern Daylight Time		06/04/2021 03:38:50 PM Eastern Daylight Time			06/04/2021 03:43:51 PM Eastern Daylight Time	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	Blue MedicareRx	www.RxMedicarePlans.com	Blue MedicareRx Value Plus (PDP)	10	29					S2893	001	0	2022	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	2	1					0	05/21/2021	2022.01	05/21/2021 02:45:36 PM Eastern Daylight Time		06/04/2021 03:38:48 PM Eastern Daylight Time			06/04/2021 03:54:20 PM Eastern Daylight Time	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	Blue MedicareRx	www.RxMedicarePlans.com	Blue MedicareRx Premier (PDP)	10	29					S2893	003	0	2022	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						04/30/2021	2022.01	04/30/2021 03:30:05 PM Eastern Daylight Time					06/01/2021 01:50:36 PM Eastern Daylight Time	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	Blue MedicareRx	Groups.RxMedicareplans.com	Blue MedicareRx (PDP)	10	29					S2893	801	0	2022	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						04/30/2021	2022.01	04/30/2021 03:31:35 PM Eastern Daylight Time					06/01/2021 02:03:06 PM Eastern Daylight Time	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	Blue MedicareRx	Groups.RxMedicareplans.com	Blue MedicareRx (PDP)	10	29					S2893	802	0	2022	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)-																
S3147	001	0		29	10	S3147_001_0	5	1					0	06/04/2021	2022.01	06/04/2021 02:57:04 PM US Mountain Standard Time		06/05/2021 05:39:24 PM US Mountain Standard Time			06/05/2021 05:41:59 PM US Mountain Standard Time	BANNER HEALTH INSURANCE GROUP	Banner Medicare Advantage Rx	www.bannerhealth.com/medicare/	Banner Medicare Simple Rx (PDP)	10	29					S3147	001	0	2022	Arizona		2					2						www.bannerhealth.com/medicare/	www.bannerhealth.com/medicare/										(844)549-1859		(602)462-0830		(844)556-7685		(602)462-0830										(711)-		(711)-		(711)-		(711)-																
S3147	002	0		29	10	S3147_002_0	5	1					1	06/04/2021	2022.01	06/04/2021 02:55:38 PM US Mountain Standard Time		06/05/2021 05:39:24 PM US Mountain Standard Time			06/05/2021 05:41:59 PM US Mountain Standard Time	BANNER HEALTH INSURANCE GROUP	Banner Medicare Advantage Rx	www.bannerhealth.com/medicare/	Banner Medicare Classic Rx (PDP)	10	29					S3147	002	0	2022	Arizona		2					2						www.bannerhealth.com/medicare/	www.bannerhealth.com/medicare/										(844)549-1859		(602)462-0830		(844)556-7685		(602)462-0830										(711)-		(711)-		(711)-		(711)-																
S3147	003	0		29	10	S3147_003_0	5	1					1	06/04/2021	2022.01	06/04/2021 02:54:08 PM US Mountain Standard Time		06/05/2021 05:39:24 PM US Mountain Standard Time			06/05/2021 05:41:59 PM US Mountain Standard Time	BANNER HEALTH INSURANCE GROUP	Banner Medicare Advantage Rx	www.bannerhealth.com/medicare/	Banner Medicare Premier Rx (PDP)	10	29					S3147	003	0	2022	Arizona		2					2						www.bannerhealth.com/medicare/	www.bannerhealth.com/medicare/										(844)549-1859		(602)462-0830		(844)556-7685		(602)462-0830										(711)-		(711)-		(711)-		(711)-																
S3285	801	0		29	10	S3285_801_0	1	1						06/02/2021	2022.01	06/02/2021 12:33:04 PM Pacific Daylight Time					06/02/2021 01:16:16 PM Pacific Daylight Time	MG INSURANCE COMPANY	MG Insurance Company	https://www.medimpact.com	VibrantRx (PDP)	10	29					S3285	801	0	2022	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						06/02/2021	2022.01	06/02/2021 12:33:43 PM Pacific Daylight Time					06/02/2021 01:16:16 PM Pacific Daylight Time	MG INSURANCE COMPANY	MG Insurance Company	https://www.medimpact.com	VibrantRx (PDP)	10	29					S3285	802	0	2022	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						06/02/2021	2022.01	06/02/2021 12:33:51 PM Pacific Daylight Time					06/02/2021 01:16:16 PM Pacific Daylight Time	MG INSURANCE COMPANY	MG Insurance Company	https://www.medimpact.com	VibrantRx (PDP)	10	29					S3285	803	0	2022	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						06/02/2021	2022.01	06/02/2021 12:34:00 PM Pacific Daylight Time					06/02/2021 01:16:16 PM Pacific Daylight Time	MG INSURANCE COMPANY	MG Insurance Company	https://www.medimpact.com	VibrantRx (PDP)	10	29					S3285	804	0	2022	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						06/02/2021	2022.01	06/02/2021 12:34:10 PM Pacific Daylight Time					06/02/2021 01:16:16 PM Pacific Daylight Time	MG INSURANCE COMPANY	MG Insurance Company	https://www.medimpact.com	VibrantRx (PDP)	10	29					S3285	805	0	2022	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						06/02/2021	2022.01	06/02/2021 12:34:20 PM Pacific Daylight Time					06/02/2021 01:16:16 PM Pacific Daylight Time	MG INSURANCE COMPANY	MG Insurance Company	https://www.medimpact.com	VibrantRx (PDP)	10	29					S3285	806	0	2022	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						06/02/2021	2022.01	06/02/2021 12:34:30 PM Pacific Daylight Time					06/02/2021 01:16:16 PM Pacific Daylight Time	MG INSURANCE COMPANY	MG Insurance Company	https://www.medimpact.com	VibrantRx (PDP)	10	29					S3285	807	0	2022	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)-																
S3375	001	0		29	10	S3375_001_0	4	1					0	07/16/2021	2022.01	07/16/2021 06:20:00 PM Eastern Daylight Time		07/16/2021 11:18:22 AM Eastern Daylight Time			07/16/2021 06:29:40 PM Eastern Daylight Time	EMPIRE HEALTHCHOICE ASSURANCE, INC.	BlueCross BlueShield: Empire, Excellus, WNY & NENY	shop.bluerxny.com/medicare	Blue Rx Standard (PDP)	10	29					S3375	001	0	2022	New York		2					2						https://shop.bluerxny.com/medicare	https://shop.bluerxny.com/medicare										(833)552-1045		(833)552-1045		(855)523-0689		(855)523-0689										(711)-		(711)-		(711)-		(711)-																
S3375	002	0		29	10	S3375_002_0	4	1					1	07/16/2021	2022.01	07/16/2021 06:25:21 PM Eastern Daylight Time		07/15/2021 12:03:19 PM Eastern Daylight Time			07/23/2021 12:48:02 PM Eastern Daylight Time	EMPIRE HEALTHCHOICE ASSURANCE, INC.	BlueCross BlueShield: Empire, Excellus, WNY & NENY	shop.bluerxny.com/medicare	Blue Rx Plus (PDP)	10	29					S3375	002	0	2022	New York		2					2						https://shop.bluerxny.com/medicare	https://shop.bluerxny.com/medicare										(833)552-1045		(833)552-1045		(855)523-0689		(855)523-0689										(711)-		(711)-		(711)-		(711)-																
S3389	802	0		29	10	S3389_802_0	1	1						05/26/2021	2022.01	05/26/2021 11:20:02 AM Eastern Daylight Time					06/02/2021 08:16:51 AM Eastern Daylight Time	UPMC HEALTH BENEFITS, INC.	UPMC Health Plan	http://www.upmchealthplan.com/medicare/	UPMC Employer Group (PDP)	10	29					S3389	802	0	2022	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										(711)-		(711)-		(711)-		(711)-																
S3389	803	0		29	10	S3389_803_0	1	1						05/26/2021	2022.01	05/26/2021 11:21:37 AM Eastern Daylight Time					06/02/2021 08:16:51 AM Eastern Daylight Time	UPMC HEALTH BENEFITS, INC.	UPMC Health Plan	http://www.upmchealthplan.com/medicare/	UPMC Employer Group (PDP)	10	29					S3389	803	0	2022	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										(711)-		(711)-		(711)-		(711)-																
S3521	801	0		29	10	S3521_801_0	4	1						05/05/2021	2022.01	05/05/2021 10:50:47 AM Eastern Daylight Time					06/07/2021 02:22:30 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.SimplyPrescriptions.com	Simply Prescriptions- Employer Group (PDP)	10	29					S3521	801	0	2022	National and US Territories		1					2						www.SimplyPrescriptions.com	www.SimplyPrescriptions.com										(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577										(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220																
S3875	802	0		29	10	S3875_802_0	1	1						05/18/2021	2022.01	05/18/2021 08:49:44 AM Mountain Daylight Time					05/18/2021 08:56:25 AM Mountain Daylight Time	GRANITE ALLIANCE INSURANCE COMPANY	Granite Alliance	www.mygraniterx.com	Granite Alliance (PDP)	10	29					S3875	802	0	2022	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						05/18/2021	2022.01	05/18/2021 08:50:45 AM Mountain Daylight Time					05/18/2021 08:56:25 AM Mountain Daylight Time	GRANITE ALLIANCE INSURANCE COMPANY	Granite Alliance	www.mygraniterx.com	Granite Alliance (PDP)	10	29					S3875	803	0	2022	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	804	0		29	10	S3875_804_0	1	1						05/18/2021	2022.01	05/18/2021 08:51:18 AM Mountain Daylight Time					05/18/2021 08:56:25 AM Mountain Daylight Time	GRANITE ALLIANCE INSURANCE COMPANY	Granite Alliance	www.mygraniterx.com	Granite Alliance (PDP)	10	29					S3875	804	0	2022	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	805	0		29	10	S3875_805_0	1	1						05/18/2021	2022.01	05/18/2021 08:51:54 AM Mountain Daylight Time					05/18/2021 08:56:25 AM Mountain Daylight Time	GRANITE ALLIANCE INSURANCE COMPANY	Granite Alliance	www.mygraniterx.com	Granite Alliance (PDP)	10	29					S3875	805	0	2022	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	806	0		29	10	S3875_806_0	1	1						05/18/2021	2022.01	05/18/2021 08:52:32 AM Mountain Daylight Time					05/18/2021 08:56:25 AM Mountain Daylight Time	GRANITE ALLIANCE INSURANCE COMPANY	Granite Alliance	www.mygraniterx.com	Granite Alliance (PDP)	10	29					S3875	806	0	2022	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	807	0		29	10	S3875_807_0	1	1						05/18/2021	2022.01	05/18/2021 08:53:02 AM Mountain Daylight Time					05/18/2021 08:56:25 AM Mountain Daylight Time	GRANITE ALLIANCE INSURANCE COMPANY	Granite Alliance	www.mygraniterx.com	Granite Alliance (PDP)	10	29					S3875	807	0	2022	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	808	0		29	10	S3875_808_0	1	1						05/18/2021	2022.01	05/18/2021 08:53:34 AM Mountain Daylight Time					05/18/2021 08:56:25 AM Mountain Daylight Time	GRANITE ALLIANCE INSURANCE COMPANY	Granite Alliance	www.mygraniterx.com	Granite Alliance (PDP)	10	29					S3875	808	0	2022	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	809	0		29	10	S3875_809_0	1	1						05/18/2021	2022.01	05/18/2021 08:54:03 AM Mountain Daylight Time					05/18/2021 08:56:25 AM Mountain Daylight Time	GRANITE ALLIANCE INSURANCE COMPANY	Granite Alliance	www.mygraniterx.com	Granite Alliance (PDP)	10	29					S3875	809	0	2022	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	810	0		29	10	S3875_810_0	1	1						05/18/2021	2022.01	05/18/2021 08:54:41 AM Mountain Daylight Time					05/18/2021 08:56:25 AM Mountain Daylight Time	GRANITE ALLIANCE INSURANCE COMPANY	Granite Alliance	www.mygraniterx.com	Granite Alliance (PDP)	10	29					S3875	810	0	2022	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	811	0		29	10	S3875_811_0	1	1						05/18/2021	2022.01	05/18/2021 08:55:11 AM Mountain Daylight Time					05/18/2021 08:56:25 AM Mountain Daylight Time	GRANITE ALLIANCE INSURANCE COMPANY	Granite Alliance	www.mygraniterx.com	Granite Alliance (PDP)	10	29					S3875	811	0	2022	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)-																
S3994	801	0		29	10	S3994_801_0	1	1						04/26/2021	2022.01	04/26/2021 04:16:10 PM Hawaiian Standard Time					06/04/2021 12:10:44 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	2022	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	1	1						04/26/2021	2022.01	04/26/2021 04:16:49 PM Hawaiian Standard Time					06/04/2021 12:14:45 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	2022	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	4	1						04/23/2021	2022.01	04/23/2021 09:49:46 AM US Eastern Daylight Time					06/06/2021 01:28:52 PM Eastern 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	2022	United States		1					2						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	4	1						04/23/2021	2022.01	04/23/2021 09:50:05 AM US Eastern Daylight Time					06/06/2021 01:28:52 PM Eastern Daylight Time	HEALTH ALLIANCE MEDICAL PLANS	Health Alliance Medicare Prescription Plan	www.healthalliancemedicare.org	Medicare Employer PDP  - non calendar year (PDP)	10	29					S4219	802	0	2022	United States		1					2						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						06/02/2021	2022.01	06/02/2021 09:19:09 AM Eastern Daylight Time					06/04/2021 09:48:30 AM Eastern Daylight Time	INDEPENDENT HEALTH BENEFITS CORPORATION	Pharmacy Benefit Dimensions PDP	independenthealth.com/medicare	Pharmacy Benefit Dimensions PDP-1 (PDP)	10	29					S4501	801	0	2022	All regions		1					2						www.pbdrx.com	www.pbdrx.com										(800)667-5936		(716)504-4444		(800)958-4405		(716)635-4900										(711)-		(711)-		(711)-		(711)-																
S4501	802	0		29	10	S4501_802_0	1	1						06/02/2021	2022.01	06/02/2021 11:10:47 AM Eastern Daylight Time					06/04/2021 09:48:30 AM 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	2022	All regions		1					2						www.pbdrx.com	www.pbdrx.com										(800)667-5936		(716)504-4444		(800)665-1502		(716)250-4401										(711)-		(711)-		(711)-		(711)-																
S4501	803	0		29	10	S4501_803_0	1	1						06/02/2021	2022.01	06/02/2021 11:10:55 AM Eastern Daylight Time					06/04/2021 09:48:30 AM Eastern Daylight Time	INDEPENDENT HEALTH BENEFITS CORPORATION	Pharmacy Benefit Dimensions PDP	independenthealth.com	Pharmacy Benefit Dimensions PDP-3 (PDP)	10	29					S4501	803	0	2022	All regions		1					2						www.pbdrx.com	www.pbdrx.com										(800)667-5936		(716)504-4444		(800)665-1502		(716)250-4401										(711)-		(711)-		(711)-		(711)-																
S4501	804	0		29	10	S4501_804_0	1	1						06/02/2021	2022.01	06/02/2021 11:11:01 AM Eastern Daylight Time					06/04/2021 09:48:30 AM 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	2022	All regions		1					2						www.pbdrx.com	www.pbdrx.com										(800)667-5936		(716)504-4444		(800)665-1502		(716)250-4401										(711)-		(711)-		(711)-		(711)-																
S4501	805	0		29	10	S4501_805_0	1	1						06/02/2021	2022.01	06/02/2021 11:11:18 AM Eastern Daylight Time					06/04/2021 09:48:30 AM 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	2022	All regions		1					2						www.pbdrx.com	www.pbdrx.com										(800)667-5936		(716)504-4444		(800)665-1502		(716)250-4401										(711)-		(711)-		(711)-		(711)-																
S4501	806	0		29	10	S4501_806_0	1	1						06/02/2021	2022.01	06/02/2021 11:11:33 AM Eastern Daylight Time					06/04/2021 09:48:30 AM 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	2022	All regions		1					2						www.pbdrx.com	www.pbdrx.com										(800)667-5936		(716)504-4444		(800)665-1502		(716)250-4401										(711)-		(711)-		(711)-		(711)-																
S4501	807	0		29	10	S4501_807_0	1	1						06/02/2021	2022.01	06/02/2021 11:11:53 AM Eastern Daylight Time					06/04/2021 09:48:30 AM 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	2022	All regions		1					2						www.pbdrx.com	www.pbdrx.com										(800)667-5936		(716)504-4444		(800)665-1502		(716)250-4401										(711)-		(711)-		(711)-		(711)-																
S4501	808	0		29	10	S4501_808_0	1	1						06/02/2021	2022.01	06/02/2021 11:12:03 AM Eastern Daylight Time					06/04/2021 09:48:30 AM Eastern Daylight Time	INDEPENDENT HEALTH BENEFITS CORPORATION	Pharmacy Benefit Dimensions PDP	www.pbdrx.com	Pharmacy Benefit Dimemsions PDP-8 (WD) (PDP)	10	29					S4501	808	0	2022	All regions		1					2						www.pbdrx.com	www.pbdrx.com										(800)667-5936		(716)504-4444		(800)665-1502		(716)250-4401										(711)-		(711)-		(711)-		(711)-																
S4501	809	0		29	10	S4501_809_0	1	1						06/02/2021	2022.01	06/02/2021 11:12:12 AM Eastern Daylight Time					06/04/2021 09:48:30 AM Eastern Daylight Time	INDEPENDENT HEALTH BENEFITS CORPORATION	Pharmacy Benefit Dimensions PDP	www.pbdrx.com	Pharmacy Benefit Dimensions PDP-9 (WD) (PDP)	10	29					S4501	809	0	2022	All regions		1					2						www.pbdrx.com	www.pbdrx.com										(800)667-5936		(716)504-4444		(800)665-1502		(716)250-4401										(711)-		(711)-		(711)-		(711)-																
S4501	810	0		29	10	S4501_810_0	1	1						06/02/2021	2022.01	06/02/2021 11:12:20 AM Eastern Daylight Time					06/04/2021 09:48:30 AM Eastern Daylight Time	INDEPENDENT HEALTH BENEFITS CORPORATION	Pharmacy Benefit Dimensions PDP	www.pbdrx.com	Pharmacy Benefit Dimensions PDP-10 (WD) (PDP)	10	29					S4501	810	0	2022	All regions		1					2						www.pbdrx.com	www.pbdrx.com										(800)667-5936		(716)504-4444		(800)665-1502		(716)250-4401										(711)-		(711)-		(711)-		(711)-																
S4501	811	0		29	10	S4501_811_0	1	1						06/02/2021	2022.01	06/02/2021 11:12:33 AM Eastern Daylight Time					06/04/2021 09:48:30 AM Eastern Daylight Time	INDEPENDENT HEALTH BENEFITS CORPORATION	Pharmacy Benefit Dimensions PDP	www.pbdrx.com	Pharmacy Benefit Dimensions PDP-11 (WD) (PDP)	10	29					S4501	811	0	2022	All regions		1					2						www.pbdrx.com	www.pbdrx.com										(800)667-5936		(716)504-4444		(800)665-1502		(716)250-4401										(711)-		(711)-		(711)-		(711)-																
S4501	812	0		29	10	S4501_812_0	1	1						06/02/2021	2022.01	06/02/2021 11:12:41 AM Eastern Daylight Time					06/04/2021 09:48:30 AM Eastern Daylight Time	INDEPENDENT HEALTH BENEFITS CORPORATION	Pharmacy Benefit Dimensions PDP	www.pbdrx.com	Pharmacy Benefit Dimensions PDP-12 (WD) (PDP)	10	29					S4501	812	0	2022	All regions		1					2						www.pbdrx.com	www.pbdrx.com										(800)667-5936		(716)504-4444		(800)665-1502		(716)250-4401										(711)-		(711)-		(711)-		(711)-																
S4501	813	0		29	10	S4501_813_0	1	1						06/02/2021	2022.01	06/02/2021 11:12:49 AM Eastern Daylight Time					06/04/2021 09:48:30 AM Eastern Daylight Time	INDEPENDENT HEALTH BENEFITS CORPORATION	Pharmacy Benefit Dimensions PDP	www.pbdrx.com	Pharmacy Benefit Dimensions PDP-13 (WD) (PDP)	10	29					S4501	813	0	2022	All regions		1					2						www.pbdrx.com	www.pbdrx.com										(800)667-5936		(716)504-4444		(800)665-1502		(716)250-4401										(711)-		(711)-		(711)-		(711)-																
S4501	814	0		29	10	S4501_814_0	1	1						06/02/2021	2022.01	06/02/2021 11:12:57 AM Eastern Daylight Time					06/04/2021 09:48:30 AM Eastern Daylight Time	INDEPENDENT HEALTH BENEFITS CORPORATION	Pharmacy Benefit Dimensions PDP	www.pbdrx.com	Pharmacy Benefit Dimensions PDP-14 (PDP)	10	29					S4501	814	0	2022	All regions		1					2						www.pbdrx.com	www.pbdrx.com										(800)667-5936		(716)504-4444		(800)665-1502		(716)250-4401										(711)-		(711)-		(711)-		(711)-																
S4501	815	0		29	10	S4501_815_0	1	1						06/02/2021	2022.01	06/02/2021 11:13:06 AM Eastern Daylight Time					06/04/2021 09:48:30 AM Eastern Daylight Time	INDEPENDENT HEALTH BENEFITS CORPORATION	Pharmacy Benefit Dimensions PDP	www.pbdrx.com	Pharmacy Benefit Dimensions PDP-15 (PDP)	10	29					S4501	815	0	2022	All regions		1					2						www.pbdrx.com	www.pbdrx.com										(800)667-5936		(716)504-4444		(800)665-1502		(716)250-4401										(711)-		(711)-		(711)-		(711)-																
S4501	816	0		29	10	S4501_816_0	1	1						06/02/2021	2022.01	06/02/2021 11:13:14 AM Eastern Daylight Time					06/04/2021 09:48:30 AM Eastern Daylight Time	INDEPENDENT HEALTH BENEFITS CORPORATION	Pharmacy Benefit Dimensions PDP	www.pbdrx.com	Pharmacy Benefit Dimensions PDP-16 (PDP)	10	29					S4501	816	0	2022	All regions		1					2						www.pbdrx.com	www.pbdrx.com										(800)667-5936		(716)504-4444		(800)665-1502		(716)250-4401										(711)-		(711)-		(711)-		(711)-																
S4802	012	0		29	10	S4802_012_0	6	1					0	06/03/2021	2022.01	06/03/2021 04:13:45 PM Eastern Daylight Time		07/23/2021 08:23:11 AM Central Daylight Time			07/26/2021 09:45:38 AM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Classic (PDP)	10	29					S4802	012	0	2022	Louisiana		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	013	0		29	10	S4802_013_0	5	1					0	06/03/2021	2022.01	06/03/2021 04:13:51 PM Eastern Daylight Time		07/21/2021 02:03:45 PM Central Daylight Time			07/22/2021 03:57:03 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Classic (PDP)	10	29					S4802	013	0	2022	Texas		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	014	0		29	10	S4802_014_0	4	1					0	06/03/2021	2022.01	06/03/2021 04:13:57 PM Eastern Daylight Time		07/21/2021 02:04:06 PM Central Daylight Time			07/22/2021 03:57:03 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Classic (PDP)	10	29					S4802	014	0	2022	Oklahoma		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	020	0		29	10	S4802_020_0	4	1					0	06/03/2021	2022.01	06/03/2021 04:14:03 PM Eastern Daylight Time		07/21/2021 02:04:25 PM Central Daylight Time			07/22/2021 03:57:03 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Classic (PDP)	10	29					S4802	020	0	2022	Oregon and Washington		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	021	0		29	10	S4802_021_0	4	1					0	06/03/2021	2022.01	06/03/2021 04:28:43 PM Eastern Daylight Time		07/21/2021 02:04:44 PM Central Daylight Time			07/22/2021 03:57:03 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Classic (PDP)	10	29					S4802	021	0	2022	Idaho and Utah		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	069	0		29	10	S4802_069_0	5	1					0	06/03/2021	2022.01	06/03/2021 04:28:36 PM Eastern Daylight Time		07/23/2021 08:24:00 AM Central Daylight Time			07/26/2021 09:45:38 AM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Classic (PDP)	10	29					S4802	069	0	2022	Virginia		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	070	0		29	10	S4802_070_0	4	1					0	06/03/2021	2022.01	06/03/2021 04:28:31 PM Eastern Daylight Time		07/21/2021 02:05:21 PM Central Daylight Time			07/22/2021 03:57:03 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Classic (PDP)	10	29					S4802	070	0	2022	South Carolina		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	071	0		29	10	S4802_071_0	4	1					0	06/03/2021	2022.01	06/03/2021 04:28:24 PM Eastern Daylight Time		07/21/2021 02:05:41 PM Central Daylight Time			07/22/2021 03:57:03 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Classic (PDP)	10	29					S4802	071	0	2022	Alabama, Tennessee		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	072	0		29	10	S4802_072_0	4	1					0	06/03/2021	2022.01	06/03/2021 04:28:18 PM Eastern Daylight Time		07/21/2021 02:06:02 PM Central Daylight Time			07/22/2021 03:57:03 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Classic (PDP)	10	29					S4802	072	0	2022	Missouri		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	073	0		29	10	S4802_073_0	4	1					0	06/03/2021	2022.01	06/03/2021 04:28:11 PM Eastern Daylight Time		07/21/2021 02:06:21 PM Central Daylight Time			07/22/2021 03:57:03 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Classic (PDP)	10	29					S4802	073	0	2022	Arkansas		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	074	0		29	10	S4802_074_0	4	1					0	06/03/2021	2022.01	06/03/2021 04:28:05 PM Eastern Daylight Time		07/21/2021 02:06:40 PM Central Daylight Time			07/22/2021 03:57:03 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Classic (PDP)	10	29					S4802	074	0	2022	Mississippi		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	075	0		29	10	S4802_075_0	4	1					0	06/03/2021	2022.01	06/03/2021 07:07:01 PM Eastern Daylight Time		07/21/2021 02:06:58 PM Central Daylight Time			07/22/2021 03:57:03 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Classic (PDP)	10	29					S4802	075	0	2022	Maine, New Hampshire		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	076	0		29	10	S4802_076_0	4	1					0	06/03/2021	2022.01	06/03/2021 04:27:53 PM Eastern Daylight Time		07/21/2021 02:07:16 PM Central Daylight Time			07/22/2021 03:57:03 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Classic (PDP)	10	29					S4802	076	0	2022	Connecticut, Massachusetts, Rhode Island, Vermont		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	077	0		29	10	S4802_077_0	4	1					0	06/03/2021	2022.01	06/03/2021 04:27:47 PM Eastern Daylight Time		07/21/2021 02:07:35 PM Central Daylight Time			07/22/2021 03:57:03 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Classic (PDP)	10	29					S4802	077	0	2022	New York		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	078	0		29	10	S4802_078_0	4	1					0	06/03/2021	2022.01	06/03/2021 04:27:41 PM Eastern Daylight Time		07/21/2021 02:07:53 PM Central Daylight Time			07/22/2021 03:57:03 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Classic (PDP)	10	29					S4802	078	0	2022	New Jersey		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	079	0		29	10	S4802_079_0	4	1					0	06/03/2021	2022.01	06/03/2021 04:27:35 PM Eastern Daylight Time		07/21/2021 02:08:11 PM Central Daylight Time			07/22/2021 03:57:03 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Classic (PDP)	10	29					S4802	079	0	2022	District of Columbia, Delaware, Maryland		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	080	0		29	10	S4802_080_0	4	1					0	06/03/2021	2022.01	06/03/2021 04:27:28 PM Eastern Daylight Time		07/21/2021 02:08:30 PM Central Daylight Time			07/22/2021 03:57:03 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Classic (PDP)	10	29					S4802	080	0	2022	Pennsylvania, West Virginia		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	081	0		29	10	S4802_081_0	4	1					0	06/03/2021	2022.01	06/03/2021 04:27:22 PM Eastern Daylight Time		07/21/2021 02:08:48 PM Central Daylight Time			07/22/2021 03:57:03 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Classic (PDP)	10	29					S4802	081	0	2022	North Carolina		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	082	0		29	10	S4802_082_0	4	1					0	06/03/2021	2022.01	06/03/2021 04:27:14 PM Eastern Daylight Time		07/21/2021 02:09:07 PM Central Daylight Time			07/22/2021 03:57:03 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Classic (PDP)	10	29					S4802	082	0	2022	Georgia		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	083	0		29	10	S4802_083_0	5	1					0	06/03/2021	2022.01	06/03/2021 04:27:08 PM Eastern Daylight Time		07/23/2021 08:24:50 AM Central Daylight Time			07/26/2021 09:45:38 AM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Classic (PDP)	10	29					S4802	083	0	2022	Florida		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	084	0		29	10	S4802_084_0	4	1					0	06/03/2021	2022.01	06/03/2021 04:27:02 PM Eastern Daylight Time		07/21/2021 02:09:43 PM Central Daylight Time			07/22/2021 03:57:03 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Classic (PDP)	10	29					S4802	084	0	2022	Michigan		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	085	0		29	10	S4802_085_0	4	1					0	06/03/2021	2022.01	06/03/2021 04:26:57 PM Eastern Daylight Time		07/21/2021 02:10:00 PM Central Daylight Time			07/22/2021 03:57:03 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Classic (PDP)	10	29					S4802	085	0	2022	Ohio		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	086	0		29	10	S4802_086_0	4	1					0	06/03/2021	2022.01	06/03/2021 04:26:50 PM Eastern Daylight Time		07/21/2021 02:10:19 PM Central Daylight Time			07/22/2021 03:57:03 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Classic (PDP)	10	29					S4802	086	0	2022	Indiana, Kentucky		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	087	0		29	10	S4802_087_0	4	1					0	06/03/2021	2022.01	06/03/2021 04:26:44 PM Eastern Daylight Time		07/21/2021 02:10:37 PM Central Daylight Time			07/22/2021 03:57:03 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Classic (PDP)	10	29					S4802	087	0	2022	Illinois		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	088	0		29	10	S4802_088_0	4	1					0	06/03/2021	2022.01	06/03/2021 04:26:39 PM Eastern Daylight Time		07/21/2021 02:10:56 PM Central Daylight Time			07/22/2021 03:57:03 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Classic (PDP)	10	29					S4802	088	0	2022	Kansas		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	089	0		29	10	S4802_089_0	5	1					0	06/03/2021	2022.01	06/03/2021 04:26:33 PM Eastern Daylight Time		07/23/2021 08:25:39 AM Central Daylight Time			07/26/2021 09:45:38 AM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Classic (PDP)	10	29					S4802	089	0	2022	IA, MN, MT, NE, ND, SD, WY		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	090	0		29	10	S4802_090_0	4	1					0	06/03/2021	2022.01	06/03/2021 04:26:27 PM Eastern Daylight Time		07/21/2021 02:12:11 PM Central Daylight Time			07/22/2021 03:57:03 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Classic (PDP)	10	29					S4802	090	0	2022	New Mexico		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	091	0		29	10	S4802_091_0	4	1					0	06/03/2021	2022.01	06/03/2021 04:26:21 PM Eastern Daylight Time		07/21/2021 02:13:00 PM Central Daylight Time			07/22/2021 03:57:03 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Classic (PDP)	10	29					S4802	091	0	2022	Colorado		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	092	0		29	10	S4802_092_0	5	1					0	06/03/2021	2022.01	06/03/2021 04:26:15 PM Eastern Daylight Time		07/23/2021 08:26:27 AM Central Daylight Time			07/26/2021 09:45:38 AM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Classic (PDP)	10	29					S4802	092	0	2022	Arizona		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	093	0		29	10	S4802_093_0	4	1					0	06/03/2021	2022.01	06/03/2021 04:26:09 PM Eastern Daylight Time		07/21/2021 02:14:43 PM Central Daylight Time			07/22/2021 03:57:03 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Classic (PDP)	10	29					S4802	093	0	2022	Nevada		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	094	0		29	10	S4802_094_0	4	1					0	06/03/2021	2022.01	06/03/2021 04:26:02 PM Eastern Daylight Time		07/21/2021 02:15:28 PM Central Daylight Time			07/22/2021 03:57:03 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Classic (PDP)	10	29					S4802	094	0	2022	California		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	095	0		29	10	S4802_095_0	4	1					0	06/03/2021	2022.01	06/03/2021 04:25:56 PM Eastern Daylight Time		07/21/2021 02:16:15 PM Central Daylight Time			07/22/2021 03:57:03 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Classic (PDP)	10	29					S4802	095	0	2022	Hawaii		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	096	0		29	10	S4802_096_0	4	1					0	06/03/2021	2022.01	06/03/2021 08:09:44 PM Eastern Daylight Time		07/22/2021 07:41:37 AM Central Daylight Time			07/22/2021 03:57:03 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Classic (PDP)	10	29					S4802	096	0	2022	Alaska		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	097	0		29	10	S4802_097_0	4	1					0	06/03/2021	2022.01	06/03/2021 04:25:42 PM Eastern Daylight Time		07/21/2021 02:17:32 PM Central Daylight Time			07/22/2021 03:57:03 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Classic (PDP)	10	29					S4802	097	0	2022	Wisconsin		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	132	0		29	10	S4802_132_0	4	1					1	06/03/2021	2022.01	06/03/2021 04:25:39 PM Eastern Daylight Time		06/04/2021 09:36:26 AM Central Daylight Time			06/04/2021 10:43:13 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Value Script (PDP)	10	29					S4802	132	0	2022	Wisconsin		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	133	0		29	10	S4802_133_0	4	1					1	06/03/2021	2022.01	06/03/2021 04:25:34 PM Eastern Daylight Time		06/04/2021 09:37:16 AM Central Daylight Time			06/04/2021 10:43:13 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Value Script (PDP)	10	29					S4802	133	0	2022	Louisiana		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	134	0		29	10	S4802_134_0	3	1					1	06/03/2021	2022.01	06/03/2021 04:25:28 PM Eastern Daylight Time		06/04/2021 09:37:36 AM Central Daylight Time			06/04/2021 09:59:38 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Value Script (PDP)	10	29					S4802	134	0	2022	Arizona		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	135	0		29	10	S4802_135_0	3	1					1	06/03/2021	2022.01	06/03/2021 04:25:22 PM Eastern Daylight Time		06/04/2021 09:38:06 AM Central Daylight Time			06/04/2021 09:59:38 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Value Script (PDP)	10	29					S4802	135	0	2022	Oregon, Washington		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	136	0		29	10	S4802_136_0	3	1					1	06/03/2021	2022.01	06/03/2021 04:25:16 PM Eastern Daylight Time		06/04/2021 09:38:32 AM Central Daylight Time			06/04/2021 09:59:38 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Value Script (PDP)	10	29					S4802	136	0	2022	Maine, New Hampshire		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	137	0		29	10	S4802_137_0	3	1					1	06/03/2021	2022.01	06/03/2021 04:25:11 PM Eastern Daylight Time		06/04/2021 09:38:54 AM Central Daylight Time			06/04/2021 09:59:38 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Value Script (PDP)	10	29					S4802	137	0	2022	Connecticut, Massachusetts, Rhode Island, Vermont		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	138	0		29	10	S4802_138_0	3	1					1	06/03/2021	2022.01	06/03/2021 04:25:05 PM Eastern Daylight Time		06/04/2021 09:39:14 AM Central Daylight Time			06/04/2021 09:59:38 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Value Script (PDP)	10	29					S4802	138	0	2022	New York		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	139	0		29	10	S4802_139_0	3	1					1	06/03/2021	2022.01	06/03/2021 04:24:59 PM Eastern Daylight Time		06/04/2021 09:39:32 AM Central Daylight Time			06/04/2021 09:59:38 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Value Script (PDP)	10	29					S4802	139	0	2022	New Jersey		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	140	0		29	10	S4802_140_0	3	1					1	06/03/2021	2022.01	06/03/2021 04:24:48 PM Eastern Daylight Time		06/04/2021 09:39:52 AM Central Daylight Time			06/04/2021 09:59:38 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Value Script (PDP)	10	29					S4802	140	0	2022	District of Columbia, Delaware, Maryland		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	141	0		29	10	S4802_141_0	3	1					1	06/03/2021	2022.01	06/03/2021 04:24:41 PM Eastern Daylight Time		06/04/2021 09:40:12 AM Central Daylight Time			06/04/2021 09:59:38 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Value Script (PDP)	10	29					S4802	141	0	2022	Pennsylvania, West Virginia		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	142	0		29	10	S4802_142_0	3	1					1	06/03/2021	2022.01	06/03/2021 04:24:34 PM Eastern Daylight Time		06/04/2021 09:40:30 AM Central Daylight Time			06/04/2021 09:59:38 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Value Script (PDP)	10	29					S4802	142	0	2022	Virginia		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	143	0		29	10	S4802_143_0	3	1					1	06/03/2021	2022.01	06/03/2021 04:24:27 PM Eastern Daylight Time		06/04/2021 09:41:04 AM Central Daylight Time			06/04/2021 09:59:38 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Value Script (PDP)	10	29					S4802	143	0	2022	North Carolina		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	144	0		29	10	S4802_144_0	3	1					1	06/03/2021	2022.01	06/03/2021 04:24:20 PM Eastern Daylight Time		06/04/2021 09:41:26 AM Central Daylight Time			06/04/2021 09:59:38 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Value Script (PDP)	10	29					S4802	144	0	2022	South Carolina		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	145	0		29	10	S4802_145_0	3	1					1	06/03/2021	2022.01	06/03/2021 04:24:14 PM Eastern Daylight Time		06/04/2021 09:41:46 AM Central Daylight Time			06/04/2021 09:59:38 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Value Script (PDP)	10	29					S4802	145	0	2022	Georgia		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	146	0		29	10	S4802_146_0	3	1					1	06/03/2021	2022.01	06/03/2021 04:24:07 PM Eastern Daylight Time		06/04/2021 09:42:06 AM Central Daylight Time			06/04/2021 09:59:38 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Value Script (PDP)	10	29					S4802	146	0	2022	Florida		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	147	0		29	10	S4802_147_0	3	1					1	06/03/2021	2022.01	06/03/2021 04:24:00 PM Eastern Daylight Time		06/04/2021 09:42:26 AM Central Daylight Time			06/04/2021 09:59:38 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Value Script (PDP)	10	29					S4802	147	0	2022	Alabama, Tennessee		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	148	0		29	10	S4802_148_0	3	1					1	06/03/2021	2022.01	06/03/2021 04:23:53 PM Eastern Daylight Time		06/04/2021 09:42:52 AM Central Daylight Time			06/04/2021 09:59:38 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Value Script (PDP)	10	29					S4802	148	0	2022	Michigan		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	149	0		29	10	S4802_149_0	3	1					1	06/03/2021	2022.01	06/03/2021 04:23:46 PM Eastern Daylight Time		06/04/2021 09:43:12 AM Central Daylight Time			06/04/2021 09:59:38 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Value Script (PDP)	10	29					S4802	149	0	2022	Ohio		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	150	0		29	10	S4802_150_0	3	1					1	06/03/2021	2022.01	06/03/2021 04:23:39 PM Eastern Daylight Time		06/04/2021 09:43:34 AM Central Daylight Time			06/04/2021 09:59:38 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Value Script (PDP)	10	29					S4802	150	0	2022	Indiana, Kentucky		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	151	0		29	10	S4802_151_0	3	1					1	06/03/2021	2022.01	06/03/2021 04:23:33 PM Eastern Daylight Time		06/04/2021 09:43:54 AM Central Daylight Time			06/04/2021 09:59:38 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Value Script (PDP)	10	29					S4802	151	0	2022	Illinois		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	152	0		29	10	S4802_152_0	3	1					1	06/03/2021	2022.01	06/03/2021 04:23:27 PM Eastern Daylight Time		06/04/2021 09:44:14 AM Central Daylight Time			06/04/2021 09:59:38 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Value Script (PDP)	10	29					S4802	152	0	2022	Missouri		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	153	0		29	10	S4802_153_0	3	1					1	06/03/2021	2022.01	06/03/2021 04:23:21 PM Eastern Daylight Time		06/04/2021 09:44:32 AM Central Daylight Time			06/04/2021 09:59:38 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Value Script (PDP)	10	29					S4802	153	0	2022	Arkansas		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	154	0		29	10	S4802_154_0	3	1					1	06/03/2021	2022.01	06/03/2021 04:23:15 PM Eastern Daylight Time		06/04/2021 09:44:54 AM Central Daylight Time			06/04/2021 09:59:38 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Value Script (PDP)	10	29					S4802	154	0	2022	Mississippi		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	155	0		29	10	S4802_155_0	3	1					1	06/03/2021	2022.01	06/03/2021 04:23:10 PM Eastern Daylight Time		06/04/2021 09:45:12 AM Central Daylight Time			06/04/2021 09:59:38 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Value Script (PDP)	10	29					S4802	155	0	2022	Texas		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	156	0		29	10	S4802_156_0	3	1					1	06/03/2021	2022.01	06/03/2021 04:23:04 PM Eastern Daylight Time		06/04/2021 09:45:44 AM Central Daylight Time			06/04/2021 09:59:38 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Value Script (PDP)	10	29					S4802	156	0	2022	Oklahoma		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	157	0		29	10	S4802_157_0	3	1					1	06/03/2021	2022.01	06/03/2021 04:22:56 PM Eastern Daylight Time		06/04/2021 09:46:36 AM Central Daylight Time			06/04/2021 09:59:38 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Value Script (PDP)	10	29					S4802	157	0	2022	Kansas		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	158	0		29	10	S4802_158_0	3	1					1	06/03/2021	2022.01	06/03/2021 04:22:46 PM Eastern Daylight Time		06/04/2021 09:46:56 AM Central Daylight Time			06/04/2021 09:59:38 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Value Script (PDP)	10	29					S4802	158	0	2022	IA, MN, MT, ND, NE, SD, WY		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	159	0		29	10	S4802_159_0	3	1					1	06/03/2021	2022.01	06/03/2021 04:22:38 PM Eastern Daylight Time		06/04/2021 09:47:14 AM Central Daylight Time			06/04/2021 09:59:38 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Value Script (PDP)	10	29					S4802	159	0	2022	New Mexico		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	160	0		29	10	S4802_160_0	3	1					1	06/03/2021	2022.01	06/03/2021 04:22:32 PM Eastern Daylight Time		06/04/2021 09:47:34 AM Central Daylight Time			06/04/2021 09:59:38 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Value Script (PDP)	10	29					S4802	160	0	2022	Colorado		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	161	0		29	10	S4802_161_0	3	1					1	06/03/2021	2022.01	06/03/2021 04:22:26 PM Eastern Daylight Time		06/04/2021 09:48:02 AM Central Daylight Time			06/04/2021 09:59:38 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Value Script (PDP)	10	29					S4802	161	0	2022	Nevada		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	162	0		29	10	S4802_162_0	3	1					1	06/03/2021	2022.01	06/03/2021 04:22:19 PM Eastern Daylight Time		06/04/2021 09:48:20 AM Central Daylight Time			06/04/2021 09:59:38 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Value Script (PDP)	10	29					S4802	162	0	2022	Idaho, Utah		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	163	0		29	10	S4802_163_0	3	1					1	06/03/2021	2022.01	06/03/2021 04:22:13 PM Eastern Daylight Time		06/04/2021 09:48:48 AM Central Daylight Time			06/04/2021 09:59:38 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Value Script (PDP)	10	29					S4802	163	0	2022	California		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	164	0		29	10	S4802_164_0	3	1					1	06/03/2021	2022.01	06/03/2021 04:22:06 PM Eastern Daylight Time		06/04/2021 09:49:08 AM Central Daylight Time			06/04/2021 09:59:38 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Value Script (PDP)	10	29					S4802	164	0	2022	Hawaii		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	165	0		29	10	S4802_165_0	3	1					1	06/03/2021	2022.01	06/03/2021 04:21:58 PM Eastern Daylight Time		06/04/2021 09:49:26 AM Central Daylight Time			06/04/2021 09:59:38 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Value Script (PDP)	10	29					S4802	165	0	2022	Alaska		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	204	0		29	10	S4802_204_0	4	1					1	06/03/2021	2022.01	06/03/2021 04:21:53 PM Eastern Daylight Time		06/04/2021 09:49:48 AM Central Daylight Time			06/04/2021 10:43:13 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Medicare Rx Value Plus (PDP)	10	29					S4802	204	0	2022	Northern New England (NH, ME)		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	205	0		29	10	S4802_205_0	4	1					1	06/03/2021	2022.01	06/03/2021 04:21:46 PM Eastern Daylight Time		06/04/2021 09:50:14 AM Central Daylight Time			06/04/2021 10:43:13 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Medicare Rx Value Plus (PDP)	10	29					S4802	205	0	2022	Central New England (CT, RI, MA, VT)		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	206	0		29	10	S4802_206_0	3	1					1	06/03/2021	2022.01	06/03/2021 04:21:40 PM Eastern Daylight Time		06/04/2021 09:50:32 AM Central Daylight Time			06/04/2021 09:59:38 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Medicare Rx Value Plus (PDP)	10	29					S4802	206	0	2022	New York		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	207	0		29	10	S4802_207_0	3	1					1	06/03/2021	2022.01	06/03/2021 04:21:34 PM Eastern Daylight Time		06/04/2021 09:50:52 AM Central Daylight Time			06/04/2021 09:59:38 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Medicare Rx Value Plus (PDP)	10	29					S4802	207	0	2022	New Jersey		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	208	0		29	10	S4802_208_0	3	1					1	06/03/2021	2022.01	06/03/2021 04:21:26 PM Eastern Daylight Time		06/04/2021 09:51:12 AM Central Daylight Time			06/04/2021 09:59:38 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Medicare Rx Value Plus (PDP)	10	29					S4802	208	0	2022	Mid-Atlantic (DE, DC, MD)		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	209	0		29	10	S4802_209_0	3	1					1	06/03/2021	2022.01	06/03/2021 04:21:19 PM Eastern Daylight Time		06/04/2021 09:51:30 AM Central Daylight Time			06/04/2021 09:59:38 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Medicare Rx Value Plus (PDP)	10	29					S4802	209	0	2022	Pennsylvania, West Virginia		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	210	0		29	10	S4802_210_0	3	1					1	06/03/2021	2022.01	06/03/2021 04:21:12 PM Eastern Daylight Time		06/04/2021 09:52:00 AM Central Daylight Time			06/04/2021 09:59:38 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Medicare Rx Value Plus (PDP)	10	29					S4802	210	0	2022	Virginia		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	211	0		29	10	S4802_211_0	3	1					1	06/03/2021	2022.01	06/03/2021 04:21:05 PM Eastern Daylight Time		06/04/2021 09:52:20 AM Central Daylight Time			06/04/2021 09:59:38 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Medicare Rx Value Plus (PDP)	10	29					S4802	211	0	2022	North Carolina		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	212	0		29	10	S4802_212_0	3	1					1	06/03/2021	2022.01	06/03/2021 04:20:59 PM Eastern Daylight Time		06/04/2021 09:52:40 AM Central Daylight Time			06/04/2021 09:59:38 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Medicare Rx Value Plus (PDP)	10	29					S4802	212	0	2022	South Carolina		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	213	0		29	10	S4802_213_0	3	1					1	06/03/2021	2022.01	06/03/2021 04:20:50 PM Eastern Daylight Time		06/04/2021 09:53:12 AM Central Daylight Time			06/04/2021 09:59:38 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Medicare Rx Value Plus (PDP)	10	29					S4802	213	0	2022	Georgia		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	214	0		29	10	S4802_214_0	3	1					1	06/03/2021	2022.01	06/03/2021 04:20:43 PM Eastern Daylight Time		06/04/2021 09:53:32 AM Central Daylight Time			06/04/2021 09:59:38 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Medicare Rx Value Plus (PDP)	10	29					S4802	214	0	2022	Florida		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	215	0		29	10	S4802_215_0	3	1					1	06/03/2021	2022.01	06/03/2021 04:20:37 PM Eastern Daylight Time		06/04/2021 09:53:52 AM Central Daylight Time			06/04/2021 09:59:38 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Medicare Rx Value Plus (PDP)	10	29					S4802	215	0	2022	Alabama, Tennessee		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	216	0		29	10	S4802_216_0	3	1					1	06/03/2021	2022.01	06/03/2021 04:20:31 PM Eastern Daylight Time		06/04/2021 09:54:12 AM Central Daylight Time			06/04/2021 09:59:38 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Medicare Rx Value Plus (PDP)	10	29					S4802	216	0	2022	Michigan		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	217	0		29	10	S4802_217_0	3	1					1	06/03/2021	2022.01	06/03/2021 04:20:24 PM Eastern Daylight Time		06/04/2021 09:54:36 AM Central Daylight Time			06/04/2021 09:59:38 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Medicare Rx Value Plus (PDP)	10	29					S4802	217	0	2022	Ohio		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	218	0		29	10	S4802_218_0	3	1					1	06/03/2021	2022.01	06/03/2021 04:20:14 PM Eastern Daylight Time		06/04/2021 09:54:58 AM Central Daylight Time			06/04/2021 09:59:38 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Medicare Rx Value Plus (PDP)	10	29					S4802	218	0	2022	Indiana, Kentucky		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	219	0		29	10	S4802_219_0	3	1					1	06/03/2021	2022.01	06/03/2021 04:20:08 PM Eastern Daylight Time		06/04/2021 09:55:18 AM Central Daylight Time			06/04/2021 09:59:38 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Medicare Rx Value Plus (PDP)	10	29					S4802	219	0	2022	Wisconsin		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	220	0		29	10	S4802_220_0	3	1					1	06/03/2021	2022.01	06/03/2021 04:20:01 PM Eastern Daylight Time		06/04/2021 09:55:38 AM Central Daylight Time			06/04/2021 09:59:38 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Medicare Rx Value Plus (PDP)	10	29					S4802	220	0	2022	Illinois		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	221	0		29	10	S4802_221_0	3	1					1	06/03/2021	2022.01	06/03/2021 04:19:55 PM Eastern Daylight Time		06/04/2021 09:56:10 AM Central Daylight Time			06/04/2021 09:59:38 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Medicare Rx Value Plus (PDP)	10	29					S4802	221	0	2022	Missouri		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	222	0		29	10	S4802_222_0	3	1					1	06/03/2021	2022.01	06/03/2021 04:18:49 PM Eastern Daylight Time		06/04/2021 09:56:30 AM Central Daylight Time			06/04/2021 09:59:38 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Medicare Rx Value Plus (PDP)	10	29					S4802	222	0	2022	Arkansas		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	223	0		29	10	S4802_223_0	3	1					1	06/03/2021	2022.01	06/03/2021 04:18:43 PM Eastern Daylight Time		06/04/2021 09:56:50 AM Central Daylight Time			06/04/2021 09:59:38 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Medicare Rx Value Plus (PDP)	10	29					S4802	223	0	2022	Mississippi		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	224	0		29	10	S4802_224_0	3	1					1	06/03/2021	2022.01	06/03/2021 04:18:35 PM Eastern Daylight Time		06/04/2021 09:57:16 AM Central Daylight Time			06/04/2021 09:59:38 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Medicare Rx Value Plus (PDP)	10	29					S4802	224	0	2022	Louisiana		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	225	0		29	10	S4802_225_0	3	1					1	06/03/2021	2022.01	06/03/2021 04:18:29 PM Eastern Daylight Time		06/04/2021 09:57:52 AM Central Daylight Time			06/04/2021 09:59:38 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Medicare Rx Value Plus (PDP)	10	29					S4802	225	0	2022	Texas		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	226	0		29	10	S4802_226_0	3	1					1	06/03/2021	2022.01	06/03/2021 04:18:22 PM Eastern Daylight Time		06/04/2021 09:58:12 AM Central Daylight Time			06/04/2021 09:59:38 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Medicare Rx Value Plus (PDP)	10	29					S4802	226	0	2022	Oklahoma		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	227	0		29	10	S4802_227_0	3	1					1	06/03/2021	2022.01	06/03/2021 04:18:15 PM Eastern Daylight Time		06/04/2021 09:58:50 AM Central Daylight Time			06/04/2021 09:59:38 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Medicare Rx Value Plus (PDP)	10	29					S4802	227	0	2022	Kansas		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	228	0		29	10	S4802_228_0	3	1					1	06/03/2021	2022.01	06/03/2021 04:18:08 PM Eastern Daylight Time		06/04/2021 09:59:22 AM Central Daylight Time			06/04/2021 09:59:38 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Medicare Rx Value Plus (PDP)	10	29					S4802	228	0	2022	Upper MW and N Plains (IA, MN, NE, SD, ND, WY, MT)		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	229	0		29	10	S4802_229_0	3	1					1	06/03/2021	2022.01	06/03/2021 04:18:02 PM Eastern Daylight Time		06/04/2021 09:59:46 AM Central Daylight Time			06/04/2021 09:59:38 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Medicare Rx Value Plus (PDP)	10	29					S4802	229	0	2022	New Mexico		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	230	0		29	10	S4802_230_0	3	1					1	06/03/2021	2022.01	06/03/2021 04:17:55 PM Eastern Daylight Time		06/04/2021 10:00:08 AM Central Daylight Time			06/04/2021 09:59:38 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Medicare Rx Value Plus (PDP)	10	29					S4802	230	0	2022	Colorado		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	231	0		29	10	S4802_231_0	3	1					1	06/03/2021	2022.01	06/03/2021 04:17:48 PM Eastern Daylight Time		06/04/2021 10:00:34 AM Central Daylight Time			06/04/2021 09:59:38 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Medicare Rx Value Plus (PDP)	10	29					S4802	231	0	2022	Arizona		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	232	0		29	10	S4802_232_0	3	1					1	06/03/2021	2022.01	06/03/2021 04:17:41 PM Eastern Daylight Time		06/04/2021 10:00:52 AM Central Daylight Time			06/04/2021 09:59:38 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Medicare Rx Value Plus (PDP)	10	29					S4802	232	0	2022	Nevada		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	233	0		29	10	S4802_233_0	3	1					1	06/03/2021	2022.01	06/03/2021 04:17:35 PM Eastern Daylight Time		06/04/2021 10:01:10 AM Central Daylight Time			06/04/2021 09:59:38 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Medicare Rx Value Plus (PDP)	10	29					S4802	233	0	2022	Oregon, Washington		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	234	0		29	10	S4802_234_0	3	1					1	06/03/2021	2022.01	06/03/2021 04:17:27 PM Eastern Daylight Time		06/04/2021 10:01:30 AM Central Daylight Time			06/04/2021 09:59:38 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Medicare Rx Value Plus (PDP)	10	29					S4802	234	0	2022	Idaho, Utah		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	235	0		29	10	S4802_235_0	3	1					1	06/03/2021	2022.01	06/03/2021 04:17:21 PM Eastern Daylight Time		06/04/2021 10:01:48 AM Central Daylight Time			06/04/2021 09:59:38 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Medicare Rx Value Plus (PDP)	10	29					S4802	235	0	2022	California		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	236	0		29	10	S4802_236_0	3	1					1	06/03/2021	2022.01	06/03/2021 04:14:27 PM Eastern Daylight Time		06/04/2021 10:02:44 AM Central Daylight Time			06/04/2021 09:59:38 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Medicare Rx Value Plus (PDP)	10	29					S4802	236	0	2022	Hawaii		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	237	0		29	10	S4802_237_0	3	1					1	06/03/2021	2022.01	06/03/2021 04:14:13 PM Eastern Daylight Time		06/04/2021 10:03:10 AM Central Daylight Time			06/04/2021 09:59:38 PM Central Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcare.com/PDP	Wellcare Medicare Rx Value Plus (PDP)	10	29					S4802	237	0	2022	Alaska		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(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						05/28/2021	2022.01	05/28/2021 03:11:00 PM Eastern Daylight Time					06/03/2021 11:46:41 PM Eastern Daylight Time	SECURITYCARE OF TENNESSEE, INC.	BlueScripts	bcbstmedicare.com	BlueScripts (PDP)	10	29					S5450	801	0	2022	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						05/28/2021	2022.01	05/28/2021 03:11:10 PM Eastern Daylight Time					06/03/2021 11:46:41 PM Eastern Daylight Time	SECURITYCARE OF TENNESSEE, INC.	BlueScripts	bcbstmedicare.com	BlueScripts (PDP)	10	29					S5450	802	0	2022	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						05/28/2021	2022.01	05/28/2021 03:11:19 PM Eastern Daylight Time					06/03/2021 11:46:41 PM Eastern Daylight Time	SECURITYCARE OF TENNESSEE, INC.	BlueScripts	bcbstmedicare.com	BlueScripts (PDP)	10	29					S5450	803	0	2022	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						05/28/2021	2022.01	05/28/2021 03:11:26 PM Eastern Daylight Time					06/03/2021 11:46:41 PM Eastern Daylight Time	SECURITYCARE OF TENNESSEE, INC.	BlueScripts	bcbstmedicare.com	BlueScripts (PDP)	10	29					S5450	804	0	2022	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						06/03/2021	2022.01	06/03/2021 07:36:09 PM Eastern Daylight Time					06/03/2021 11:46:41 PM Eastern Daylight Time	SECURITYCARE OF TENNESSEE, INC.	BlueScripts	bcbstmedicare.com	BlueScripts (PDP)	10	29					S5450	805	0	2022	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						06/03/2021	2022.01	06/03/2021 07:34:48 PM Eastern Daylight Time					06/03/2021 11:46:41 PM Eastern Daylight Time	SECURITYCARE OF TENNESSEE, INC.	BlueScripts	bcbstmedicare.com	BlueScripts (PDP)	10	29					S5450	806	0	2022	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						06/03/2021	2022.01	06/03/2021 07:33:28 PM Eastern Daylight Time					06/03/2021 11:46:41 PM Eastern Daylight Time	SECURITYCARE OF TENNESSEE, INC.	BlueScripts	bcbstmedicare.com	BlueScripts (PDP)	10	29					S5450	807	0	2022	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	3	1					0	06/02/2021	2022.01	06/02/2021 02:58:08 PM Eastern Daylight Time		06/04/2021 04:28:01 PM Eastern Daylight Time			06/05/2021 03:32:37 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	2022	North Carolina		2					2						https://www.myprime.com/en/find-pharmacy.html	https://www.bluecrossnc.com/find-a-drug-or-pharmacy										(888)247-4142		(888)247-4142		(800)661-5518		(800)661-5518										(711)-		(711)-		(711)-		(711)-																
S5540	004	0		29	10	S5540_004_0	3	1					0	06/02/2021	2022.01	06/02/2021 09:56:20 AM Eastern Daylight Time		06/04/2021 04:28:01 PM Eastern Daylight Time			06/05/2021 03:32:37 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	2022	North Carolina		2					2						https://www.myprime.com/en/find-pharmacy.html	https://www.bluecrossnc.com/find-a-drug-or-pharmacy										(888)247-4142		(888)247-4142		(800)661-5518		(800)661-5518										(711)-		(711)-		(711)-		(711)-																
S5540	801	0		29	10	S5540_801_0	2	1						05/03/2021	2022.01	05/03/2021 03:37:33 PM Eastern Daylight Time					06/05/2021 03:32:37 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	2022	National Employer Group Retirees		1					2						https://www.myprime.com/en/find-pharmacy.html	https://www.bluecrossnc.com/find-a-drug-or-pharmacy										(888)247-4142		(888)247-4142		(800)661-5518		(800)661-5518										(711)-		(711)-		(711)-		(711)-																
S5540	803	0		29	10	S5540_803_0	2	1						05/03/2021	2022.01	05/03/2021 03:37:44 PM Eastern Daylight Time					06/05/2021 03:32:37 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 Complete (PDP)	10	29					S5540	803	0	2022	NC Employer Groups		1					2						https://www.myprime.com/en/find-pharmacy.html	https://www.bluecrossnc.com/find-a-drug-or-pharmacy										(888)247-4142		(888)247-4142		(800)661-5518		(800)661-5518										(711)-		(711)-		(711)-		(711)-																
S5552	004	0		29	10	S5552_004_0	4	1					0	07/01/2021	2022.01	07/01/2021 11:50:38 AM Eastern Daylight Time		06/02/2021 08:17:34 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5552	004	0	2022	State of New York		2					2						https://www.humana.com/pharmacy/	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	5	1					1	07/01/2021	2022.01	07/01/2021 11:50:59 AM Eastern Daylight Time		06/02/2021 08:17:50 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5552	005	0	2022	State of New York		2					2						https://www.humana.com/pharmacy/	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	006	0		29	10	S5552_006_0	4	1					0	07/01/2021	2022.01	07/01/2021 11:51:16 AM Eastern Daylight Time		06/02/2021 08:18:06 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5552	006	0	2022	State of New York		2					2						https://www.humana.com/pharmacy/	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	3	1						05/18/2021	2022.01	05/18/2021 10:10:23 AM Eastern Daylight Time					06/01/2021 02:13:18 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana	www.humana.com/medicare	Humana Medicare Employer (PDP)	10	29					S5552	801	0	2022	State of New York		1					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-																
S5584	001	0		29	10	S5584_001_0	4	1					0	06/01/2021	2022.01	06/01/2021 11:45:17 AM Eastern Daylight Time		06/06/2021 08:33:44 PM Eastern Daylight Time			06/07/2021 01:05:03 AM 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	2022	State of Michigan		2					2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare										(800)565-1770		(800)565-1770		(855)425-7720		(855)425-7720										(711)-		(711)-		(711)-		(711)-																
S5584	002	0		29	10	S5584_002_0	4	1					0	06/01/2021	2022.01	06/01/2021 11:44:46 AM Eastern Daylight Time		06/06/2021 08:33:56 PM Eastern Daylight Time			06/07/2021 01:05:03 AM 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	2022	State of Michigan		2					2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare										(800)565-1770		(800)565-1770		(855)425-7720		(855)425-7720										(711)-		(711)-		(711)-		(711)-																
S5584	801	0		29	10	S5584_801_0	4	1						05/03/2021	2022.01	05/03/2021 09:30:12 PM Eastern Daylight Time					06/07/2021 01:05:03 AM 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	2022	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	4	1						05/03/2021	2022.01	05/03/2021 09:31:14 PM Eastern Daylight Time					06/07/2021 01:05:03 AM 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	2022	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						05/26/2021	2022.01	05/26/2021 08:40:59 AM Eastern Daylight Time					06/01/2021 10:50:47 AM Eastern Daylight Time	PARAMOUNT INSURANCE COMPANY	Paramount Prescription Drug Plan	paramounthealthcare.com	Paramount Standard Prescription Drug Plan Empl (PDP)	10	29					S5588	802	0	2022	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						05/26/2021	2022.01	05/26/2021 08:41:40 AM Eastern Daylight Time					06/01/2021 10:50:47 AM Eastern Daylight Time	PARAMOUNT INSURANCE COMPANY	Paramount Prescription Drug Plan	paramounthealthcare.com	Paramount Enhanced Prescription Drug Plan Empl (PDP)	10	29					S5588	803	0	2022	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	3	1					0	06/03/2021	2022.01	06/03/2021 10:26:07 AM Eastern Daylight Time		06/04/2021 11:32:22 AM Eastern Daylight Time			06/04/2021 01:37:54 PM Eastern Daylight Time	HM HEALTH INSURANCE COMPANY	Highmark Inc.	medicare.highmark.com	Blue Rx PDP Plus (PDP)	10	29					S5593	002	0	2022	Pennsylvania  and West Virginia		2					2						medicare.highmark.com	medicare.highmark.com										(800)290-3914		(800)290-3914		(866)435-1047		(866)435-1047										(711)-		(711)-		(711)-		(711)-																
S5593	003	0		29	10	S5593_003_0	3	1					0	06/03/2021	2022.01	06/03/2021 10:28:17 AM Eastern Daylight Time		06/04/2021 11:33:20 AM Eastern Daylight Time			06/04/2021 01:37:54 PM Eastern Daylight Time	HM HEALTH INSURANCE COMPANY	Highmark Inc.	medicare.highmark.com	Blue Rx PDP Complete (PDP)	10	29					S5593	003	0	2022	Pennsylvania  and West Virginia		2					2						medicare.highmark.com	medicare.highmark.com										(800)290-3914		(800)290-3914		(866)435-1047		(866)435-1047										(711)-		(711)-		(711)-		(711)-																
S5593	801	0		29	10	S5593_801_0	2	1						06/02/2021	2022.01	06/02/2021 10:28:13 AM Eastern Daylight Time					06/04/2021 01:37:54 PM Eastern Daylight Time	HM HEALTH INSURANCE COMPANY	Highmark Inc.	medicare.highmark.com	Blue Rx PDP Employer Group Calendar (PDP)	10	29					S5593	801	0	2022	National		1					2						medicare.highmark.com	medicare.highmark.com										(800)290-3914		(800)290-3914		(866)435-1047		(866)435-1047										(711)-		(711)-		(711)-		(711)-																
S5593	802	0		29	10	S5593_802_0	2	1						04/29/2021	2022.01	04/29/2021 01:05:02 PM Eastern Daylight Time					06/04/2021 01:37:54 PM Eastern Daylight Time	HM HEALTH INSURANCE COMPANY	Highmark Inc.	medicare.highmark.com	Blue Rx PDP Employer Group Non-Calendar (PDP)	10	29					S5593	802	0	2022	National		1					2						medicare.highmark.com	medicare.highmark.com										(800)290-3914		(800)290-3914		(866)435-1047		(866)435-1047										(711)-		(711)-		(711)-		(711)-																
S5596	001	0		29	10	S5596_001_0	4	1					1	07/16/2021	2022.01	07/16/2021 10:55:31 AM Eastern Daylight Time		07/14/2021 03:46:59 PM Eastern Daylight Time			07/26/2021 08:24:25 AM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem / Anthem or Blue KC in Missouri	https://shop.anthem.com/medicare	Anthem MediBlue Rx Plus (PDP)	10	29					S5596	001	0	2022	Maine and New Hampshire		2					2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare										(866)755-2776		(866)755-2776		(855)793-1938		(855)793-1938										(711)-		(711)-		(711)-		(711)-																
S5596	005	0		29	10	S5596_005_0	4	1					0	05/28/2021	2022.01	05/28/2021 03:02:30 PM Eastern Daylight Time		07/16/2021 11:04:08 AM Eastern Daylight Time			07/16/2021 08:45:10 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem / Anthem or Blue KC in Missouri	https://shop.anthem.com/medicare	Anthem MediBlue Rx Standard (PDP)	10	29					S5596	005	0	2022	Virginia		2					2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare										(866)755-2776		(866)755-2776		(855)793-1938		(855)793-1938										(711)-		(711)-		(711)-		(711)-																
S5596	006	0		29	10	S5596_006_0	4	1					1	07/16/2021	2022.01	07/16/2021 10:55:53 AM Eastern Daylight Time		07/14/2021 03:43:11 PM Eastern Daylight Time			07/26/2021 08:24:25 AM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem / Anthem or Blue KC in Missouri	https://shop.anthem.com/medicare	Anthem MediBlue Rx Plus (PDP)	10	29					S5596	006	0	2022	Virginia		2					2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare										(866)755-2776		(866)755-2776		(855)793-1938		(855)793-1938										(711)-		(711)-		(711)-		(711)-																
S5596	013	0		29	10	S5596_013_0	4	1					0	06/02/2021	2022.01	06/02/2021 02:28:40 PM Eastern Daylight Time		07/16/2021 11:04:24 AM Eastern Daylight Time			07/16/2021 08:45:10 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem / Anthem or Blue KC in Missouri	https://shop.anthem.com/medicare	Anthem MediBlue Rx Standard (PDP)	10	29					S5596	013	0	2022	Ohio		2					2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare										(866)755-2776		(866)755-2776		(855)793-1938		(855)793-1938										(711)-		(711)-		(711)-		(711)-																
S5596	014	0		29	10	S5596_014_0	4	1					1	07/16/2021	2022.01	07/16/2021 10:56:11 AM Eastern Daylight Time		07/15/2021 11:00:07 AM Eastern Daylight Time			07/26/2021 08:24:25 AM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem / Anthem or Blue KC in Missouri	https://shop.anthem.com/medicare	Anthem MediBlue Rx Plus (PDP)	10	29					S5596	014	0	2022	Ohio		2					2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare										(866)755-2776		(866)755-2776		(855)793-1938		(855)793-1938										(711)-		(711)-		(711)-		(711)-																
S5596	017	0		29	10	S5596_017_0	4	1					0	05/28/2021	2022.01	05/28/2021 03:06:14 PM Eastern Daylight Time		07/16/2021 11:04:40 AM Eastern Daylight Time			07/16/2021 08:45:10 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem / Anthem or Blue KC in Missouri	https://shop.anthem.com/medicare	Anthem MediBlue Rx Standard (PDP)	10	29					S5596	017	0	2022	Indiana and Kentucky		2					2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare										(866)755-2776		(866)755-2776		(855)793-1938		(855)793-1938										(711)-		(711)-		(711)-		(711)-																
S5596	018	0		29	10	S5596_018_0	4	1					1	07/16/2021	2022.01	07/16/2021 10:56:27 AM Eastern Daylight Time		07/14/2021 03:47:47 PM Eastern Daylight Time			07/26/2021 08:24:25 AM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem / Anthem or Blue KC in Missouri	https://shop.anthem.com/medicare	Anthem MediBlue Rx Plus (PDP)	10	29					S5596	018	0	2022	Indiana and Kentucky		2					2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare										(866)755-2776		(866)755-2776		(855)793-1938		(855)793-1938										(711)-		(711)-		(711)-		(711)-																
S5596	043	0		29	10	S5596_043_0	4	1					0	05/28/2021	2022.01	05/28/2021 03:08:32 PM Eastern Daylight Time		07/16/2021 11:04:56 AM Eastern Daylight Time			07/16/2021 08:45:10 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem / Anthem or Blue KC in Missouri	https://shop.anthem.com/medicare	Blue MedicareRx Value (PDP)	10	29					S5596	043	0	2022	Missouri		2					2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare										(866)755-2776		(866)755-2776		(855)793-1938		(855)793-1938										(711)-		(711)-		(711)-		(711)-																
S5596	044	0		29	10	S5596_044_0	4	1					1	07/16/2021	2022.01	07/16/2021 10:56:44 AM Eastern Daylight Time		07/15/2021 11:00:20 AM Eastern Daylight Time			07/26/2021 08:24:25 AM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem / Anthem or Blue KC in Missouri	https://shop.anthem.com/medicare	Blue MedicareRx Plus (PDP)	10	29					S5596	044	0	2022	Missouri		2					2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare										(866)755-2776		(866)755-2776		(855)793-1938		(855)793-1938										(711)-		(711)-		(711)-		(711)-																
S5596	046	0		29	10	S5596_046_0	4	1					0	05/28/2021	2022.01	05/28/2021 03:09:42 PM Eastern Daylight Time		07/16/2021 11:05:12 AM Eastern Daylight Time			07/16/2021 08:45:10 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem / Anthem or Blue KC in Missouri	https://shop.anthem.com/medicare	Anthem MediBlue Rx Standard (PDP)	10	29					S5596	046	0	2022	Maine and New Hampshire		2					2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare										(866)755-2776		(866)755-2776		(855)793-1938		(855)793-1938										(711)-		(711)-		(711)-		(711)-																
S5596	056	0		29	10	S5596_056_0	4	1					0	05/28/2021	2022.01	05/28/2021 03:10:19 PM Eastern Daylight Time		07/16/2021 11:05:28 AM Eastern Daylight Time			07/16/2021 08:45:10 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem / Anthem or Blue KC in Missouri	https://shop.anthem.com/medicare	Anthem MediBlue Rx Standard (PDP)	10	29					S5596	056	0	2022	Wisconsin		2					2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare										(866)755-2776		(866)755-2776		(855)793-1938		(855)793-1938										(711)-		(711)-		(711)-		(711)-																
S5596	057	0		29	10	S5596_057_0	4	1					1	07/16/2021	2022.01	07/16/2021 10:57:04 AM Eastern Daylight Time		07/15/2021 11:00:34 AM Eastern Daylight Time			07/26/2021 08:24:25 AM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem / Anthem or Blue KC in Missouri	https://shop.anthem.com/medicare	Anthem MediBlue Rx Plus (PDP)	10	29					S5596	057	0	2022	Wisconsin		2					2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare										(866)755-2776		(866)755-2776		(855)793-1938		(855)793-1938										(711)-		(711)-		(711)-		(711)-																
S5596	059	0		29	10	S5596_059_0	4	1					0	05/28/2021	2022.01	05/28/2021 03:11:53 PM Eastern Daylight Time		07/16/2021 11:05:43 AM Eastern Daylight Time			07/16/2021 08:45:10 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem / Anthem or Blue KC in Missouri	https://shop.anthem.com/medicare	Anthem MediBlue Rx Standard (PDP)	10	29					S5596	059	0	2022	Colorado		2					2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare										(866)755-2776		(866)755-2776		(855)793-1938		(855)793-1938										(711)-		(711)-		(711)-		(711)-																
S5596	060	0		29	10	S5596_060_0	4	1					1	07/16/2021	2022.01	07/16/2021 10:57:18 AM Eastern Daylight Time		07/15/2021 08:36:01 PM Eastern Daylight Time			07/26/2021 08:24:25 AM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem / Anthem or Blue KC in Missouri	https://shop.anthem.com/medicare	Anthem MediBlue Rx Plus (PDP)	10	29					S5596	060	0	2022	Colorado		2					2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare										(866)755-2776		(866)755-2776		(855)793-1938		(855)793-1938										(711)-		(711)-		(711)-		(711)-																
S5596	062	0		29	10	S5596_062_0	4	1					0	05/28/2021	2022.01	05/28/2021 03:13:15 PM Eastern Daylight Time		07/16/2021 11:05:58 AM Eastern Daylight Time			07/16/2021 08:45:10 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem / Anthem or Blue KC in Missouri	https://shop.anthem.com/medicare	Anthem MediBlue Rx Standard (PDP)	10	29					S5596	062	0	2022	Nevada		2					2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare										(833)285-4639		(833)285-4639		(855)793-1938		(855)793-1938										(711)-		(711)-		(711)-		(711)-																
S5596	063	0		29	10	S5596_063_0	4	1					1	07/16/2021	2022.01	07/16/2021 10:57:31 AM Eastern Daylight Time		07/15/2021 09:41:51 PM Eastern Daylight Time			07/26/2021 08:24:25 AM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem / Anthem or Blue KC in Missouri	https://shop.anthem.com/medicare	Anthem MediBlue Rx Plus (PDP)	10	29					S5596	063	0	2022	Nevada		2					2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare										(866)755-2776		(866)755-2776		(855)793-1938		(855)793-1938										(711)-		(711)-		(711)-		(711)-																
S5596	085	0		29	10	S5596_085_0	3	1					0	05/28/2021	2022.01	05/28/2021 09:40:18 PM Eastern Daylight Time		07/16/2021 11:06:15 AM Eastern Daylight Time			07/18/2021 10:41:55 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem / Anthem or Blue KC in Missouri	https://shop.anthem.com/medicare	Anthem MediBlue Rx Standard (PDP)	10	29					S5596	085	0	2022	Georgia		2					2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare										(866)755-2776		(866)755-2776		(855)793-1938		(855)793-1938										(711)-		(711)-		(711)-		(711)-																
S5596	086	0		29	10	S5596_086_0	3	1					1	07/16/2021	2022.01	07/16/2021 10:57:45 AM Eastern Daylight Time		07/15/2021 11:16:40 AM Eastern Daylight Time			07/26/2021 08:24:25 AM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem / Anthem or Blue KC in Missouri	https://shop.anthem.com/medicare	Anthem MediBlue Rx Plus (PDP)	10	29					S5596	086	0	2022	Georgia		2					2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare										(866)755-2776		(866)755-2776		(855)793-1938		(855)793-1938										(711)-		(711)-		(711)-		(711)-																
S5596	087	0		29	10	S5596_087_0	3	1					0	05/28/2021	2022.01	05/28/2021 09:43:29 PM Eastern Daylight Time		07/16/2021 11:06:31 AM Eastern Daylight Time			07/18/2021 10:41:55 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem / Anthem or Blue KC in Missouri	https://shop.anthem.com/medicare	Anthem Blue Cross MediBlue Rx Standard (PDP)	10	29					S5596	087	0	2022	California		2					2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare										(866)755-2776		(866)755-2776		(855)793-1938		(855)793-1938										(711)-		(711)-		(711)-		(711)-																
S5596	088	0		29	10	S5596_088_0	3	1					1	07/16/2021	2022.01	07/16/2021 10:58:03 AM Eastern Daylight Time		07/15/2021 11:16:59 AM Eastern Daylight Time			07/26/2021 08:24:25 AM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem / Anthem or Blue KC in Missouri	https://shop.anthem.com/medicare	Anthem Blue Cross MediBlue Rx Plus (PDP)	10	29					S5596	088	0	2022	California		2					2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare										(866)755-2776		(866)755-2776		(855)793-1938		(855)793-1938										(711)-		(711)-		(711)-		(711)-																
S5596	803	0		29	10	S5596_803_0	1	1						05/28/2021	2022.01	05/28/2021 09:44:29 PM Eastern Daylight Time					06/04/2021 02:36:40 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem / Anthem or Blue KC in Missouri	https://shop.anthem.com/medicare	Blue MedicareRx (PDP)	10	29					S5596	803	0	2022	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)830-0174		(866)830-0174		(833)285-4636		(833)285-4636										(711)-		(711)-		(711)-		(711)-																
S5596	804	0		29	10	S5596_804_0	1	1						05/28/2021	2022.01	05/28/2021 09:44:34 PM Eastern Daylight Time					06/04/2021 02:36:40 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem / Anthem or Blue KC in Missouri	https://shop.anthem.com/medicare	Blue MedicareRx (PDP)	10	29					S5596	804	0	2022	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)830-0174		(866)830-0174		(833)285-4636		(833)285-4636										(711)-		(711)-		(711)-		(711)-																
S5596	844	0		29	10	S5596_844_0	1	1						05/28/2021	2022.01	05/28/2021 09:44:24 PM Eastern Daylight Time					06/04/2021 02:36:40 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem / Anthem or Blue KC in Missouri	https://shop.anthem.com/medicare	Blue MedicareRx (PDP)	10	29					S5596	844	0	2022	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)830-0174		(866)830-0174		(833)285-4636		(833)285-4636										(711)-		(711)-		(711)-		(711)-																
S5596	845	0		29	10	S5596_845_0	1	1						05/28/2021	2022.01	05/28/2021 09:44:38 PM Eastern Daylight Time					06/04/2021 02:36:40 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem / Anthem or Blue KC in Missouri	https://shop.anthem.com/medicare	Blue MedicareRx (PDP)	10	29					S5596	845	0	2022	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)830-0174		(866)830-0174		(833)285-4636		(833)285-4636										(711)-		(711)-		(711)-		(711)-																
S5601	002	0		29	10	S5601_002_0	2	1					0	05/26/2021	2022.01	05/26/2021 04:11:29 PM Eastern Daylight Time		06/01/2021 02:58:58 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Choice (PDP)	10	29					S5601	002	0	2022	Northern New England (NH, ME)		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	003	0		29	10	S5601_003_0	1	1					1	06/02/2021	2022.01	06/02/2021 04:08:11 PM Eastern Daylight Time		06/01/2021 02:59:02 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Plus (PDP)	10	29					S5601	003	0	2022	Northern New England (NH, ME)		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	004	0		29	10	S5601_004_0	1	1					0	05/26/2021	2022.01	05/26/2021 12:33:53 PM Eastern Daylight Time		06/01/2021 02:59:06 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Choice (PDP)	10	29					S5601	004	0	2022	Central New England (CT, MA, RI, VT)		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	005	0		29	10	S5601_005_0	1	1					1	05/26/2021	2022.01	05/26/2021 02:11:01 PM Eastern Daylight Time		06/01/2021 02:59:10 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Plus (PDP)	10	29					S5601	005	0	2022	Central New England (CT, MA, RI, VT)		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	006	0		29	10	S5601_006_0	1	1					0	05/26/2021	2022.01	05/26/2021 12:34:34 PM Eastern Daylight Time		06/01/2021 02:59:14 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Choice (PDP)	10	29					S5601	006	0	2022	New York		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	007	0		29	10	S5601_007_0	1	1					1	05/26/2021	2022.01	05/26/2021 02:17:55 PM Eastern Daylight Time		06/01/2021 02:59:18 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Plus (PDP)	10	29					S5601	007	0	2022	New York		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	008	0		29	10	S5601_008_0	1	1					0	05/26/2021	2022.01	05/26/2021 12:35:22 PM Eastern Daylight Time		06/01/2021 02:59:23 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Choice (PDP)	10	29					S5601	008	0	2022	New Jersey		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	009	0		29	10	S5601_009_0	1	1					1	05/26/2021	2022.01	05/26/2021 02:31:40 PM Eastern Daylight Time		06/01/2021 02:59:27 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Plus (PDP)	10	29					S5601	009	0	2022	New Jersey		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	010	0		29	10	S5601_010_0	1	1					0	05/26/2021	2022.01	05/26/2021 12:35:58 PM Eastern Daylight Time		06/01/2021 02:59:31 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Choice (PDP)	10	29					S5601	010	0	2022	Mid-Atlantic (DE, DC, MD)		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	011	0		29	10	S5601_011_0	1	1					1	05/26/2021	2022.01	05/26/2021 03:20:36 PM Eastern Daylight Time		06/01/2021 02:59:36 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Plus (PDP)	10	29					S5601	011	0	2022	Mid-Atlantic (DE, DC, MD)		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	012	0		29	10	S5601_012_0	1	1					0	05/26/2021	2022.01	05/26/2021 12:36:31 PM Eastern Daylight Time		06/01/2021 02:59:40 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Choice (PDP)	10	29					S5601	012	0	2022	Pennsylvania, West Virginia		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	013	0		29	10	S5601_013_0	1	1					1	05/26/2021	2022.01	05/26/2021 03:24:11 PM Eastern Daylight Time		06/01/2021 02:59:44 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Plus (PDP)	10	29					S5601	013	0	2022	Pennsylvania, West Virginia		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	014	0		29	10	S5601_014_0	2	1					0	05/26/2021	2022.01	05/26/2021 12:39:01 PM Eastern Daylight Time		07/21/2021 12:27:57 PM Eastern Daylight Time			07/26/2021 12:24:48 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Choice (PDP)	10	29					S5601	014	0	2022	Virginia		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	015	0		29	10	S5601_015_0	1	1					1	05/26/2021	2022.01	05/26/2021 03:26:21 PM Eastern Daylight Time		06/01/2021 02:59:53 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Plus (PDP)	10	29					S5601	015	0	2022	Virginia		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	016	0		29	10	S5601_016_0	1	1					0	05/26/2021	2022.01	05/26/2021 12:39:42 PM Eastern Daylight Time		06/01/2021 02:59:57 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Choice (PDP)	10	29					S5601	016	0	2022	North Carolina		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	017	0		29	10	S5601_017_0	1	1					1	05/26/2021	2022.01	05/26/2021 03:28:30 PM Eastern Daylight Time		06/01/2021 03:00:01 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Plus (PDP)	10	29					S5601	017	0	2022	North Carolina		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	018	0		29	10	S5601_018_0	1	1					0	05/26/2021	2022.01	05/26/2021 12:40:40 PM Eastern Daylight Time		06/01/2021 03:00:06 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Choice (PDP)	10	29					S5601	018	0	2022	South Carolina		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	019	0		29	10	S5601_019_0	1	1					1	05/26/2021	2022.01	05/26/2021 03:30:51 PM Eastern Daylight Time		06/01/2021 03:00:10 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Plus (PDP)	10	29					S5601	019	0	2022	South Carolina		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	020	0		29	10	S5601_020_0	1	1					0	05/26/2021	2022.01	05/26/2021 12:41:33 PM Eastern Daylight Time		06/01/2021 03:00:14 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Choice (PDP)	10	29					S5601	020	0	2022	Georgia		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	021	0		29	10	S5601_021_0	1	1					1	05/26/2021	2022.01	05/26/2021 03:32:54 PM Eastern Daylight Time		06/01/2021 03:00:19 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Plus (PDP)	10	29					S5601	021	0	2022	Georgia		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	022	0		29	10	S5601_022_0	2	1					0	05/26/2021	2022.01	05/26/2021 12:42:05 PM Eastern Daylight Time		07/21/2021 12:28:22 PM Eastern Daylight Time			07/26/2021 12:24:48 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Choice (PDP)	10	29					S5601	022	0	2022	Florida		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	023	0		29	10	S5601_023_0	1	1					1	05/26/2021	2022.01	05/26/2021 03:35:01 PM Eastern Daylight Time		06/01/2021 03:00:27 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Plus (PDP)	10	29					S5601	023	0	2022	Florida		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	024	0		29	10	S5601_024_0	1	1					0	05/26/2021	2022.01	05/26/2021 12:44:06 PM Eastern Daylight Time		06/01/2021 03:00:31 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Choice (PDP)	10	29					S5601	024	0	2022	Alabama, Tennessee		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	025	0		29	10	S5601_025_0	1	1					1	05/26/2021	2022.01	05/26/2021 03:36:58 PM Eastern Daylight Time		06/01/2021 03:00:36 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Plus (PDP)	10	29					S5601	025	0	2022	Alabama, Tennessee		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	026	0		29	10	S5601_026_0	1	1					0	05/26/2021	2022.01	05/26/2021 12:44:44 PM Eastern Daylight Time		06/01/2021 03:00:42 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Choice (PDP)	10	29					S5601	026	0	2022	Michigan		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	027	0		29	10	S5601_027_0	1	1					1	05/26/2021	2022.01	05/26/2021 03:38:53 PM Eastern Daylight Time		06/01/2021 03:00:47 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Plus (PDP)	10	29					S5601	027	0	2022	Michigan		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	028	0		29	10	S5601_028_0	1	1					0	05/26/2021	2022.01	05/26/2021 12:45:17 PM Eastern Daylight Time		06/01/2021 03:00:51 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Choice (PDP)	10	29					S5601	028	0	2022	Ohio		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	029	0		29	10	S5601_029_0	1	1					1	05/26/2021	2022.01	05/26/2021 03:43:40 PM Eastern Daylight Time		06/01/2021 03:00:55 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Plus (PDP)	10	29					S5601	029	0	2022	Ohio		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	030	0		29	10	S5601_030_0	1	1					0	05/26/2021	2022.01	05/26/2021 12:45:45 PM Eastern Daylight Time		06/01/2021 03:01:00 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Choice (PDP)	10	29					S5601	030	0	2022	Indiana, Kentucky		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	031	0		29	10	S5601_031_0	1	1					1	05/26/2021	2022.01	05/26/2021 03:46:28 PM Eastern Daylight Time		06/01/2021 03:01:04 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Plus (PDP)	10	29					S5601	031	0	2022	Indiana, Kentucky		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	032	0		29	10	S5601_032_0	1	1					0	05/26/2021	2022.01	05/26/2021 12:47:27 PM Eastern Daylight Time		06/01/2021 03:01:08 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Choice (PDP)	10	29					S5601	032	0	2022	Wisconsin		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	033	0		29	10	S5601_033_0	1	1					1	05/26/2021	2022.01	05/26/2021 03:48:56 PM Eastern Daylight Time		06/01/2021 03:01:12 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Plus (PDP)	10	29					S5601	033	0	2022	Wisconsin		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	034	0		29	10	S5601_034_0	1	1					0	05/26/2021	2022.01	05/26/2021 12:49:29 PM Eastern Daylight Time		06/01/2021 03:01:17 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Choice (PDP)	10	29					S5601	034	0	2022	Illinois		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	035	0		29	10	S5601_035_0	1	1					1	05/26/2021	2022.01	05/26/2021 03:53:07 PM Eastern Daylight Time		06/01/2021 03:01:21 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Plus (PDP)	10	29					S5601	035	0	2022	Illinois		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	036	0		29	10	S5601_036_0	1	1					0	05/26/2021	2022.01	05/26/2021 12:50:11 PM Eastern Daylight Time		06/01/2021 03:01:25 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Choice (PDP)	10	29					S5601	036	0	2022	Missouri		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	037	0		29	10	S5601_037_0	1	1					1	05/26/2021	2022.01	05/26/2021 04:58:32 PM Eastern Daylight Time		06/01/2021 03:01:30 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Plus (PDP)	10	29					S5601	037	0	2022	Missouri		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	038	0		29	10	S5601_038_0	1	1					0	05/26/2021	2022.01	05/26/2021 12:50:42 PM Eastern Daylight Time		06/01/2021 03:01:35 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Choice (PDP)	10	29					S5601	038	0	2022	Arkansas		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	040	0		29	10	S5601_040_0	1	1					0	05/26/2021	2022.01	05/26/2021 12:54:06 PM Eastern Daylight Time		06/01/2021 03:01:40 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Choice (PDP)	10	29					S5601	040	0	2022	Mississippi		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	041	0		29	10	S5601_041_0	1	1					1	05/26/2021	2022.01	05/26/2021 05:08:11 PM Eastern Daylight Time		06/01/2021 03:01:45 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Plus (PDP)	10	29					S5601	041	0	2022	Mississippi		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	042	0		29	10	S5601_042_0	1	1					0	05/26/2021	2022.01	05/26/2021 12:55:30 PM Eastern Daylight Time		06/01/2021 03:01:50 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Choice (PDP)	10	29					S5601	042	0	2022	Louisiana		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	044	0		29	10	S5601_044_0	1	1					0	05/26/2021	2022.01	05/26/2021 12:57:23 PM Eastern Daylight Time		06/01/2021 03:01:55 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Choice (PDP)	10	29					S5601	044	0	2022	Texas		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	045	0		29	10	S5601_045_0	1	1					1	05/26/2021	2022.01	05/26/2021 05:10:18 PM Eastern Daylight Time		06/01/2021 03:02:00 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Plus (PDP)	10	29					S5601	045	0	2022	Texas		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	046	0		29	10	S5601_046_0	1	1					0	05/26/2021	2022.01	05/26/2021 12:58:04 PM Eastern Daylight Time		06/01/2021 03:02:09 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Choice (PDP)	10	29					S5601	046	0	2022	Oklahoma		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	048	0		29	10	S5601_048_0	1	1					0	05/26/2021	2022.01	05/26/2021 12:58:44 PM Eastern Daylight Time		06/01/2021 03:02:14 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Choice (PDP)	10	29					S5601	048	0	2022	Kansas		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	049	0		29	10	S5601_049_0	1	1					1	05/26/2021	2022.01	05/26/2021 05:14:21 PM Eastern Daylight Time		06/01/2021 03:02:18 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Plus (PDP)	10	29					S5601	049	0	2022	Kansas		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	050	0		29	10	S5601_050_0	1	1					0	05/26/2021	2022.01	05/26/2021 12:59:24 PM Eastern Daylight Time		06/01/2021 03:02:23 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Choice (PDP)	10	29					S5601	050	0	2022	Upper MW and N.Plains (IA, MN, MT, ND, NE, SD, WY)		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	051	0		29	10	S5601_051_0	1	1					1	05/26/2021	2022.01	05/26/2021 05:19:37 PM Eastern Daylight Time		06/01/2021 03:02:28 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Plus (PDP)	10	29					S5601	051	0	2022	Upper MW and N.Plains (IA, MN, MT, ND, NE, SD, WY)		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	052	0		29	10	S5601_052_0	1	1					0	05/26/2021	2022.01	05/26/2021 01:00:05 PM Eastern Daylight Time		06/01/2021 03:02:33 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Choice (PDP)	10	29					S5601	052	0	2022	New Mexico		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	053	0		29	10	S5601_053_0	1	1					1	05/26/2021	2022.01	05/26/2021 05:22:57 PM Eastern Daylight Time		06/01/2021 03:02:39 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Plus (PDP)	10	29					S5601	053	0	2022	New Mexico		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	054	0		29	10	S5601_054_0	1	1					0	05/26/2021	2022.01	05/26/2021 01:01:41 PM Eastern Daylight Time		06/01/2021 03:02:44 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Choice (PDP)	10	29					S5601	054	0	2022	Colorado		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	055	0		29	10	S5601_055_0	1	1					1	05/26/2021	2022.01	05/26/2021 05:25:04 PM Eastern Daylight Time		06/01/2021 03:02:49 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Plus (PDP)	10	29					S5601	055	0	2022	Colorado		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	056	0		29	10	S5601_056_0	2	1					0	05/26/2021	2022.01	05/26/2021 01:02:10 PM Eastern Daylight Time		07/21/2021 12:28:40 PM Eastern Daylight Time			07/26/2021 12:24:48 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Choice (PDP)	10	29					S5601	056	0	2022	Arizona		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	057	0		29	10	S5601_057_0	1	1					1	05/26/2021	2022.01	05/26/2021 05:27:06 PM Eastern Daylight Time		06/01/2021 03:02:58 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Plus (PDP)	10	29					S5601	057	0	2022	Arizona		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	058	0		29	10	S5601_058_0	1	1					0	05/26/2021	2022.01	05/26/2021 01:02:54 PM Eastern Daylight Time		06/01/2021 03:03:03 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Choice (PDP)	10	29					S5601	058	0	2022	Nevada		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	059	0		29	10	S5601_059_0	1	1					1	05/26/2021	2022.01	05/26/2021 05:29:22 PM Eastern Daylight Time		06/01/2021 03:03:08 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Plus (PDP)	10	29					S5601	059	0	2022	Nevada		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	060	0		29	10	S5601_060_0	1	1					0	05/26/2021	2022.01	05/26/2021 01:03:25 PM Eastern Daylight Time		06/01/2021 03:03:14 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Choice (PDP)	10	29					S5601	060	0	2022	Oregon, Washington		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	061	0		29	10	S5601_061_0	1	1					1	05/26/2021	2022.01	05/26/2021 05:31:26 PM Eastern Daylight Time		06/01/2021 03:03:19 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Plus (PDP)	10	29					S5601	061	0	2022	Oregon, Washington		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	062	0		29	10	S5601_062_0	1	1					0	05/26/2021	2022.01	05/26/2021 01:03:52 PM Eastern Daylight Time		06/01/2021 03:03:24 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Choice (PDP)	10	29					S5601	062	0	2022	Idaho, Utah		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	063	0		29	10	S5601_063_0	1	1					1	05/26/2021	2022.01	05/26/2021 05:33:17 PM Eastern Daylight Time		06/01/2021 03:03:29 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Plus (PDP)	10	29					S5601	063	0	2022	Idaho, Utah		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	064	0		29	10	S5601_064_0	1	1					0	05/26/2021	2022.01	05/26/2021 01:04:40 PM Eastern Daylight Time		06/01/2021 03:03:33 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Choice (PDP)	10	29					S5601	064	0	2022	California		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	065	0		29	10	S5601_065_0	1	1					1	05/26/2021	2022.01	05/26/2021 05:35:36 PM Eastern Daylight Time		06/01/2021 03:03:38 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Plus (PDP)	10	29					S5601	065	0	2022	California		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	066	0		29	10	S5601_066_0	1	1					0	05/26/2021	2022.01	05/26/2021 01:05:14 PM Eastern Daylight Time		06/01/2021 03:03:42 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Choice (PDP)	10	29					S5601	066	0	2022	Hawaii		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	067	0		29	10	S5601_067_0	1	1					1	05/26/2021	2022.01	05/26/2021 05:35:31 PM Eastern Daylight Time		06/01/2021 03:03:46 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Plus (PDP)	10	29					S5601	067	0	2022	Hawaii		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	068	0		29	10	S5601_068_0	1	1					0	05/26/2021	2022.01	05/26/2021 01:05:42 PM Eastern Daylight Time		06/01/2021 03:03:50 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Choice (PDP)	10	29					S5601	068	0	2022	Alaska		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	107	0		29	10	S5601_107_0	1	1					1	05/26/2021	2022.01	05/26/2021 05:32:07 PM Eastern Daylight Time		06/01/2021 03:03:55 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Plus (PDP)	10	29					S5601	107	0	2022	Arkansas		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	108	0		29	10	S5601_108_0	1	1					1	05/26/2021	2022.01	05/26/2021 05:28:57 PM Eastern Daylight Time		06/01/2021 03:03:59 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Plus (PDP)	10	29					S5601	108	0	2022	Louisiana		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	109	0		29	10	S5601_109_0	1	1					1	05/26/2021	2022.01	05/26/2021 05:25:16 PM Eastern Daylight Time		06/01/2021 03:04:03 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Plus (PDP)	10	29					S5601	109	0	2022	Oklahoma		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	176	0		29	10	S5601_176_0	1	1					0	05/26/2021	2022.01	05/26/2021 04:12:21 PM Eastern Daylight Time		06/01/2021 03:04:08 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript SmartRx (PDP)	10	29					S5601	176	0	2022	Northern New England (NH, ME)		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	177	0		29	10	S5601_177_0	1	1					0	05/26/2021	2022.01	05/26/2021 01:43:30 PM Eastern Daylight Time		06/01/2021 03:04:12 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript SmartRx (PDP)	10	29					S5601	177	0	2022	Central New England (CT, MA, RI, VT)		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	178	0		29	10	S5601_178_0	1	1					0	05/26/2021	2022.01	05/26/2021 02:11:57 PM Eastern Daylight Time		06/01/2021 03:04:16 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript SmartRx (PDP)	10	29					S5601	178	0	2022	New York		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	179	0		29	10	S5601_179_0	1	1					0	05/26/2021	2022.01	05/26/2021 02:12:36 PM Eastern Daylight Time		06/01/2021 03:04:21 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript SmartRx (PDP)	10	29					S5601	179	0	2022	New Jersey		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	180	0		29	10	S5601_180_0	1	1					0	05/26/2021	2022.01	05/26/2021 02:13:09 PM Eastern Daylight Time		06/01/2021 03:04:25 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript SmartRx (PDP)	10	29					S5601	180	0	2022	Mid-Atlantic (DE, DC, MD)		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	181	0		29	10	S5601_181_0	1	1					0	05/26/2021	2022.01	05/26/2021 02:13:41 PM Eastern Daylight Time		06/01/2021 03:04:29 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript SmartRx (PDP)	10	29					S5601	181	0	2022	Pennsylvania, West Virginia		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	182	0		29	10	S5601_182_0	1	1					0	05/26/2021	2022.01	05/26/2021 02:14:22 PM Eastern Daylight Time		06/01/2021 03:04:34 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript SmartRx (PDP)	10	29					S5601	182	0	2022	Virginia		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	183	0		29	10	S5601_183_0	1	1					0	05/26/2021	2022.01	05/26/2021 02:14:58 PM Eastern Daylight Time		06/01/2021 03:04:38 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript SmartRx (PDP)	10	29					S5601	183	0	2022	North Carolina		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	184	0		29	10	S5601_184_0	1	1					0	05/26/2021	2022.01	05/26/2021 02:15:29 PM Eastern Daylight Time		06/01/2021 03:04:42 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript SmartRx (PDP)	10	29					S5601	184	0	2022	South Carolina		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	185	0		29	10	S5601_185_0	1	1					0	05/26/2021	2022.01	05/26/2021 02:15:58 PM Eastern Daylight Time		06/01/2021 03:04:47 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript SmartRx (PDP)	10	29					S5601	185	0	2022	Georgia		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	186	0		29	10	S5601_186_0	1	1					0	05/26/2021	2022.01	05/26/2021 02:16:30 PM Eastern Daylight Time		06/01/2021 03:04:51 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript SmartRx (PDP)	10	29					S5601	186	0	2022	Florida		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	187	0		29	10	S5601_187_0	1	1					0	05/26/2021	2022.01	05/26/2021 02:17:03 PM Eastern Daylight Time		06/01/2021 03:04:55 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript SmartRx (PDP)	10	29					S5601	187	0	2022	Alabama, Tennessee		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	188	0		29	10	S5601_188_0	1	1					0	05/26/2021	2022.01	05/26/2021 02:17:34 PM Eastern Daylight Time		06/01/2021 03:05:00 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript SmartRx (PDP)	10	29					S5601	188	0	2022	Michigan		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	189	0		29	10	S5601_189_0	1	1					0	05/26/2021	2022.01	05/26/2021 02:18:16 PM Eastern Daylight Time		06/01/2021 03:05:04 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript SmartRx (PDP)	10	29					S5601	189	0	2022	Ohio		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	190	0		29	10	S5601_190_0	1	1					0	05/26/2021	2022.01	05/26/2021 02:18:45 PM Eastern Daylight Time		06/01/2021 03:05:08 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript SmartRx (PDP)	10	29					S5601	190	0	2022	Indiana, Kentucky		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	191	0		29	10	S5601_191_0	1	1					0	05/26/2021	2022.01	05/26/2021 02:19:15 PM Eastern Daylight Time		06/01/2021 03:05:12 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript SmartRx (PDP)	10	29					S5601	191	0	2022	Wisconsin		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	192	0		29	10	S5601_192_0	1	1					0	05/26/2021	2022.01	05/26/2021 02:19:47 PM Eastern Daylight Time		06/01/2021 03:05:17 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript SmartRx (PDP)	10	29					S5601	192	0	2022	Illinois		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	193	0		29	10	S5601_193_0	1	1					0	05/26/2021	2022.01	05/26/2021 02:20:10 PM Eastern Daylight Time		06/01/2021 03:05:21 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript SmartRx (PDP)	10	29					S5601	193	0	2022	Missouri		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	194	0		29	10	S5601_194_0	1	1					0	05/26/2021	2022.01	05/26/2021 02:20:33 PM Eastern Daylight Time		06/01/2021 03:05:25 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript SmartRx (PDP)	10	29					S5601	194	0	2022	Arkansas		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	195	0		29	10	S5601_195_0	1	1					0	05/26/2021	2022.01	05/26/2021 02:20:55 PM Eastern Daylight Time		06/01/2021 03:05:30 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript SmartRx (PDP)	10	29					S5601	195	0	2022	Mississippi		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	196	0		29	10	S5601_196_0	1	1					0	05/26/2021	2022.01	05/26/2021 02:21:18 PM Eastern Daylight Time		06/01/2021 03:05:34 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript SmartRx (PDP)	10	29					S5601	196	0	2022	Louisiana		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	197	0		29	10	S5601_197_0	1	1					0	05/26/2021	2022.01	05/26/2021 02:21:40 PM Eastern Daylight Time		06/01/2021 03:05:38 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript SmartRx (PDP)	10	29					S5601	197	0	2022	Texas		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	198	0		29	10	S5601_198_0	1	1					0	05/26/2021	2022.01	05/26/2021 02:22:03 PM Eastern Daylight Time		06/01/2021 03:05:42 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript SmartRx (PDP)	10	29					S5601	198	0	2022	Oklahoma		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	199	0		29	10	S5601_199_0	1	1					0	05/26/2021	2022.01	05/26/2021 02:22:26 PM Eastern Daylight Time		06/01/2021 03:05:47 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript SmartRx (PDP)	10	29					S5601	199	0	2022	Kansas		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	200	0		29	10	S5601_200_0	1	1					0	05/26/2021	2022.01	05/26/2021 02:22:48 PM Eastern Daylight Time		06/01/2021 03:05:51 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript SmartRx (PDP)	10	29					S5601	200	0	2022	Upper MW and N.Plains (IA, MN, MT, ND, NE, SD, WY)		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	201	0		29	10	S5601_201_0	1	1					0	05/26/2021	2022.01	05/26/2021 02:23:07 PM Eastern Daylight Time		06/01/2021 03:05:55 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript SmartRx (PDP)	10	29					S5601	201	0	2022	New Mexico		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	202	0		29	10	S5601_202_0	1	1					0	05/26/2021	2022.01	05/26/2021 02:23:30 PM Eastern Daylight Time		06/01/2021 03:05:59 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript SmartRx (PDP)	10	29					S5601	202	0	2022	Colorado		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	203	0		29	10	S5601_203_0	1	1					0	05/26/2021	2022.01	05/26/2021 02:23:53 PM Eastern Daylight Time		06/01/2021 03:06:04 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript SmartRx (PDP)	10	29					S5601	203	0	2022	Arizona		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	204	0		29	10	S5601_204_0	1	1					0	05/26/2021	2022.01	05/26/2021 02:24:15 PM Eastern Daylight Time		06/01/2021 03:06:08 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript SmartRx (PDP)	10	29					S5601	204	0	2022	Nevada		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	205	0		29	10	S5601_205_0	1	1					0	05/26/2021	2022.01	05/26/2021 02:26:35 PM Eastern Daylight Time		06/01/2021 03:06:13 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript SmartRx (PDP)	10	29					S5601	205	0	2022	Oregon, Washington		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	206	0		29	10	S5601_206_0	2	1					0	05/26/2021	2022.01	05/26/2021 02:27:01 PM Eastern Daylight Time		06/02/2021 08:30:10 PM Eastern Daylight Time			06/03/2021 09:11:49 AM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript SmartRx (PDP)	10	29					S5601	206	0	2022	Idaho, Utah		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	207	0		29	10	S5601_207_0	1	1					0	05/26/2021	2022.01	05/26/2021 02:27:29 PM Eastern Daylight Time		06/01/2021 02:17:14 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript SmartRx (PDP)	10	29					S5601	207	0	2022	California		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	208	0		29	10	S5601_208_0	2	1					0	05/26/2021	2022.01	05/26/2021 02:27:59 PM Eastern Daylight Time		06/04/2021 12:24:00 PM Eastern Daylight Time			06/04/2021 01:19:49 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript SmartRx (PDP)	10	29					S5601	208	0	2022	Hawaii		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	209	0		29	10	S5601_209_0	1	1					0	05/26/2021	2022.01	05/26/2021 02:28:42 PM Eastern Daylight Time		06/01/2021 02:17:23 PM Eastern Daylight Time			06/02/2021 05:34:44 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript SmartRx (PDP)	10	29					S5601	209	0	2022	Alaska		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	210	0		29	10	S5601_210_0	2	1					1	05/26/2021	2022.01	05/26/2021 04:27:33 PM Eastern Daylight Time		06/21/2021 04:59:34 PM Eastern Daylight Time			06/23/2021 03:02:27 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Plus (PDP)	10	29					S5601	210	0	2022	Alaska		2					2						www.aetnamedicare.com	www.aetnamedicare.com										(866)235-5660		(866)235-5660		(833)526-2445		(833)526-2445										(711)-		(711)-		(711)-		(711)-																
S5601	801	0		29	10	S5601_801_0	1	1						05/26/2021	2022.01	05/26/2021 02:13:24 PM Central Daylight Time					05/26/2021 02:49:59 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Group (PDP)	10	29					S5601	801	0	2022	National SilverScript Group		1					2						www.aetnamedicare.com/findpharmacy	http://www.aetnamedicare.com/formulary										(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						05/26/2021	2022.01	05/26/2021 02:16:23 PM Central Daylight Time					05/26/2021 02:49:59 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Group (PDP)	10	29					S5601	802	0	2022	National SilverScript Group		1					2						www.aetnamedicare.com/findpharmacy	http://www.aetnamedicare.com/formulary										(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						05/26/2021	2022.01	05/26/2021 02:22:03 PM Central Daylight Time					05/26/2021 02:49:59 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Group FI AET (PDP)	10	29					S5601	803	0	2022	National SilverScript Group		1					2						www.aetnamedicare.com/findpharmacy	http://www.aetnamedicare.com/formulary										(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						05/26/2021	2022.01	05/26/2021 02:22:42 PM Central Daylight Time					05/26/2021 02:49:59 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Group FI (PDP)	10	29					S5601	804	0	2022	National SilverScript Group		1					2						www.aetnamedicare.com/findpharmacy	http://www.aetnamedicare.com/formulary										(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						05/26/2021	2022.01	05/26/2021 02:24:17 PM Central Daylight Time					05/26/2021 02:49:59 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Group SF (PDP)	10	29					S5601	805	0	2022	National SilverScript Group		1					2						www.aetnamedicare.com/findpharmacy	http://www.aetnamedicare.com/formulary										(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						05/26/2021	2022.01	05/26/2021 02:24:45 PM Central Daylight Time					05/26/2021 02:49:59 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Group SF AET (PDP)	10	29					S5601	806	0	2022	National SilverScript Group		1					2						www.aetnamedicare.com/findpharmacy	http://www.aetnamedicare.com/formulary										(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						05/26/2021	2022.01	05/26/2021 02:25:04 PM Central Daylight Time					05/26/2021 02:49:59 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Group SF (PDP)	10	29					S5601	807	0	2022	National SilverScript Group		1					2						www.aetnamedicare.com/findpharmacy	http://www.aetnamedicare.com/formulary										(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						05/26/2021	2022.01	05/26/2021 02:25:22 PM Central Daylight Time					05/26/2021 02:49:59 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Group SF - Non Calendar (PDP)	10	29					S5601	808	0	2022	National SilverScript Group		1					2						www.aetnamedicare.com/findpharmacy	http://www.aetnamedicare.com/formulary										(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						05/26/2021	2022.01	05/26/2021 02:25:40 PM Central Daylight Time					05/26/2021 02:49:59 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Group SF (PDP)	10	29					S5601	809	0	2022	National SilverScript Group		1					2						www.aetnamedicare.com/findpharmacy	http://www.aetnamedicare.com/formulary										(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						05/26/2021	2022.01	05/26/2021 02:25:59 PM Central Daylight Time					05/26/2021 02:49:59 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Group SF - Non Calendar (PDP)	10	29					S5601	810	0	2022	National SilverScript Group		1					2						www.aetnamedicare.com/findpharmacy	http://www.aetnamedicare.com/formulary										(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						05/26/2021	2022.01	05/26/2021 02:26:57 PM Central Daylight Time					05/26/2021 02:49:59 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Group - State of NY (PDP)	10	29					S5601	811	0	2022	National		1					2						www.aetnamedicare.com/findpharmacy	http://www.aetnamedicare.com/formulary										(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						05/26/2021	2022.01	05/26/2021 02:27:25 PM Central Daylight Time					05/26/2021 02:49:59 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Group SF (PDP)	10	29					S5601	812	0	2022	National SilverScript Group		1					2						www.aetnamedicare.com/findpharmacy	http://www.aetnamedicare.com/formulary										(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						05/26/2021	2022.01	05/26/2021 02:27:49 PM Central Daylight Time					05/26/2021 02:49:59 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Group SF (PDP)	10	29					S5601	813	0	2022	National SilverScript Group		1					2						www.aetnamedicare.com/findpharmacy	http://www.aetnamedicare.com/formulary										(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						05/26/2021	2022.01	05/26/2021 02:28:30 PM Central Daylight Time					05/26/2021 02:49:59 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Group SF (PDP)	10	29					S5601	814	0	2022	National SilverScript Group		1					2						www.aetnamedicare.com/findpharmacy	http://www.aetnamedicare.com/formulary										(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						05/26/2021	2022.01	05/26/2021 02:29:49 PM Central Daylight Time					05/26/2021 02:49:59 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	SilverScript Group SF (PDP)	10	29					S5601	815	0	2022	National SilverScript Group		1					2						www.aetnamedicare.com/findpharmacy	http://www.aetnamedicare.com/formulary										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	816	0		29	10	S5601_816_0	1	1						05/26/2021	2022.01	05/26/2021 02:30:11 PM Central Daylight Time					05/26/2021 02:49:59 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx offered by SilverScript - FI (PDP)	10	29					S5601	816	0	2022	Employer National		1					2						www.aetnamedicare.com/findpharmacy	http://www.aetnamedicare.com/formulary										(855)222-6857		(855)222-6857		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	818	0		29	10	S5601_818_0	1	1						05/26/2021	2022.01	05/26/2021 02:30:28 PM Central Daylight Time					05/26/2021 02:49:59 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx offered by SilverScript - SF (PDP)	10	29					S5601	818	0	2022	Employer National		1					2						www.aetnamedicare.com/findpharmacy	http://www.aetnamedicare.com/formulary										(855)222-6857		(855)222-6857		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	820	0		29	10	S5601_820_0	1	1						05/26/2021	2022.01	05/26/2021 02:31:37 PM Central Daylight Time					05/26/2021 02:49:59 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx offered by SilverScript - DC (PDP)	10	29					S5601	820	0	2022	Employer National		1					2						www.aetnamedicare.com/findpharmacy	http://www.aetnamedicare.com/formulary										(855)222-6857		(855)222-6857		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5609	001	0		29	10	S5609_001_0	2	1					0	06/02/2021	2022.01	06/02/2021 03:55:48 PM Pacific Daylight Time		06/04/2021 02:29:12 PM Pacific Daylight Time			06/04/2021 03:12:43 PM Pacific Daylight Time	ASURIS NORTHWEST HEALTH	Asuris Northwest Health	www.asuris.com/medicare	Asuris Medicare Script Basic (PDP)	10	29					S5609	001	0	2022	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	3	1					0	06/02/2021	2022.01	06/02/2021 03:56:16 PM Pacific Daylight Time		06/29/2021 03:29:13 PM Pacific Daylight Time			07/01/2021 10:11:37 AM Pacific Daylight Time	ASURIS NORTHWEST HEALTH	Asuris Northwest Health	www.asuris.com/medicare	Asuris Medicare Script Enhanced (PDP)	10	29					S5609	002	0	2022	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	3	1						05/05/2021	2022.01	05/05/2021 09:48:27 AM Pacific Daylight Time					06/03/2021 11:12:52 AM Pacific Daylight Time	ASURIS NORTHWEST HEALTH	Asuris Northwest Health	www.asuris.com/medicare	Asuris Medicare Script (PDP)	10	29					S5609	802	0	2022	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	3	1						04/19/2021	2022.01	04/19/2021 09:56:40 AM Pacific Daylight Time					06/03/2021 11:12:52 AM Pacific Daylight Time	ASURIS NORTHWEST HEALTH	Asuris Northwest Health	www.asuris.com/medicare	Asuris Medicare Script 02 (PDP)	10	29					S5609	804	0	2022	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	3	1						04/19/2021	2022.01	04/19/2021 09:56:51 AM Pacific Daylight Time					06/03/2021 11:12:52 AM Pacific Daylight Time	ASURIS NORTHWEST HEALTH	Asuris Northwest Health	www.asuris.com/medicare	Asuris Medicare Script 03 (PDP)	10	29					S5609	805	0	2022	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					0	06/01/2021	2022.01	06/01/2021 08:52:04 AM Central Daylight Time		06/04/2021 02:00:37 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Secure Rx (PDP)	10	29					S5617	003	0	2022	New Hampshire and Maine		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(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					0	06/01/2021	2022.01	06/01/2021 08:52:13 AM Central Daylight Time		06/04/2021 02:00:37 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Secure Rx (PDP)	10	29					S5617	008	0	2022	Connecticut, Massachusetts, Rhode Island, Vermont		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(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					0	06/01/2021	2022.01	06/01/2021 08:52:21 AM Central Daylight Time		06/04/2021 02:00:37 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Secure Rx (PDP)	10	29					S5617	013	0	2022	New York		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(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					0	06/01/2021	2022.01	06/01/2021 08:52:31 AM Central Daylight Time		06/04/2021 02:00:37 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Secure Rx (PDP)	10	29					S5617	018	0	2022	New Jersey		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(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					0	06/01/2021	2022.01	06/01/2021 11:27:44 AM Central Daylight Time		06/04/2021 02:00:37 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Secure Rx (PDP)	10	29					S5617	053	0	2022	Florida		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(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					0	06/02/2021	2022.01	06/02/2021 02:12:56 PM Central Daylight Time		06/04/2021 02:00:37 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Secure Rx (PDP)	10	29					S5617	068	0	2022	Ohio		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(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					0	06/01/2021	2022.01	06/01/2021 09:58:37 AM Central Daylight Time		06/04/2021 02:00:37 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Secure Rx (PDP)	10	29					S5617	088	0	2022	Missouri		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(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					0	06/01/2021	2022.01	06/01/2021 10:11:26 AM Central Daylight Time		06/04/2021 02:00:37 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Secure Rx (PDP)	10	29					S5617	103	0	2022	Louisiana		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	108	0		29	10	S5617_108_0	5	1					0	06/01/2021	2022.01	06/01/2021 10:13:33 AM Central Daylight Time		06/04/2021 02:00:38 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Secure Rx (PDP)	10	29					S5617	108	0	2022	Texas		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	113	0		29	10	S5617_113_0	5	1					0	06/01/2021	2022.01	06/01/2021 08:18:36 AM Central Daylight Time		06/04/2021 02:00:38 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Secure Rx (PDP)	10	29					S5617	113	0	2022	Oklahoma		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	118	0		29	10	S5617_118_0	5	1					0	06/01/2021	2022.01	06/01/2021 08:21:55 AM Central Daylight Time		06/04/2021 02:00:38 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Secure Rx (PDP)	10	29					S5617	118	0	2022	Kansas		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	123	0		29	10	S5617_123_0	5	1					0	06/01/2021	2022.01	06/01/2021 08:25:51 AM Central Daylight Time		06/04/2021 02:00:38 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Secure Rx (PDP)	10	29					S5617	123	0	2022	IA, MN, MT, ND, NE, SD, WY		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	128	0		29	10	S5617_128_0	5	1					0	06/01/2021	2022.01	06/01/2021 10:17:04 AM Central Daylight Time		06/04/2021 02:00:38 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Secure Rx (PDP)	10	29					S5617	128	0	2022	New Mexico		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	133	0		29	10	S5617_133_0	5	1					0	06/01/2021	2022.01	06/01/2021 10:20:44 AM Central Daylight Time		06/04/2021 02:00:38 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Secure Rx (PDP)	10	29					S5617	133	0	2022	Colorado		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	138	0		29	10	S5617_138_0	5	1					0	06/01/2021	2022.01	06/01/2021 10:24:39 AM Central Daylight Time		06/04/2021 02:00:38 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Secure Rx (PDP)	10	29					S5617	138	0	2022	Arizona		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	143	0		29	10	S5617_143_0	5	1					0	06/01/2021	2022.01	06/01/2021 10:26:48 AM Central Daylight Time		06/04/2021 02:00:38 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Secure Rx (PDP)	10	29					S5617	143	0	2022	Nevada		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	148	0		29	10	S5617_148_0	5	1					0	06/01/2021	2022.01	06/01/2021 10:28:38 AM Central Daylight Time		06/04/2021 02:00:38 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Secure Rx (PDP)	10	29					S5617	148	0	2022	Oregon and Washington		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	153	0		29	10	S5617_153_0	5	1					0	06/01/2021	2022.01	06/01/2021 10:31:28 AM Central Daylight Time		06/04/2021 02:00:38 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Secure Rx (PDP)	10	29					S5617	153	0	2022	Idaho and Utah		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	158	0		29	10	S5617_158_0	5	1					0	06/01/2021	2022.01	06/01/2021 09:13:40 AM Central Daylight Time		06/04/2021 02:00:38 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Secure Rx (PDP)	10	29					S5617	158	0	2022	California		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	163	0		29	10	S5617_163_0	5	1					0	06/01/2021	2022.01	06/01/2021 11:25:09 AM Central Daylight Time		06/04/2021 02:00:38 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Secure Rx (PDP)	10	29					S5617	163	0	2022	Hawaii		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	214	0		29	10	S5617_214_0	5	1					0	06/01/2021	2022.01	06/01/2021 09:13:32 AM Central Daylight Time		06/04/2021 02:00:38 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Secure Rx (PDP)	10	29					S5617	214	0	2022	Delaware, District of Columbia and Maryland		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	215	0		29	10	S5617_215_0	5	1					0	06/01/2021	2022.01	06/01/2021 09:13:25 AM Central Daylight Time		06/04/2021 02:00:38 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Secure Rx (PDP)	10	29					S5617	215	0	2022	Pennsylvania and West Virginia		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	216	0		29	10	S5617_216_0	5	1					0	06/01/2021	2022.01	06/01/2021 11:31:34 AM Central Daylight Time		06/04/2021 02:00:38 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Secure Rx (PDP)	10	29					S5617	216	0	2022	Virginia		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	217	0		29	10	S5617_217_0	5	1					0	06/01/2021	2022.01	06/01/2021 11:15:23 AM Central Daylight Time		06/04/2021 02:00:38 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Secure Rx (PDP)	10	29					S5617	217	0	2022	North Carolina		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	218	0		29	10	S5617_218_0	5	1					0	06/01/2021	2022.01	06/01/2021 09:12:59 AM Central Daylight Time		06/04/2021 02:00:38 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Secure Rx (PDP)	10	29					S5617	218	0	2022	South Carolina		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	219	0		29	10	S5617_219_0	5	1					0	06/01/2021	2022.01	06/01/2021 09:12:47 AM Central Daylight Time		06/04/2021 02:00:38 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Secure Rx (PDP)	10	29					S5617	219	0	2022	Georgia		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	220	0		29	10	S5617_220_0	5	1					0	06/01/2021	2022.01	06/01/2021 09:12:33 AM Central Daylight Time		06/04/2021 02:00:38 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Secure Rx (PDP)	10	29					S5617	220	0	2022	Alabama and Tennessee		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	221	0		29	10	S5617_221_0	5	1					0	06/01/2021	2022.01	06/01/2021 08:35:24 AM Central Daylight Time		06/04/2021 02:00:38 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Secure Rx (PDP)	10	29					S5617	221	0	2022	Michigan		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	222	0		29	10	S5617_222_0	5	1					0	06/01/2021	2022.01	06/01/2021 08:37:58 AM Central Daylight Time		06/04/2021 02:00:38 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Secure Rx (PDP)	10	29					S5617	222	0	2022	Indiana and Kentucky		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	223	0		29	10	S5617_223_0	5	1					0	06/01/2021	2022.01	06/01/2021 08:40:26 AM Central Daylight Time		06/04/2021 02:00:38 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Secure Rx (PDP)	10	29					S5617	223	0	2022	Wisconsin		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	224	0		29	10	S5617_224_0	5	1					0	06/01/2021	2022.01	06/01/2021 10:08:37 AM Central Daylight Time		06/04/2021 02:00:38 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Secure Rx (PDP)	10	29					S5617	224	0	2022	Illinois		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	225	0		29	10	S5617_225_0	5	1					0	06/01/2021	2022.01	06/01/2021 11:25:39 AM Central Daylight Time		06/04/2021 02:00:38 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Secure Rx (PDP)	10	29					S5617	225	0	2022	Arkansas		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	226	0		29	10	S5617_226_0	5	1					0	06/01/2021	2022.01	06/01/2021 10:08:21 AM Central Daylight Time		06/04/2021 02:00:38 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Secure Rx (PDP)	10	29					S5617	226	0	2022	Mississippi		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	227	0		29	10	S5617_227_0	5	1					0	06/01/2021	2022.01	06/01/2021 08:57:50 AM Central Daylight Time		06/04/2021 02:00:38 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Secure Rx (PDP)	10	29					S5617	227	0	2022	Alaska		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(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					1	06/01/2021	2022.01	06/01/2021 02:04:55 PM Central Daylight Time		06/04/2021 02:00:38 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Extra Rx (PDP)	10	29					S5617	246	0	2022	New Hampshire and Maine		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	247	0		29	10	S5617_247_0	5	1					1	06/01/2021	2022.01	06/01/2021 02:05:22 PM Central Daylight Time		06/04/2021 02:00:38 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Extra Rx (PDP)	10	29					S5617	247	0	2022	Connecticut, Massachusetts, Rhode Island, Vermont		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	248	0		29	10	S5617_248_0	5	1					1	06/01/2021	2022.01	06/01/2021 02:05:47 PM Central Daylight Time		06/04/2021 02:00:38 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Extra Rx (PDP)	10	29					S5617	248	0	2022	New York		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	249	0		29	10	S5617_249_0	5	1					1	06/01/2021	2022.01	06/01/2021 02:06:11 PM Central Daylight Time		06/04/2021 02:00:38 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Extra Rx (PDP)	10	29					S5617	249	0	2022	New Jersey		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	250	0		29	10	S5617_250_0	5	1					1	06/01/2021	2022.01	06/01/2021 02:06:33 PM Central Daylight Time		06/04/2021 02:00:38 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Extra Rx (PDP)	10	29					S5617	250	0	2022	Delaware, Maryland and District of Columbia		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	251	0		29	10	S5617_251_0	5	1					1	06/01/2021	2022.01	06/01/2021 02:06:53 PM Central Daylight Time		06/04/2021 02:00:39 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Extra Rx (PDP)	10	29					S5617	251	0	2022	Pennsylvania and West Virginia		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	252	0		29	10	S5617_252_0	6	1					1	06/01/2021	2022.01	06/01/2021 02:07:17 PM Central Daylight Time		06/04/2021 02:00:39 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Extra Rx (PDP)	10	29					S5617	252	0	2022	Virginia		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	253	0		29	10	S5617_253_0	5	1					1	06/01/2021	2022.01	06/01/2021 02:07:40 PM Central Daylight Time		06/04/2021 02:00:39 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Extra Rx (PDP)	10	29					S5617	253	0	2022	North Carolina		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	254	0		29	10	S5617_254_0	5	1					1	06/01/2021	2022.01	06/01/2021 02:08:01 PM Central Daylight Time		06/04/2021 02:00:39 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Extra Rx (PDP)	10	29					S5617	254	0	2022	South Carolina		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	255	0		29	10	S5617_255_0	5	1					1	06/01/2021	2022.01	06/01/2021 02:08:27 PM Central Daylight Time		06/04/2021 02:00:39 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Extra Rx (PDP)	10	29					S5617	255	0	2022	Georgia		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	256	0		29	10	S5617_256_0	5	1					1	06/01/2021	2022.01	06/01/2021 02:08:50 PM Central Daylight Time		06/04/2021 02:00:39 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Extra Rx (PDP)	10	29					S5617	256	0	2022	Florida		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	257	0		29	10	S5617_257_0	5	1					1	06/01/2021	2022.01	06/01/2021 02:09:10 PM Central Daylight Time		06/04/2021 02:00:39 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Extra Rx (PDP)	10	29					S5617	257	0	2022	Alabama and Tennessee		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	258	0		29	10	S5617_258_0	5	1					1	06/01/2021	2022.01	06/01/2021 02:09:28 PM Central Daylight Time		06/04/2021 02:00:39 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Extra Rx (PDP)	10	29					S5617	258	0	2022	Michigan		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	259	0		29	10	S5617_259_0	5	1					1	06/01/2021	2022.01	06/01/2021 02:09:49 PM Central Daylight Time		06/04/2021 02:00:39 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Extra Rx (PDP)	10	29					S5617	259	0	2022	Ohio		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	260	0		29	10	S5617_260_0	5	1					1	06/01/2021	2022.01	06/01/2021 02:12:19 PM Central Daylight Time		06/04/2021 02:00:39 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Extra Rx (PDP)	10	29					S5617	260	0	2022	Indiana and Kentucky		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	261	0		29	10	S5617_261_0	5	1					1	06/01/2021	2022.01	06/01/2021 02:12:38 PM Central Daylight Time		06/04/2021 02:00:39 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Extra Rx (PDP)	10	29					S5617	261	0	2022	Wisconsin		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	262	0		29	10	S5617_262_0	5	1					1	06/01/2021	2022.01	06/01/2021 02:13:00 PM Central Daylight Time		06/04/2021 02:00:39 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Extra Rx (PDP)	10	29					S5617	262	0	2022	Illinois		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	263	0		29	10	S5617_263_0	5	1					1	06/01/2021	2022.01	06/01/2021 02:14:09 PM Central Daylight Time		06/04/2021 02:00:39 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Extra Rx (PDP)	10	29					S5617	263	0	2022	Missouri		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	264	0		29	10	S5617_264_0	5	1					1	06/01/2021	2022.01	06/01/2021 02:14:30 PM Central Daylight Time		06/04/2021 02:00:39 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Extra Rx (PDP)	10	29					S5617	264	0	2022	Arkansas		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	265	0		29	10	S5617_265_0	5	1					1	06/01/2021	2022.01	06/01/2021 02:14:50 PM Central Daylight Time		06/04/2021 02:00:39 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Extra Rx (PDP)	10	29					S5617	265	0	2022	Mississippi		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	266	0		29	10	S5617_266_0	5	1					1	06/01/2021	2022.01	06/01/2021 02:15:10 PM Central Daylight Time		06/04/2021 02:00:39 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Extra Rx (PDP)	10	29					S5617	266	0	2022	Louisiana		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	267	0		29	10	S5617_267_0	5	1					1	06/01/2021	2022.01	06/01/2021 02:15:35 PM Central Daylight Time		06/04/2021 02:00:39 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Extra Rx (PDP)	10	29					S5617	267	0	2022	Texas		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(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					1	06/01/2021	2022.01	06/01/2021 02:15:55 PM Central Daylight Time		06/04/2021 02:00:39 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Extra Rx (PDP)	10	29					S5617	268	0	2022	Oklahoma		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	269	0		29	10	S5617_269_0	5	1					1	06/01/2021	2022.01	06/01/2021 02:16:13 PM Central Daylight Time		06/04/2021 02:00:39 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Extra Rx (PDP)	10	29					S5617	269	0	2022	Kansas		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	270	0		29	10	S5617_270_0	5	1					1	06/01/2021	2022.01	06/01/2021 02:16:30 PM Central Daylight Time		06/04/2021 02:00:39 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Extra Rx (PDP)	10	29					S5617	270	0	2022	IA, MN, MT, ND, NE, SD, WY		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	271	0		29	10	S5617_271_0	5	1					1	06/01/2021	2022.01	06/01/2021 02:16:49 PM Central Daylight Time		06/04/2021 02:00:39 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Extra Rx (PDP)	10	29					S5617	271	0	2022	New Mexico		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	272	0		29	10	S5617_272_0	5	1					1	06/01/2021	2022.01	06/01/2021 02:17:09 PM Central Daylight Time		06/04/2021 02:00:39 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Extra Rx (PDP)	10	29					S5617	272	0	2022	Colorado		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	273	0		29	10	S5617_273_0	5	1					1	06/01/2021	2022.01	06/01/2021 02:17:29 PM Central Daylight Time		06/04/2021 02:00:39 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Extra Rx (PDP)	10	29					S5617	273	0	2022	Arizona		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	274	0		29	10	S5617_274_0	5	1					1	06/01/2021	2022.01	06/01/2021 02:17:49 PM Central Daylight Time		06/04/2021 02:00:39 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Extra Rx (PDP)	10	29					S5617	274	0	2022	Nevada		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	275	0		29	10	S5617_275_0	5	1					1	06/01/2021	2022.01	06/01/2021 02:18:08 PM Central Daylight Time		06/04/2021 02:00:39 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Extra Rx (PDP)	10	29					S5617	275	0	2022	Oregon and Washington		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	276	0		29	10	S5617_276_0	5	1					1	06/01/2021	2022.01	06/01/2021 02:18:45 PM Central Daylight Time		06/04/2021 02:00:39 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Extra Rx (PDP)	10	29					S5617	276	0	2022	Idaho and Utah		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(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					1	06/01/2021	2022.01	06/01/2021 02:19:07 PM Central Daylight Time		06/04/2021 02:00:39 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Extra Rx (PDP)	10	29					S5617	277	0	2022	California		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	278	0		29	10	S5617_278_0	5	1					1	06/01/2021	2022.01	06/01/2021 02:19:24 PM Central Daylight Time		06/04/2021 02:00:39 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Extra Rx (PDP)	10	29					S5617	278	0	2022	Hawaii		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	279	0		29	10	S5617_279_0	5	1					1	06/01/2021	2022.01	06/01/2021 02:19:43 PM Central Daylight Time		06/04/2021 02:00:39 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Extra Rx (PDP)	10	29					S5617	279	0	2022	Alaska		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(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					0	06/01/2021	2022.01	06/01/2021 02:52:52 PM Central Daylight Time		06/04/2021 02:00:39 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Essential Rx (PDP)	10	29					S5617	280	0	2022	New Hampshire and Maine		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(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					0	06/01/2021	2022.01	06/01/2021 02:52:18 PM Central Daylight Time		06/04/2021 02:00:39 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Essential Rx (PDP)	10	29					S5617	281	0	2022	Connecticut, Massachusetts, Rhode Island, Vermont		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(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					0	05/27/2021	2022.01	05/27/2021 05:44:40 PM Central Daylight Time		06/04/2021 02:00:39 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Essential Rx (PDP)	10	29					S5617	282	0	2022	New York		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(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					0	06/01/2021	2022.01	06/01/2021 02:51:31 PM Central Daylight Time		06/04/2021 02:00:39 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Essential Rx (PDP)	10	29					S5617	283	0	2022	New Jersey		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	284	0		29	10	S5617_284_0	5	1					0	05/27/2021	2022.01	05/27/2021 05:42:20 PM Central Daylight Time		06/04/2021 02:00:39 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Essential Rx (PDP)	10	29					S5617	284	0	2022	Delaware, District of Columbia and Maryland		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(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					0	05/27/2021	2022.01	05/27/2021 05:40:56 PM Central Daylight Time		06/04/2021 02:00:39 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Essential Rx (PDP)	10	29					S5617	285	0	2022	Pennsylvania and West Virginia		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	286	0		29	10	S5617_286_0	6	1					0	05/27/2021	2022.01	05/27/2021 05:39:49 PM Central Daylight Time		06/04/2021 02:00:39 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Essential Rx (PDP)	10	29					S5617	286	0	2022	Virginia		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(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					0	05/27/2021	2022.01	05/27/2021 05:38:53 PM Central Daylight Time		06/04/2021 02:00:39 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Essential Rx (PDP)	10	29					S5617	287	0	2022	North Carolina		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	288	0		29	10	S5617_288_0	5	1					0	06/01/2021	2022.01	06/01/2021 02:50:47 PM Central Daylight Time		06/04/2021 02:00:39 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Essential Rx (PDP)	10	29					S5617	288	0	2022	South Carolina		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	289	0		29	10	S5617_289_0	5	1					0	05/27/2021	2022.01	05/27/2021 05:37:06 PM Central Daylight Time		06/04/2021 02:00:39 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Essential Rx (PDP)	10	29					S5617	289	0	2022	Georgia		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(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					0	05/27/2021	2022.01	05/27/2021 05:36:11 PM Central Daylight Time		06/04/2021 02:00:39 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Essential Rx (PDP)	10	29					S5617	290	0	2022	Florida		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(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					0	06/01/2021	2022.01	06/01/2021 02:50:13 PM Central Daylight Time		06/04/2021 02:00:39 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Essential Rx (PDP)	10	29					S5617	291	0	2022	Alabama and Tennessee		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(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					0	05/27/2021	2022.01	05/27/2021 05:33:56 PM Central Daylight Time		06/04/2021 02:00:39 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Essential Rx (PDP)	10	29					S5617	292	0	2022	Michigan		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(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					0	05/27/2021	2022.01	05/27/2021 05:32:42 PM Central Daylight Time		06/04/2021 02:00:39 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Essential Rx (PDP)	10	29					S5617	293	0	2022	Ohio		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(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					0	05/27/2021	2022.01	05/27/2021 05:31:53 PM Central Daylight Time		06/04/2021 02:00:39 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Essential Rx (PDP)	10	29					S5617	294	0	2022	Indiana and Kentucky		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(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					0	05/27/2021	2022.01	05/27/2021 05:31:02 PM Central Daylight Time		06/04/2021 02:00:39 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Essential Rx (PDP)	10	29					S5617	295	0	2022	Wisconsin		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(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					0	05/27/2021	2022.01	05/27/2021 05:30:08 PM Central Daylight Time		06/04/2021 02:00:40 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Essential Rx (PDP)	10	29					S5617	296	0	2022	Illinois		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(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					0	06/01/2021	2022.01	06/01/2021 02:49:32 PM Central Daylight Time		06/04/2021 02:00:40 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Essential Rx (PDP)	10	29					S5617	297	0	2022	Missouri		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	298	0		29	10	S5617_298_0	5	1					0	06/02/2021	2022.01	06/02/2021 02:15:23 PM Central Daylight Time		06/04/2021 02:00:40 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Essential Rx (PDP)	10	29					S5617	298	0	2022	Arkansas		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	299	0		29	10	S5617_299_0	5	1					0	06/01/2021	2022.01	06/01/2021 02:48:31 PM Central Daylight Time		06/04/2021 02:00:40 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Essential Rx (PDP)	10	29					S5617	299	0	2022	Mississippi		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(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					0	06/01/2021	2022.01	06/01/2021 02:47:50 PM Central Daylight Time		06/04/2021 02:00:40 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Essential Rx (PDP)	10	29					S5617	300	0	2022	Louisiana		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	301	0		29	10	S5617_301_0	5	1					0	05/27/2021	2022.01	05/27/2021 05:23:28 PM Central Daylight Time		06/04/2021 02:00:40 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Essential Rx (PDP)	10	29					S5617	301	0	2022	Texas		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(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					0	06/01/2021	2022.01	06/01/2021 02:46:27 PM Central Daylight Time		06/04/2021 02:00:40 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Essential Rx (PDP)	10	29					S5617	302	0	2022	Oklahoma		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	303	0		29	10	S5617_303_0	5	1					0	05/27/2021	2022.01	05/27/2021 05:21:35 PM Central Daylight Time		06/04/2021 02:00:40 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Essential Rx (PDP)	10	29					S5617	303	0	2022	Kansas		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(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					0	05/27/2021	2022.01	05/27/2021 05:20:47 PM Central Daylight Time		06/04/2021 02:00:40 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Essential Rx (PDP)	10	29					S5617	304	0	2022	IA, MN, MT, ND, SD, NE, WY		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	305	0		29	10	S5617_305_0	5	1					0	06/01/2021	2022.01	06/01/2021 02:45:54 PM Central Daylight Time		06/04/2021 02:00:40 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Essential Rx (PDP)	10	29					S5617	305	0	2022	New Mexico		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	306	0		29	10	S5617_306_0	5	1					0	06/01/2021	2022.01	06/01/2021 02:45:06 PM Central Daylight Time		06/04/2021 02:00:40 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Essential Rx (PDP)	10	29					S5617	306	0	2022	Colorado		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	307	0		29	10	S5617_307_0	5	1					0	05/27/2021	2022.01	05/27/2021 05:17:07 PM Central Daylight Time		06/04/2021 02:00:40 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Essential Rx (PDP)	10	29					S5617	307	0	2022	Arizona		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(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					0	06/01/2021	2022.01	06/01/2021 02:44:21 PM Central Daylight Time		06/04/2021 02:00:40 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Essential Rx (PDP)	10	29					S5617	308	0	2022	Nevada		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	309	0		29	10	S5617_309_0	5	1					0	05/27/2021	2022.01	05/27/2021 05:15:03 PM Central Daylight Time		06/04/2021 02:00:40 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Essential Rx (PDP)	10	29					S5617	309	0	2022	Oregon and Washington		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(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					0	05/27/2021	2022.01	05/27/2021 05:13:30 PM Central Daylight Time		06/04/2021 02:00:40 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Essential Rx (PDP)	10	29					S5617	310	0	2022	Idaho and Utah		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(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					0	06/01/2021	2022.01	06/01/2021 02:43:20 PM Central Daylight Time		06/04/2021 02:00:40 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Essential Rx (PDP)	10	29					S5617	311	0	2022	California		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(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					0	06/01/2021	2022.01	06/01/2021 02:42:28 PM Central Daylight Time		06/04/2021 02:00:40 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Essential Rx (PDP)	10	29					S5617	312	0	2022	Hawaii		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(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					0	06/02/2021	2022.01	06/02/2021 02:16:53 PM Central Daylight Time		06/04/2021 02:00:40 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Essential Rx (PDP)	10	29					S5617	313	0	2022	Alaska		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	348	0		29	10	S5617_348_0	5	1					0	06/01/2021	2022.01	06/01/2021 10:37:29 AM Central Daylight Time		06/04/2021 02:00:40 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Secure Rx (PDP)	10	29					S5617	348	0	2022	Puerto Rico		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	349	0		29	10	S5617_349_0	5	1					1	06/01/2021	2022.01	06/01/2021 02:20:09 PM Central Daylight Time		06/04/2021 02:00:40 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Extra Rx (PDP)	10	29					S5617	349	0	2022	Puerto Rico		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	350	0		29	10	S5617_350_0	5	1					0	06/01/2021	2022.01	06/01/2021 02:39:20 PM Central Daylight Time		06/04/2021 02:00:40 PM Central Daylight Time			06/04/2021 04:55:48 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Essential Rx (PDP)	10	29					S5617	350	0	2022	Puerto Rico		2					2						www.cigna.com/part-d	www.cigna.com/part-d										(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						06/01/2021	2022.01	06/01/2021 12:01:01 PM Central Daylight Time					06/03/2021 10:43:52 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Rx Medicare (PDP)	10	29					S5617	801	0	2022	Nationwide		1					2						www.cigna.com/medicare	www.cignamedicare.com										(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						06/01/2021	2022.01	06/01/2021 12:01:24 PM Central Daylight Time					06/03/2021 10:43:52 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Rx Medicare FY (PDP)	10	29					S5617	802	0	2022	Nationwide		1					2						www.cigna.com/medicare	www.cignamedicare.com										(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						06/01/2021	2022.01	06/01/2021 12:01:19 PM Central Daylight Time					06/03/2021 10:43:52 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Rx Medicare (PDP)	10	29					S5617	805	0	2022	Nationwide		1					2						www.cigna.com/medicare	www.cignamedicare.com										(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						06/01/2021	2022.01	06/01/2021 12:01:12 PM Central Daylight Time					06/03/2021 10:43:52 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna	www.cignamedicare.com	Cigna Rx Medicare FY (PDP)	10	29					S5617	806	0	2022	Nationwide		1					2						www.cigna.com/medicare	www.cignamedicare.com										(800)558-9562		(800)558-9562		(800)558-9562		(800)558-9562										(711)-		(711)-		(711)-		(711)-																
S5660	801	0		29	10	S5660_801_0	1	1						06/01/2021	2022.01	06/01/2021 12:02:01 PM Central Daylight Time					06/02/2021 08:03:58 PM Central 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	2022	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						06/01/2021	2022.01	06/01/2021 12:01:55 PM Central Daylight Time					06/02/2021 08:03:58 PM Central 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	2022	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						06/01/2021	2022.01	06/01/2021 12:01:51 PM Central Daylight Time					06/02/2021 08:03:58 PM Central 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	2022	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						06/01/2021	2022.01	06/01/2021 12:01:39 PM Central Daylight Time					06/02/2021 08:03:58 PM Central 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	2022	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						06/01/2021	2022.01	06/01/2021 12:01:35 PM Central Daylight Time					06/02/2021 08:03:58 PM Central 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	2022	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	3	1					0	05/26/2021	2022.01	05/26/2021 06:04:09 PM Central Daylight Time		06/05/2021 04:24:26 PM Central Daylight Time			06/05/2021 04:36:47 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of IL, NM, OK, TX	www.getblueil.com/pdp	Blue Cross MedicareRx Value (PDP)	10	29					S5715	001	0	2022	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	3	1					0	05/26/2021	2022.01	05/26/2021 05:47:14 PM Central Daylight Time		06/05/2021 04:24:33 PM Central Daylight Time			06/05/2021 04:36:47 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of IL, NM, OK, TX	www.getbluenm.com/pdp	Blue Cross MedicareRx Value (PDP)	10	29					S5715	003	0	2022	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	3	1					0	05/26/2021	2022.01	05/26/2021 05:48:07 PM Central Daylight Time		06/05/2021 04:24:40 PM Central Daylight Time			06/05/2021 04:36:47 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of IL, NM, OK, TX	www.getbluenm.com/pdp	Blue Cross MedicareRx Plus (PDP)	10	29					S5715	004	0	2022	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	3	1					0	05/26/2021	2022.01	05/26/2021 05:49:25 PM Central Daylight Time		06/05/2021 04:24:47 PM Central Daylight Time			06/05/2021 04:36:47 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of IL, NM, OK, TX	www.getbluetx.com/pdp	Blue Cross MedicareRx Value (PDP)	10	29					S5715	005	0	2022	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	3	1					0	05/26/2021	2022.01	05/26/2021 05:50:41 PM Central Daylight Time		06/05/2021 04:24:54 PM Central Daylight Time			06/05/2021 04:36:47 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of IL, NM, OK, TX	www.getbluetx.com/pdp	Blue Cross MedicareRx Plus (PDP)	10	29					S5715	006	0	2022	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	3	1					0	05/26/2021	2022.01	05/26/2021 05:53:13 PM Central Daylight Time		06/05/2021 04:25:01 PM Central Daylight Time			06/05/2021 04:36:47 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of IL, NM, OK, TX	www.getblueok.com/pdp	Blue Cross MedicareRx Value (PDP)	10	29					S5715	010	0	2022	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	4	1					0	05/26/2021	2022.01	05/26/2021 05:54:22 PM Central Daylight Time		07/21/2021 04:14:58 PM Central Daylight Time			07/23/2021 01:11:41 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of IL, NM, OK, TX	www.getblueil.com/pdp	Blue Cross MedicareRx Basic (PDP)	10	29					S5715	012	0	2022	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	4	1					0	07/23/2021	2022.01	07/23/2021 01:08:51 PM Central Daylight Time		07/21/2021 04:16:56 PM Central Daylight Time			07/23/2021 01:11:41 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of IL, NM, OK, TX	www.getbluenm.com/pdp	Blue Cross MedicareRx Basic (PDP)	10	29					S5715	013	0	2022	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	4	1					0	06/02/2021	2022.01	06/02/2021 11:22:34 PM Central Daylight Time		07/21/2021 04:19:04 PM Central Daylight Time			07/23/2021 01:11:41 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of IL, NM, OK, TX	www.getbluetx.com/pdp	Blue Cross MedicareRx Basic (PDP)	10	29					S5715	014	0	2022	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	4	1					0	06/02/2021	2022.01	06/02/2021 11:21:55 PM Central Daylight Time		07/21/2021 04:20:54 PM Central Daylight Time			07/23/2021 01:11:41 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of IL, NM, OK, TX	www.getblueok.com/pdp	Blue Cross MedicareRx Basic (PDP)	10	29					S5715	015	0	2022	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	018	0		29	10	S5715_018_0	4	1					0	05/26/2021	2022.01	05/26/2021 06:00:31 PM Central Daylight Time		07/21/2021 04:23:12 PM Central Daylight Time			07/23/2021 01:11:41 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of IL, NM, OK, TX	www.getblueok.com/pdp	Blue Cross MedicareRx Choice (PDP)	10	29					S5715	018	0	2022	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	019	0		29	10	S5715_019_0	4	1					0	05/26/2021	2022.01	05/26/2021 06:02:37 PM Central Daylight Time		07/21/2021 04:25:10 PM Central Daylight Time			07/23/2021 01:11:41 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of IL, NM, OK, TX	www.getblueil.com/pdp	Blue Cross MedicareRx Choice (PDP)	10	29					S5715	019	0	2022	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	801	0		29	10	S5715_801_0	2	1						04/29/2021	2022.01	04/29/2021 02:10:59 PM Central Daylight Time					06/03/2021 05:04:16 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of IL, NM, OK, TX	www.hcsc.com	Blue Cross Group MedicareRx Plan (PDP)	10	29					S5715	801	0	2022	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	2	1						04/29/2021	2022.01	04/29/2021 02:11:11 PM Central Daylight Time					06/03/2021 05:04:16 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of IL, NM, OK, TX	www.hcsc.com	Blue Cross Group MedicareRx Plan (PDP)	10	29					S5715	802	0	2022	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	2	1						04/29/2021	2022.01	04/29/2021 02:11:15 PM Central Daylight Time					06/03/2021 05:04:16 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of IL, NM, OK, TX	www.hcsc.com	Blue Cross Group MedicareRx Plan (PDP)	10	29					S5715	803	0	2022	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	2	1						04/29/2021	2022.01	04/29/2021 02:11:20 PM Central Daylight Time					06/03/2021 05:04:16 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of IL, NM, OK, TX	www.hcsc.com	Blue Cross Group MedicareRx Plan (PDP)	10	29					S5715	807	0	2022	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	2	1						04/29/2021	2022.01	04/29/2021 02:11:28 PM Central Daylight Time					06/03/2021 05:04:16 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of IL, NM, OK, TX	www.hcsc.com	Blue Cross Group MedicareRx Plan (PDP)	10	29					S5715	809	0	2022	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	2	1						04/29/2021	2022.01	04/29/2021 02:11:35 PM Central Daylight Time					06/03/2021 05:04:16 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of IL, NM, OK, TX	www.hcsc.com	Blue Cross Group MedicareRx Plan (PDP)	10	29					S5715	811	0	2022	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	2	1						04/29/2021	2022.01	04/29/2021 02:11:41 PM Central Daylight Time					06/03/2021 05:04:16 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of IL, NM, OK, TX	www.hcsc.com	Blue Cross Group MedicareRx Plan (PDP)	10	29					S5715	813	0	2022	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	2	1						04/29/2021	2022.01	04/29/2021 02:11:48 PM Central Daylight Time					06/03/2021 05:04:16 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of IL, NM, OK, TX	www.hcsc.com	Blue Cross Group MedicareRx Plan (PDP)	10	29					S5715	815	0	2022	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	2	1						04/29/2021	2022.01	04/29/2021 02:11:54 PM Central Daylight Time					06/03/2021 05:04:16 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of IL, NM, OK, TX	www.hcsc.com	Blue Cross Group MedicareRx Plan (PDP)	10	29					S5715	817	0	2022	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	2	1						04/29/2021	2022.01	04/29/2021 02:12:00 PM Central Daylight Time					06/03/2021 05:04:16 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of IL, NM, OK, TX	www.hcsc.com	Blue Cross Group MedicareRx Plan (PDP)	10	29					S5715	818	0	2022	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	2	1						04/29/2021	2022.01	04/29/2021 02:12:06 PM Central Daylight Time					06/03/2021 05:04:16 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of IL, NM, OK, TX	www.hcsc.com	Blue Cross Group MedicareRx Plan (PDP)	10	29					S5715	819	0	2022	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	820	0		29	10	S5715_820_0	2	1						04/29/2021	2022.01	04/29/2021 02:12:12 PM Central Daylight Time					06/03/2021 05:04:16 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of IL, NM, OK, TX	www.hcsc.com	Blue Cross Group MedicareRx Plan (PDP)	10	29					S5715	820	0	2022	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	821	0		29	10	S5715_821_0	2	1						04/29/2021	2022.01	04/29/2021 02:12:18 PM Central Daylight Time					06/03/2021 05:04:16 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of IL, NM, OK, TX	www.hcsc.com	Blue Cross Group MedicareRx Plan (PDP)	10	29					S5715	821	0	2022	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	822	0		29	10	S5715_822_0	2	1						04/29/2021	2022.01	04/29/2021 02:12:29 PM Central Daylight Time					06/03/2021 05:04:16 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of IL, NM, OK, TX	www.hcsc.com	Blue Cross Group MedicareRx Plan (PDP)	10	29					S5715	822	0	2022	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	823	0		29	10	S5715_823_0	2	1						04/29/2021	2022.01	04/29/2021 02:12:34 PM Central Daylight Time					06/03/2021 05:04:16 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of IL, NM, OK, TX	www.hcsc.com	Blue Cross Group MedicareRx Plan (PDP)	10	29					S5715	823	0	2022	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	824	0		29	10	S5715_824_0	2	1						04/29/2021	2022.01	04/29/2021 02:12:41 PM Central Daylight Time					06/03/2021 05:04:16 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of IL, NM, OK, TX	www.hcsc.com	Blue Cross Group MedicareRx Plan (PDP)	10	29					S5715	824	0	2022	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	6	1					0	07/16/2021	2022.01	07/16/2021 06:24:48 PM Eastern Daylight Time		08/10/2021 12:42:42 PM Eastern Daylight Time			08/10/2021 04:44:16 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF KANSAS	Blue Cross and Blue Shield of Kansas or Blue KC	https://shop.partdkansas.com/medicare	Blue MedicareRx Value (PDP)	10	29					S5726	013	0	2022	Kansas		2					2						https://shop.partdkansas.com/medicare	https://shop.partdkansas.com/medicare										(866)755-2776		(866)755-2776		(855)793-1939		(855)793-1939										(711)-		(711)-		(711)-		(711)-																
S5726	014	0		29	10	S5726_014_0	6	1					1	07/16/2021	2022.01	07/16/2021 06:24:33 PM Eastern Daylight Time		08/10/2021 03:51:17 PM Eastern Daylight Time			08/10/2021 04:44:16 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF KANSAS	Blue Cross and Blue Shield of Kansas or Blue KC	https://shop.partdkansas.com/medicare	Blue MedicareRx Plus (PDP)	10	29					S5726	014	0	2022	Kansas		2					2						https://shop.partdkansas.com/medicare	https://shop.partdkansas.com/medicare										(866)755-2776		(866)755-2776		(855)793-1939		(855)793-1939										(711)-		(711)-		(711)-		(711)-																
S5726	805	0		29	10	S5726_805_0	2	1						05/30/2021	2022.01	05/30/2021 07:56:07 AM Eastern Daylight Time					06/04/2021 05:49:04 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF KANSAS	Blue Cross and Blue Shield of Kansas or Blue KC	https://shop.partdkansas.com/medicare	Blue MedicareRx (PDP)	10	29					S5726	805	0	2022	Kansas		1					2						https://shop.partdkansas.com/medicare	https://shop.partdkansas.com/medicare										(866)830-0174		(866)830-0174		(833)348-5338		(833)348-5338										(711)-		(711)-		(711)-		(711)-																
S5743	001	0		29	10	S5743_001_0	2	1					0	06/04/2021	2022.01	06/04/2021 07:26:04 PM Central Daylight Time		06/05/2021 11:56:00 AM Central Daylight Time			06/05/2021 09:55:10 PM 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	2022	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					0	06/02/2021	2022.01	06/02/2021 05:38:48 PM Central Daylight Time		06/05/2021 11:57:00 AM Central Daylight Time			06/05/2021 09:55:10 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	2022	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	2	1						05/05/2021	2022.01	05/05/2021 05:07:05 PM Central Daylight Time					06/05/2021 09:55:10 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	2022	Nationwide		1					2						www.YourMedicareSolutions.com	www.YourMedicareSolutions.com										(877)838-3827		(877)838-3827		(866)434-2037		(866)434-2037										(711)-		(711)-		(711)-		(711)-																
S5743	805	0		29	10	S5743_805_0	2	1						05/05/2021	2022.01	05/05/2021 05:08:17 PM Central Daylight Time					06/05/2021 09:55:10 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	2022	Nationwide		1					2						www.YourMedicareSolutions.com	www.YourMedicareSolutions.com										(877)838-3827		(877)838-3827		(866)434-2037		(866)434-2037										(711)-		(711)-		(711)-		(711)-																
S5753	006	0		29	10	S5753_006_0	4	1					0	06/06/2021	2022.01	06/06/2021 07:19:09 PM Central Daylight Time		06/07/2021 01:59:12 PM Central Daylight Time			06/07/2021 01:59:52 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	2022	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					0	06/06/2021	2022.01	06/06/2021 07:34:52 PM Central Daylight Time		06/07/2021 01:59:12 PM Central Daylight Time			06/07/2021 01:59:52 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	2022	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)-																
S5795	002	0		29	10	S5795_002_0	2	1					0	06/04/2021	2022.01	06/04/2021 12:51:22 PM Central Daylight Time		06/03/2021 09:44:38 PM Central Daylight Time			06/04/2021 06:15:13 PM Central Daylight Time	USABLE MUTUAL INSURANCE COMPANY	Arkansas Blue Medicare	www.arkansasbluecross.com/medicare	BlueMedicare Premier Rx (PDP)	10	29					S5795	002	0	2022	State of Arkansas		2					2						www.arkansasbluecross.com/medicare	http://www.arkansasbluecross.com/LookingForInsurance/MedicarePlans/default.aspx										(866)390-3369		(866)390-3369		(888)605-0322		(888)605-0322										(711)-		(711)-		(711)-		(711)-																
S5795	003	0		29	10	S5795_003_0	2	1					0	07/02/2021	2022.01	07/02/2021 10:13:11 AM Central Daylight Time		06/03/2021 09:44:58 PM Central Daylight Time			07/02/2021 10:25:31 AM Central Daylight Time	USABLE MUTUAL INSURANCE COMPANY	Arkansas Blue Medicare	www.arkansasbluecross.com/medicare	BlueMedicare Value Rx (PDP)	10	29					S5795	003	0	2022	State of Arkansas		2					2						www.arkansasbluecross.com/medicare	http://www.arkansasbluecross.com/LookingForInsurance/MedicarePlans/default.aspx										(866)390-3369		(866)390-3369		(888)605-0322		(888)605-0322										(711)-		(711)-		(711)-		(711)-																
S5795	008	0		29	10	S5795_008_0	2	1					0	07/02/2021	2022.01	07/02/2021 10:13:37 AM Central Daylight Time		06/03/2021 09:45:16 PM Central Daylight Time			07/02/2021 10:25:31 AM Central Daylight Time	USABLE MUTUAL INSURANCE COMPANY	Arkansas Blue Medicare	www.arkansasbluecross.com/medicare	BlueMedicare Saver Rx (PDP)	10	29					S5795	008	0	2022	State of Arkansas		2					2						www.arkansasbluecross.com/medicare	www.arkansasbluecross.com										(866)390-3369		(866)390-3369		(888)605-0322		(888)605-0322										(711)-		(711)-		(711)-		(711)-																
S5795	804	0		29	10	S5795_804_0	1	1						05/20/2021	2022.01	05/20/2021 02:54:47 PM Central Daylight Time					06/02/2021 03:29:18 PM Central Daylight Time	USABLE MUTUAL INSURANCE COMPANY	Arkansas Blue Medicare	www.arkansasbluecross.com	Arkansas BCBS Std Def Employer CY 4 (PDP)	10	29					S5795	804	0	2022	Employer Group Plan		1					2						http://www.arkansasbluecross.com/medicare	http://www.arkansasbluecross.com/medicare										(866)390-3369		(866)390-3369		(888)605-0322		(888)605-0322										(711)-		(711)-		(711)-		(711)-																
S5795	809	0		29	10	S5795_809_0	1	1						05/20/2021	2022.01	05/20/2021 02:54:54 PM Central Daylight Time					06/02/2021 03:29:18 PM Central Daylight Time	USABLE MUTUAL INSURANCE COMPANY	Arkansas Blue Medicare	www.arkansasbluecross.com	Arkansas BCBS Std Def Employer NCY 4 (PDP)	10	29					S5795	809	0	2022	Employer Group Plan		1					2						http://www.arkansasbluecross.com/medicare	http://www.arkansasbluecross.com/medicare										(866)390-3369		(866)390-3369		(888)605-0322		(888)605-0322										(711)-		(711)-		(711)-		(711)-																
S5795	811	0		29	10	S5795_811_0	1	1						05/20/2021	2022.01	05/20/2021 02:55:00 PM Central Daylight Time					06/02/2021 03:29:18 PM Central Daylight Time	USABLE MUTUAL INSURANCE COMPANY	Arkansas Blue Medicare	www.arkansasbluecross.com	ABCBS Group Basic CY (PDP)	10	29					S5795	811	0	2022	Employer Group Plan		1					2						http://www.arkansasbluecross.com/medicare	http://www.arkansasbluecross.com/medicare										(866)390-3369		(866)390-3369		(888)605-0322		(888)605-0322										(711)-		(711)-		(711)-		(711)-																
S5795	812	0		29	10	S5795_812_0	1	1						05/20/2021	2022.01	05/20/2021 02:55:06 PM Central Daylight Time					06/02/2021 03:29:18 PM Central Daylight Time	USABLE MUTUAL INSURANCE COMPANY	Arkansas Blue Medicare	www.arkansasbluecross.com	ABCBS Group Basic PY (PDP)	10	29					S5795	812	0	2022	Employer Group Plan		1					2						http://www.arkansasbluecross.com/medicare	http://www.arkansasbluecross.com/medicare										(866)390-3369		(866)390-3369		(888)605-0322		(888)605-0322										(711)-		(711)-		(711)-		(711)-																
S5805	001	0		29	10	S5805_001_0	3	1					1	05/25/2021	2022.01	05/25/2021 09:55:00 AM Central Daylight Time		06/03/2021 08:39:02 PM Central Daylight Time			06/04/2021 10:57:38 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5805	001	0	2022	New York		2					2						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						05/24/2021	2022.01	05/24/2021 04:09:12 PM Eastern Daylight Time					06/02/2021 10:35:38 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	803	0	2022	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5805	804	0		29	10	S5805_804_0	1	1						05/25/2021	2022.01	05/25/2021 07:55:01 AM Eastern Daylight Time					06/02/2021 10:35:38 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	804	0	2022	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5805	807	0		29	10	S5805_807_0	1	1						05/25/2021	2022.01	05/25/2021 07:55:07 AM Eastern Daylight Time					06/02/2021 10:35:38 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	807	0	2022	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5805	808	0		29	10	S5805_808_0	1	1						05/25/2021	2022.01	05/25/2021 07:55:13 AM Eastern Daylight Time					06/02/2021 10:35:38 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	808	0	2022	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5805	809	0		29	10	S5805_809_0	1	1						05/25/2021	2022.01	05/25/2021 07:55:20 AM Eastern Daylight Time					06/02/2021 10:35:38 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	809	0	2022	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5805	810	0		29	10	S5805_810_0	1	1						05/25/2021	2022.01	05/25/2021 07:55:26 AM Eastern Daylight Time					06/02/2021 10:35:38 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	810	0	2022	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5805	811	0		29	10	S5805_811_0	1	1						05/25/2021	2022.01	05/25/2021 07:55:32 AM Eastern Daylight Time					06/02/2021 10:35:38 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	811	0	2022	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5805	812	0		29	10	S5805_812_0	1	1						05/25/2021	2022.01	05/25/2021 07:55:39 AM Eastern Daylight Time					06/02/2021 10:35:38 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	812	0	2022	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5805	813	0		29	10	S5805_813_0	1	1						05/25/2021	2022.01	05/25/2021 07:55:46 AM Eastern Daylight Time					06/02/2021 10:35:38 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	813	0	2022	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5805	814	0		29	10	S5805_814_0	1	1						05/25/2021	2022.01	05/25/2021 07:55:52 AM Eastern Daylight Time					06/02/2021 10:35:38 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	814	0	2022	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5805	815	0		29	10	S5805_815_0	1	1						05/25/2021	2022.01	05/25/2021 07:55:58 AM Eastern Daylight Time					06/02/2021 10:35:38 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	815	0	2022	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5805	816	0		29	10	S5805_816_0	1	1						05/25/2021	2022.01	05/25/2021 07:56:04 AM Eastern Daylight Time					06/02/2021 10:35:38 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	816	0	2022	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5805	818	0		29	10	S5805_818_0	1	1						05/25/2021	2022.01	05/25/2021 07:56:10 AM Eastern Daylight Time					06/02/2021 10:35:38 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	818	0	2022	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5805	819	0		29	10	S5805_819_0	1	1						05/25/2021	2022.01	05/25/2021 07:56:16 AM Eastern Daylight Time					06/02/2021 10:35:38 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	819	0	2022	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5805	820	0		29	10	S5805_820_0	1	1						05/25/2021	2022.01	05/25/2021 07:56:22 AM Eastern Daylight Time					06/02/2021 10:35:38 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	820	0	2022	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5805	821	0		29	10	S5805_821_0	1	1						05/25/2021	2022.01	05/25/2021 07:56:28 AM Eastern Daylight Time					06/02/2021 10:35:38 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	821	0	2022	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5805	822	0		29	10	S5805_822_0	1	1						05/25/2021	2022.01	05/25/2021 07:56:34 AM Eastern Daylight Time					06/02/2021 10:35:38 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	822	0	2022	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5805	823	0		29	10	S5805_823_0	1	1						05/25/2021	2022.01	05/25/2021 07:56:40 AM Eastern Daylight Time					06/02/2021 10:35:38 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	823	0	2022	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5805	824	0		29	10	S5805_824_0	1	1						05/25/2021	2022.01	05/25/2021 07:56:45 AM Eastern Daylight Time					06/02/2021 10:35:38 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	824	0	2022	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5805	825	0		29	10	S5805_825_0	1	1						05/25/2021	2022.01	05/25/2021 07:56:51 AM Eastern Daylight Time					06/02/2021 10:35:38 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	825	0	2022	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5805	826	0		29	10	S5805_826_0	1	1						05/25/2021	2022.01	05/25/2021 07:56:57 AM Eastern Daylight Time					06/02/2021 10:35:38 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	826	0	2022	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5805	827	0		29	10	S5805_827_0	1	1						05/25/2021	2022.01	05/25/2021 07:57:03 AM Eastern Daylight Time					06/02/2021 10:35:38 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	827	0	2022	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5805	828	0		29	10	S5805_828_0	1	1						05/25/2021	2022.01	05/25/2021 07:57:09 AM Eastern Daylight Time					06/02/2021 10:35:38 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	828	0	2022	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5805	829	0		29	10	S5805_829_0	1	1						05/25/2021	2022.01	05/25/2021 07:57:15 AM Eastern Daylight Time					06/02/2021 10:35:38 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	829	0	2022	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5805	830	0		29	10	S5805_830_0	1	1						05/25/2021	2022.01	05/25/2021 07:57:25 AM Eastern Daylight Time					06/02/2021 10:35:38 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	830	0	2022	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5805	831	0		29	10	S5805_831_0	1	1						05/25/2021	2022.01	05/25/2021 07:57:31 AM Eastern Daylight Time					06/02/2021 10:35:38 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	831	0	2022	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5805	832	0		29	10	S5805_832_0	1	1						05/25/2021	2022.01	05/25/2021 07:57:37 AM Eastern Daylight Time					06/02/2021 10:35:38 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	832	0	2022	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5805	833	0		29	10	S5805_833_0	1	1						05/25/2021	2022.01	05/25/2021 07:57:42 AM Eastern Daylight Time					06/02/2021 10:35:38 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	833	0	2022	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5805	834	0		29	10	S5805_834_0	1	1						05/25/2021	2022.01	05/25/2021 07:57:48 AM Eastern Daylight Time					06/02/2021 10:35:38 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	834	0	2022	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5805	835	0		29	10	S5805_835_0	1	1						05/25/2021	2022.01	05/25/2021 07:57:54 AM Eastern Daylight Time					06/02/2021 10:35:38 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	835	0	2022	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5805	836	0		29	10	S5805_836_0	1	1						05/25/2021	2022.01	05/25/2021 07:58:04 AM Eastern Daylight Time					06/02/2021 10:35:38 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.AARPMedicareRx.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	836	0	2022	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5805	837	0		29	10	S5805_837_0	1	1						05/25/2021	2022.01	05/25/2021 07:58:10 AM Eastern Daylight Time					06/02/2021 10:35:38 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.AARPMedicareRx.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	837	0	2022	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5805	838	0		29	10	S5805_838_0	1	1						05/25/2021	2022.01	05/25/2021 07:58:16 AM Eastern Daylight Time					06/02/2021 10:35:38 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.AARPMedicareRx.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	838	0	2022	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	001	0		29	10	S5820_001_0	2	1					1	05/25/2021	2022.01	05/25/2021 09:55:16 AM Central Daylight Time		06/03/2021 08:39:03 PM Central Daylight Time			06/04/2021 09:51:50 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	001	0	2022	Northern New England (NH, ME)		2					2						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	2	1					1	05/25/2021	2022.01	05/25/2021 09:56:25 AM Central Daylight Time		06/03/2021 08:39:03 PM Central Daylight Time			06/04/2021 09:51:50 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	002	0	2022	Central New England (CT, MA, RI, VT)		2					2						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	2	1					1	05/25/2021	2022.01	05/25/2021 09:58:17 AM Central Daylight Time		06/03/2021 08:39:04 PM Central Daylight Time			06/04/2021 09:51:50 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	003	0	2022	New Jersey		2					2						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	2	1					1	05/25/2021	2022.01	05/25/2021 09:58:27 AM Central Daylight Time		06/03/2021 08:39:04 PM Central Daylight Time			06/04/2021 09:51:50 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	004	0	2022	Mid-Atlantic (DE, DC, MD)		2					2						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	2	1					1	05/25/2021	2022.01	05/25/2021 09:58:36 AM Central Daylight Time		06/03/2021 08:39:05 PM Central Daylight Time			06/04/2021 09:51:50 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	005	0	2022	Pennsylvania, West Virginia		2					2						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	2	1					1	05/25/2021	2022.01	05/25/2021 09:58:46 AM Central Daylight Time		06/03/2021 08:39:05 PM Central Daylight Time			06/04/2021 09:51:50 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	006	0	2022	Virginia		2					2						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	2	1					1	05/25/2021	2022.01	05/25/2021 10:00:51 AM Central Daylight Time		06/03/2021 08:39:06 PM Central Daylight Time			06/04/2021 09:51:50 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	007	0	2022	North Carolina		2					2						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	2	1					1	05/25/2021	2022.01	05/25/2021 10:01:01 AM Central Daylight Time		06/03/2021 08:39:06 PM Central Daylight Time			06/04/2021 09:51:50 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	008	0	2022	South Carolina		2					2						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	2	1					1	05/25/2021	2022.01	05/25/2021 10:01:11 AM Central Daylight Time		06/03/2021 08:39:07 PM Central Daylight Time			06/04/2021 09:51:50 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	009	0	2022	Georgia		2					2						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	2	1					1	05/25/2021	2022.01	05/25/2021 10:01:22 AM Central Daylight Time		06/03/2021 08:39:07 PM Central Daylight Time			06/04/2021 09:51:50 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	010	0	2022	Florida		2					2						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	2	1					1	05/25/2021	2022.01	05/25/2021 10:01:32 AM Central Daylight Time		06/03/2021 08:39:08 PM Central Daylight Time			06/04/2021 09:51:50 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	011	0	2022	Alabama, Tennessee		2					2						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	2	1					1	05/25/2021	2022.01	05/25/2021 10:01:42 AM Central Daylight Time		06/03/2021 08:39:08 PM Central Daylight Time			06/04/2021 09:51:50 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	012	0	2022	Michigan		2					2						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	2	1					1	05/25/2021	2022.01	05/25/2021 10:01:57 AM Central Daylight Time		06/03/2021 08:39:09 PM Central Daylight Time			06/04/2021 09:51:50 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	013	0	2022	Ohio		2					2						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	2	1					1	05/25/2021	2022.01	05/25/2021 10:02:29 AM Central Daylight Time		06/03/2021 08:39:09 PM Central Daylight Time			06/04/2021 09:51:50 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	014	0	2022	Indiana, Kentucky		2					2						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	2	1					1	05/25/2021	2022.01	05/25/2021 10:02:43 AM Central Daylight Time		06/03/2021 08:39:10 PM Central Daylight Time			06/04/2021 09:51:50 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	015	0	2022	Wisconsin		2					2						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	2	1					1	05/25/2021	2022.01	05/25/2021 10:02:57 AM Central Daylight Time		06/03/2021 08:39:10 PM Central Daylight Time			06/04/2021 09:51:50 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	016	0	2022	Illinois		2					2						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	2	1					1	05/25/2021	2022.01	05/25/2021 10:03:32 AM Central Daylight Time		06/03/2021 08:39:11 PM Central Daylight Time			06/04/2021 09:51:50 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	017	0	2022	Missouri		2					2						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	2	1					1	05/25/2021	2022.01	05/25/2021 10:03:55 AM Central Daylight Time		06/03/2021 08:39:11 PM Central Daylight Time			06/04/2021 09:51:50 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	018	0	2022	Arkansas		2					2						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	2	1					1	05/25/2021	2022.01	05/25/2021 10:04:06 AM Central Daylight Time		06/03/2021 08:39:12 PM Central Daylight Time			06/04/2021 09:51:50 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	019	0	2022	Mississippi		2					2						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	2	1					1	05/25/2021	2022.01	05/25/2021 10:04:18 AM Central Daylight Time		06/03/2021 08:39:12 PM Central Daylight Time			06/04/2021 09:51:50 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	020	0	2022	Louisiana		2					2						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	2	1					1	05/25/2021	2022.01	05/25/2021 10:04:50 AM Central Daylight Time		06/03/2021 08:39:12 PM Central Daylight Time			06/04/2021 09:51:50 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	021	0	2022	Texas		2					2						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	2	1					1	05/25/2021	2022.01	05/25/2021 10:05:20 AM Central Daylight Time		06/03/2021 08:39:13 PM Central Daylight Time			06/04/2021 09:51:50 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	022	0	2022	Oklahoma		2					2						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	2	1					1	05/25/2021	2022.01	05/25/2021 10:05:31 AM Central Daylight Time		06/03/2021 08:39:13 PM Central Daylight Time			06/04/2021 09:51:50 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	023	0	2022	Kansas		2					2						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	2	1					1	05/25/2021	2022.01	05/25/2021 10:05:41 AM Central Daylight Time		06/03/2021 08:39:14 PM Central Daylight Time			06/04/2021 09:51:50 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	024	0	2022	Upper Midwest and Northern Plains		2					2						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	2	1					1	05/25/2021	2022.01	05/25/2021 10:05:53 AM Central Daylight Time		06/03/2021 08:39:14 PM Central Daylight Time			06/04/2021 09:51:50 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	025	0	2022	New Mexico		2					2						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	2	1					1	05/25/2021	2022.01	05/25/2021 10:06:03 AM Central Daylight Time		06/03/2021 08:39:14 PM Central Daylight Time			06/04/2021 09:51:50 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	026	0	2022	Colorado		2					2						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	2	1					1	05/25/2021	2022.01	05/25/2021 10:06:14 AM Central Daylight Time		06/03/2021 08:39:15 PM Central Daylight Time			06/04/2021 09:51:50 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	027	0	2022	Arizona		2					2						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	2	1					1	05/25/2021	2022.01	05/25/2021 10:06:24 AM Central Daylight Time		06/03/2021 08:39:15 PM Central Daylight Time			06/04/2021 09:51:50 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	028	0	2022	Nevada		2					2						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	2	1					1	05/25/2021	2022.01	05/25/2021 10:06:38 AM Central Daylight Time		06/03/2021 08:39:16 PM Central Daylight Time			06/04/2021 09:51:50 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	029	0	2022	Oregon, Washington		2					2						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	2	1					1	05/25/2021	2022.01	05/25/2021 10:06:53 AM Central Daylight Time		06/03/2021 08:39:16 PM Central Daylight Time			06/04/2021 09:51:50 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	030	0	2022	Idaho, Utah		2					2						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	2	1					1	05/25/2021	2022.01	05/25/2021 10:07:07 AM Central Daylight Time		06/03/2021 08:39:16 PM Central Daylight Time			06/04/2021 09:51:50 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	031	0	2022	California		2					2						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	2	1					1	05/25/2021	2022.01	05/25/2021 10:07:17 AM Central Daylight Time		06/03/2021 08:39:17 PM Central Daylight Time			06/04/2021 09:51:50 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	032	0	2022	Hawaii		2					2						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	2	1					1	05/25/2021	2022.01	05/25/2021 10:07:28 AM Central Daylight Time		06/03/2021 08:39:17 PM Central Daylight Time			06/04/2021 09:51:50 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	033	0	2022	Alaska		2					2						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	2	1					0	05/25/2021	2022.01	05/25/2021 10:07:54 AM Central Daylight Time		06/03/2021 08:39:18 PM Central Daylight Time			06/04/2021 09:51:50 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	034	0	2022	American Samoa		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com										(877)521-7035		(877)521-7035		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	035	0		29	10	S5820_035_0	2	1					0	05/25/2021	2022.01	05/25/2021 10:08:05 AM Central Daylight Time		06/03/2021 08:39:19 PM Central Daylight Time			06/04/2021 09:51:50 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	035	0	2022	Guam		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com										(877)521-7034		(877)521-7034		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	036	0		29	10	S5820_036_0	3	1					0	05/25/2021	2022.01	05/25/2021 10:08:14 AM Central Daylight Time		06/03/2021 08:39:19 PM Central Daylight Time			06/04/2021 09:51:50 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	036	0	2022	Northern Mariana Islands		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com										(877)521-7034		(877)521-7034		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	037	0		29	10	S5820_037_0	2	1					0	05/25/2021	2022.01	05/25/2021 10:08:26 AM Central Daylight Time		06/03/2021 08:39:20 PM Central Daylight Time			06/04/2021 09:51:50 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	037	0	2022	Puerto Rico		2					2						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	2	1					0	05/25/2021	2022.01	05/25/2021 10:08:44 AM Central Daylight Time		06/03/2021 08:39:20 PM Central Daylight Time			06/04/2021 09:51:50 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	038	0	2022	US Virgin Islands		2					2						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						05/25/2021	2022.01	05/25/2021 07:58:26 AM Eastern Daylight Time					06/02/2021 10:37:23 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	803	0	2022	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	804	0		29	10	S5820_804_0	1	1						05/25/2021	2022.01	05/25/2021 07:58:32 AM Eastern Daylight Time					06/02/2021 10:37:23 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	804	0	2022	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	807	0		29	10	S5820_807_0	1	1						05/25/2021	2022.01	05/25/2021 07:58:37 AM Eastern Daylight Time					06/02/2021 10:37:23 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	807	0	2022	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	808	0		29	10	S5820_808_0	1	1						05/25/2021	2022.01	05/25/2021 07:58:44 AM Eastern Daylight Time					06/02/2021 10:37:23 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	808	0	2022	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	810	0		29	10	S5820_810_0	1	1						05/25/2021	2022.01	05/25/2021 07:58:50 AM Eastern Daylight Time					06/02/2021 10:37:23 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	810	0	2022	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	811	0		29	10	S5820_811_0	1	1						05/25/2021	2022.01	05/25/2021 07:58:56 AM Eastern Daylight Time					06/02/2021 10:37:23 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	811	0	2022	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	812	0		29	10	S5820_812_0	1	1						05/25/2021	2022.01	05/25/2021 07:59:01 AM Eastern Daylight Time					06/02/2021 10:37:23 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	812	0	2022	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	813	0		29	10	S5820_813_0	1	1						05/25/2021	2022.01	05/25/2021 07:59:08 AM Eastern Daylight Time					06/02/2021 10:37:23 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	813	0	2022	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	814	0		29	10	S5820_814_0	1	1						05/25/2021	2022.01	05/25/2021 07:59:14 AM Eastern Daylight Time					06/02/2021 10:37:23 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	814	0	2022	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	815	0		29	10	S5820_815_0	1	1						05/25/2021	2022.01	05/25/2021 07:59:20 AM Eastern Daylight Time					06/02/2021 10:37:23 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	815	0	2022	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	816	0		29	10	S5820_816_0	1	1						05/25/2021	2022.01	05/25/2021 07:59:26 AM Eastern Daylight Time					06/02/2021 10:37:23 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	816	0	2022	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	817	0		29	10	S5820_817_0	1	1						05/25/2021	2022.01	05/25/2021 07:59:32 AM Eastern Daylight Time					06/02/2021 10:37:23 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	817	0	2022	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	818	0		29	10	S5820_818_0	1	1						05/25/2021	2022.01	05/25/2021 07:59:38 AM Eastern Daylight Time					06/02/2021 10:37:23 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	818	0	2022	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	819	0		29	10	S5820_819_0	1	1						05/25/2021	2022.01	05/25/2021 07:59:43 AM Eastern Daylight Time					06/02/2021 10:37:23 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	819	0	2022	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	820	0		29	10	S5820_820_0	1	1						05/25/2021	2022.01	05/25/2021 07:59:49 AM Eastern Daylight Time					06/02/2021 10:37:23 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	820	0	2022	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	821	0		29	10	S5820_821_0	1	1						05/25/2021	2022.01	05/25/2021 07:59:54 AM Eastern Daylight Time					06/02/2021 10:37:23 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	821	0	2022	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	822	0		29	10	S5820_822_0	1	1						05/25/2021	2022.01	05/25/2021 08:00:00 AM Eastern Daylight Time					06/02/2021 10:37:23 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	822	0	2022	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	823	0		29	10	S5820_823_0	1	1						05/25/2021	2022.01	05/25/2021 08:00:06 AM Eastern Daylight Time					06/02/2021 10:37:23 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	823	0	2022	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	824	0		29	10	S5820_824_0	1	1						05/25/2021	2022.01	05/25/2021 08:00:12 AM Eastern Daylight Time					06/02/2021 10:37:23 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	824	0	2022	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	825	0		29	10	S5820_825_0	1	1						05/25/2021	2022.01	05/25/2021 08:00:18 AM Eastern Daylight Time					06/02/2021 10:37:23 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	825	0	2022	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	826	0		29	10	S5820_826_0	1	1						05/25/2021	2022.01	05/25/2021 08:00:23 AM Eastern Daylight Time					06/02/2021 10:37:23 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	826	0	2022	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	827	0		29	10	S5820_827_0	1	1						05/25/2021	2022.01	05/25/2021 08:00:30 AM Eastern Daylight Time					06/02/2021 10:37:23 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	827	0	2022	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	828	0		29	10	S5820_828_0	1	1						05/25/2021	2022.01	05/25/2021 08:00:35 AM Eastern Daylight Time					06/02/2021 10:37:23 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	828	0	2022	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	829	0		29	10	S5820_829_0	1	1						05/25/2021	2022.01	05/25/2021 08:00:41 AM Eastern Daylight Time					06/02/2021 10:37:23 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	829	0	2022	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	830	0		29	10	S5820_830_0	1	1						05/25/2021	2022.01	05/25/2021 08:00:46 AM Eastern Daylight Time					06/02/2021 10:37:23 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	830	0	2022	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	831	0		29	10	S5820_831_0	1	1						05/25/2021	2022.01	05/25/2021 08:00:51 AM Eastern Daylight Time					06/02/2021 10:37:23 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	831	0	2022	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	832	0		29	10	S5820_832_0	1	1						05/25/2021	2022.01	05/25/2021 08:00:57 AM Eastern Daylight Time					06/02/2021 10:37:23 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	832	0	2022	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	833	0		29	10	S5820_833_0	1	1						05/25/2021	2022.01	05/25/2021 08:01:03 AM Eastern Daylight Time					06/02/2021 10:37:23 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	833	0	2022	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	834	0		29	10	S5820_834_0	1	1						05/25/2021	2022.01	05/25/2021 08:01:09 AM Eastern Daylight Time					06/02/2021 10:37:23 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	834	0	2022	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	835	0		29	10	S5820_835_0	1	1						05/25/2021	2022.01	05/25/2021 08:01:14 AM Eastern Daylight Time					06/02/2021 10:37:23 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	835	0	2022	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	836	0		29	10	S5820_836_0	1	1						05/25/2021	2022.01	05/25/2021 08:01:20 AM Eastern Daylight Time					06/02/2021 10:37:23 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	836	0	2022	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5857	802	0		29	10	S5857_802_0	7	1						05/20/2021	2022.01	05/20/2021 01:49:20 AM Eastern Daylight Time					06/07/2021 11:18:26 PM 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	2022	United States		1					2						www.prioritymedicare.com	www.prioritymedicare.com										(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850										(711)-		(711)-		(711)-		(711)-																
S5857	803	0		29	10	S5857_803_0	7	1						05/20/2021	2022.01	05/20/2021 01:49:29 AM Eastern Daylight Time					06/07/2021 11:18:26 PM Eastern Daylight Time	PRIORITY HEALTH INSURANCE COMPANY	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Rx EG Calendar Year (PDP)	10	29					S5857	803	0	2022	United States		1					2						www.prioritymedicare.com	www.prioritymedicare.com										(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850										(711)-		(711)-		(711)-		(711)-																
S5877	803	0		29	10	S5877_803_0	1	1						06/02/2021	2022.01	06/02/2021 01:53:25 PM Mountain Daylight Time					06/02/2021 01:59:41 PM Mountain Daylight Time	EDUCATORS MUTUAL INSURANCE ASSOCIATION	EMI Health	www.emihealth.com	Alpine School District Retiree Plan (PDP)	10	29					S5877	803	0	2022	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						06/02/2021	2022.01	06/02/2021 01:53:35 PM Mountain Daylight Time					06/02/2021 01:59:41 PM Mountain Daylight Time	EDUCATORS MUTUAL INSURANCE ASSOCIATION	EMI Health	www.emihealth.com	Educators Mutual Retiree Plan (PDP)	10	29					S5877	804	0	2022	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	101	0		29	10	S5884_101_0	5	1					0	07/01/2021	2022.01	07/01/2021 11:52:21 AM Eastern Daylight Time		06/02/2021 08:18:24 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	101	0	2022	States of Maine and New Hampshire		2					2						https://www.humana.com/pharmacy/	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	4	1					0	07/01/2021	2022.01	07/01/2021 11:53:51 AM Eastern Daylight Time		06/02/2021 08:18:40 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	102	0	2022	States of CT, MA, RI, VT		2					2						https://www.humana.com/pharmacy/	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	4	1					0	07/01/2021	2022.01	07/01/2021 11:54:18 AM Eastern Daylight Time		06/02/2021 08:18:58 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	103	0	2022	States of DC, DE, MD		2					2						https://www.humana.com/pharmacy/	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	4	1					0	07/01/2021	2022.01	07/01/2021 12:02:23 PM Eastern Daylight Time		06/02/2021 08:19:14 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	104	0	2022	States of Pennsylvania and West Virginia		2					2						https://www.humana.com/pharmacy/	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	4	1					0	07/01/2021	2022.01	07/01/2021 12:04:11 PM Eastern Daylight Time		06/02/2021 08:19:30 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	105	0	2022	State of Florida		2					2						https://www.humana.com/pharmacy/	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	4	1					0	07/01/2021	2022.01	07/01/2021 12:04:33 PM Eastern Daylight Time		06/02/2021 08:19:46 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	106	0	2022	States of Alabama and Tennessee		2					2						https://www.humana.com/pharmacy/	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	4	1					0	07/01/2021	2022.01	07/01/2021 12:05:03 PM Eastern Daylight Time		06/02/2021 08:20:04 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	107	0	2022	State of Illinois		2					2						https://www.humana.com/pharmacy/	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	5	1					0	07/01/2021	2022.01	07/01/2021 12:05:32 PM Eastern Daylight Time		07/26/2021 04:26:21 PM Eastern Daylight Time			07/27/2021 10:47:19 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	108	0	2022	State of Louisiana		2					2						https://www.humana.com/pharmacy/	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	4	1					0	07/01/2021	2022.01	07/01/2021 12:05:58 PM Eastern Daylight Time		06/02/2021 08:20:36 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	109	0	2022	State of Kansas		2					2						https://www.humana.com/pharmacy/	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	4	1					0	07/01/2021	2022.01	07/01/2021 12:06:38 PM Eastern Daylight Time		06/02/2021 08:20:54 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	110	0	2022	State of New Mexico		2					2						https://www.humana.com/pharmacy/	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	4	1					0	07/01/2021	2022.01	07/01/2021 12:06:58 PM Eastern Daylight Time		06/02/2021 08:21:10 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	111	0	2022	State of Colorado		2					2						https://www.humana.com/pharmacy/	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	4	1					0	07/01/2021	2022.01	07/01/2021 12:07:27 PM Eastern Daylight Time		06/02/2021 08:21:26 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	112	0	2022	State of Nevada		2					2						https://www.humana.com/pharmacy/	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	4	1					0	07/01/2021	2022.01	07/01/2021 12:07:50 PM Eastern Daylight Time		06/02/2021 08:21:42 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	113	0	2022	States of Oregon and Washington		2					2						https://www.humana.com/pharmacy/	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	4	1					0	07/01/2021	2022.01	07/01/2021 12:08:09 PM Eastern Daylight Time		06/02/2021 08:21:58 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	114	0	2022	State of California		2					2						https://www.humana.com/pharmacy/	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	4	1					0	07/01/2021	2022.01	07/01/2021 12:09:32 PM Eastern Daylight Time		06/02/2021 08:22:18 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	115	0	2022	State of Hawaii		2					2						https://www.humana.com/pharmacy/	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					0	07/01/2021	2022.01	07/01/2021 12:09:55 PM Eastern Daylight Time		06/02/2021 08:22:34 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	116	0	2022	State of Alaska		2					2						https://www.humana.com/pharmacy/	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	4	1					0	07/01/2021	2022.01	07/01/2021 12:10:16 PM Eastern Daylight Time		06/02/2021 08:22:50 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	131	0	2022	State of New Jersey		2					2						https://www.humana.com/pharmacy/	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	5	1					0	07/01/2021	2022.01	07/01/2021 12:10:36 PM Eastern Daylight Time		07/26/2021 04:26:22 PM Eastern Daylight Time			07/27/2021 10:47:19 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	132	0	2022	State of Virginia		2					2						https://www.humana.com/pharmacy/	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	4	1					0	07/01/2021	2022.01	07/01/2021 12:10:54 PM Eastern Daylight Time		06/02/2021 08:23:22 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	133	0	2022	State of North Carolina		2					2						https://www.humana.com/pharmacy/	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	4	1					0	07/01/2021	2022.01	07/01/2021 12:11:14 PM Eastern Daylight Time		06/02/2021 08:23:38 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	134	0	2022	State of South Carolina		2					2						https://www.humana.com/pharmacy/	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	4	1					0	07/01/2021	2022.01	07/01/2021 12:11:34 PM Eastern Daylight Time		06/02/2021 08:23:56 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	135	0	2022	State of Georgia		2					2						https://www.humana.com/pharmacy/	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	4	1					0	07/01/2021	2022.01	07/01/2021 12:12:08 PM Eastern Daylight Time		06/02/2021 08:24:12 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	136	0	2022	State of Michigan		2					2						https://www.humana.com/pharmacy/	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	4	1					0	07/01/2021	2022.01	07/01/2021 12:12:30 PM Eastern Daylight Time		06/02/2021 08:24:28 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	137	0	2022	State of Ohio		2					2						https://www.humana.com/pharmacy/	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	4	1					0	07/01/2021	2022.01	07/01/2021 12:12:47 PM Eastern Daylight Time		06/02/2021 08:24:44 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	138	0	2022	States of Indiana and Kentucky		2					2						https://www.humana.com/pharmacy/	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	4	1					0	07/01/2021	2022.01	07/01/2021 12:13:27 PM Eastern Daylight Time		06/02/2021 08:25:00 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	139	0	2022	State of Wisconsin		2					2						https://www.humana.com/pharmacy/	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	4	1					0	07/01/2021	2022.01	07/01/2021 12:16:45 PM Eastern Daylight Time		06/02/2021 08:25:16 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	140	0	2022	State of Missouri		2					2						https://www.humana.com/pharmacy/	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	4	1					0	07/01/2021	2022.01	07/01/2021 12:17:14 PM Eastern Daylight Time		06/02/2021 08:25:32 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	141	0	2022	State of Arkansas		2					2						https://www.humana.com/pharmacy/	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	4	1					0	07/01/2021	2022.01	07/01/2021 12:17:36 PM Eastern Daylight Time		06/02/2021 08:25:48 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	142	0	2022	State of Mississippi		2					2						https://www.humana.com/pharmacy/	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	4	1					0	07/01/2021	2022.01	07/01/2021 12:17:54 PM Eastern Daylight Time		06/02/2021 08:26:04 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	143	0	2022	State of Texas		2					2						https://www.humana.com/pharmacy/	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	4	1					0	07/01/2021	2022.01	07/01/2021 12:18:15 PM Eastern Daylight Time		06/02/2021 08:26:20 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	144	0	2022	State of Oklahoma		2					2						https://www.humana.com/pharmacy/	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					0	07/01/2021	2022.01	07/01/2021 12:20:50 PM Eastern Daylight Time		06/02/2021 08:26:36 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	145	0	2022	States of IA, MN, MT, ND, NE, SD, WY		2					2						https://www.humana.com/pharmacy/	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					0	07/01/2021	2022.01	07/01/2021 12:21:29 PM Eastern Daylight Time		06/02/2021 08:26:52 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	146	0	2022	State of Arizona		2					2						https://www.humana.com/pharmacy/	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	4	1					0	07/01/2021	2022.01	07/01/2021 12:21:58 PM Eastern Daylight Time		06/02/2021 08:27:06 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	147	0	2022	States of Idaho and Utah		2					2						https://www.humana.com/pharmacy/	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	6	1					1	07/01/2021	2022.01	07/01/2021 12:22:17 PM Eastern Daylight Time		06/02/2021 08:27:22 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	148	0	2022	States of Maine and New Hampshire		2					2						https://www.humana.com/pharmacy/	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	4	1					1	07/01/2021	2022.01	07/01/2021 12:22:41 PM Eastern Daylight Time		06/02/2021 08:27:38 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	149	0	2022	States of CT, MA, RI, VT		2					2						https://www.humana.com/pharmacy/	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	4	1					1	07/01/2021	2022.01	07/01/2021 12:23:02 PM Eastern Daylight Time		06/02/2021 08:27:54 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	150	0	2022	State of New Jersey		2					2						https://www.humana.com/pharmacy/	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	4	1					1	07/01/2021	2022.01	07/01/2021 12:23:20 PM Eastern Daylight Time		06/02/2021 08:28:10 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	151	0	2022	States of DC, DE, MD		2					2						https://www.humana.com/pharmacy/	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	4	1					1	07/01/2021	2022.01	07/01/2021 12:23:37 PM Eastern Daylight Time		06/02/2021 08:28:26 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	152	0	2022	States of Pennsylvania and West Virginia		2					2						https://www.humana.com/pharmacy/	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	4	1					1	07/01/2021	2022.01	07/01/2021 12:24:01 PM Eastern Daylight Time		06/02/2021 08:28:40 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	153	0	2022	State of Virginia		2					2						https://www.humana.com/pharmacy/	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	4	1					1	07/01/2021	2022.01	07/01/2021 12:24:20 PM Eastern Daylight Time		06/02/2021 08:28:56 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	154	0	2022	State of North Carolina		2					2						https://www.humana.com/pharmacy/	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	4	1					1	07/01/2021	2022.01	07/01/2021 12:24:42 PM Eastern Daylight Time		06/02/2021 08:29:12 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	155	0	2022	State of South Carolina		2					2						https://www.humana.com/pharmacy/	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	4	1					1	07/01/2021	2022.01	07/01/2021 12:24:59 PM Eastern Daylight Time		06/02/2021 08:29:28 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	156	0	2022	State of Georgia		2					2						https://www.humana.com/pharmacy/	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	4	1					1	07/01/2021	2022.01	07/01/2021 12:25:23 PM Eastern Daylight Time		06/02/2021 08:29:44 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	157	0	2022	State of Florida		2					2						https://www.humana.com/pharmacy/	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	4	1					1	07/01/2021	2022.01	07/01/2021 12:25:44 PM Eastern Daylight Time		06/02/2021 08:30:00 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	158	0	2022	States of Alabama and Tennessee		2					2						https://www.humana.com/pharmacy/	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	4	1					1	07/01/2021	2022.01	07/01/2021 12:26:01 PM Eastern Daylight Time		06/02/2021 08:30:16 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	159	0	2022	State of Michigan		2					2						https://www.humana.com/pharmacy/	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	4	1					1	07/01/2021	2022.01	07/01/2021 12:26:24 PM Eastern Daylight Time		06/02/2021 08:30:34 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	160	0	2022	State of Ohio		2					2						https://www.humana.com/pharmacy/	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	4	1					1	07/01/2021	2022.01	07/01/2021 12:26:44 PM Eastern Daylight Time		06/02/2021 08:30:50 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	161	0	2022	States of Indiana and Kentucky		2					2						https://www.humana.com/pharmacy/	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	4	1					1	07/01/2021	2022.01	07/01/2021 12:27:35 PM Eastern Daylight Time		06/02/2021 08:31:06 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	162	0	2022	State of Wisconsin		2					2						https://www.humana.com/pharmacy/	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	4	1					1	07/01/2021	2022.01	07/01/2021 12:27:52 PM Eastern Daylight Time		06/02/2021 08:31:22 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	163	0	2022	State of Illinois		2					2						https://www.humana.com/pharmacy/	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	4	1					1	07/01/2021	2022.01	07/01/2021 12:28:37 PM Eastern Daylight Time		06/02/2021 08:31:38 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	164	0	2022	State of Missouri		2					2						https://www.humana.com/pharmacy/	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	4	1					1	07/01/2021	2022.01	07/01/2021 12:29:05 PM Eastern Daylight Time		06/02/2021 08:31:54 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	165	0	2022	State of Arkansas		2					2						https://www.humana.com/pharmacy/	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	4	1					1	07/01/2021	2022.01	07/01/2021 12:29:23 PM Eastern Daylight Time		06/02/2021 08:32:10 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	166	0	2022	State of Mississippi		2					2						https://www.humana.com/pharmacy/	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	4	1					1	07/01/2021	2022.01	07/01/2021 12:29:41 PM Eastern Daylight Time		06/02/2021 08:32:26 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	167	0	2022	State of Louisiana		2					2						https://www.humana.com/pharmacy/	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	4	1					1	07/01/2021	2022.01	07/01/2021 12:29:58 PM Eastern Daylight Time		06/02/2021 08:32:42 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	168	0	2022	State of Texas		2					2						https://www.humana.com/pharmacy/	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	4	1					1	07/01/2021	2022.01	07/01/2021 12:30:14 PM Eastern Daylight Time		06/02/2021 08:32:56 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	169	0	2022	State of Oklahoma		2					2						https://www.humana.com/pharmacy/	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	4	1					1	07/01/2021	2022.01	07/01/2021 12:31:21 PM Eastern Daylight Time		06/02/2021 08:33:12 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	170	0	2022	State of Kansas		2					2						https://www.humana.com/pharmacy/	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	4	1					1	07/01/2021	2022.01	07/01/2021 12:31:39 PM Eastern Daylight Time		06/02/2021 08:33:28 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	171	0	2022	States of IA, MN, MT, ND, NE, SD, WY		2					2						https://www.humana.com/pharmacy/	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	4	1					1	07/01/2021	2022.01	07/01/2021 12:32:09 PM Eastern Daylight Time		06/02/2021 08:33:44 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	172	0	2022	State of New Mexico		2					2						https://www.humana.com/pharmacy/	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	4	1					1	07/01/2021	2022.01	07/01/2021 12:32:27 PM Eastern Daylight Time		06/02/2021 08:34:00 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	173	0	2022	State of Colorado		2					2						https://www.humana.com/pharmacy/	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	4	1					1	07/01/2021	2022.01	07/01/2021 12:32:45 PM Eastern Daylight Time		06/02/2021 08:34:16 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	174	0	2022	State of Arizona		2					2						https://www.humana.com/pharmacy/	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	4	1					1	07/01/2021	2022.01	07/01/2021 12:33:04 PM Eastern Daylight Time		06/02/2021 08:34:32 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	175	0	2022	State of Nevada		2					2						https://www.humana.com/pharmacy/	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	4	1					1	07/01/2021	2022.01	07/01/2021 12:34:06 PM Eastern Daylight Time		06/02/2021 08:34:48 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	176	0	2022	States of Oregon and Washington		2					2						https://www.humana.com/pharmacy/	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	4	1					1	07/01/2021	2022.01	07/01/2021 12:34:24 PM Eastern Daylight Time		06/02/2021 08:35:04 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	177	0	2022	States of Idaho and Utah		2					2						https://www.humana.com/pharmacy/	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	4	1					1	07/01/2021	2022.01	07/01/2021 12:34:40 PM Eastern Daylight Time		06/02/2021 08:35:20 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	178	0	2022	State of California		2					2						https://www.humana.com/pharmacy/	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	4	1					1	07/01/2021	2022.01	07/01/2021 12:35:15 PM Eastern Daylight Time		06/02/2021 08:35:36 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	179	0	2022	State of Hawaii		2					2						https://www.humana.com/pharmacy/	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	4	1					1	07/01/2021	2022.01	07/01/2021 12:35:32 PM Eastern Daylight Time		06/02/2021 08:35:52 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	180	0	2022	State of Alaska		2					2						https://www.humana.com/pharmacy/	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	181	0		29	10	S5884_181_0	5	1					0	07/01/2021	2022.01	07/01/2021 12:35:49 PM Eastern Daylight Time		06/02/2021 08:36:08 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	181	0	2022	States of Maine and New Hampshire		2					2						https://www.humana.com/pharmacy/	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	182	0		29	10	S5884_182_0	4	1					0	07/01/2021	2022.01	07/01/2021 12:36:49 PM Eastern Daylight Time		06/02/2021 08:36:24 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	182	0	2022	States of CT, MA, RI, VT		2					2						https://www.humana.com/pharmacy/	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	183	0		29	10	S5884_183_0	4	1					0	07/01/2021	2022.01	07/01/2021 12:37:04 PM Eastern Daylight Time		06/02/2021 08:36:40 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	183	0	2022	State of New Jersey		2					2						https://www.humana.com/pharmacy/	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	184	0		29	10	S5884_184_0	4	1					0	07/01/2021	2022.01	07/01/2021 12:37:21 PM Eastern Daylight Time		06/02/2021 08:36:56 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	184	0	2022	States of DC, DE, MD		2					2						https://www.humana.com/pharmacy/	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	185	0		29	10	S5884_185_0	4	1					0	07/01/2021	2022.01	07/01/2021 12:37:41 PM Eastern Daylight Time		06/02/2021 08:37:12 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	185	0	2022	States of Pennsylvania and West Virginia		2					2						https://www.humana.com/pharmacy/	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	186	0		29	10	S5884_186_0	4	1					0	07/01/2021	2022.01	07/01/2021 12:37:57 PM Eastern Daylight Time		06/02/2021 08:37:28 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	186	0	2022	State of Virginia		2					2						https://www.humana.com/pharmacy/	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	187	0		29	10	S5884_187_0	4	1					0	07/01/2021	2022.01	07/01/2021 12:38:16 PM Eastern Daylight Time		06/02/2021 08:37:44 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	187	0	2022	State of North Carolina		2					2						https://www.humana.com/pharmacy/	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	188	0		29	10	S5884_188_0	4	1					0	07/01/2021	2022.01	07/01/2021 12:38:34 PM Eastern Daylight Time		06/02/2021 08:38:00 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	188	0	2022	State of South Carolina		2					2						https://www.humana.com/pharmacy/	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	189	0		29	10	S5884_189_0	4	1					0	07/01/2021	2022.01	07/01/2021 12:38:51 PM Eastern Daylight Time		06/02/2021 08:38:16 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	189	0	2022	State of Georgia		2					2						https://www.humana.com/pharmacy/	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	190	0		29	10	S5884_190_0	4	1					0	07/01/2021	2022.01	07/01/2021 12:39:15 PM Eastern Daylight Time		06/02/2021 08:38:32 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	190	0	2022	State of Florida		2					2						https://www.humana.com/pharmacy/	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	191	0		29	10	S5884_191_0	4	1					0	07/01/2021	2022.01	07/01/2021 12:39:32 PM Eastern Daylight Time		06/02/2021 08:38:48 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	191	0	2022	States of Alabama and Tennessee		2					2						https://www.humana.com/pharmacy/	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	192	0		29	10	S5884_192_0	4	1					0	07/01/2021	2022.01	07/01/2021 12:39:49 PM Eastern Daylight Time		06/02/2021 08:39:04 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	192	0	2022	State of Michigan		2					2						https://www.humana.com/pharmacy/	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	193	0		29	10	S5884_193_0	4	1					0	07/01/2021	2022.01	07/01/2021 12:40:05 PM Eastern Daylight Time		06/02/2021 08:39:22 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	193	0	2022	State of Ohio		2					2						https://www.humana.com/pharmacy/	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	194	0		29	10	S5884_194_0	4	1					0	07/01/2021	2022.01	07/01/2021 12:40:21 PM Eastern Daylight Time		06/02/2021 08:39:36 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	194	0	2022	States of Indiana and Kentucky		2					2						https://www.humana.com/pharmacy/	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	195	0		29	10	S5884_195_0	4	1					0	07/01/2021	2022.01	07/01/2021 12:40:37 PM Eastern Daylight Time		06/02/2021 08:39:52 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	195	0	2022	State of Wisconsin		2					2						https://www.humana.com/pharmacy/	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	196	0		29	10	S5884_196_0	4	1					0	07/01/2021	2022.01	07/01/2021 12:40:53 PM Eastern Daylight Time		06/02/2021 08:40:10 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	196	0	2022	State of Illinois		2					2						https://www.humana.com/pharmacy/	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	197	0		29	10	S5884_197_0	4	1					0	07/01/2021	2022.01	07/01/2021 12:41:09 PM Eastern Daylight Time		06/02/2021 08:40:26 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	197	0	2022	State of Missouri		2					2						https://www.humana.com/pharmacy/	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	198	0		29	10	S5884_198_0	4	1					0	07/01/2021	2022.01	07/01/2021 12:41:29 PM Eastern Daylight Time		06/02/2021 08:40:42 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	198	0	2022	State of Arkansas		2					2						https://www.humana.com/pharmacy/	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	199	0		29	10	S5884_199_0	4	1					0	07/01/2021	2022.01	07/01/2021 12:41:44 PM Eastern Daylight Time		06/02/2021 08:41:00 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	199	0	2022	State of Mississippi		2					2						https://www.humana.com/pharmacy/	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	200	0		29	10	S5884_200_0	4	1					0	07/01/2021	2022.01	07/01/2021 12:42:00 PM Eastern Daylight Time		06/02/2021 08:41:16 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	200	0	2022	State of Louisiana		2					2						https://www.humana.com/pharmacy/	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	201	0		29	10	S5884_201_0	4	1					0	07/01/2021	2022.01	07/01/2021 12:42:16 PM Eastern Daylight Time		06/02/2021 08:41:32 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	201	0	2022	State of Texas		2					2						https://www.humana.com/pharmacy/	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	202	0		29	10	S5884_202_0	4	1					0	07/01/2021	2022.01	07/01/2021 12:42:33 PM Eastern Daylight Time		06/02/2021 08:41:48 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	202	0	2022	State of Oklahoma		2					2						https://www.humana.com/pharmacy/	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	203	0		29	10	S5884_203_0	4	1					0	07/01/2021	2022.01	07/01/2021 12:42:49 PM Eastern Daylight Time		06/02/2021 08:42:04 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	203	0	2022	State of Kansas		2					2						https://www.humana.com/pharmacy/	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	204	0		29	10	S5884_204_0	4	1					0	07/01/2021	2022.01	07/01/2021 12:43:05 PM Eastern Daylight Time		06/02/2021 08:42:20 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	204	0	2022	States of IA, MN, MT, ND, NE, SD, WY		2					2						https://www.humana.com/pharmacy/	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	205	0		29	10	S5884_205_0	4	1					0	07/01/2021	2022.01	07/01/2021 12:43:24 PM Eastern Daylight Time		06/02/2021 08:42:36 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	205	0	2022	State of New Mexico		2					2						https://www.humana.com/pharmacy/	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	206	0		29	10	S5884_206_0	4	1					0	07/01/2021	2022.01	07/01/2021 12:43:41 PM Eastern Daylight Time		06/02/2021 08:42:52 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	206	0	2022	State of Colorado		2					2						https://www.humana.com/pharmacy/	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	207	0		29	10	S5884_207_0	4	1					0	07/01/2021	2022.01	07/01/2021 12:44:06 PM Eastern Daylight Time		06/02/2021 08:43:08 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	207	0	2022	State of Arizona		2					2						https://www.humana.com/pharmacy/	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	208	0		29	10	S5884_208_0	4	1					0	07/01/2021	2022.01	07/01/2021 12:45:27 PM Eastern Daylight Time		06/02/2021 08:43:24 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	208	0	2022	State of Nevada		2					2						https://www.humana.com/pharmacy/	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	209	0		29	10	S5884_209_0	4	1					0	07/01/2021	2022.01	07/01/2021 12:45:43 PM Eastern Daylight Time		06/02/2021 08:43:40 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	209	0	2022	States of Oregon and Washington		2					2						https://www.humana.com/pharmacy/	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	210	0		29	10	S5884_210_0	4	1					0	07/01/2021	2022.01	07/01/2021 12:46:03 PM Eastern Daylight Time		06/02/2021 08:43:56 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	210	0	2022	States of Idaho and Utah		2					2						https://www.humana.com/pharmacy/	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	211	0		29	10	S5884_211_0	4	1					0	07/01/2021	2022.01	07/01/2021 12:46:30 PM Eastern Daylight Time		06/02/2021 08:44:12 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	211	0	2022	State of California		2					2						https://www.humana.com/pharmacy/	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	212	0		29	10	S5884_212_0	4	1					0	07/01/2021	2022.01	07/01/2021 12:46:44 PM Eastern Daylight Time		06/02/2021 08:44:28 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	212	0	2022	State of Hawaii		2					2						https://www.humana.com/pharmacy/	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	213	0		29	10	S5884_213_0	4	1					0	07/01/2021	2022.01	07/01/2021 12:47:09 PM Eastern Daylight Time		06/02/2021 08:44:44 PM Eastern Daylight Time			07/02/2021 11:23:21 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	213	0	2022	State of Alaska		2					2						https://www.humana.com/pharmacy/	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	3	1						05/18/2021	2022.01	05/18/2021 10:11:48 AM Eastern Daylight Time					06/01/2021 02:13:18 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PDP)	10	29					S5884	834	0	2022	All Regions		1					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(866)396-8810		(866)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-																
S5904	001	0		29	10	S5904_001_0	5	1					0	05/28/2021	2022.01	05/28/2021 11:19:09 PM Eastern Daylight Time		07/26/2021 11:23:33 AM Eastern Daylight Time			07/26/2021 05:19:39 PM 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	2022	State of Florida		2					2						FloridaBlue.com/medicare	MyPrime.com										(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	3	1					1	06/03/2021	2022.01	06/03/2021 05:16:25 PM Eastern Daylight Time		06/07/2021 01:53:29 PM Eastern Daylight Time			06/07/2021 04:37:14 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	2022	State of Florida		2					2						FloridaBlue.com/medicare	MyPrime.com										(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	3	1						06/04/2021	2022.01	06/04/2021 06:57:38 PM Eastern Daylight Time					06/07/2021 04:37:14 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	2022	State of Florida with National Coverage		1					2						FloridaBlue.com/medicare	MyPrime.com										(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	3	1						06/04/2021	2022.01	06/04/2021 07:12:38 PM Eastern Daylight Time					06/07/2021 04:37:14 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	2022	State of Florida with National Coverage		1					2						FloridaBlue.com/medicare	MyPrime.com										(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	2	1					0	06/02/2021	2022.01	06/02/2021 03:53:48 PM Pacific Daylight Time		06/04/2021 02:34:04 PM Pacific Daylight Time			06/04/2021 03:12:43 PM Pacific 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	2022	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	3	1					0	06/02/2021	2022.01	06/02/2021 03:56:39 PM Pacific Daylight Time		06/29/2021 03:32:22 PM Pacific Daylight Time			07/01/2021 10:11:37 AM Pacific 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	2022	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	802	0		29	10	S5916_802_0	3	1						04/19/2021	2022.01	04/19/2021 09:57:05 AM Pacific Daylight Time					06/03/2021 11:12:52 AM Pacific 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	2022	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	3	1						04/19/2021	2022.01	04/19/2021 09:57:10 AM Pacific Daylight Time					06/03/2021 11:12:52 AM Pacific 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	2022	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	3	1						05/05/2021	2022.01	05/05/2021 09:51:26 AM Pacific Daylight Time					06/03/2021 11:12:52 AM Pacific 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	2022	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	3	1					0	05/25/2021	2022.01	05/25/2021 10:17:24 AM Central Daylight Time		06/03/2021 08:39:21 PM Central Daylight Time			06/04/2021 10:15:14 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	348	0	2022	Connecticut, Massachusetts, Rhode Island, Vermont		2					2						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	3	1					0	05/25/2021	2022.01	05/25/2021 10:25:48 AM Central Daylight Time		06/03/2021 08:39:21 PM Central Daylight Time			06/04/2021 10:15:14 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	349	0	2022	New Jersey		2					2						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	3	1					0	05/25/2021	2022.01	05/25/2021 10:25:58 AM Central Daylight Time		06/03/2021 08:39:22 PM Central Daylight Time			06/04/2021 10:15:14 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	350	0	2022	Delaware, Maryland and Washington D.C.		2					2						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	3	1					0	05/25/2021	2022.01	05/25/2021 10:26:08 AM Central Daylight Time		06/03/2021 08:39:22 PM Central Daylight Time			06/04/2021 10:15:14 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	351	0	2022	Pennsylvania and West Virginia		2					2						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					0	05/25/2021	2022.01	05/25/2021 10:26:18 AM Central Daylight Time		07/14/2021 01:25:40 PM Central Daylight Time			07/26/2021 01:00:40 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	352	0	2022	Virginia		2					2						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	3	1					0	05/25/2021	2022.01	05/25/2021 10:26:29 AM Central Daylight Time		06/03/2021 08:39:23 PM Central Daylight Time			06/04/2021 10:15:14 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	353	0	2022	North Carolina		2					2						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	3	1					0	05/25/2021	2022.01	05/25/2021 10:26:40 AM Central Daylight Time		06/03/2021 08:39:24 PM Central Daylight Time			06/04/2021 10:15:14 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	354	0	2022	South Carolina		2					2						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	3	1					0	05/25/2021	2022.01	05/25/2021 10:27:12 AM Central Daylight Time		06/03/2021 08:39:24 PM Central Daylight Time			06/04/2021 10:15:14 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	355	0	2022	Georgia		2					2						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					0	05/25/2021	2022.01	05/25/2021 10:27:22 AM Central Daylight Time		06/03/2021 08:39:24 PM Central Daylight Time			06/04/2021 10:15:14 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	356	0	2022	Florida		2					2						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	3	1					0	05/25/2021	2022.01	05/25/2021 10:27:31 AM Central Daylight Time		06/03/2021 08:39:25 PM Central Daylight Time			06/04/2021 10:15:14 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	357	0	2022	Alabama and Tennessee		2					2						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	3	1					0	05/25/2021	2022.01	05/25/2021 10:27:40 AM Central Daylight Time		06/03/2021 08:39:26 PM Central Daylight Time			06/04/2021 10:15:14 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	358	0	2022	Michigan		2					2						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	3	1					0	05/25/2021	2022.01	05/25/2021 10:27:50 AM Central Daylight Time		06/03/2021 08:39:26 PM Central Daylight Time			06/04/2021 10:15:14 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	359	0	2022	Ohio		2					2						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	3	1					0	05/25/2021	2022.01	05/25/2021 10:28:00 AM Central Daylight Time		06/03/2021 08:39:27 PM Central Daylight Time			06/04/2021 10:15:14 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	360	0	2022	Indiana and Kentucky		2					2						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	4	1					0	05/25/2021	2022.01	05/25/2021 10:28:10 AM Central Daylight Time		06/03/2021 08:39:27 PM Central Daylight Time			06/04/2021 10:15:14 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	361	0	2022	Wisconsin		2					2						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	3	1					0	05/25/2021	2022.01	05/25/2021 10:28:21 AM Central Daylight Time		06/03/2021 08:39:27 PM Central Daylight Time			06/04/2021 10:15:14 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	362	0	2022	Illinois		2					2						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	3	1					0	05/25/2021	2022.01	05/25/2021 10:28:32 AM Central Daylight Time		06/03/2021 08:39:28 PM Central Daylight Time			06/04/2021 10:15:14 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	363	0	2022	Missouri		2					2						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	3	1					0	05/25/2021	2022.01	05/25/2021 10:28:45 AM Central Daylight Time		06/03/2021 08:39:28 PM Central Daylight Time			06/04/2021 10:15:14 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	364	0	2022	Arkansas		2					2						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	3	1					0	05/25/2021	2022.01	05/25/2021 10:28:57 AM Central Daylight Time		06/03/2021 08:39:29 PM Central Daylight Time			06/04/2021 10:15:14 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	365	0	2022	Mississippi		2					2						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					0	05/25/2021	2022.01	05/25/2021 10:29:12 AM Central Daylight Time		07/14/2021 01:25:53 PM Central Daylight Time			07/26/2021 01:00:40 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	366	0	2022	Louisiana		2					2						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	3	1					0	05/25/2021	2022.01	05/25/2021 10:29:22 AM Central Daylight Time		06/03/2021 08:39:29 PM Central Daylight Time			06/04/2021 10:15:14 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	367	0	2022	Texas		2					2						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					0	05/25/2021	2022.01	05/25/2021 10:29:33 AM Central Daylight Time		06/03/2021 08:39:30 PM Central Daylight Time			06/04/2021 10:15:14 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	368	0	2022	Oklahoma		2					2						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	3	1					0	05/25/2021	2022.01	05/25/2021 10:29:49 AM Central Daylight Time		06/03/2021 08:39:30 PM Central Daylight Time			06/04/2021 10:15:14 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	369	0	2022	Kansas		2					2						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	4	1					0	05/25/2021	2022.01	05/25/2021 10:29:59 AM Central Daylight Time		07/14/2021 01:26:06 PM Central Daylight Time			07/26/2021 01:00:40 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	370	0	2022	IA, MN, MT, ND, NE, SD, WY		2					2						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	3	1					0	05/25/2021	2022.01	05/25/2021 10:30:12 AM Central Daylight Time		06/03/2021 08:39:31 PM Central Daylight Time			06/04/2021 10:15:14 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	371	0	2022	New Mexico		2					2						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	3	1					0	05/25/2021	2022.01	05/25/2021 10:30:29 AM Central Daylight Time		06/03/2021 08:39:32 PM Central Daylight Time			06/04/2021 10:15:14 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	372	0	2022	Colorado		2					2						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	3	1					0	05/25/2021	2022.01	05/25/2021 10:31:09 AM Central Daylight Time		06/03/2021 08:39:32 PM Central Daylight Time			06/04/2021 10:15:14 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	373	0	2022	Nevada		2					2						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	3	1					0	05/25/2021	2022.01	05/25/2021 10:31:58 AM Central Daylight Time		06/03/2021 08:39:33 PM Central Daylight Time			06/04/2021 10:15:14 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	374	0	2022	Oregon and Washington		2					2						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	3	1					0	05/25/2021	2022.01	05/25/2021 10:32:10 AM Central Daylight Time		06/03/2021 08:39:33 PM Central Daylight Time			06/04/2021 10:15:14 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	375	0	2022	Idaho and Utah		2					2						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	3	1					0	05/25/2021	2022.01	05/25/2021 10:32:19 AM Central Daylight Time		06/03/2021 08:39:33 PM Central Daylight Time			06/04/2021 10:15:14 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	376	0	2022	California		2					2						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	3	1					0	05/25/2021	2022.01	05/25/2021 10:32:53 AM Central Daylight Time		06/03/2021 08:39:34 PM Central Daylight Time			06/04/2021 10:15:14 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	377	0	2022	Alaska		2					2						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	3	1					0	05/25/2021	2022.01	05/25/2021 10:33:03 AM Central Daylight Time		06/03/2021 08:39:34 PM Central Daylight Time			06/04/2021 10:15:14 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	378	0	2022	Maine and New Hampshire		2					2						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	3	1					0	05/25/2021	2022.01	05/25/2021 10:33:17 AM Central Daylight Time		06/03/2021 08:39:35 PM Central Daylight Time			06/04/2021 10:15:14 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	379	0	2022	New York		2					2						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	4	1					0	05/25/2021	2022.01	05/25/2021 10:33:46 AM Central Daylight Time		06/03/2021 08:39:35 PM Central Daylight Time			06/04/2021 10:15:14 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	380	0	2022	Arizona		2					2						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	3	1					0	05/25/2021	2022.01	05/25/2021 10:34:14 AM Central Daylight Time		06/03/2021 08:39:35 PM Central Daylight Time			06/04/2021 10:15:14 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	381	0	2022	Hawaii		2					2						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	3	1					0	05/25/2021	2022.01	05/25/2021 10:34:25 AM Central Daylight Time		06/03/2021 08:39:36 PM Central Daylight Time			06/04/2021 10:57:38 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	382	0	2022	New York		2					2						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	3	1					0	05/25/2021	2022.01	05/25/2021 10:34:35 AM Central Daylight Time		06/03/2021 08:39:36 PM Central Daylight Time			06/04/2021 10:57:38 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	383	0	2022	Florida		2					2						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	3	1					0	05/25/2021	2022.01	05/25/2021 10:34:46 AM Central Daylight Time		06/03/2021 08:39:37 PM Central Daylight Time			06/04/2021 10:57:38 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	384	0	2022	Northern New England		2					2						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	3	1					0	05/25/2021	2022.01	05/25/2021 10:34:56 AM Central Daylight Time		06/03/2021 08:39:37 PM Central Daylight Time			06/04/2021 10:57:38 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	385	0	2022	Central New England		2					2						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	3	1					0	05/25/2021	2022.01	05/25/2021 10:35:06 AM Central Daylight Time		06/03/2021 08:39:37 PM Central Daylight Time			06/04/2021 10:57:38 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	386	0	2022	New Jersey		2					2						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	3	1					0	05/25/2021	2022.01	05/25/2021 10:35:19 AM Central Daylight Time		06/03/2021 08:39:38 PM Central Daylight Time			06/04/2021 10:57:38 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	387	0	2022	Mid-Atlantic		2					2						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	3	1					0	05/25/2021	2022.01	05/25/2021 10:35:30 AM Central Daylight Time		06/03/2021 08:39:38 PM Central Daylight Time			06/04/2021 10:57:38 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	388	0	2022	Pennsylvania and West Virginia		2					2						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	3	1					0	05/25/2021	2022.01	05/25/2021 10:35:40 AM Central Daylight Time		06/03/2021 08:39:39 PM Central Daylight Time			06/04/2021 10:57:38 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	389	0	2022	Virginia		2					2						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	3	1					0	05/25/2021	2022.01	05/25/2021 10:35:50 AM Central Daylight Time		06/03/2021 08:39:39 PM Central Daylight Time			06/04/2021 10:57:38 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	390	0	2022	North Carolina		2					2						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	3	1					0	05/25/2021	2022.01	05/25/2021 10:36:01 AM Central Daylight Time		06/03/2021 08:39:39 PM Central Daylight Time			06/04/2021 10:57:38 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	391	0	2022	South Carolina		2					2						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	3	1					0	05/25/2021	2022.01	05/25/2021 10:36:12 AM Central Daylight Time		06/03/2021 08:39:40 PM Central Daylight Time			06/04/2021 10:57:38 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	392	0	2022	Georgia		2					2						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					0	05/25/2021	2022.01	05/25/2021 10:36:22 AM Central Daylight Time		06/03/2021 08:39:40 PM Central Daylight Time			06/04/2021 10:57:38 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	393	0	2022	Alabama and Tennessee		2					2						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	3	1					0	05/25/2021	2022.01	05/25/2021 10:36:32 AM Central Daylight Time		06/03/2021 08:39:41 PM Central Daylight Time			06/04/2021 10:57:38 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	394	0	2022	Michigan		2					2						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	3	1					0	05/25/2021	2022.01	05/25/2021 10:36:42 AM Central Daylight Time		06/03/2021 08:39:41 PM Central Daylight Time			06/04/2021 10:57:38 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	395	0	2022	Ohio		2					2						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	3	1					0	05/25/2021	2022.01	05/25/2021 10:36:52 AM Central Daylight Time		06/03/2021 08:39:42 PM Central Daylight Time			06/04/2021 10:57:38 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	396	0	2022	Indiana and Kentucky		2					2						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	3	1					0	05/25/2021	2022.01	05/25/2021 10:37:02 AM Central Daylight Time		06/03/2021 08:39:42 PM Central Daylight Time			06/04/2021 10:57:38 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	397	0	2022	Wisconsin		2					2						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	3	1					0	05/25/2021	2022.01	05/25/2021 10:37:13 AM Central Daylight Time		06/03/2021 08:39:42 PM Central Daylight Time			06/04/2021 10:57:38 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	398	0	2022	Illinois		2					2						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	3	1					0	05/25/2021	2022.01	05/25/2021 10:37:34 AM Central Daylight Time		06/03/2021 08:39:43 PM Central Daylight Time			06/04/2021 10:57:38 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	399	0	2022	Missouri		2					2						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	3	1					0	05/25/2021	2022.01	05/25/2021 10:37:45 AM Central Daylight Time		06/03/2021 08:39:43 PM Central Daylight Time			06/04/2021 10:57:38 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	400	0	2022	Arkansas		2					2						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	3	1					0	05/25/2021	2022.01	05/25/2021 10:37:57 AM Central Daylight Time		06/03/2021 08:39:44 PM Central Daylight Time			06/04/2021 10:57:38 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	401	0	2022	Mississippi		2					2						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	3	1					0	05/25/2021	2022.01	05/25/2021 10:38:13 AM Central Daylight Time		06/03/2021 08:39:44 PM Central Daylight Time			06/04/2021 10:57:38 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	402	0	2022	Louisiana		2					2						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	3	1					0	05/25/2021	2022.01	05/25/2021 10:38:28 AM Central Daylight Time		06/03/2021 08:39:45 PM Central Daylight Time			06/04/2021 10:57:38 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	403	0	2022	Texas		2					2						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	3	1					0	05/25/2021	2022.01	05/25/2021 10:38:40 AM Central Daylight Time		06/03/2021 08:39:45 PM Central Daylight Time			06/04/2021 10:57:38 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	404	0	2022	Oklahoma		2					2						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	3	1					0	05/25/2021	2022.01	05/25/2021 10:38:53 AM Central Daylight Time		06/03/2021 08:39:45 PM Central Daylight Time			06/04/2021 10:57:38 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	405	0	2022	Kansas		2					2						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	3	1					0	05/25/2021	2022.01	05/25/2021 10:39:03 AM Central Daylight Time		06/03/2021 08:39:46 PM Central Daylight Time			06/04/2021 10:57:38 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	406	0	2022	Upper Midwest and Northern Plains		2					2						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	4	1					0	05/25/2021	2022.01	05/25/2021 10:39:13 AM Central Daylight Time		06/03/2021 08:39:46 PM Central Daylight Time			06/04/2021 10:57:38 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	407	0	2022	New Mexico		2					2						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	3	1					0	05/25/2021	2022.01	05/25/2021 10:39:44 AM Central Daylight Time		06/03/2021 08:39:46 PM Central Daylight Time			06/04/2021 10:57:38 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	408	0	2022	Colorado		2					2						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	3	1					0	05/25/2021	2022.01	05/25/2021 10:39:55 AM Central Daylight Time		06/03/2021 08:39:47 PM Central Daylight Time			06/04/2021 10:57:38 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	409	0	2022	Arizona		2					2						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	3	1					0	05/25/2021	2022.01	05/25/2021 10:40:06 AM Central Daylight Time		06/03/2021 08:39:47 PM Central Daylight Time			06/04/2021 10:57:38 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	410	0	2022	Nevada		2					2						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	3	1					0	05/25/2021	2022.01	05/25/2021 10:40:17 AM Central Daylight Time		06/03/2021 08:39:48 PM Central Daylight Time			06/04/2021 10:57:38 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	411	0	2022	Oregon and Washington		2					2						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	3	1					0	05/25/2021	2022.01	05/25/2021 10:40:36 AM Central Daylight Time		06/03/2021 08:39:48 PM Central Daylight Time			06/04/2021 10:57:38 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	412	0	2022	Idaho and Utah		2					2						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	3	1					0	05/25/2021	2022.01	05/25/2021 10:40:47 AM Central Daylight Time		06/03/2021 08:39:49 PM Central Daylight Time			06/04/2021 10:57:38 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	413	0	2022	California		2					2						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	3	1					0	05/25/2021	2022.01	05/25/2021 10:40:58 AM Central Daylight Time		06/03/2021 08:39:49 PM Central Daylight Time			06/04/2021 10:57:38 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	414	0	2022	Hawaii		2					2						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	3	1					0	05/25/2021	2022.01	05/25/2021 10:41:09 AM Central Daylight Time		06/03/2021 08:39:50 PM Central Daylight Time			06/04/2021 10:57:38 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	415	0	2022	Alaska		2					2						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						05/25/2021	2022.01	05/25/2021 08:01:30 AM Eastern Daylight Time					06/02/2021 10:38:37 AM Eastern Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5921	802	0	2022	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5921	837	0		29	10	S5921_837_0	1	1						05/25/2021	2022.01	05/25/2021 08:01:35 AM Eastern Daylight Time					06/02/2021 10:38:37 AM Eastern Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5921	837	0	2022	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5953	001	0		29	10	S5953_001_0	2	1					0	06/03/2021	2022.01	06/03/2021 01:58:40 PM Eastern Daylight Time		06/05/2021 09:07:03 PM Eastern Daylight Time			06/06/2021 02:05:24 PM Eastern Daylight Time	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Blue Cross Blue Shield of South Carolina	www.scbluesmedadvantage.com/marx22	BlueCross Rx Value (PDP)	10	29					S5953	001	0	2022	South Carolina		2					2						www.scbluesmedadvantage.com/marx22	www.scbluesmedadvantage.com/marx22										(888)645-6025		(888)645-6025		(800)930-2836		(800)930-2836										(711)-		(711)-		(711)-		(711)-																
S5953	002	0		29	10	S5953_002_0	3	1					0	05/28/2021	2022.01	05/28/2021 03:38:29 PM Eastern Daylight Time		06/07/2021 12:30:10 AM Eastern Daylight Time			06/07/2021 10:28:37 AM Eastern Daylight Time	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Blue Cross Blue Shield of South Carolina	www.scbluesmedadvantage.com/marx22	BlueCross Rx Plus (PDP)	10	29					S5953	002	0	2022	South Carolina		2					2						www.scbluesmedadvantage.com/marx22	www.scbluesmedadvantage.com/marx22										(888)645-6025		(888)645-6025		(800)930-2836		(800)930-2836										(711)-		(711)-		(711)-		(711)-																
S5953	004	0		29	10	S5953_004_0	3	1					0	06/02/2021	2022.01	06/02/2021 03:24:41 PM Eastern Daylight Time		06/24/2021 05:37:08 PM Eastern Daylight Time			07/07/2021 10:37:26 AM Eastern Daylight Time	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Blue Cross Blue Shield of South Carolina	www.scbluesmedadvantage.com/marx22	BlueCross Rx Essential (PDP)	10	29					S5953	004	0	2022	South Carolina		2					2						www.scbluesmedadvantage.com/marx22	www.scbluesmedadvantage.com/marx22										(888)645-6025		(888)645-6025		(800)930-2836		(800)930-2836										(711)-		(711)-		(711)-		(711)-																
S5953	801	0		29	10	S5953_801_0	2	1						05/28/2021	2022.01	05/28/2021 04:06:49 PM Eastern Daylight Time					06/07/2021 01:55:56 PM Eastern Daylight Time	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Blue Cross Blue Shield of South Carolina	www.scbluesmedadvantage.com	Group Blue Rx Plus (PDP)	10	29					S5953	801	0	2022	South Carolina		1					2						www.scbluesmedadvantage.com	www.scbluesmedadvantage.com										(888)645-6025		(888)645-6025		(800)930-2836		(800)930-2836										(711)-		(711)-		(711)-		(711)-																
S5953	802	0		29	10	S5953_802_0	2	1						05/28/2021	2022.01	05/28/2021 04:07:00 PM Eastern Daylight Time					06/07/2021 01:55:56 PM Eastern Daylight Time	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Blue Cross Blue Shield of South Carolina	www.scbluesmedadvantage.com	Group Blue Rx Plus (PDP)	10	29					S5953	802	0	2022	South Carolina		1					2						www.scbluesmedadvantage.com	www.scbluesmedadvantage.com										(888)645-6025		(888)645-6025		(800)930-2836		(800)930-2836										(711)-		(711)-		(711)-		(711)-																
S5960	803	0		29	10	S5960_803_0	1	1						05/14/2021	2022.01	05/14/2021 09:08:54 AM Eastern Daylight Time					06/04/2021 05:49:04 PM Eastern Daylight Time	UNICARE LIFE & HEALTH INSURANCE COMPANY	UniCare	shop.unicare.com/medicare	MedicareRx Rewards (PDP)	10	29					S5960	803	0	2022	All States (Nationwide)		1					2						www.unicare.com/medicare	www.unicare.com/medicare										(866)470-6265		(866)470-6265		(833)285-4638		(833)285-4638										(711)-		(711)-		(711)-		(711)-																
S5960	804	0		29	10	S5960_804_0	1	1						05/30/2021	2022.01	05/30/2021 11:11:03 AM Eastern Daylight Time					06/04/2021 05:49:04 PM Eastern Daylight Time	UNICARE LIFE & HEALTH INSURANCE COMPANY	UniCare	shop.unicare.com/medicare	MedicareRx Rewards (PDP)	10	29					S5960	804	0	2022	All States (Nationwide)		1					2						www.unicare.com/medicare	www.unicare.com/medicare										(866)470-6265		(866)470-6265		(833)285-4638		(833)285-4638										(711)-		(711)-		(711)-		(711)-																
S5960	805	0		29	10	S5960_805_0	1	1						05/30/2021	2022.01	05/30/2021 11:12:09 AM Eastern Daylight Time					06/04/2021 05:49:04 PM Eastern Daylight Time	UNICARE LIFE & HEALTH INSURANCE COMPANY	UniCare	shop.unicare.com/medicare	MedicareRx Rewards (PDP)	10	29					S5960	805	0	2022	All States (Nationwide)		1					2						www.unicare.com/medicare	www.unicare.com/medicare										(866)470-6265		(866)470-6265		(833)285-4638		(833)285-4638										(711)-		(711)-		(711)-		(711)-																
S5966	803	0		29	10	S5966_803_0	2	1						05/25/2021	2022.01	05/25/2021 02:33:17 PM Eastern Daylight Time					06/07/2021 04:16:18 PM Eastern Daylight Time	EmblemHealth, Inc	EmblemHealth Medicare PDP	www.emblemhealth.com	EmblemHealth National Drug Plan (PDP)	10	29					S5966	803	0	2022	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	2	1						05/25/2021	2022.01	05/25/2021 02:33:22 PM Eastern Daylight Time					06/07/2021 04:16:18 PM Eastern Daylight Time	EmblemHealth, Inc	EmblemHealth Medicare PDP	www.emblemhealth.com	EmblemHealth National Drug Plan (PDP)	10	29					S5966	804	0	2022	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	4	1						04/19/2021	2022.01	04/19/2021 01:38:50 PM Pacific Daylight Time					06/03/2021 10:35:09 AM Pacific Daylight Time	MODA HEALTH PLAN, INC.	Moda Health Plan, Inc.	www.modahealth.com/medicare	Moda Health Rx (PDP)	10	29					S5975	801	0	2022	National		1					2						www.modahealth.com/medicare	www.modahealth.com/medicare										(888)786-7509		(503)265-4709		(888)217-2375		(503)265-2975										(711)-		(711)-		(711)-		(711)-																
S5975	807	0		29	10	S5975_807_0	4	1						04/19/2021	2022.01	04/19/2021 01:39:34 PM Pacific Daylight Time					06/03/2021 10:35:09 AM Pacific Daylight Time	MODA HEALTH PLAN, INC.	Moda Health Plan, Inc.	www.modahealth.com/medicare	Moda Alaska Group Rx (PDP)	10	29					S5975	807	0	2022	Alaska		1					2						www.modahealth.com/medicare	www.modahealth.com/medicare										(888)786-7509		(503)265-4709		(888)217-2375		(503)265-2975										(711)-		(711)-		(711)-		(711)-																
S5993	001	0		29	10	S5993_001_0	5	1					0	06/01/2021	2022.01	06/01/2021 11:50:17 AM Eastern Daylight Time		06/04/2021 03:42:53 PM Eastern Daylight Time			06/04/2021 03:59:31 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	2022	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	5	1					0	06/01/2021	2022.01	06/01/2021 11:41:05 AM Eastern Daylight Time		06/04/2021 03:42:10 PM Eastern Daylight Time			06/04/2021 03:59:31 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	2022	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	007	0		29	10	S5993_007_0	6	1					0	06/01/2021	2022.01	06/01/2021 11:34:17 AM Eastern Daylight Time		06/06/2021 09:59:34 AM Eastern Daylight Time			06/06/2021 10:12:29 AM Eastern Daylight Time	HORIZON INSURANCE COMPANY	Horizon Blue Cross Blue Shield of New Jersey	www.horizonblue.com/Medicare	Horizon Medicare Blue Rx Saver (PDP)	10	29					S5993	007	0	2022	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	2	1						06/02/2021	2022.01	06/02/2021 08:35:29 AM Eastern Daylight Time					06/03/2021 07:11:27 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	2022	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	2	1						05/17/2021	2022.01	05/17/2021 04:03:58 PM Eastern Daylight Time					06/03/2021 07:11:27 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	2022	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	2	1						05/17/2021	2022.01	05/17/2021 04:05:03 PM Eastern Daylight Time					06/03/2021 07:11:27 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	2022	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	806	0		29	10	S5993_806_0	2	1						05/17/2021	2022.01	05/17/2021 04:09:21 PM Eastern Daylight Time					06/03/2021 07:11:27 PM Eastern Daylight Time	HORIZON INSURANCE COMPANY	Horizon Blue Cross Blue Shield of New Jersey	www.HorizonBlue.com	Horizon Medicare Group RX ASO (PDP)	10	29					S5993	806	0	2022	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	9	1					0	06/05/2021	2022.01	06/05/2021 04:52:18 PM US Mountain Standard Time		06/06/2021 11:55:49 AM US Mountain Standard Time			06/06/2021 01:39:34 PM US Mountain Standard Time	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Blue Cross Blue Shield of Arizona	www.YourAZMedicareSolutions.com	Blue MedicareRx Value (PDP)	10	29					S6506	001	0	2022	Arizona		2					2						www.YourAZMedicareSolutions.com	www.YourAZMedicareSolutions.com										(833)229-3593		(833)229-3593		(800)422-0761		(800)422-0761										(711)-		(711)-		(711)-		(711)-																
S6506	002	0		29	10	S6506_002_0	9	1					0	06/05/2021	2022.01	06/05/2021 04:52:46 PM US Mountain Standard Time		06/06/2021 11:56:00 AM US Mountain Standard Time			06/06/2021 01:39:34 PM US Mountain Standard Time	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Blue Cross Blue Shield of Arizona	www.YourAZMedicareSolutions.com	Blue MedicareRx Enhanced (PDP)	10	29					S6506	002	0	2022	Arizona		2					2						www.YourAZMedicareSolutions.com	www.YourAZMedicareSolutions.com										(833)229-3593		(833)229-3593		(800)422-0761		(800)422-0761										(711)-		(711)-		(711)-		(711)-																
S6506	801	0		29	10	S6506_801_0	9	1						06/03/2021	2022.01	06/03/2021 04:05:46 PM US Mountain Standard Time					06/06/2021 01:39:34 PM US Mountain Standard Time	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Blue Cross Blue Shield of Arizona	www.YourAZMedicareSolutions.com	Blue MedicareRx for Groups (PDP)	10	29					S6506	801	0	2022	Nationwide		1					2						www.YourAZMedicareSolutions.com	www.YourAZMedicareSolutions.com										(833)229-3593		(833)229-3593		(800)422-0761		(800)422-0761										(711)-		(711)-		(711)-		(711)-																
S6875	801	0		29	10	S6875_801_0	1	1						05/19/2021	2022.01	05/19/2021 11:38:17 AM Eastern Daylight Time					06/04/2021 06:09:23 PM Eastern Daylight Time	QCC INSURANCE COMPANY	Independence Blue Cross	http://www.ibxmedicare.com	Select Option Rx Group Option I CY (PDP)	10	29					S6875	801	0	2022	National		1					2						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						05/19/2021	2022.01	05/19/2021 11:41:22 AM Eastern Daylight Time					06/04/2021 06:09:23 PM Eastern Daylight Time	QCC INSURANCE COMPANY	Independence Blue Cross	http://www.ibxmedicare.com	Select Option Rx Group Option I Non-CY (PDP)	10	29					S6875	802	0	2022	National		1					2						http://www.ibxmedicare.com	http://www.ibxmedicare.com										(888)678-7009		(888)678-7009		(888)678-7009		(888)678-7009										(711)-		(711)-		(711)-		(711)-																
S6946	001	0		29	10	S6946_001_0	5	1					0	06/24/2021	2022.01	06/24/2021 09:58:57 AM Central Daylight Time		07/20/2021 09:17:12 AM Central Daylight Time			07/20/2021 04:16:26 PM Central Daylight Time	CLEAR SPRING HEALTH INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Value Rx (PDP)	10	29					S6946	001	0	2022	New Jersey		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(877)317-6082		(877)317-6082		(877)317-6082		(877)317-6082										(711)-		(711)-		(711)-		(711)-																
S6946	002	0		29	10	S6946_002_0	4	1					0	06/03/2021	2022.01	06/03/2021 03:41:09 PM Central Daylight Time		07/20/2021 09:17:17 AM Central Daylight Time			07/20/2021 04:16:26 PM Central Daylight Time	CLEAR SPRING HEALTH INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Value Rx (PDP)	10	29					S6946	002	0	2022	D.C., Delaware, Maryland		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(877)317-6082		(877)317-6082		(877)317-6082		(877)317-6082										(711)-		(711)-		(711)-		(711)-																
S6946	003	0		29	10	S6946_003_0	4	1					0	06/01/2021	2022.01	06/01/2021 09:34:03 AM Central Daylight Time		07/20/2021 09:17:21 AM Central Daylight Time			07/20/2021 04:16:26 PM Central Daylight Time	CLEAR SPRING HEALTH INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Value Rx (PDP)	10	29					S6946	003	0	2022	Pennsylvania, West Virginia		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(877)317-6082		(877)317-6082		(877)317-6082		(877)317-6082										(711)-		(711)-		(711)-		(711)-																
S6946	004	0		29	10	S6946_004_0	4	1					0	06/01/2021	2022.01	06/01/2021 10:02:21 AM Central Daylight Time		07/20/2021 09:17:26 AM Central Daylight Time			07/20/2021 04:16:26 PM Central Daylight Time	CLEAR SPRING HEALTH INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Value Rx (PDP)	10	29					S6946	004	0	2022	Virginia		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(877)317-6082		(877)317-6082		(877)317-6082		(877)317-6082										(711)-		(711)-		(711)-		(711)-																
S6946	005	0		29	10	S6946_005_0	4	1					0	06/01/2021	2022.01	06/01/2021 10:51:17 AM Central Daylight Time		07/20/2021 09:17:32 AM Central Daylight Time			07/20/2021 04:16:26 PM Central Daylight Time	CLEAR SPRING HEALTH INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Value Rx (PDP)	10	29					S6946	005	0	2022	North Carolina		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(877)317-6082		(877)317-6082		(877)317-6082		(877)317-6082										(711)-		(711)-		(711)-		(711)-																
S6946	006	0		29	10	S6946_006_0	4	1					0	06/01/2021	2022.01	06/01/2021 10:56:07 AM Central Daylight Time		07/20/2021 09:17:41 AM Central Daylight Time			07/20/2021 04:16:26 PM Central Daylight Time	CLEAR SPRING HEALTH INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Value Rx (PDP)	10	29					S6946	006	0	2022	South Carolina		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(877)317-6082		(877)317-6082		(877)317-6082		(877)317-6082										(711)-		(711)-		(711)-		(711)-																
S6946	007	0		29	10	S6946_007_0	4	1					0	06/01/2021	2022.01	06/01/2021 11:05:11 AM Central Daylight Time		07/20/2021 09:17:46 AM Central Daylight Time			07/20/2021 04:16:26 PM Central Daylight Time	CLEAR SPRING HEALTH INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Value Rx (PDP)	10	29					S6946	007	0	2022	Georgia		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(877)317-6082		(877)317-6082		(877)317-6082		(877)317-6082										(711)-		(711)-		(711)-		(711)-																
S6946	008	0		29	10	S6946_008_0	4	1					0	06/01/2021	2022.01	06/01/2021 11:08:50 AM Central Daylight Time		07/20/2021 09:17:50 AM Central Daylight Time			07/20/2021 04:16:26 PM Central Daylight Time	CLEAR SPRING HEALTH INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Value Rx (PDP)	10	29					S6946	008	0	2022	Florida		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(877)317-6082		(877)317-6082		(877)317-6082		(877)317-6082										(711)-		(711)-		(711)-		(711)-																
S6946	009	0		29	10	S6946_009_0	4	1					0	06/01/2021	2022.01	06/01/2021 11:11:55 AM Central Daylight Time		07/20/2021 09:17:55 AM Central Daylight Time			07/20/2021 04:16:26 PM Central Daylight Time	CLEAR SPRING HEALTH INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Value Rx (PDP)	10	29					S6946	009	0	2022	Alabama and Tennessee		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(877)317-6082		(877)317-6082		(877)317-6082		(877)317-6082										(711)-		(711)-		(711)-		(711)-																
S6946	010	0		29	10	S6946_010_0	4	1					0	06/01/2021	2022.01	06/01/2021 11:16:34 AM Central Daylight Time		07/20/2021 09:18:00 AM Central Daylight Time			07/20/2021 04:16:26 PM Central Daylight Time	CLEAR SPRING HEALTH INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Value Rx (PDP)	10	29					S6946	010	0	2022	Michigan		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(877)317-6082		(877)317-6082		(877)317-6082		(877)317-6082										(711)-		(711)-		(711)-		(711)-																
S6946	011	0		29	10	S6946_011_0	4	1					0	06/01/2021	2022.01	06/01/2021 04:44:42 PM Central Daylight Time		07/20/2021 09:18:04 AM Central Daylight Time			07/20/2021 04:16:26 PM Central Daylight Time	CLEAR SPRING HEALTH INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Value Rx (PDP)	10	29					S6946	011	0	2022	Ohio		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(877)317-6082		(877)317-6082		(877)317-6082		(877)317-6082										(711)-		(711)-		(711)-		(711)-																
S6946	012	0		29	10	S6946_012_0	4	1					0	06/01/2021	2022.01	06/01/2021 11:22:46 AM Central Daylight Time		07/20/2021 09:18:11 AM Central Daylight Time			07/20/2021 04:16:26 PM Central Daylight Time	CLEAR SPRING HEALTH INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Value Rx (PDP)	10	29					S6946	012	0	2022	Kentucky and Indiana		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(877)317-6082		(877)317-6082		(877)317-6082		(877)317-6082										(711)-		(711)-		(711)-		(711)-																
S6946	013	0		29	10	S6946_013_0	4	1					0	06/01/2021	2022.01	06/01/2021 11:26:48 AM Central Daylight Time		07/20/2021 09:18:17 AM Central Daylight Time			07/20/2021 04:16:26 PM Central Daylight Time	CLEAR SPRING HEALTH INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Value Rx (PDP)	10	29					S6946	013	0	2022	Wisconsin		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(877)317-6082		(877)317-6082		(877)317-6082		(877)317-6082										(711)-		(711)-		(711)-		(711)-																
S6946	014	0		29	10	S6946_014_0	4	1					0	06/01/2021	2022.01	06/01/2021 11:30:01 AM Central Daylight Time		07/20/2021 09:18:21 AM Central Daylight Time			07/20/2021 04:16:26 PM Central Daylight Time	CLEAR SPRING HEALTH INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Value Rx (PDP)	10	29					S6946	014	0	2022	Illinois		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(877)317-6082		(877)317-6082		(877)317-6082		(877)317-6082										(711)-		(711)-		(711)-		(711)-																
S6946	015	0		29	10	S6946_015_0	4	1					0	06/01/2021	2022.01	06/01/2021 11:31:17 AM Central Daylight Time		07/20/2021 09:18:26 AM Central Daylight Time			07/20/2021 04:16:26 PM Central Daylight Time	CLEAR SPRING HEALTH INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Value Rx (PDP)	10	29					S6946	015	0	2022	Missouri		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(877)317-6082		(877)317-6082		(877)317-6082		(877)317-6082										(711)-		(711)-		(711)-		(711)-																
S6946	016	0		29	10	S6946_016_0	4	1					0	06/01/2021	2022.01	06/01/2021 09:43:21 AM Central Daylight Time		07/20/2021 09:18:31 AM Central Daylight Time			07/20/2021 04:16:26 PM Central Daylight Time	CLEAR SPRING HEALTH INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Value Rx (PDP)	10	29					S6946	016	0	2022	Arkansas		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(877)317-6082		(877)317-6082		(877)317-6082		(877)317-6082										(711)-		(711)-		(711)-		(711)-																
S6946	017	0		29	10	S6946_017_0	4	1					0	06/01/2021	2022.01	06/01/2021 09:49:48 AM Central Daylight Time		07/20/2021 09:18:39 AM Central Daylight Time			07/20/2021 04:16:26 PM Central Daylight Time	CLEAR SPRING HEALTH INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Value Rx (PDP)	10	29					S6946	017	0	2022	Mississippi		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(877)317-6082		(877)317-6082		(877)317-6082		(877)317-6082										(711)-		(711)-		(711)-		(711)-																
S6946	018	0		29	10	S6946_018_0	4	1					0	06/01/2021	2022.01	06/01/2021 09:59:37 AM Central Daylight Time		07/20/2021 09:18:43 AM Central Daylight Time			07/20/2021 04:16:26 PM Central Daylight Time	CLEAR SPRING HEALTH INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Value Rx (PDP)	10	29					S6946	018	0	2022	Louisiana		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(877)317-6082		(877)317-6082		(877)317-6082		(877)317-6082										(711)-		(711)-		(711)-		(711)-																
S6946	019	0		29	10	S6946_019_0	4	1					0	06/01/2021	2022.01	06/01/2021 10:05:37 AM Central Daylight Time		07/20/2021 09:18:48 AM Central Daylight Time			07/20/2021 04:16:26 PM Central Daylight Time	CLEAR SPRING HEALTH INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Value Rx (PDP)	10	29					S6946	019	0	2022	Texas		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(877)317-6082		(877)317-6082		(877)317-6082		(877)317-6082										(711)-		(711)-		(711)-		(711)-																
S6946	020	0		29	10	S6946_020_0	4	1					0	06/01/2021	2022.01	06/01/2021 10:10:10 AM Central Daylight Time		07/20/2021 09:18:53 AM Central Daylight Time			07/20/2021 04:16:26 PM Central Daylight Time	CLEAR SPRING HEALTH INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Value Rx (PDP)	10	29					S6946	020	0	2022	Oklahoma		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(877)317-6082		(877)317-6082		(877)317-6082		(877)317-6082										(711)-		(711)-		(711)-		(711)-																
S6946	021	0		29	10	S6946_021_0	4	1					0	06/01/2021	2022.01	06/01/2021 10:15:05 AM Central Daylight Time		07/20/2021 09:18:57 AM Central Daylight Time			07/20/2021 04:16:26 PM Central Daylight Time	CLEAR SPRING HEALTH INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Value Rx (PDP)	10	29					S6946	021	0	2022	Kansas		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(877)317-6082		(877)317-6082		(877)317-6082		(877)317-6082										(711)-		(711)-		(711)-		(711)-																
S6946	022	0		29	10	S6946_022_0	4	1					0	06/01/2021	2022.01	06/01/2021 10:20:09 AM Central Daylight Time		07/20/2021 09:19:02 AM Central Daylight Time			07/20/2021 04:16:26 PM Central Daylight Time	CLEAR SPRING HEALTH INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Value Rx (PDP)	10	29					S6946	022	0	2022	IA, MT, MN, NE, ND, SD, WY		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(877)317-6082		(877)317-6082		(877)317-6082		(877)317-6082										(711)-		(711)-		(711)-		(711)-																
S6946	023	0		29	10	S6946_023_0	4	1					0	06/01/2021	2022.01	06/01/2021 10:24:04 AM Central Daylight Time		07/20/2021 09:19:09 AM Central Daylight Time			07/20/2021 04:16:26 PM Central Daylight Time	CLEAR SPRING HEALTH INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Value Rx (PDP)	10	29					S6946	023	0	2022	Arizona		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(877)317-6082		(877)317-6082		(877)317-6082		(877)317-6082										(711)-		(711)-		(711)-		(711)-																
S6946	024	0		29	10	S6946_024_0	4	1					0	06/01/2021	2022.01	06/01/2021 10:27:50 AM Central Daylight Time		07/20/2021 09:19:14 AM Central Daylight Time			07/20/2021 04:16:26 PM Central Daylight Time	CLEAR SPRING HEALTH INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Value Rx (PDP)	10	29					S6946	024	0	2022	Nevada		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(877)317-6082		(877)317-6082		(877)317-6082		(877)317-6082										(711)-		(711)-		(711)-		(711)-																
S6946	025	0		29	10	S6946_025_0	4	1					0	06/01/2021	2022.01	06/01/2021 10:30:52 AM Central Daylight Time		07/20/2021 09:19:18 AM Central Daylight Time			07/20/2021 04:16:26 PM Central Daylight Time	CLEAR SPRING HEALTH INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Value Rx (PDP)	10	29					S6946	025	0	2022	Oregon and Washington		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(877)317-6082		(877)317-6082		(877)317-6082		(877)317-6082										(711)-		(711)-		(711)-		(711)-																
S6946	026	0		29	10	S6946_026_0	4	1					0	06/01/2021	2022.01	06/01/2021 10:34:47 AM Central Daylight Time		07/20/2021 09:19:23 AM Central Daylight Time			07/20/2021 04:16:26 PM Central Daylight Time	CLEAR SPRING HEALTH INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Value Rx (PDP)	10	29					S6946	026	0	2022	Idaho and Utah		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(877)317-6082		(877)317-6082		(877)317-6082		(877)317-6082										(711)-		(711)-		(711)-		(711)-																
S6946	027	0		29	10	S6946_027_0	4	1					0	06/01/2021	2022.01	06/01/2021 10:38:07 AM Central Daylight Time		07/20/2021 09:19:27 AM Central Daylight Time			07/20/2021 04:16:26 PM Central Daylight Time	CLEAR SPRING HEALTH INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Value Rx (PDP)	10	29					S6946	027	0	2022	California		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(877)317-6082		(877)317-6082		(877)317-6082		(877)317-6082										(711)-		(711)-		(711)-		(711)-																
S6946	028	0		29	10	S6946_028_0	4	1					0	06/01/2021	2022.01	06/01/2021 10:41:04 AM Central Daylight Time		07/20/2021 09:19:32 AM Central Daylight Time			07/20/2021 04:16:26 PM Central Daylight Time	CLEAR SPRING HEALTH INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Value Rx (PDP)	10	29					S6946	028	0	2022	Hawaii		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(877)317-6082		(877)317-6082		(877)317-6082		(877)317-6082										(711)-		(711)-		(711)-		(711)-																
S6946	029	0		29	10	S6946_029_0	4	1					0	06/01/2021	2022.01	06/01/2021 10:43:32 AM Central Daylight Time		07/20/2021 09:19:38 AM Central Daylight Time			07/20/2021 04:16:26 PM Central Daylight Time	CLEAR SPRING HEALTH INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Value Rx (PDP)	10	29					S6946	029	0	2022	Alaska		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(877)317-6082		(877)317-6082		(877)317-6082		(877)317-6082										(711)-		(711)-		(711)-		(711)-																
S6946	030	0		29	10	S6946_030_0	5	1					0	05/26/2021	2022.01	05/26/2021 04:43:43 PM Central Daylight Time		07/20/2021 09:11:40 AM Central Daylight Time			07/20/2021 04:16:26 PM Central Daylight Time	CLEAR SPRING HEALTH INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Premier Rx (PDP)	10	29					S6946	030	0	2022	New Jersey		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(877)317-6082		(877)317-6082		(877)317-6082		(877)317-6082										(711)-		(711)-		(711)-		(711)-																
S6946	031	0		29	10	S6946_031_0	4	1					0	05/26/2021	2022.01	05/27/2021 01:17:51 PM Central Daylight Time		07/20/2021 09:11:44 AM Central Daylight Time			07/20/2021 04:16:26 PM Central Daylight Time	CLEAR SPRING HEALTH INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Premier Rx (PDP)	10	29					S6946	031	0	2022	D.C., Delaware, Maryland		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(877)317-6082		(877)317-6082		(877)317-6082		(877)317-6082										(711)-		(711)-		(711)-		(711)-																
S6946	032	0		29	10	S6946_032_0	4	1					0	05/27/2021	2022.01	05/27/2021 01:28:53 PM Central Daylight Time		07/20/2021 09:11:48 AM Central Daylight Time			07/20/2021 04:16:26 PM Central Daylight Time	CLEAR SPRING HEALTH INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Premier Rx (PDP)	10	29					S6946	032	0	2022	Pennsylvania, West Virginia		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(877)317-6082		(877)317-6082		(877)317-6082		(877)317-6082										(711)-		(711)-		(711)-		(711)-																
S6946	033	0		29	10	S6946_033_0	4	1					0	05/26/2021	2022.01	05/27/2021 01:18:10 PM Central Daylight Time		07/20/2021 09:11:53 AM Central Daylight Time			07/20/2021 04:16:26 PM Central Daylight Time	CLEAR SPRING HEALTH INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Premier Rx (PDP)	10	29					S6946	033	0	2022	Virginia		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(877)317-6082		(877)317-6082		(877)317-6082		(877)317-6082										(711)-		(711)-		(711)-		(711)-																
S6946	034	0		29	10	S6946_034_0	4	1					0	05/27/2021	2022.01	05/27/2021 01:23:33 PM Central Daylight Time		07/20/2021 09:11:57 AM Central Daylight Time			07/20/2021 04:16:26 PM Central Daylight Time	CLEAR SPRING HEALTH INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Premier Rx (PDP)	10	29					S6946	034	0	2022	North Carolina		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(877)317-6082		(877)317-6082		(877)317-6082		(877)317-6082										(711)-		(711)-		(711)-		(711)-																
S6946	035	0		29	10	S6946_035_0	4	1					0	05/27/2021	2022.01	05/27/2021 01:23:05 PM Central Daylight Time		07/20/2021 09:12:05 AM Central Daylight Time			07/20/2021 04:16:26 PM Central Daylight Time	CLEAR SPRING HEALTH INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Premier Rx (PDP)	10	29					S6946	035	0	2022	South Carolina		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(877)317-6082		(877)317-6082		(877)317-6082		(877)317-6082										(711)-		(711)-		(711)-		(711)-																
S6946	036	0		29	10	S6946_036_0	4	1					0	05/27/2021	2022.01	05/27/2021 01:23:48 PM Central Daylight Time		07/20/2021 09:12:09 AM Central Daylight Time			07/20/2021 04:16:26 PM Central Daylight Time	CLEAR SPRING HEALTH INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Premier Rx (PDP)	10	29					S6946	036	0	2022	Georgia		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(877)317-6082		(877)317-6082		(877)317-6082		(877)317-6082										(711)-		(711)-		(711)-		(711)-																
S6946	037	0		29	10	S6946_037_0	4	1					0	05/27/2021	2022.01	05/27/2021 01:24:03 PM Central Daylight Time		07/20/2021 09:12:13 AM Central Daylight Time			07/20/2021 04:16:26 PM Central Daylight Time	CLEAR SPRING HEALTH INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Premier Rx (PDP)	10	29					S6946	037	0	2022	Florida		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(877)317-6082		(877)317-6082		(877)317-6082		(877)317-6082										(711)-		(711)-		(711)-		(711)-																
S6946	038	0		29	10	S6946_038_0	4	1					0	05/27/2021	2022.01	05/27/2021 01:24:23 PM Central Daylight Time		07/20/2021 09:12:17 AM Central Daylight Time			07/20/2021 04:16:26 PM Central Daylight Time	CLEAR SPRING HEALTH INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Premier Rx (PDP)	10	29					S6946	038	0	2022	Alabama and Tennessee		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(877)317-6082		(877)317-6082		(877)317-6082		(877)317-6082										(711)-		(711)-		(711)-		(711)-																
S6946	039	0		29	10	S6946_039_0	4	1					0	05/27/2021	2022.01	05/27/2021 01:24:53 PM Central Daylight Time		07/20/2021 09:12:22 AM Central Daylight Time			07/20/2021 04:16:26 PM Central Daylight Time	CLEAR SPRING HEALTH INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Premier Rx (PDP)	10	29					S6946	039	0	2022	Michigan		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(877)317-6082		(877)317-6082		(877)317-6082		(877)317-6082										(711)-		(711)-		(711)-		(711)-																
S6946	040	0		29	10	S6946_040_0	4	1					0	05/27/2021	2022.01	05/27/2021 01:25:20 PM Central Daylight Time		07/20/2021 09:12:27 AM Central Daylight Time			07/20/2021 04:16:26 PM Central Daylight Time	CLEAR SPRING HEALTH INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Premier Rx (PDP)	10	29					S6946	040	0	2022	Ohio		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(877)317-6082		(877)317-6082		(877)317-6082		(877)317-6082										(711)-		(711)-		(711)-		(711)-																
S6946	041	0		29	10	S6946_041_0	4	1					0	05/27/2021	2022.01	05/27/2021 01:25:35 PM Central Daylight Time		07/20/2021 09:12:33 AM Central Daylight Time			07/20/2021 04:16:26 PM Central Daylight Time	CLEAR SPRING HEALTH INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Premier Rx (PDP)	10	29					S6946	041	0	2022	Kentucky and Indiana		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(877)317-6082		(877)317-6082		(877)317-6082		(877)317-6082										(711)-		(711)-		(711)-		(711)-																
S6946	042	0		29	10	S6946_042_0	4	1					0	05/27/2021	2022.01	05/27/2021 01:26:00 PM Central Daylight Time		07/20/2021 09:12:39 AM Central Daylight Time			07/20/2021 04:16:26 PM Central Daylight Time	CLEAR SPRING HEALTH INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Premier Rx (PDP)	10	29					S6946	042	0	2022	Wisconsin		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(877)317-6082		(877)317-6082		(877)317-6082		(877)317-6082										(711)-		(711)-		(711)-		(711)-																
S6946	043	0		29	10	S6946_043_0	4	1					0	05/27/2021	2022.01	05/27/2021 01:26:27 PM Central Daylight Time		07/20/2021 09:12:43 AM Central Daylight Time			07/20/2021 04:16:26 PM Central Daylight Time	CLEAR SPRING HEALTH INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Premier Rx (PDP)	10	29					S6946	043	0	2022	Illinois		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(877)317-6082		(877)317-6082		(877)317-6082		(877)317-6082										(711)-		(711)-		(711)-		(711)-																
S6946	044	0		29	10	S6946_044_0	4	1					0	05/27/2021	2022.01	05/27/2021 01:26:48 PM Central Daylight Time		07/20/2021 09:12:48 AM Central Daylight Time			07/20/2021 04:16:26 PM Central Daylight Time	CLEAR SPRING HEALTH INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Premier Rx (PDP)	10	29					S6946	044	0	2022	Missouri		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(877)317-6082		(877)317-6082		(877)317-6082		(877)317-6082										(711)-		(711)-		(711)-		(711)-																
S6946	045	0		29	10	S6946_045_0	4	1					0	05/27/2021	2022.01	05/27/2021 01:27:12 PM Central Daylight Time		07/20/2021 09:12:52 AM Central Daylight Time			07/20/2021 04:16:26 PM Central Daylight Time	CLEAR SPRING HEALTH INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Premier Rx (PDP)	10	29					S6946	045	0	2022	Arkansas		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(877)317-6082		(877)317-6082		(877)317-6082		(877)317-6082										(711)-		(711)-		(711)-		(711)-																
S6946	046	0		29	10	S6946_046_0	4	1					0	05/27/2021	2022.01	05/27/2021 01:27:28 PM Central Daylight Time		07/20/2021 09:13:00 AM Central Daylight Time			07/20/2021 04:16:26 PM Central Daylight Time	CLEAR SPRING HEALTH INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Premier Rx (PDP)	10	29					S6946	046	0	2022	Mississippi		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(877)317-6082		(877)317-6082		(877)317-6082		(877)317-6082										(711)-		(711)-		(711)-		(711)-																
S6946	047	0		29	10	S6946_047_0	4	1					0	05/27/2021	2022.01	05/27/2021 01:27:44 PM Central Daylight Time		07/20/2021 09:13:06 AM Central Daylight Time			07/20/2021 04:16:26 PM Central Daylight Time	CLEAR SPRING HEALTH INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Premier Rx (PDP)	10	29					S6946	047	0	2022	Louisiana		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(877)317-6082		(877)317-6082		(877)317-6082		(877)317-6082										(711)-		(711)-		(711)-		(711)-																
S6946	048	0		29	10	S6946_048_0	4	1					0	05/27/2021	2022.01	05/27/2021 01:28:01 PM Central Daylight Time		07/20/2021 09:13:10 AM Central Daylight Time			07/20/2021 04:16:26 PM Central Daylight Time	CLEAR SPRING HEALTH INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Premier Rx (PDP)	10	29					S6946	048	0	2022	Texas		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(877)317-6082		(877)317-6082		(877)317-6082		(877)317-6082										(711)-		(711)-		(711)-		(711)-																
S6946	049	0		29	10	S6946_049_0	4	1					0	05/27/2021	2022.01	05/27/2021 01:28:17 PM Central Daylight Time		07/20/2021 09:13:15 AM Central Daylight Time			07/20/2021 04:16:26 PM Central Daylight Time	CLEAR SPRING HEALTH INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Premier Rx (PDP)	10	29					S6946	049	0	2022	Oklahoma		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(877)317-6082		(877)317-6082		(877)317-6082		(877)317-6082										(711)-		(711)-		(711)-		(711)-																
S6946	050	0		29	10	S6946_050_0	4	1					0	05/27/2021	2022.01	05/27/2021 01:28:40 PM Central Daylight Time		07/20/2021 09:13:19 AM Central Daylight Time			07/20/2021 04:16:26 PM Central Daylight Time	CLEAR SPRING HEALTH INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Premier Rx (PDP)	10	29					S6946	050	0	2022	Kansas		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(877)317-6082		(877)317-6082		(877)317-6082		(877)317-6082										(711)-		(711)-		(711)-		(711)-																
S6946	051	0		29	10	S6946_051_0	4	1					0	05/27/2021	2022.01	05/27/2021 01:28:07 PM Central Daylight Time		07/20/2021 09:13:24 AM Central Daylight Time			07/20/2021 04:16:26 PM Central Daylight Time	CLEAR SPRING HEALTH INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Premier Rx (PDP)	10	29					S6946	051	0	2022	IA, MT, MN, NE, ND, SD, WY		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(877)317-6082		(877)317-6082		(877)317-6082		(877)317-6082										(711)-		(711)-		(711)-		(711)-																
S6946	052	0		29	10	S6946_052_0	4	1					0	05/27/2021	2022.01	05/27/2021 01:26:51 PM Central Daylight Time		07/20/2021 09:13:31 AM Central Daylight Time			07/20/2021 04:16:26 PM Central Daylight Time	CLEAR SPRING HEALTH INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Premier Rx (PDP)	10	29					S6946	052	0	2022	Arizona		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(877)317-6082		(877)317-6082		(877)317-6082		(877)317-6082										(711)-		(711)-		(711)-		(711)-																
S6946	053	0		29	10	S6946_053_0	4	1					0	05/27/2021	2022.01	05/27/2021 01:26:30 PM Central Daylight Time		07/20/2021 09:13:35 AM Central Daylight Time			07/20/2021 04:16:26 PM Central Daylight Time	CLEAR SPRING HEALTH INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Premier Rx (PDP)	10	29					S6946	053	0	2022	Nevada		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(877)317-6082		(877)317-6082		(877)317-6082		(877)317-6082										(711)-		(711)-		(711)-		(711)-																
S6946	054	0		29	10	S6946_054_0	4	1					0	05/27/2021	2022.01	05/27/2021 01:26:00 PM Central Daylight Time		07/20/2021 09:13:40 AM Central Daylight Time			07/20/2021 04:16:26 PM Central Daylight Time	CLEAR SPRING HEALTH INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Premier Rx (PDP)	10	29					S6946	054	0	2022	Oregon and Washington		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(877)317-6082		(877)317-6082		(877)317-6082		(877)317-6082										(711)-		(711)-		(711)-		(711)-																
S6946	055	0		29	10	S6946_055_0	4	1					0	05/27/2021	2022.01	05/27/2021 01:25:41 PM Central Daylight Time		07/20/2021 09:13:45 AM Central Daylight Time			07/20/2021 04:16:26 PM Central Daylight Time	CLEAR SPRING HEALTH INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Premier Rx (PDP)	10	29					S6946	055	0	2022	Idaho and Utah		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(877)317-6082		(877)317-6082		(877)317-6082		(877)317-6082										(711)-		(711)-		(711)-		(711)-																
S6946	056	0		29	10	S6946_056_0	4	1					0	05/27/2021	2022.01	05/27/2021 01:25:11 PM Central Daylight Time		07/20/2021 09:13:53 AM Central Daylight Time			07/20/2021 04:16:26 PM Central Daylight Time	CLEAR SPRING HEALTH INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Premier Rx (PDP)	10	29					S6946	056	0	2022	California		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(877)317-6082		(877)317-6082		(877)317-6082		(877)317-6082										(711)-		(711)-		(711)-		(711)-																
S6946	057	0		29	10	S6946_057_0	4	1					0	05/27/2021	2022.01	05/27/2021 01:24:50 PM Central Daylight Time		07/20/2021 09:13:59 AM Central Daylight Time			07/20/2021 04:16:26 PM Central Daylight Time	CLEAR SPRING HEALTH INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Premier Rx (PDP)	10	29					S6946	057	0	2022	Hawaii		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(877)317-6082		(877)317-6082		(877)317-6082		(877)317-6082										(711)-		(711)-		(711)-		(711)-																
S6946	058	0		29	10	S6946_058_0	4	1					0	05/27/2021	2022.01	05/27/2021 01:24:18 PM Central Daylight Time		07/20/2021 09:14:04 AM Central Daylight Time			07/20/2021 04:16:26 PM Central Daylight Time	CLEAR SPRING HEALTH INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Premier Rx (PDP)	10	29					S6946	058	0	2022	Alaska		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(877)317-6082		(877)317-6082		(877)317-6082		(877)317-6082										(711)-		(711)-		(711)-		(711)-																
S7126	001	0		29	10	S7126_001_0	3	1					0	06/06/2021	2022.01	06/06/2021 09:44:44 PM Central Daylight Time		06/06/2021 09:06:14 AM Central Daylight Time			06/06/2021 09:55:40 PM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	001	0	2022	Northern New England		2					2						www.mutualofomaharx.com	www.mutualofomaharx.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(711)-		(711)-																
S7126	002	0		29	10	S7126_002_0	1	1					0	06/05/2021	2022.01	06/05/2021 04:39:08 PM Central Daylight Time		06/06/2021 09:06:32 AM Central Daylight Time			06/06/2021 09:55:40 PM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	002	0	2022	Central New England		2					2						www.mutualofomaharx.com	www.mutualofomaharx.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					0	06/05/2021	2022.01	06/05/2021 04:39:18 PM Central Daylight Time		06/06/2021 09:06:50 AM Central Daylight Time			06/06/2021 09:55:40 PM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	003	0	2022	State of New Jersey		2					2						www.mutualofomaharx.com	www.mutualofomaharx.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					0	06/05/2021	2022.01	06/05/2021 04:39:27 PM Central Daylight Time		06/06/2021 09:07:10 AM Central Daylight Time			06/06/2021 09:55:40 PM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	004	0	2022	Mid-Atlantic		2					2						www.mutualofomaharx.com	www.mutualofomaharx.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					0	06/05/2021	2022.01	06/05/2021 04:39:37 PM Central Daylight Time		06/06/2021 09:07:28 AM Central Daylight Time			06/06/2021 09:55:40 PM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	005	0	2022	States of Pennsylvania and West Virginia		2					2						www.mutualofomaharx.com	www.mutualofomaharx.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					0	06/05/2021	2022.01	06/05/2021 04:39:49 PM Central Daylight Time		06/06/2021 09:07:48 AM Central Daylight Time			06/06/2021 09:55:40 PM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	006	0	2022	State of Virginia		2					2						www.mutualofomaharx.com	www.mutualofomaharx.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					0	06/05/2021	2022.01	06/05/2021 04:40:00 PM Central Daylight Time		06/06/2021 09:08:05 AM Central Daylight Time			06/06/2021 09:55:40 PM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	007	0	2022	State of North Carolina		2					2						www.mutualofomaharx.com	www.mutualofomaharx.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					0	06/05/2021	2022.01	06/05/2021 04:40:11 PM Central Daylight Time		06/06/2021 09:08:50 AM Central Daylight Time			06/06/2021 09:55:40 PM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	008	0	2022	State of South Carolina		2					2						www.mutualofomaharx.com	www.mutualofomaharx.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					0	06/05/2021	2022.01	06/05/2021 04:40:24 PM Central Daylight Time		06/06/2021 09:10:15 AM Central Daylight Time			06/06/2021 09:55:40 PM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	009	0	2022	State of Georgia		2					2						www.mutualofomaharx.com	www.mutualofomaharx.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					0	06/05/2021	2022.01	06/05/2021 04:40:34 PM Central Daylight Time		06/06/2021 09:10:52 AM Central Daylight Time			06/06/2021 09:55:40 PM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	010	0	2022	State of Florida		2					2						www.mutualofomaharx.com	www.mutualofomaharx.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					0	06/05/2021	2022.01	06/05/2021 04:40:45 PM Central Daylight Time		06/06/2021 09:11:12 AM Central Daylight Time			06/06/2021 09:55:40 PM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	011	0	2022	States of Alabama and Tennessee		2					2						www.mutualofomaharx.com	www.mutualofomaharx.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					0	06/05/2021	2022.01	06/05/2021 04:41:09 PM Central Daylight Time		06/06/2021 09:11:29 AM Central Daylight Time			06/06/2021 09:55:40 PM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	012	0	2022	State of Michigan		2					2						www.mutualofomaharx.com	www.mutualofomaharx.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					0	06/05/2021	2022.01	06/05/2021 04:41:21 PM Central Daylight Time		06/06/2021 09:11:46 AM Central Daylight Time			06/06/2021 09:55:40 PM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	013	0	2022	State of Ohio		2					2						www.mutualofomaharx.com	www.mutualofomaharx.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					0	06/05/2021	2022.01	06/05/2021 04:41:32 PM Central Daylight Time		06/06/2021 09:12:08 AM Central Daylight Time			06/06/2021 09:55:40 PM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	014	0	2022	States of Indiana and Kentucky		2					2						www.mutualofomaharx.com	www.mutualofomaharx.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					0	06/05/2021	2022.01	06/05/2021 04:41:43 PM Central Daylight Time		06/06/2021 09:12:24 AM Central Daylight Time			06/06/2021 09:55:40 PM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	015	0	2022	State of Wisconsin		2					2						www.mutualofomaharx.com	www.mutualofomaharx.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					0	06/05/2021	2022.01	06/05/2021 04:41:54 PM Central Daylight Time		06/06/2021 09:12:41 AM Central Daylight Time			06/06/2021 09:55:40 PM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	016	0	2022	State of Illinois		2					2						www.mutualofomaharx.com	www.mutualofomaharx.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					0	06/05/2021	2022.01	06/05/2021 04:42:05 PM Central Daylight Time		06/06/2021 09:12:58 AM Central Daylight Time			06/06/2021 09:55:40 PM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	017	0	2022	State of Missouri		2					2						www.mutualofomaharx.com	www.mutualofomaharx.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					0	06/05/2021	2022.01	06/05/2021 04:42:17 PM Central Daylight Time		06/06/2021 09:13:16 AM Central Daylight Time			06/06/2021 09:55:40 PM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	018	0	2022	State of Arkansas		2					2						www.mutualofomaharx.com	www.mutualofomaharx.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					0	06/05/2021	2022.01	06/05/2021 04:42:32 PM Central Daylight Time		06/06/2021 09:13:36 AM Central Daylight Time			06/06/2021 09:55:40 PM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	019	0	2022	State of Mississippi		2					2						www.mutualofomaharx.com	www.mutualofomaharx.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					0	06/05/2021	2022.01	06/05/2021 04:42:46 PM Central Daylight Time		06/06/2021 09:13:58 AM Central Daylight Time			06/06/2021 09:55:40 PM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	020	0	2022	State of Louisiana		2					2						www.mutualofomaharx.com	www.mutualofomaharx.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					0	06/05/2021	2022.01	06/05/2021 04:42:57 PM Central Daylight Time		06/06/2021 09:14:17 AM Central Daylight Time			06/06/2021 09:55:40 PM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	021	0	2022	State of Texas		2					2						www.mutualofomaharx.com	www.mutualofomaharx.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					0	06/05/2021	2022.01	06/05/2021 04:43:12 PM Central Daylight Time		06/06/2021 09:14:43 AM Central Daylight Time			06/06/2021 09:55:40 PM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	022	0	2022	State of Oklahoma		2					2						www.mutualofomaharx.com	www.mutualofomaharx.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					0	06/05/2021	2022.01	06/05/2021 04:43:25 PM Central Daylight Time		06/06/2021 09:15:03 AM Central Daylight Time			06/06/2021 09:55:40 PM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	023	0	2022	State of Kansas		2					2						www.mutualofomaharx.com	www.mutualofomaharx.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					0	06/05/2021	2022.01	06/05/2021 04:43:38 PM Central Daylight Time		06/06/2021 09:15:27 AM Central Daylight Time			06/06/2021 09:55:40 PM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	024	0	2022	Upper Midwest and Northern Plains		2					2						www.mutualofomaharx.com	www.mutualofomaharx.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					0	06/05/2021	2022.01	06/05/2021 04:43:50 PM Central Daylight Time		06/06/2021 09:15:50 AM Central Daylight Time			06/06/2021 09:55:40 PM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	025	0	2022	State of New Mexico		2					2						www.mutualofomaharx.com	www.mutualofomaharx.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					0	06/05/2021	2022.01	06/05/2021 04:44:02 PM Central Daylight Time		06/06/2021 09:16:10 AM Central Daylight Time			06/06/2021 09:55:40 PM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	026	0	2022	State of Colorado		2					2						www.mutualofomaharx.com	www.mutualofomaharx.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					0	06/05/2021	2022.01	06/05/2021 04:44:13 PM Central Daylight Time		06/06/2021 09:16:29 AM Central Daylight Time			06/06/2021 09:55:40 PM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	027	0	2022	State of Arizona		2					2						www.mutualofomaharx.com	www.mutualofomaharx.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					0	06/05/2021	2022.01	06/05/2021 04:44:27 PM Central Daylight Time		06/06/2021 09:16:50 AM Central Daylight Time			06/06/2021 09:55:40 PM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	028	0	2022	State of Nevada		2					2						www.mutualofomaharx.com	www.mutualofomaharx.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					0	06/05/2021	2022.01	06/05/2021 04:44:38 PM Central Daylight Time		06/06/2021 09:17:11 AM Central Daylight Time			06/06/2021 09:55:40 PM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	029	0	2022	States of Oregon and Washington		2					2						www.mutualofomaharx.com	www.mutualofomaharx.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					0	06/05/2021	2022.01	06/05/2021 04:44:49 PM Central Daylight Time		06/06/2021 09:17:34 AM Central Daylight Time			06/06/2021 09:55:40 PM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	030	0	2022	States of Idaho and Utah		2					2						www.mutualofomaharx.com	www.mutualofomaharx.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					0	06/05/2021	2022.01	06/05/2021 04:44:59 PM Central Daylight Time		06/06/2021 09:17:55 AM Central Daylight Time			06/06/2021 09:55:40 PM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	031	0	2022	State of California		2					2						www.mutualofomaharx.com	www.mutualofomaharx.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					0	06/05/2021	2022.01	06/05/2021 04:45:09 PM Central Daylight Time		06/06/2021 09:18:18 AM Central Daylight Time			06/06/2021 09:55:40 PM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	032	0	2022	State of Hawaii		2					2						www.mutualofomaharx.com	www.mutualofomaharx.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					0	06/05/2021	2022.01	06/05/2021 04:45:20 PM Central Daylight Time		06/06/2021 08:11:04 PM Central Daylight Time			06/06/2021 09:55:40 PM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	033	0	2022	State of Alaska		2					2						www.mutualofomaharx.com	www.mutualofomaharx.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	071	0		29	10	S7126_071_0	2	1					1	06/06/2021	2022.01	06/06/2021 09:45:37 PM Central Daylight Time		06/06/2021 09:18:59 AM Central Daylight Time			06/06/2021 09:55:40 PM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Premier (PDP)	10	29					S7126	071	0	2022	Northern New England		2					2						www.mutualofomaharx.com	www.mutualofomaharx.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	072	0		29	10	S7126_072_0	1	1					1	06/06/2021	2022.01	06/06/2021 09:45:47 PM Central Daylight Time		06/06/2021 09:19:19 AM Central Daylight Time			06/06/2021 09:55:40 PM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Premier (PDP)	10	29					S7126	072	0	2022	Central New England		2					2						www.mutualofomaharx.com	www.mutualofomaharx.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	073	0		29	10	S7126_073_0	1	1					1	06/06/2021	2022.01	06/06/2021 09:45:56 PM Central Daylight Time		06/06/2021 09:19:39 AM Central Daylight Time			06/06/2021 09:55:40 PM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Premier (PDP)	10	29					S7126	073	0	2022	State of New Jersey		2					2						www.mutualofomaharx.com	www.mutualofomaharx.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	074	0		29	10	S7126_074_0	1	1					1	06/06/2021	2022.01	06/06/2021 09:46:05 PM Central Daylight Time		06/06/2021 09:20:00 AM Central Daylight Time			06/06/2021 09:55:40 PM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Premier (PDP)	10	29					S7126	074	0	2022	Mid-Atlantic		2					2						www.mutualofomaharx.com	www.mutualofomaharx.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	075	0		29	10	S7126_075_0	1	1					1	06/06/2021	2022.01	06/06/2021 09:46:15 PM Central Daylight Time		06/06/2021 09:20:22 AM Central Daylight Time			06/06/2021 09:55:40 PM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Premier (PDP)	10	29					S7126	075	0	2022	States of Pennsylvania and West Virginia		2					2						www.mutualofomaharx.com	www.mutualofomaharx.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	076	0		29	10	S7126_076_0	1	1					1	06/06/2021	2022.01	06/06/2021 09:46:23 PM Central Daylight Time		06/06/2021 09:20:42 AM Central Daylight Time			06/06/2021 09:55:40 PM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Premier (PDP)	10	29					S7126	076	0	2022	State of Virginia		2					2						www.mutualofomaharx.com	www.mutualofomaharx.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	077	0		29	10	S7126_077_0	1	1					1	06/06/2021	2022.01	06/06/2021 09:46:32 PM Central Daylight Time		06/06/2021 09:21:06 AM Central Daylight Time			06/06/2021 09:55:40 PM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Premier (PDP)	10	29					S7126	077	0	2022	State of North Carolina		2					2						www.mutualofomaharx.com	www.mutualofomaharx.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	078	0		29	10	S7126_078_0	1	1					1	06/06/2021	2022.01	06/06/2021 09:46:42 PM Central Daylight Time		06/06/2021 09:21:28 AM Central Daylight Time			06/06/2021 09:55:40 PM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Premier (PDP)	10	29					S7126	078	0	2022	State of South Carolina		2					2						www.mutualofomaharx.com	www.mutualofomaharx.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	079	0		29	10	S7126_079_0	1	1					1	06/06/2021	2022.01	06/06/2021 09:46:51 PM Central Daylight Time		06/06/2021 09:21:49 AM Central Daylight Time			06/06/2021 09:55:40 PM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Premier (PDP)	10	29					S7126	079	0	2022	State of Georgia		2					2						www.mutualofomaharx.com	www.mutualofomaharx.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	080	0		29	10	S7126_080_0	1	1					1	06/06/2021	2022.01	06/06/2021 09:46:59 PM Central Daylight Time		06/06/2021 09:22:16 AM Central Daylight Time			06/06/2021 09:55:40 PM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Premier (PDP)	10	29					S7126	080	0	2022	State of Florida		2					2						www.mutualofomaharx.com	www.mutualofomaharx.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	081	0		29	10	S7126_081_0	1	1					1	06/06/2021	2022.01	06/06/2021 09:47:08 PM Central Daylight Time		06/06/2021 09:22:36 AM Central Daylight Time			06/06/2021 09:55:40 PM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Premier (PDP)	10	29					S7126	081	0	2022	States of Alabama and Tennessee		2					2						www.mutualofomaharx.com	www.mutualofomaharx.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	082	0		29	10	S7126_082_0	1	1					1	06/06/2021	2022.01	06/06/2021 09:47:18 PM Central Daylight Time		06/06/2021 09:22:59 AM Central Daylight Time			06/06/2021 09:55:40 PM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Premier (PDP)	10	29					S7126	082	0	2022	State of Michigan		2					2						www.mutualofomaharx.com	www.mutualofomaharx.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	083	0		29	10	S7126_083_0	1	1					1	06/06/2021	2022.01	06/06/2021 09:47:27 PM Central Daylight Time		06/06/2021 09:23:19 AM Central Daylight Time			06/06/2021 09:55:40 PM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Premier (PDP)	10	29					S7126	083	0	2022	State of Ohio		2					2						www.mutualofomaharx.com	www.mutualofomaharx.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	084	0		29	10	S7126_084_0	1	1					1	06/06/2021	2022.01	06/06/2021 09:47:35 PM Central Daylight Time		06/06/2021 09:23:39 AM Central Daylight Time			06/06/2021 09:55:40 PM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Premier (PDP)	10	29					S7126	084	0	2022	States of Indiana and Kentucky		2					2						www.mutualofomaharx.com	www.mutualofomaharx.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	085	0		29	10	S7126_085_0	1	1					1	06/06/2021	2022.01	06/06/2021 09:47:43 PM Central Daylight Time		06/06/2021 09:24:00 AM Central Daylight Time			06/06/2021 09:55:40 PM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Premier (PDP)	10	29					S7126	085	0	2022	State of Wisconsin		2					2						www.mutualofomaharx.com	www.mutualofomaharx.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	086	0		29	10	S7126_086_0	1	1					1	06/06/2021	2022.01	06/06/2021 09:47:51 PM Central Daylight Time		06/06/2021 09:24:21 AM Central Daylight Time			06/06/2021 09:55:40 PM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Premier (PDP)	10	29					S7126	086	0	2022	State of Illinois		2					2						www.mutualofomaharx.com	www.mutualofomaharx.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	087	0		29	10	S7126_087_0	1	1					1	06/06/2021	2022.01	06/06/2021 09:47:58 PM Central Daylight Time		06/06/2021 09:24:43 AM Central Daylight Time			06/06/2021 09:55:40 PM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Premier (PDP)	10	29					S7126	087	0	2022	State of Missouri		2					2						www.mutualofomaharx.com	www.mutualofomaharx.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	088	0		29	10	S7126_088_0	1	1					1	06/06/2021	2022.01	06/06/2021 09:48:07 PM Central Daylight Time		06/06/2021 09:25:04 AM Central Daylight Time			06/06/2021 09:55:40 PM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Premier (PDP)	10	29					S7126	088	0	2022	State of Arkansas		2					2						www.mutualofomaharx.com	www.mutualofomaharx.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	089	0		29	10	S7126_089_0	1	1					1	06/06/2021	2022.01	06/06/2021 09:48:17 PM Central Daylight Time		06/06/2021 09:25:39 AM Central Daylight Time			06/06/2021 09:55:40 PM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Premier (PDP)	10	29					S7126	089	0	2022	State of Mississippi		2					2						www.mutualofomaharx.com	www.mutualofomaharx.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	090	0		29	10	S7126_090_0	1	1					1	06/06/2021	2022.01	06/06/2021 09:48:26 PM Central Daylight Time		06/06/2021 09:26:00 AM Central Daylight Time			06/06/2021 09:55:40 PM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Premier (PDP)	10	29					S7126	090	0	2022	State of Louisiana		2					2						www.mutualofomaharx.com	www.mutualofomaharx.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	091	0		29	10	S7126_091_0	1	1					1	06/06/2021	2022.01	06/06/2021 09:48:35 PM Central Daylight Time		06/06/2021 09:26:21 AM Central Daylight Time			06/06/2021 09:55:40 PM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Premier (PDP)	10	29					S7126	091	0	2022	State of Texas		2					2						www.mutualofomaharx.com	www.mutualofomaharx.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	092	0		29	10	S7126_092_0	1	1					1	06/06/2021	2022.01	06/06/2021 09:48:43 PM Central Daylight Time		06/06/2021 09:26:42 AM Central Daylight Time			06/06/2021 09:55:40 PM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Premier (PDP)	10	29					S7126	092	0	2022	State of Oklahoma		2					2						www.mutualofomaharx.com	www.mutualofomaharx.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	093	0		29	10	S7126_093_0	1	1					1	06/06/2021	2022.01	06/06/2021 09:48:52 PM Central Daylight Time		06/06/2021 09:27:02 AM Central Daylight Time			06/06/2021 09:55:40 PM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Premier (PDP)	10	29					S7126	093	0	2022	State of Kansas		2					2						www.mutualofomaharx.com	www.mutualofomaharx.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	094	0		29	10	S7126_094_0	1	1					1	06/06/2021	2022.01	06/06/2021 09:49:02 PM Central Daylight Time		06/06/2021 09:28:06 AM Central Daylight Time			06/06/2021 09:55:40 PM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Premier (PDP)	10	29					S7126	094	0	2022	Upper Midwest and Northern Plains		2					2						www.mutualofomaharx.com	www.mutualofomaharx.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	095	0		29	10	S7126_095_0	1	1					1	06/06/2021	2022.01	06/06/2021 09:49:11 PM Central Daylight Time		06/06/2021 09:28:30 AM Central Daylight Time			06/06/2021 09:55:40 PM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Premier (PDP)	10	29					S7126	095	0	2022	State of New Mexico		2					2						www.mutualofomaharx.com	www.mutualofomaharx.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	096	0		29	10	S7126_096_0	1	1					1	06/06/2021	2022.01	06/06/2021 09:49:21 PM Central Daylight Time		06/06/2021 09:28:51 AM Central Daylight Time			06/06/2021 09:55:40 PM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Premier (PDP)	10	29					S7126	096	0	2022	State of Colorado		2					2						www.mutualofomaharx.com	www.mutualofomaharx.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	097	0		29	10	S7126_097_0	1	1					1	06/06/2021	2022.01	06/06/2021 09:49:30 PM Central Daylight Time		06/06/2021 09:29:13 AM Central Daylight Time			06/06/2021 09:55:40 PM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Premier (PDP)	10	29					S7126	097	0	2022	State of Arizona		2					2						www.mutualofomaharx.com	www.mutualofomaharx.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	098	0		29	10	S7126_098_0	1	1					1	06/06/2021	2022.01	06/06/2021 09:49:39 PM Central Daylight Time		06/06/2021 09:29:33 AM Central Daylight Time			06/06/2021 09:55:40 PM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Premier (PDP)	10	29					S7126	098	0	2022	State of Nevada		2					2						www.mutualofomaharx.com	www.mutualofomaharx.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	099	0		29	10	S7126_099_0	1	1					1	06/06/2021	2022.01	06/06/2021 09:49:47 PM Central Daylight Time		06/06/2021 09:29:53 AM Central Daylight Time			06/06/2021 09:55:40 PM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Premier (PDP)	10	29					S7126	099	0	2022	States of Oregon and Washington		2					2						www.mutualofomaharx.com	www.mutualofomaharx.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	100	0		29	10	S7126_100_0	1	1					1	06/06/2021	2022.01	06/06/2021 09:49:56 PM Central Daylight Time		06/06/2021 09:30:15 AM Central Daylight Time			06/06/2021 09:55:40 PM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Premier (PDP)	10	29					S7126	100	0	2022	States of Idaho and Utah		2					2						www.mutualofomaharx.com	www.mutualofomaharx.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	101	0		29	10	S7126_101_0	1	1					1	06/06/2021	2022.01	06/06/2021 09:50:05 PM Central Daylight Time		06/06/2021 09:30:34 AM Central Daylight Time			06/06/2021 09:55:40 PM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Premier (PDP)	10	29					S7126	101	0	2022	State of California		2					2						www.mutualofomaharx.com	www.mutualofomaharx.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	102	0		29	10	S7126_102_0	1	1					1	06/06/2021	2022.01	06/06/2021 09:50:16 PM Central Daylight Time		06/06/2021 09:30:57 AM Central Daylight Time			06/06/2021 09:55:40 PM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Premier (PDP)	10	29					S7126	102	0	2022	State of Hawaii		2					2						www.mutualofomaharx.com	www.mutualofomaharx.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	103	0		29	10	S7126_103_0	1	1					1	06/06/2021	2022.01	06/06/2021 09:50:26 PM Central Daylight Time		06/06/2021 09:31:17 AM Central Daylight Time			06/06/2021 09:55:40 PM Central Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	www.mutualofomaharx.com	Mutual of Omaha Rx Premier (PDP)	10	29					S7126	103	0	2022	State of Alaska		2					2						www.mutualofomaharx.com	www.mutualofomaharx.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					0	06/03/2021	2022.01	06/03/2021 10:59:28 PM Eastern Daylight Time		06/03/2021 10:50:54 PM Eastern Daylight Time			06/04/2021 09:07:58 AM Eastern Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxSecure (PDP)	10	29					S7694	001	0	2022	Maine, New Hampshire Elixir RxSecure Region 01		2					2						https://envisionrxplus.com/Pharmacy	https://envisionrxplus.com/Resources/Formulary										(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					0	05/29/2021	2022.01	05/29/2021 01:15:49 PM Eastern Daylight Time		06/03/2021 10:50:54 PM Eastern Daylight Time			06/04/2021 09:15:43 AM Eastern Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxSecure (PDP)	10	29					S7694	002	0	2022	Central New England Elixir RxSecure Region 02		2					2						https://envisionrxplus.com/Pharmacy	https://envisionrxplus.com/Resources/Formulary										(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					0	05/29/2021	2022.01	05/29/2021 01:58:05 PM Eastern Daylight Time		06/03/2021 10:50:54 PM Eastern Daylight Time			06/04/2021 09:15:43 AM Eastern Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxSecure (PDP)	10	29					S7694	003	0	2022	New York Elixir RxSecure Region 03		2					2						https://envisionrxplus.com/Pharmacy	https://envisionrxplus.com/Resources/Formulary										(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	004	0		29	10	S7694_004_0	1	1					0	05/29/2021	2022.01	05/29/2021 02:08:38 PM Eastern Daylight Time		06/03/2021 10:50:54 PM Eastern Daylight Time			06/04/2021 09:15:43 AM Eastern Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxSecure (PDP)	10	29					S7694	004	0	2022	New Jersey Elixir RxSecure Region 04		2					2						https://envisionrxplus.com/Pharmacy	https://envisionrxplus.com/Resources/Formulary										(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					0	05/29/2021	2022.01	05/29/2021 01:58:47 PM Eastern Daylight Time		06/03/2021 10:50:54 PM Eastern Daylight Time			06/04/2021 09:19:29 AM Eastern Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxSecure (PDP)	10	29					S7694	005	0	2022	Mid-Atlantic Elixir RxSecure Region 05		2					2						https://envisionrxplus.com/Pharmacy	https://envisionrxplus.com/Resources/Formulary										(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					0	05/29/2021	2022.01	05/29/2021 01:13:46 PM Eastern Daylight Time		06/03/2021 10:50:55 PM Eastern Daylight Time			06/04/2021 09:19:29 AM Eastern Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxSecure (PDP)	10	29					S7694	006	0	2022	Pennsylvania, WV Elixir RxSecure Region 06		2					2						https://envisionrxplus.com/Pharmacy	https://envisionrxplus.com/Resources/Formulary										(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	007	0		29	10	S7694_007_0	1	1					0	05/29/2021	2022.01	05/29/2021 01:55:28 PM Eastern Daylight Time		06/03/2021 10:50:55 PM Eastern Daylight Time			06/04/2021 09:19:29 AM Eastern Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxSecure (PDP)	10	29					S7694	007	0	2022	Virginia Elixir RxSecure Region 07		2					2						https://envisionrxplus.com/Pharmacy	https://envisionrxplus.com/Resources/Formulary										(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					0	05/29/2021	2022.01	05/29/2021 01:18:30 PM Eastern Daylight Time		06/03/2021 10:50:55 PM Eastern Daylight Time			06/04/2021 09:19:29 AM Eastern Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxSecure (PDP)	10	29					S7694	008	0	2022	North Carolina Elixir RxSecure Region 08		2					2						https://envisionrxplus.com/Pharmacy	https://envisionrxplus.com/Resources/Formulary										(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					0	05/29/2021	2022.01	05/29/2021 01:59:34 PM Eastern Daylight Time		06/03/2021 10:50:55 PM Eastern Daylight Time			06/04/2021 09:19:29 AM Eastern Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxSecure (PDP)	10	29					S7694	009	0	2022	South Carolina Elixir RxSecure Region 09		2					2						https://envisionrxplus.com/Pharmacy	https://envisionrxplus.com/Resources/Formulary										(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					0	05/29/2021	2022.01	05/29/2021 01:17:53 PM Eastern Daylight Time		06/03/2021 10:50:55 PM Eastern Daylight Time			06/04/2021 09:21:42 AM Eastern Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxSecure (PDP)	10	29					S7694	010	0	2022	Georgia Elixir RxSecure Region 10		2					2						https://envisionrxplus.com/Pharmacy	https://envisionrxplus.com/Resources/Formulary										(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	011	0		29	10	S7694_011_0	1	1					0	05/29/2021	2022.01	05/29/2021 02:10:39 PM Eastern Daylight Time		06/03/2021 10:50:55 PM Eastern Daylight Time			06/04/2021 09:21:42 AM Eastern Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxSecure (PDP)	10	29					S7694	011	0	2022	Florida Elixir RxSecure Region 11		2					2						https://envisionrxplus.com/Pharmacy	https://envisionrxplus.com/Resources/Formulary										(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	012	0		29	10	S7694_012_0	1	1					0	05/29/2021	2022.01	05/29/2021 01:57:13 PM Eastern Daylight Time		06/03/2021 10:50:55 PM Eastern Daylight Time			06/04/2021 09:21:42 AM Eastern Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxSecure (PDP)	10	29					S7694	012	0	2022	Alabama,Tennessee Elixir RxSecure Region 12		2					2						https://envisionrxplus.com/Pharmacy	https://envisionrxplus.com/Resources/Formulary										(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					0	05/29/2021	2022.01	05/29/2021 01:17:20 PM Eastern Daylight Time		06/03/2021 10:50:55 PM Eastern Daylight Time			06/04/2021 09:21:42 AM Eastern Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxSecure (PDP)	10	29					S7694	014	0	2022	Ohio Elixir RxSecure Region 14		2					2						https://envisionrxplus.com/Pharmacy	https://envisionrxplus.com/Resources/Formulary										(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	015	0		29	10	S7694_015_0	1	1					0	05/29/2021	2022.01	05/29/2021 01:56:28 PM Eastern Daylight Time		06/03/2021 10:50:55 PM Eastern Daylight Time			06/04/2021 09:21:42 AM Eastern Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxSecure (PDP)	10	29					S7694	015	0	2022	Indiana, Kentucky Elixir RxSecure Region 15		2					2						https://envisionrxplus.com/Pharmacy	https://envisionrxplus.com/Resources/Formulary										(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	016	0		29	10	S7694_016_0	1	1					0	05/29/2021	2022.01	05/29/2021 02:02:01 PM Eastern Daylight Time		06/03/2021 10:50:55 PM Eastern Daylight Time			06/04/2021 09:21:42 AM Eastern Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxSecure (PDP)	10	29					S7694	016	0	2022	Wisconsin Elixir RxSecure Region 16		2					2						https://envisionrxplus.com/Pharmacy	https://envisionrxplus.com/Resources/Formulary										(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					0	05/29/2021	2022.01	05/29/2021 02:00:16 PM Eastern Daylight Time		06/03/2021 10:50:55 PM Eastern Daylight Time			06/04/2021 09:21:42 AM Eastern Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxSecure (PDP)	10	29					S7694	017	0	2022	Illinois Elixir RxSecure Region 17		2					2						https://envisionrxplus.com/Pharmacy	https://envisionrxplus.com/Resources/Formulary										(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	018	0		29	10	S7694_018_0	1	1					0	05/29/2021	2022.01	05/29/2021 02:15:30 PM Eastern Daylight Time		06/03/2021 10:50:55 PM Eastern Daylight Time			06/04/2021 09:21:42 AM Eastern Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxSecure (PDP)	10	29					S7694	018	0	2022	Missouri Elixir RxSecure Region 18		2					2						https://envisionrxplus.com/Pharmacy	https://envisionrxplus.com/Resources/Formulary										(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	019	0		29	10	S7694_019_0	1	1					0	05/29/2021	2022.01	05/29/2021 02:14:18 PM Eastern Daylight Time		06/03/2021 10:50:55 PM Eastern Daylight Time			06/04/2021 09:21:42 AM Eastern Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxSecure (PDP)	10	29					S7694	019	0	2022	Arkansas Elixir RxSecure Region 19		2					2						https://envisionrxplus.com/Pharmacy	https://envisionrxplus.com/Resources/Formulary										(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					0	05/29/2021	2022.01	05/29/2021 01:20:49 PM Eastern Daylight Time		06/03/2021 10:50:55 PM Eastern Daylight Time			06/04/2021 09:21:42 AM Eastern Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxSecure (PDP)	10	29					S7694	020	0	2022	Mississippi Elixir RxSecure Region 20		2					2						https://envisionrxplus.com/Pharmacy	https://envisionrxplus.com/Resources/Formulary										(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	021	0		29	10	S7694_021_0	1	1					0	05/29/2021	2022.01	05/29/2021 02:09:17 PM Eastern Daylight Time		06/03/2021 10:50:55 PM Eastern Daylight Time			06/04/2021 09:23:46 AM Eastern Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxSecure (PDP)	10	29					S7694	021	0	2022	Louisiana Elixir RxSecure Region 21		2					2						https://envisionrxplus.com/Pharmacy	https://envisionrxplus.com/Resources/Formulary										(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	022	0		29	10	S7694_022_0	1	1					0	05/29/2021	2022.01	05/29/2021 01:21:54 PM Eastern Daylight Time		06/03/2021 10:50:55 PM Eastern Daylight Time			06/04/2021 09:23:46 AM Eastern Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxSecure (PDP)	10	29					S7694	022	0	2022	Texas Elixir RxSecure Region 22		2					2						https://envisionrxplus.com/Pharmacy	https://envisionrxplus.com/Resources/Formulary										(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	023	0		29	10	S7694_023_0	1	1					0	05/29/2021	2022.01	05/29/2021 02:12:32 PM Eastern Daylight Time		06/03/2021 10:50:55 PM Eastern Daylight Time			06/04/2021 09:23:46 AM Eastern Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxSecure (PDP)	10	29					S7694	023	0	2022	Oklahoma Elixir RxSecure Region 23		2					2						https://envisionrxplus.com/Pharmacy	https://envisionrxplus.com/Resources/Formulary										(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	024	0		29	10	S7694_024_0	1	1					0	05/29/2021	2022.01	05/29/2021 02:11:20 PM Eastern Daylight Time		06/03/2021 10:50:55 PM Eastern Daylight Time			06/04/2021 09:23:46 AM Eastern Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxSecure (PDP)	10	29					S7694	024	0	2022	Kansas Elixir RxSecure Region 24		2					2						https://envisionrxplus.com/Pharmacy	https://envisionrxplus.com/Resources/Formulary										(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	025	0		29	10	S7694_025_0	1	1					0	05/29/2021	2022.01	05/29/2021 02:15:00 PM Eastern Daylight Time		06/03/2021 10:50:55 PM Eastern Daylight Time			06/04/2021 09:23:46 AM Eastern Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxSecure (PDP)	10	29					S7694	025	0	2022	Midwest/Plains Elixir RxSecure Region 25		2					2						https://envisionrxplus.com/Pharmacy	https://envisionrxplus.com/Resources/Formulary										(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					0	05/29/2021	2022.01	05/29/2021 02:04:02 PM Eastern Daylight Time		06/03/2021 10:50:55 PM Eastern Daylight Time			06/04/2021 09:23:46 AM Eastern Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxSecure (PDP)	10	29					S7694	026	0	2022	New Mexico Elixir RxSecure Region 26		2					2						https://envisionrxplus.com/Pharmacy	https://envisionrxplus.com/Resources/Formulary										(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					0	05/29/2021	2022.01	05/29/2021 02:00:49 PM Eastern Daylight Time		06/03/2021 10:50:55 PM Eastern Daylight Time			06/04/2021 09:23:46 AM Eastern Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxSecure (PDP)	10	29					S7694	027	0	2022	Colorado Elixir RxSecure Region 27		2					2						https://envisionrxplus.com/Pharmacy	https://envisionrxplus.com/Resources/Formulary										(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					0	05/29/2021	2022.01	05/29/2021 02:01:22 PM Eastern Daylight Time		06/03/2021 10:50:55 PM Eastern Daylight Time			06/04/2021 09:23:46 AM Eastern Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxSecure (PDP)	10	29					S7694	028	0	2022	Arizona Elixir RxSecure Region 28		2					2						https://envisionrxplus.com/Pharmacy	https://envisionrxplus.com/Resources/Formulary										(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	029	0		29	10	S7694_029_0	1	1					0	05/29/2021	2022.01	05/29/2021 02:16:05 PM Eastern Daylight Time		06/03/2021 10:50:55 PM Eastern Daylight Time			06/04/2021 09:23:46 AM Eastern Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxSecure (PDP)	10	29					S7694	029	0	2022	Nevada Elixir RxSecure Region 29		2					2						https://envisionrxplus.com/Pharmacy	https://envisionrxplus.com/Resources/Formulary										(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					0	05/29/2021	2022.01	05/29/2021 01:14:23 PM Eastern Daylight Time		06/03/2021 10:50:55 PM Eastern Daylight Time			06/04/2021 09:23:46 AM Eastern Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxSecure (PDP)	10	29					S7694	030	0	2022	Oregon, Washington Elixir RxSecure Region 30		2					2						https://envisionrxplus.com/Pharmacy	https://envisionrxplus.com/Resources/Formulary										(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					0	05/29/2021	2022.01	05/29/2021 02:03:27 PM Eastern Daylight Time		06/03/2021 10:50:55 PM Eastern Daylight Time			06/04/2021 09:23:46 AM Eastern Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxSecure (PDP)	10	29					S7694	031	0	2022	Idaho, Utah Elixir RxSecure Region 31		2					2						https://envisionrxplus.com/Pharmacy	https://envisionrxplus.com/Resources/Formulary										(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					0	05/29/2021	2022.01	05/29/2021 01:21:17 PM Eastern Daylight Time		06/03/2021 10:50:55 PM Eastern Daylight Time			06/04/2021 09:23:46 AM Eastern Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxSecure (PDP)	10	29					S7694	032	0	2022	California Elixir RxSecure Region 32		2					2						https://envisionrxplus.com/Pharmacy	https://envisionrxplus.com/Resources/Formulary										(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	033	0		29	10	S7694_033_0	1	1					0	05/29/2021	2022.01	05/29/2021 02:16:41 PM Eastern Daylight Time		06/03/2021 10:50:55 PM Eastern Daylight Time			06/04/2021 09:23:46 AM Eastern Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxSecure (PDP)	10	29					S7694	033	0	2022	Hawaii Elixir RxSecure Region 33		2					2						https://envisionrxplus.com/Pharmacy	https://envisionrxplus.com/Resources/Formulary										(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					0	05/29/2021	2022.01	05/29/2021 02:05:22 PM Eastern Daylight Time		06/03/2021 10:50:55 PM Eastern Daylight Time			06/04/2021 09:26:18 AM Eastern Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxSecure (PDP)	10	29					S7694	034	0	2022	Alaska Elixir RxSecure Region 34		2					2						https://envisionrxplus.com/Pharmacy	https://envisionrxplus.com/Resources/Formulary										(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					0	05/29/2021	2022.01	05/29/2021 01:15:02 PM Eastern Daylight Time		06/03/2021 10:50:55 PM Eastern Daylight Time			06/04/2021 09:26:18 AM Eastern Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxSecure (PDP)	10	29					S7694	070	0	2022	Michigan Elixir RxSecure Region 13		2					2						https://envisionrxplus.com/Pharmacy	https://envisionrxplus.com/Resources/Formulary										(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	121	0		29	10	S7694_121_0	1	1					0	05/29/2021	2022.01	05/29/2021 02:25:44 PM Eastern Daylight Time		06/03/2021 10:50:55 PM Eastern Daylight Time			06/04/2021 09:26:18 AM Eastern Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxPlus (PDP)	10	29					S7694	121	0	2022	New York Elixir RxPlus Region 3		2					2						https://envisionrxplus.com/Pharmacy	https://envisionrxplus.com/Resources/Formulary										(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	122	0		29	10	S7694_122_0	1	1					0	05/29/2021	2022.01	05/29/2021 02:26:36 PM Eastern Daylight Time		06/03/2021 10:50:55 PM Eastern Daylight Time			06/04/2021 09:26:18 AM Eastern Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxPlus (PDP)	10	29					S7694	122	0	2022	Mid-Atlantic Elixir RxPlus Region - 05		2					2						https://envisionrxplus.com/Pharmacy	https://envisionrxplus.com/Resources/Formulary										(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	123	0		29	10	S7694_123_0	1	1					0	05/29/2021	2022.01	05/29/2021 02:27:17 PM Eastern Daylight Time		06/03/2021 10:50:55 PM Eastern Daylight Time			06/04/2021 09:26:18 AM Eastern Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxPlus (PDP)	10	29					S7694	123	0	2022	South Carolina Elixir RxPlus Region 09		2					2						https://envisionrxplus.com/Pharmacy	https://envisionrxplus.com/Resources/Formulary										(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	124	0		29	10	S7694_124_0	1	1					0	05/29/2021	2022.01	05/29/2021 02:27:45 PM Eastern Daylight Time		06/03/2021 10:50:55 PM Eastern Daylight Time			06/04/2021 09:26:18 AM Eastern Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxPlus (PDP)	10	29					S7694	124	0	2022	Maine, New Hampshire Elixir RxPlus Region 01		2					2						https://envisionrxplus.com/Pharmacy	https://envisionrxplus.com/Resources/Formulary										(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	125	0		29	10	S7694_125_0	1	1					0	05/29/2021	2022.01	05/29/2021 02:28:57 PM Eastern Daylight Time		06/03/2021 10:50:56 PM Eastern Daylight Time			06/04/2021 09:26:18 AM Eastern Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxPlus (PDP)	10	29					S7694	125	0	2022	Central New England Elixir RxPlus Region 02		2					2						https://envisionrxplus.com/Pharmacy	https://envisionrxplus.com/Resources/Formulary										(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	126	0		29	10	S7694_126_0	1	1					0	05/29/2021	2022.01	05/29/2021 02:29:28 PM Eastern Daylight Time		06/03/2021 10:50:56 PM Eastern Daylight Time			06/04/2021 09:26:18 AM Eastern Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxPlus (PDP)	10	29					S7694	126	0	2022	Pennsylvania, W Virginia Elixir RxPlus Region 06		2					2						https://envisionrxplus.com/Pharmacy	https://envisionrxplus.com/Resources/Formulary										(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	127	0		29	10	S7694_127_0	1	1					0	05/29/2021	2022.01	05/29/2021 02:30:01 PM Eastern Daylight Time		06/03/2021 10:50:56 PM Eastern Daylight Time			06/04/2021 09:26:18 AM Eastern Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxPlus (PDP)	10	29					S7694	127	0	2022	Virginia Elixir RxPlus Region 07		2					2						https://envisionrxplus.com/Pharmacy	https://envisionrxplus.com/Resources/Formulary										(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	128	0		29	10	S7694_128_0	1	1					0	05/29/2021	2022.01	05/29/2021 02:30:38 PM Eastern Daylight Time		06/03/2021 10:50:56 PM Eastern Daylight Time			06/04/2021 09:26:18 AM Eastern Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxPlus (PDP)	10	29					S7694	128	0	2022	North Carolina Elixir RxPlus Region 08		2					2						https://envisionrxplus.com/Pharmacy	https://envisionrxplus.com/Resources/Formulary										(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	129	0		29	10	S7694_129_0	1	1					0	05/29/2021	2022.01	05/29/2021 02:31:09 PM Eastern Daylight Time		06/03/2021 10:50:56 PM Eastern Daylight Time			06/04/2021 09:26:18 AM Eastern Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxPlus (PDP)	10	29					S7694	129	0	2022	Georgia Elixir RxPlus Region 10		2					2						https://envisionrxplus.com/Pharmacy	https://envisionrxplus.com/Resources/Formulary										(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	130	0		29	10	S7694_130_0	1	1					0	05/29/2021	2022.01	05/29/2021 02:31:36 PM Eastern Daylight Time		06/03/2021 10:50:56 PM Eastern Daylight Time			06/04/2021 09:26:18 AM Eastern Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxPlus (PDP)	10	29					S7694	130	0	2022	Alabama/Tennessee Elixir RxPlus Region 12		2					2						https://envisionrxplus.com/Pharmacy	https://envisionrxplus.com/Resources/Formulary										(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	131	0		29	10	S7694_131_0	1	1					0	05/29/2021	2022.01	05/29/2021 02:33:01 PM Eastern Daylight Time		06/03/2021 10:50:56 PM Eastern Daylight Time			06/04/2021 09:53:32 AM Eastern Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxPlus (PDP)	10	29					S7694	131	0	2022	Michigan Elixir RxPlus Region 13		2					2						https://envisionrxplus.com/Pharmacy	https://envisionrxplus.com/Resources/Formulary										(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	132	0		29	10	S7694_132_0	1	1					0	05/29/2021	2022.01	05/29/2021 02:40:14 PM Eastern Daylight Time		06/03/2021 10:50:56 PM Eastern Daylight Time			06/04/2021 09:44:41 AM Eastern Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxPlus (PDP)	10	29					S7694	132	0	2022	Ohio Elixir RxPlus Region 14		2					2						https://envisionrxplus.com/Pharmacy	https://envisionrxplus.com/Resources/Formulary										(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	133	0		29	10	S7694_133_0	1	1					0	05/29/2021	2022.01	05/29/2021 02:40:51 PM Eastern Daylight Time		06/03/2021 10:50:56 PM Eastern Daylight Time			06/04/2021 09:46:20 AM Eastern Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxPlus (PDP)	10	29					S7694	133	0	2022	Indiana/Kentucky Elixir RxPlus Region 15		2					2						https://envisionrxplus.com/Pharmacy	https://envisionrxplus.com/Resources/Formulary										(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	134	0		29	10	S7694_134_0	1	1					0	05/29/2021	2022.01	05/29/2021 02:41:23 PM Eastern Daylight Time		06/03/2021 10:50:56 PM Eastern Daylight Time			06/04/2021 09:46:20 AM Eastern Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxPlus (PDP)	10	29					S7694	134	0	2022	Mississippi Elixir RxPlus Region 20		2					2						https://envisionrxplus.com/Pharmacy	https://envisionrxplus.com/Resources/Formulary										(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	135	0		29	10	S7694_135_0	1	1					0	05/29/2021	2022.01	05/29/2021 02:42:17 PM Eastern Daylight Time		06/03/2021 10:50:56 PM Eastern Daylight Time			06/04/2021 09:46:20 AM Eastern Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxPlus (PDP)	10	29					S7694	135	0	2022	Texas Elixir RxPlus Region 22		2					2						https://envisionrxplus.com/Pharmacy	https://envisionrxplus.com/Resources/Formulary										(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	136	0		29	10	S7694_136_0	1	1					0	05/29/2021	2022.01	05/29/2021 02:43:11 PM Eastern Daylight Time		06/03/2021 10:50:56 PM Eastern Daylight Time			06/04/2021 09:46:20 AM Eastern Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxPlus (PDP)	10	29					S7694	136	0	2022	Oregon/Washington Elixir RxPlus Region 30		2					2						https://envisionrxplus.com/Pharmacy	https://envisionrxplus.com/Resources/Formulary										(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	137	0		29	10	S7694_137_0	1	1					0	05/29/2021	2022.01	05/29/2021 02:44:19 PM Eastern Daylight Time		06/03/2021 10:50:56 PM Eastern Daylight Time			06/04/2021 09:46:20 AM Eastern Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://elixirinsurance.com	Elixir RxPlus (PDP)	10	29					S7694	137	0	2022	California Elixir RxPlus Region 32		2					2						https://envisionrxplus.com/Pharmacy	https://envisionrxplus.com/Resources/Formulary										(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						05/10/2021	2022.01	05/10/2021 02:33:49 PM Eastern Daylight Time					06/04/2021 09:41:37 AM Eastern Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://envisionrxplus.com	Employer Plan Calendar Year (PDP)	10	29					S7694	801	0	2022	National EGWP		1					2						https://envisionrxplus.com/Pharmacy	https://envisionrxplus.com/Resources/Formulary										(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						05/10/2021	2022.01	05/10/2021 02:33:56 PM Eastern Daylight Time					06/04/2021 09:36:12 AM Eastern Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://envisionrxplus.com	Employer Group Non-Calendar Year (PDP)	10	29					S7694	802	0	2022	National EGWP		1					2						https://envisionrxplus.com/Pharmacy	https://envisionrxplus.com/Resources/Formulary										(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						05/10/2021	2022.01	05/10/2021 02:34:01 PM Eastern Daylight Time					06/04/2021 09:37:58 AM Eastern Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	retireerxcare.amwins.com	Retiree RxCare 4TC (PDP)	10	29					S7694	803	0	2022	National EGWP		1					2						https://envisionrxplus.com/Pharmacy	retireerxcare.amwins.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						05/10/2021	2022.01	05/10/2021 02:34:06 PM Eastern Daylight Time					06/04/2021 09:37:58 AM Eastern Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	retireerxcare.amwins.com	Retiree RxCare 5TC (PDP)	10	29					S7694	804	0	2022	National EGWP		1					2						https://envisionrxplus.com/Pharmacy	retireerxcare.amwins.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						05/10/2021	2022.01	05/10/2021 02:34:11 PM Eastern Daylight Time					06/04/2021 09:37:58 AM Eastern Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	retireerxcare.amwins.com	Retiree RxCare 4TO (PDP)	10	29					S7694	805	0	2022	National EGWP		1					2						https://envisionrxplus.com/Pharmacy	retireerxcare.amwins.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						05/10/2021	2022.01	05/10/2021 02:34:16 PM Eastern Daylight Time					06/04/2021 09:39:30 AM Eastern Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	retireerxcare.amwins.com	Retiree RxCare 5TO (PDP)	10	29					S7694	806	0	2022	National EGWP		1					2						https://envisionrxplus.com/Pharmacy	retireerxcare.amwins.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						05/10/2021	2022.01	05/10/2021 02:34:21 PM Eastern Daylight Time					06/04/2021 09:39:30 AM Eastern Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	retireerxcare.amwins.com	Retiree RxCare Bronze (PDP)	10	29					S7694	807	0	2022	National EGWP		1					2						https://envisionrxplus.com/Pharmacy	retireerxcare.amwins.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						05/10/2021	2022.01	05/10/2021 02:34:26 PM Eastern Daylight Time					06/04/2021 09:39:30 AM Eastern Daylight Time	ELIXIR INSURANCE COMPANY	Elixir Insurance	https://envisionrxplus.com	Employer Group Broad (PDP)	10	29					S7694	808	0	2022	National EGWP		1					2						https://envisionrxplus.com/Pharmacy	https://envisionrxplus.com/Resources/Formulary										(844)293-4760		(844)293-4760		(844)293-4760		(844)293-4760										(711)-		(711)-		(711)-		(711)-																
S8067	001	0		29	10	S8067_001_0	1	1					0	06/02/2021	2022.01	06/02/2021 03:38:57 PM Eastern Daylight Time		06/03/2021 04:03:20 PM Eastern Daylight Time			06/04/2021 11:19:23 AM Eastern Daylight Time	AVALON INSURANCE COMPANY	Avalon Insurance Company	www.avalonsecurerxpdp.com	SecureRx - Option 3 (PDP)	10	29					S8067	001	0	2022	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	1	1					1	06/02/2021	2022.01	06/02/2021 11:03:46 PM Eastern Daylight Time		06/03/2021 04:03:36 PM Eastern Daylight Time			06/04/2021 11:22:27 AM Eastern Daylight Time	AVALON INSURANCE COMPANY	Avalon Insurance Company	www.avalonsecurerxpdp.com	SecureRx - Option 1 (PDP)	10	29					S8067	003	0	2022	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						05/11/2021	2022.01	05/11/2021 01:44:17 PM Eastern Daylight Time					06/04/2021 12:32:53 PM Eastern Daylight Time	AVALON INSURANCE COMPANY	Avalon Insurance Company	www.avalonsecurerxpdp.com	SecureRx Group PDP Silver Rx (PDP)	10	29					S8067	801	0	2022	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						05/13/2021	2022.01	05/13/2021 07:06:52 AM Eastern Daylight Time					06/04/2021 12:32:53 PM Eastern Daylight Time	AVALON INSURANCE COMPANY	Avalon Insurance Company	www.avalonsecurerxpdp.com	SecureRx Group PDP Bronze Rx FY (PDP)	10	29					S8067	802	0	2022	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	803	0		29	10	S8067_803_0	1	1						05/13/2021	2022.01	05/13/2021 07:07:41 AM Eastern Daylight Time					06/04/2021 12:32:53 PM Eastern Daylight Time	AVALON INSURANCE COMPANY	Avalon Insurance Company	www.avalonsecurerxpdp.com	SecureRx Group PDP Gold Rx (PDP)	10	29					S8067	803	0	2022	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	804	0		29	10	S8067_804_0	1	1						05/13/2021	2022.01	05/13/2021 07:08:48 AM Eastern Daylight Time					06/04/2021 12:32:53 PM Eastern Daylight Time	AVALON INSURANCE COMPANY	Avalon Insurance Company	www.avalonsecurerxpdp.com	SecureRx Group PDP Bronze Rx (PDP)	10	29					S8067	804	0	2022	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	805	0		29	10	S8067_805_0	1	1						05/13/2021	2022.01	05/13/2021 11:11:08 AM Eastern Daylight Time					06/04/2021 12:35:45 PM Eastern Daylight Time	AVALON INSURANCE COMPANY	Avalon Insurance Company	www.avalonsecurerxpdp.com	SecureRx Group PDP Platinum Rx (PDP)	10	29					S8067	805	0	2022	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	806	0		29	10	S8067_806_0	1	1						05/13/2021	2022.01	05/13/2021 11:11:56 AM Eastern Daylight Time					06/04/2021 12:35:45 PM Eastern Daylight Time	AVALON INSURANCE COMPANY	Avalon Insurance Company	www.avalonsecurerxpdp.com	SecureRx Group PDP Platinum Rx FY (PDP)	10	29					S8067	806	0	2022	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	807	0		29	10	S8067_807_0	1	1						05/13/2021	2022.01	05/13/2021 11:13:13 AM Eastern Daylight Time					06/04/2021 12:35:45 PM Eastern Daylight Time	AVALON INSURANCE COMPANY	Avalon Insurance Company	www.avalonsecurerxpdp.com	SecureRx Group PDP Gold Rx FY (PDP)	10	29					S8067	807	0	2022	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	808	0		29	10	S8067_808_0	1	1						05/13/2021	2022.01	05/13/2021 11:14:15 AM Eastern Daylight Time					06/04/2021 12:35:45 PM Eastern Daylight Time	AVALON INSURANCE COMPANY	Avalon Insurance Company	www.avalonsecurerxpdp.com	SecureRx Group PDP Silver Rx FY (PDP)	10	29					S8067	808	0	2022	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)-																
S8182	001	0		29	10	S8182_001_0	4	1					0	05/28/2021	2022.01	05/28/2021 02:56:42 PM Eastern Daylight Time		07/16/2021 11:07:02 AM Eastern Daylight Time			07/16/2021 08:45:10 PM Eastern Daylight Time	AMERIGROUP INSURANCE COMPANY	Amerigroup	shop.amerigroup.com/medicare	Amerivantage Rx Basic (PDP)	10	29					S8182	001	0	2022	Texas		2					2						https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare										(844)209-5420		(844)209-5420		(855)793-1941		(855)793-1941										(711)-		(711)-		(711)-		(711)-																
S8182	003	0		29	10	S8182_003_0	4	1					0	06/01/2021	2022.01	06/01/2021 02:44:24 PM Eastern Daylight Time		07/16/2021 11:07:17 AM Eastern Daylight Time			07/16/2021 08:45:10 PM Eastern Daylight Time	AMERIGROUP INSURANCE COMPANY	Amerigroup	shop.amerigroup.com/medicare	Amerivantage Rx Basic (PDP)	10	29					S8182	003	0	2022	Arizona		2					2						https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare										(844)209-5420		(844)209-5420		(855)793-1941		(855)793-1941										(711)-		(711)-		(711)-		(711)-																
S8182	005	0		29	10	S8182_005_0	4	1					1	05/28/2021	2022.01	05/28/2021 02:59:20 PM Eastern Daylight Time		07/15/2021 09:42:06 PM Eastern Daylight Time			07/26/2021 08:24:25 AM Eastern Daylight Time	AMERIGROUP INSURANCE COMPANY	Amerigroup	shop.amerigroup.com/medicare	Amerivantage Rx Plus (PDP)	10	29					S8182	005	0	2022	Texas		2					2						https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare										(844)209-5420		(844)209-5420		(855)793-1941		(855)793-1941										(711)-		(711)-		(711)-		(711)-																
S8182	006	0		29	10	S8182_006_0	4	1					1	05/28/2021	2022.01	05/28/2021 03:00:50 PM Eastern Daylight Time		07/15/2021 09:42:21 PM Eastern Daylight Time			07/26/2021 08:24:25 AM Eastern Daylight Time	AMERIGROUP INSURANCE COMPANY	Amerigroup	shop.amerigroup.com/medicare	Amerivantage Rx Plus (PDP)	10	29					S8182	006	0	2022	Arizona		2					2						https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare										(844)209-5420		(844)209-5420		(855)793-1941		(855)793-1941										(711)-		(711)-		(711)-		(711)-																
S8677	803	0		29	10	S8677_803_0	1	1						06/08/2021	2022.01	06/08/2021 07:54:34 AM Pacific Daylight Time					06/09/2021 09:32:37 AM Pacific Daylight Time	PROVIDENCE HEALTH ASSURANCE	Providence Health Assurance	www.ProvidenceHealthAssurance.com	Providence Medicare Part D Group Plan (PDP)	10	29					S8677	803	0	2022	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						06/03/2021	2022.01	06/03/2021 08:03:54 PM US Mountain Standard Time					06/04/2021 09:23:56 AM US Mountain Standard Time	OPTUM INSURANCE OF OHIO, INC.	Optum Insurance of Ohio, Inc.	www.optum.com	OptumRx CORE Silver 2022 - CY (PDP)	10	29					S8841	803	0	2022	National		1					2						www.optumrx.com	www.optumrx.com										(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						06/03/2021	2022.01	06/03/2021 08:04:02 PM US Mountain Standard Time					06/04/2021 09:23:56 AM US Mountain Standard Time	OPTUM INSURANCE OF OHIO, INC.	Optum Insurance of Ohio, Inc.	www.optum.com	OptumRx CORE Silver 2022 - NCY (PDP)	10	29					S8841	804	0	2022	National		1					2						www.optumrx.com	www.optumrx.com										(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						06/03/2021	2022.01	06/03/2021 08:04:14 PM US Mountain Standard Time					06/04/2021 09:23:56 AM US Mountain Standard Time	OPTUM INSURANCE OF OHIO, INC.	Optum Insurance of Ohio, Inc.	www.optum.com	OptumRx CORE Bronze 2022 - CY (PDP)	10	29					S8841	807	0	2022	National		1					2						www.optumrx.com	www.optumrx.com										(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						06/03/2021	2022.01	06/03/2021 08:04:20 PM US Mountain Standard Time					06/04/2021 09:23:56 AM US Mountain Standard Time	OPTUM INSURANCE OF OHIO, INC.	Optum Insurance of Ohio, Inc.	www.optum.com	OptumRx CORE Bronze 2022 - NCY (PDP)	10	29					S8841	808	0	2022	National		1					2						www.optumrx.com	www.optumrx.com										(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						06/03/2021	2022.01	06/03/2021 08:04:30 PM US Mountain Standard Time					06/04/2021 09:23:56 AM US Mountain Standard Time	OPTUM INSURANCE OF OHIO, INC.	Optum Insurance of Ohio, Inc.	www.optum.com	MPSERS 2022 (PDP)	10	29					S8841	810	0	2022	National		1					2						www.optumrx.com	www.optumrx.com										(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						06/03/2021	2022.01	06/03/2021 08:04:39 PM US Mountain Standard Time					06/04/2021 09:23:56 AM US Mountain Standard Time	OPTUM INSURANCE OF OHIO, INC.	Optum Insurance of Ohio, Inc.	www.optum.com	OptumRx CORE Gold 5-Tier 2022 - CY (PDP)	10	29					S8841	812	0	2022	National		1					2						www.optumrx.com	www.optumrx.com										(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						06/03/2021	2022.01	06/03/2021 08:04:46 PM US Mountain Standard Time					06/04/2021 09:23:56 AM US Mountain Standard Time	OPTUM INSURANCE OF OHIO, INC.	Optum Insurance of Ohio, Inc.	www.optum.com	OptumRx CORE Gold 5-Tier 2022 - NCY (PDP)	10	29					S8841	813	0	2022	National		1					2						www.optumrx.com	www.optumrx.com										(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						06/03/2021	2022.01	06/03/2021 08:04:55 PM US Mountain Standard Time					06/04/2021 09:23:56 AM US Mountain Standard Time	OPTUM INSURANCE OF OHIO, INC.	Optum Insurance of Ohio, Inc.	www.optum.com	OptumRx CORE PDP 2022 - CY (PDP)	10	29					S8841	814	0	2022	National		1					2						www.optumrx.com	www.optumrx.com										(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						06/03/2021	2022.01	06/03/2021 08:05:01 PM US Mountain Standard Time					06/04/2021 09:23:56 AM US Mountain Standard Time	OPTUM INSURANCE OF OHIO, INC.	Optum Insurance of Ohio, Inc.	www.optum.com	OptumRx CORE PDP 2022 - NCY (PDP)	10	29					S8841	815	0	2022	National		1					2						www.optumrx.com	www.optumrx.com										(866)443-1095		(866)443-1095		(866)443-1095		(866)443-1095										(711)-		(711)-		(711)-		(711)-																
S8841	816	0		29	10	S8841_816_0	1	1						06/03/2021	2022.01	06/03/2021 08:05:11 PM US Mountain Standard Time					06/04/2021 09:23:56 AM US Mountain Standard Time	OPTUM INSURANCE OF OHIO, INC.	Optum Insurance of Ohio, Inc.	www.optum.com	OptumRx CORE Copper 2022 - CY (PDP)	10	29					S8841	816	0	2022	National		1					2						www.optumrx.com	www.optumrx.com										(866)443-1095		(866)443-1095		(866)443-1095		(866)443-1095										(711)-		(711)-		(711)-		(711)-																
S8841	817	0		29	10	S8841_817_0	1	1						06/03/2021	2022.01	06/03/2021 08:05:18 PM US Mountain Standard Time					06/04/2021 09:23:56 AM US Mountain Standard Time	OPTUM INSURANCE OF OHIO, INC.	Optum Insurance of Ohio, Inc.	www.optum.com	OptumRx CORE Copper 2022 - NCY (PDP)	10	29					S8841	817	0	2022	National		1					2						www.optumrx.com	www.optumrx.com										(866)443-1095		(866)443-1095		(866)443-1095		(866)443-1095										(711)-		(711)-		(711)-		(711)-																
S8841	818	0		29	10	S8841_818_0	1	1						06/03/2021	2022.01	06/03/2021 08:05:28 PM US Mountain Standard Time					06/04/2021 09:23:56 AM US Mountain Standard Time	OPTUM INSURANCE OF OHIO, INC.	Optum Insurance of Ohio, Inc.	www.optum.com	OptumRx CORE PDP Basic 2022 (CY) (PDP)	10	29					S8841	818	0	2022	National		1					2						www.optumrx.com	www.optumrx.com										(866)443-1095		(866)443-1095		(866)443-1095		(866)443-1095										(711)-		(711)-		(711)-		(711)-																
S8841	819	0		29	10	S8841_819_0	1	1						06/03/2021	2022.01	06/03/2021 08:05:34 PM US Mountain Standard Time					06/04/2021 09:23:56 AM US Mountain Standard Time	OPTUM INSURANCE OF OHIO, INC.	Optum Insurance of Ohio, Inc.	www.optum.com	OptumRx CORE Basic 2022 (NCY) (PDP)	10	29					S8841	819	0	2022	National		1					2						www.optumrx.com	www.optumrx.com										(866)443-1095		(866)443-1095		(866)443-1095		(866)443-1095										(711)-		(711)-		(711)-		(711)-																
S9701	801	0		29	10	S9701_801_0	2	1						06/03/2021	2022.01	06/03/2021 09:23:20 AM Central Daylight Time					06/03/2021 09:25:28 AM Central Daylight Time	DEAN HEALTH INSURANCE, INC.	Navitus MedicareRx	https://medicarerx.navitus.com	Navitus MedicareRx (PDP)	10	29					S9701	801	0	2022	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	2	1						06/03/2021	2022.01	06/03/2021 09:23:30 AM Central Daylight Time					06/03/2021 09:25:28 AM Central Daylight Time	DEAN HEALTH INSURANCE, INC.	Navitus MedicareRx	https://medicarerx.navitus.com	Navitus MedicareRx (PDP)	10	29					S9701	802	0	2022	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	2	1						06/03/2021	2022.01	06/03/2021 09:23:40 AM Central Daylight Time					06/03/2021 09:25:28 AM Central Daylight Time	DEAN HEALTH INSURANCE, INC.	Navitus MedicareRx	https://medicarerx.navitus.com	Navitus MedicareRx (PDP)	10	29					S9701	803	0	2022	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	2	1						06/03/2021	2022.01	06/03/2021 09:23:48 AM Central Daylight Time					06/03/2021 09:25:28 AM Central Daylight Time	DEAN HEALTH INSURANCE, INC.	Navitus MedicareRx	https://medicarerx.navitus.com	Navitus MedicareRx (PDP)	10	29					S9701	804	0	2022	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	2	1						06/03/2021	2022.01	06/03/2021 09:24:09 AM Central Daylight Time					06/03/2021 09:25:28 AM Central Daylight Time	DEAN HEALTH INSURANCE, INC.	Navitus MedicareRx	https://medicarerx.navitus.com	Navitus MedicareRx (PDP)	10	29					S9701	807	0	2022	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	808	0		29	10	S9701_808_0	2	1						06/03/2021	2022.01	06/03/2021 09:24:17 AM Central Daylight Time					06/03/2021 09:25:28 AM Central Daylight Time	DEAN HEALTH INSURANCE, INC.	Navitus MedicareRx	https://medicarerx.navitus.com	Navitus MedicareRx (PDP)	10	29					S9701	808	0	2022	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)-																
